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Pekkari C, Lund B, Davidson T, Naimi-Akbar A, Marcusson A, Weiner CK. Cost analysis of orthognathic surgery: outpatient care versus inpatient care. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00053-5. [PMID: 38429199 DOI: 10.1016/j.ijom.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
With limited healthcare resources, it is important to provide the right level and form of care. The aim of this study was to determine whether selected single-jaw orthognathic surgery in outpatient care (OPC) generates lower healthcare costs than in inpatient care (IPC). The costs of surgically assisted rapid maxillary expansion (SARME), Le Fort I osteotomy (LFI), and bilateral sagittal split osteotomy (BSSO) were calculated for 165 patients, 107 treated in OPC and 58 in IPC. Additionally, costs for revisits, emergency visits, emergency phone calls, re-operations, and plate removal during the first 12 months postoperatively were recorded. The total mean costs of the different operations including revisits, emergency visits, and phone calls were 34.2-48.8% lower in OPC than in IPC at 12 months postoperatively. Operation costs were lower for LFI in OPC (P = 0.009) and for SARME in IPC (P = 0.007). Anaesthesia costs were lower for LFI (P < 0.001) and BSSO (P < 0.001) in OPC, and there were fewer revisits (P = 0.001) and lower costs (P = 0.002) after LFI in OPC compared to IPC. This study showed that selected single-jaw orthognathic surgeries in outpatient care are associated with lower healthcare costs compared to inpatient care.
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Affiliation(s)
- C Pekkari
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Eastman Institute, Folktandvården Stockholm AB, Stockholm, Sweden.
| | - B Lund
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - T Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Naimi-Akbar
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Eastman Institute, Folktandvården Stockholm AB, Stockholm, Sweden; Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Marcusson
- Maxillofacial Unit in Linköping, and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - C K Weiner
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Gävle Hospital, Folktandvården Gävleborg, Gävleborg, Sweden
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Eshet Y, Tau N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Eifer M, Davidson T, Nidam M, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Breast Cancer Response Assessment and Follow-Up. Clin Nucl Med 2023; 48:685-688. [PMID: 37339456 DOI: 10.1097/rlu.0000000000004744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE 68 Ga-fibroblast activation protein inhibitor (FAPI), a new PET/CT radiotracer targeting cancer-associated fibroblasts in tumor microenvironment, can detect many types of cancer. We aimed to assess whether it can also be used for response assessment and follow-up. METHODS We followed up patients with FAPI-avid invasive lobular breast cancer (ILC) before and after treatment changes and correlated qualitative maximal intensity projection images and quantitative tumor volume with CT results and blood tumor biomarkers. RESULTS Six consenting ILC breast cancer patients (53 ± 8 years old) underwent a total of 24 scans (baseline for each patient and 2-4 follow-up scans). We found a strong correlation between 68 Ga-FAPI tumor volume and blood biomarkers ( r = 0.7, P < 0.01), but weak correlation between CT and 68 Ga-FAPI maximal intensity projection-based qualitative response assessment. CONCLUSIONS We found a strong correlation between ILC progression and regression (as assessed by blood biomarkers) and 68 Ga-FAPI tumor volume. 68 Ga-FAPI PET/CT could possibly be used for disease response assessment and follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Meital Nidam
- From the Department of Nuclear Imaging, Sheba Medical Center, Ramat Gan
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Kukuy OL, Cohen R, Gilburd B, Zeruya E, Weinstein T, Agur T, Dinour D, Beckerman P, Volkov A, Nissan J, Davidson T, Amital H, Shoenfeld Y, Shovman O. The Prognostic Value of Anti-PLA2R Antibodies Levels in Primary Membranous Nephropathy. Int J Mol Sci 2023; 24:ijms24109051. [PMID: 37240397 DOI: 10.3390/ijms24109051] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Anti-PLA2R antibodies (Ab) are a diagnostic and prognostic biomarker in primary membranous nephropathy (PMN). We assessed the relationship between the levels of anti-PLA2R Ab at diagnosis and different variables related to disease activity and prognosis in a western population of PMN patients. Forty-one patients with positive anti-PLA2R Ab from three nephrology departments in Israel were enrolled. Clinical and laboratory data were collected at diagnosis and after one year of follow-up, including serum anti-PLA2R Ab levels (ELISA) and glomerular PLA2R deposits on biopsy. Univariable statistical analysis and permutation-based ANOVA and ANCOVA tests were performed. The median [(interquartile range (IQR)) age of the patients was 63 [50-71], with 28 (68%) males. At the time of diagnosis, 38 (93%) of the patients had nephrotic range proteinuria, and 19 (46%) had heavy proteinuria (≥8 gr/24 h). The median [IQR] level of anti-PLA2R at diagnosis was 78 [35-183] RU/mL. Anti-PLA2R levels at diagnosis were correlated with 24 h proteinuria, hypoalbuminemia and remission after one year (p = 0.017, p = 0.003 and p = 0.034, respectively). The correlations for 24 h proteinuria and hypoalbuminemia remained significant after adjustment for immunosuppressive treatment (p = 0.003 and p = 0.034, respectively). Higher levels of anti-PLA2R Ab at diagnosis in patients with active PMN from a western population are associated with higher proteinuria, lower serum albumin and remission one year after the diagnosis. This finding supports the prognostic value of anti-PLA2R Ab levels and their possible use in stratifying PMN patients.
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Affiliation(s)
- Olga Lesya Kukuy
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Ron Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Boris Gilburd
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Eleanor Zeruya
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Talia Weinstein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Department of Nephrology, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Timna Agur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva 4941492, Israel
| | - Dganit Dinour
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan 5265601, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Pazit Beckerman
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan 5265601, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Alexander Volkov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Institute of Pathology, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Johnatan Nissan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Department of Nuclear Medicine, Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- Department of Medicine 'B', Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Ora Shovman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel
- Department of Medicine 'B', Sheba Medical Center, Ramat Gan 5265601, Israel
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4
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Eshet Y, Tau N, Apter S, Nissan N, Levanon K, Bernstein-Molho R, Globus O, Itay A, Shapira T, Oedegaard C, Gorfine M, Eifer M, Davidson T, Gal-Yam E, Domachevsky L. The Role of 68 Ga-FAPI PET/CT in Detection of Metastatic Lobular Breast Cancer. Clin Nucl Med 2023; 48:228-232. [PMID: 36638243 DOI: 10.1097/rlu.0000000000004540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Invasive lobular breast cancer (ILC) may be hard to detect using conventional imaging modalities and usually shows less avidity to 18 F-FDG PET/CT. 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has shown promising results in detecting non- 18 F-FDG-avid cancers. We aimed to assess the feasibility of detecting metastatic disease in patients with non- 18 F-FDG-avid ILC. METHODS This prospective study included patients with metastatic ILC, infiltrative to soft tissues, which was not 18 F-FDG avid. The patients underwent 68 Ga-FAPI PET/CT for evaluation, which was correlated with the fully diagnostic CT performed at the same time. RESULTS Seven women (aged 57 ± 10 years) were included. Among the 30 organs and structures found to be involved by tumor, the number of findings observed by FAPI PET/CT was significantly higher than that observed by CT alone ( P = 0.022), especially in infiltrative soft tissue and serosal locations. CONCLUSIONS This small pilot trial suggests a role for 68 Ga-FAPI PET/CT in ILC, which needs to be confirmed by subsequent trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Malka Gorfine
- Department of Statistics and Operations Research, Tel-Aviv University, Tel Aviv, Israel
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5
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Appel S, Lawrence YR, Bar J, Jacobson G, Marom EM, Katzman T, Ben-Ayun M, Dubinski S, Haisraely O, Weizman N, Davidson T, Weiss I, Mansano A, Goldstein JD, Symon Z. Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy. Cancer Radiother 2023; 27:23-30. [PMID: 36057519 DOI: 10.1016/j.canrad.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT). MATERIAL AND METHODS Patients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017-5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively. RESULTS Forty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5cm3 (SD 7.9), mean planning target volume 20cm3 (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292cm3 (SD 1106). Mean duration of CPAP-DIBH was 41.3s (IQR 31-46.8). LC at 2 years was 89.5% (95% CI 76-95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84cm (SD 0.65) with FB to 1.23cm (SD 0.8) with CPAP-DIBH (p=0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities. CONCLUSION CPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.
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Affiliation(s)
- Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Jacobson
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Katzman
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maoz Ben-Ayun
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergei Dubinski
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ory Haisraely
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Tima Davidson
- Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilana Weiss
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mansano
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Krivitski D, Alcalay Y, Peer M, Paran Y, Eisenstein O, Davidson T, Gadoth A. Bilateral hearing loss preceding rhomboencephalitis - a hint for Kelch-like 11 syndrome. Neurol Sci 2023; 44:369-372. [PMID: 36112277 DOI: 10.1007/s10072-022-06369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Paraneoplastic neurological syndromes have diverse clinical presentations and offer an opportunity for early diagnosis of malignancy and treatment. Recently, a new paraneoplastic syndrome associated with seminoma was described, consisting of rhombencephalitis with antibodies targeting the Kelch-like protein 11 (KLHL11). Questions were raised as to the spectrum of clinical symptoms and strength of association to seminoma. METHODS We present a 45-year-old man with bilateral sensorineural hearing loss, vertigo, and progressive ataxia. An extensive diagnostic workup led to the diagnosis of anti-KLHL11 paraneoplastic syndrome based on an immunofluorescence assay showing a typical pattern and a confirmatory serological assay. As a result, the patient underwent a meticulous search for an underlying seminoma. RESULTS Although initially, all images were interpreted as negative, a revision of the positron emission tomography-CT (PET-CT) examination identified a small mediastinal suspicious mass. The mass was resected, and pathological examination confirmed it to be an extra-testicular seminoma. CONCLUSIONS Patients presenting with progressive sensorineural hearing loss, vertigo, and ataxia should be evaluated for KLHL11 paraneoplastic syndrome. Furthermore, we support a strong association between anti-KLH11 rhombencephalitis and an underlying seminoma and recommend a thorough search for an undiagnosed germ cell tumor in these patients.
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Affiliation(s)
- David Krivitski
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv, 6243906, Israel.
| | - Yifat Alcalay
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv, 6243906, Israel.,Immunology Laboratory, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel.,Encephalitis Center, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel
| | - Michael Peer
- Department of Thoracic Surgery, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel
| | - Yael Paran
- Encephalitis Center, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel.,Infectious Disease Unit, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel
| | - Orna Eisenstein
- Encephalitis Center, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel.,Imaging Division, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Avi Gadoth
- Department of Neurology, Tel Aviv Medical Center, Tel Aviv, 6243906, Israel.,Encephalitis Center, Epilepsy Service Imaging Unit, Tel Aviv Medical Center, 6243906, Tel Aviv, Israel
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7
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Ben Shimol J, Lewin R, Symon Z, Rosenzweig B, Leibowitz-Amit R, Eshet Y, Domachevsky L, Davidson T. The Utility of 68Ga-PSMA PET/CT in Decisions Regarding Administering Salvage Radiotherapy to Men with Prostate Cancer. Int J Environ Res Public Health 2022; 20:537. [PMID: 36612859 PMCID: PMC9819101 DOI: 10.3390/ijerph20010537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Numerous papers have described 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)'s sensitivity in identifying prostate cancer (PCa) recurrence. This study aimed to characterize the role of 68Ga-PSMA PET/CT in deciding to re-irradiate pelvic structures. METHODS 68Ga-PSMA PET/CT scans performed at Sheba Medical Center over seven years in 113 men were reviewed. All had undergone radiation to the prostate (70, 61.9%) or post-radical prostatectomy radiation to the prostate fossa (PF) (43, 48.1%), and had local or oligometastatic PCa recurrence and received salvage radiotherapy (SRT) based on PET/CT findings. RESULTS Mean age was 70.7 years. The mean grade group was 2.9; the mean prostate-specific antigen was 9.0. The 68Ga-PSMA PET/CT positive findings included: 37 (32.7%) in the prostate, 23 (20.4%) in seminal vesicles, 7 (6.2%) in the PF, and 3 (2.7%) in the seminal vesicle fossa. The mean standardized uptake value was 10.6 ± 10.2 (range: 1.4-61.6); the mean lesion size was 1.8 ± 3.5 mm (range: 0.5-5.1). SRT was directed toward the prostate and seminal vesicles in 48 (42.5%), PF in 18 (15.9%), and intrapelvic lymph node and bone in 47 (41.6%). Toxicities were mostly mild to moderate. CONCLUSION 68Ga-PSMA PET/CT-identified relapse with targeted SRT was well-tolerated and may result in less onerous treatments.
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Affiliation(s)
- Jennifer Ben Shimol
- Barzilai Medical Center, Ashqelon 7830604, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ron Lewin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Zvi Symon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Raya Leibowitz-Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Oncology Institute, Shamir Medical Center, Zerifin 7033001, Israel
| | - Yael Eshet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
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8
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Pekkari C, Weiner C, Marcusson A, Davidson T, Naimi-Akbar A, Lund B. Patient safety with orthognathic surgery in an outpatient setting. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00468-4. [DOI: 10.1016/j.ijom.2022.12.001] [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] [Received: 05/11/2022] [Revised: 11/04/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
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9
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Damiani G, Finelli R, Kridin K, Pacifico A, Bragazzi NL, Malagoli P, Fabbrocini G, Bonifazi E, Mazzotta F, Lovati C, Savoia P, Gironi LC, Morello M, Davidson T, Watad A, Goker F, Mortellaro C, Del Fabbro M. Chilblain-like lesions (COVID-19 toes) have the same impact on family members than psoriasis systemically treated: insights from a case-control study targeting the pediatric population. Eur Rev Med Pharmacol Sci 2022; 26:87-93. [PMID: 36591876 DOI: 10.26355/eurrev_202212_30798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE COVID-19 toes represent the main dermatological COVID-19 cutaneous manifestation in pediatric patients. Its diagnosis exposes the whole family to social stigma and this aspect was not previously evaluated. PATIENTS AND METHODS This was a multicenter, case-control, observational study that compared the family impact of COVID-19 toes vs. psoriasis (PsO). We enrolled 46 pediatric patients (23 with psoriasis and 23 with COVID-19 toes, age and gender matched) and their parents/caregivers that had to fill the Dermatitis Family Impact (DFI) questionnaire. RESULTS DFI index did not differ significantly between both subgroups (p=0.48), and in psoriatic patients did not correlate with both Psoriasis Area Severity Index (PASI) (p=0.59) and itch-VAS (p=0.16). CONCLUSIONS COVID-19 toes, a transitory dermatosis, exerted a similar impact/perturbation on family dynamics than PsO, a well-known stigmatizing, chronic inflammatory dermatosis.
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Affiliation(s)
- G Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
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10
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Cunningham-Myrie C, Theall KP, Younger-Coleman N, Wiggan J, McFarlane S, Francis D, Bennett N, Tulloch-Reid M, Ferguson TS, Davidson T, Govia I, Guthrie-Dixon N, Aiken W, Grant A, Webster-Kerr K, Wilks R. Who moves in vulnerable Caribbean neighborhoods? Positive deviance for physical activity: Findings from the Jamaica health and Lifestyle Survey 2017 (JHLS III). Prev Med Rep 2022; 30:101998. [PMID: 36189127 PMCID: PMC9519374 DOI: 10.1016/j.pmedr.2022.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.
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Affiliation(s)
- C Cunningham-Myrie
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - K P Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - N Younger-Coleman
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - J Wiggan
- Ministry of Health & Wellness, Jamaica
| | - S McFarlane
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - D Francis
- School of Health and Human Performance, Georgia College and State University, Milledgeville, GA, USA
| | - N Bennett
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - M Tulloch-Reid
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - T S Ferguson
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | | | - I Govia
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - N Guthrie-Dixon
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - W Aiken
- Department of Surgery, Radiology, Anaesthesia & Intensive Care, University of the West Indies, Mona, Kingston, Jamaica
| | - A Grant
- Ministry of Health & Wellness, Jamaica
| | | | - R Wilks
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
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Eifer M, Pinian H, Klang E, Alhoubani Y, Kanana N, Tau N, Davidson T, Konen E, Catalano OA, Eshet Y, Domachevsky L. FDG PET/CT radiomics as a tool to differentiate between reactive axillary lymphadenopathy following COVID-19 vaccination and metastatic breast cancer axillary lymphadenopathy: a pilot study. Eur Radiol 2022; 32:5921-5929. [PMID: 35385985 PMCID: PMC8985565 DOI: 10.1007/s00330-022-08725-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate if radiomics with machine learning can differentiate between F-18-fluorodeoxyglucose (FDG)-avid breast cancer metastatic lymphadenopathy and FDG-avid COVID-19 mRNA vaccine-related axillary lymphadenopathy. MATERIALS AND METHODS We retrospectively analyzed FDG-positive, pathology-proven, metastatic axillary lymph nodes in 53 breast cancer patients who had PET/CT for follow-up or staging, and FDG-positive axillary lymph nodes in 46 patients who were vaccinated with the COVID-19 mRNA vaccine. Radiomics features (110 features classified into 7 groups) were extracted from all segmented lymph nodes. Analysis was performed on PET, CT, and combined PET/CT inputs. Lymph nodes were randomly assigned to a training (n = 132) and validation cohort (n = 33) by 5-fold cross-validation. K-nearest neighbors (KNN) and random forest (RF) machine learning models were used. Performance was evaluated using an area under the receiver-operator characteristic curve (AUC-ROC) score. RESULTS Axillary lymph nodes from breast cancer patients (n = 85) and COVID-19-vaccinated individuals (n = 80) were analyzed. Analysis of first-order features showed statistically significant differences (p < 0.05) in all combined PET/CT features, most PET features, and half of the CT features. The KNN model showed the best performance score for combined PET/CT and PET input with 0.98 (± 0.03) and 0.88 (± 0.07) validation AUC, and 96% (± 4%) and 85% (± 9%) validation accuracy, respectively. The RF model showed the best result for CT input with 0.96 (± 0.04) validation AUC and 90% (± 6%) validation accuracy. CONCLUSION Radiomics features can differentiate between FDG-avid breast cancer metastatic and FDG-avid COVID-19 vaccine-related axillary lymphadenopathy. Such a model may have a role in differentiating benign nodes from malignant ones. KEY POINTS • Patients who were vaccinated with the COVID-19 mRNA vaccine have shown FDG-avid reactive axillary lymph nodes in PET-CT scans. • We evaluated if radiomics and machine learning can distinguish between FDG-avid metastatic axillary lymphadenopathy in breast cancer patients and FDG-avid reactive axillary lymph nodes. • Combined PET and CT radiomics data showed good test AUC (0.98) for distinguishing between metastatic axillary lymphadenopathy and post-COVID-19 vaccine-associated axillary lymphadenopathy. Therefore, the use of radiomics may have a role in differentiating between benign from malignant FDG-avid nodes.
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Affiliation(s)
- Michal Eifer
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hodaya Pinian
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- ARC Center for Digital Innovation, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yousef Alhoubani
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
| | - Nayroz Kanana
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Tau
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tima Davidson
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yael Eshet
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, 2 Sheba Road, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Rosenzweig B, Haramaty R, Davidson T, Lazarovich A, Shvero A, Haifler M, Gal J, Golan S, Shpitzer S, Hoffman A, Nativ O, Freifeld Y, Zreik R, Dotan ZA. Reply to Veerman et al. Comment on “Rosenzweig et al. Very Low Prostate PET/CT PSMA Uptake May Be Misleading in Staging Radical Prostatectomy Candidates. J. Pers. Med. 2022, 12, 410”. J Pers Med 2022; 12:jpm12060861. [PMID: 35743645 PMCID: PMC9225530 DOI: 10.3390/jpm12060861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Correspondence: ; Tel.: +972-3-5302221
| | - Rennen Haramaty
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel
| | - Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
| | - Miki Haifler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Department of Urology, Shamir Medical Center, Tzrifin 6093000, Israel;
| | - Jonathan Gal
- Department of Urology, Shamir Medical Center, Tzrifin 6093000, Israel;
| | - Shay Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel;
| | - Sagi Shpitzer
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel;
| | - Azik Hoffman
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel; (A.H.); (O.N.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
| | - Omri Nativ
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel; (A.H.); (O.N.)
| | - Yuval Freifeld
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
- Department of Urology, Carmel Medical Center, Haifa 3436212, Israel
| | - Rani Zreik
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
| | - Zohar A. Dotan
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
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13
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Rosenzweig B, Haramaty R, Davidson T, Lazarovich A, Shvero A, Haifler M, Gal J, Golan S, Shpitzer S, Hoffman A, Nativ O, Freifeld Y, Zreik R, Dotan ZA. Very Low Prostate PET/CT PSMA Uptake May Be Misleading in Staging Radical Prostatectomy Candidates. J Pers Med 2022; 12:jpm12030410. [PMID: 35330410 PMCID: PMC8951096 DOI: 10.3390/jpm12030410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: to evaluate a unique subpopulation of radical prostatectomy (RP) candidates with “negative” prostate 68Ga-labeled prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computed tomography (CT) imaging scans and to characterize the clinical implications of misleading findings. Materials and Methods: This case-control retrospective study compared the final histological outcomes of patients with “negative” pre-RP PSMA PET/CT prostate scans (with a prostate maximal standardized uptake value [SUVmax] below the physiologic uptake) to those with an “intense” prostatic tracer uptake (with a SUVmax above the physiologic uptake). The patients underwent an RP between March 2015 and July 2019 in five academic centers. Data on the demographics, comorbidities, prostate-specific antigen (PSA) and rectal exam findings, prior biopsies, imaging results, biopsies, and RP histology results were collected. Results: Ninety-seven of the 392 patients who underwent an RP had PSMA PET/CT imaging preoperatively. Fifty-two (54%) had a “negative” uptake (in the study group), and 45 (46%) had a “positive” uptake (in the control group). Only the lesion size and SUVmax values on the PSMA PET/CT differed between the groups preoperatively. On the histological analysis, only the ISUP score, seminal vesicles invasion, T stage, and positive margin rates differed between the groups (p < 0.05), while 50 (96%) study group patients harbored clinically significant disease (ISUP ≥ 2), with an extra-prostatic disease in 24 (46%), perineural invasion in 35 (67%), and positive lymph nodes in 4 (8%). Conclusions: Disease aggressiveness generally correlated with an intense PSMA uptake on the preoperative PSMA PET/CT, but a subpopulation of patients with clinically significant cancer and aggressive characteristics showed a deceptively weak PSMA uptake. These data raise a concern about the unqualified application of PSMA PET/CT for staging RP candidates.
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Affiliation(s)
- Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Correspondence: ; Tel.: +972-3-5302221
| | - Rennen Haramaty
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel
| | - Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
| | - Miki Haifler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Department of Urology, Shamir Medical Center, Tzrifin 6093000, Israel;
| | - Jonathan Gal
- Department of Urology, Shamir Medical Center, Tzrifin 6093000, Israel;
| | - Shay Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel;
| | - Sagi Shpitzer
- Section of Urology, Rabin Medical Center, Petah Tikva 4941492, Israel;
| | - Azik Hoffman
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel; (A.H.); (O.N.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
| | - Omri Nativ
- Department of Urology, Rambam Health Center, Haifa 3109601, Israel; (A.H.); (O.N.)
| | - Yuval Freifeld
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
- Department of Urology, Carmel Medical Center, Haifa 3436212, Israel
| | - Rani Zreik
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel; (Y.F.); (R.Z.)
| | - Zohar A. Dotan
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5211401, Israel; (R.H.); (A.L.); (A.S.); (Z.A.D.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (T.D.); (M.H.); (S.G.)
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14
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Seepersaud M, Marrero A, Davidson T, Smith S. SARS-CoV-2, Lung Protective Ventilation, Low Middle Income Countries, and Pediatric Intensivists as Cross Disciplinary Knowledge Translation and Implementation Science Specialists. Int J Infect Dis 2022. [PMCID: PMC8884746 DOI: 10.1016/j.ijid.2021.12.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We hypothesized that despite the low incidence of severe SARS-CoV-2 infections in children in Guyana, due to their specific skillset in lung protective ventilation, our Pediatric Intensivists were uniquely positioned to address significant training and readiness gaps in our colleagues attending a surging critically ill Adult COVID-19 patient population. Methods & Materials In Guyana, there are few clinicians trained in Critical-Care Medicine (CCM). The high incidence of ventilator dependence in seriously ill SARS-CoV2 patients, combined with a dearth of CCM practitioners competent in complex mechanical ventilation management left Guyana ill prepared to manage these patients. This knowledge deficit was further exacerbated in that many clinicians at our National Infectious Diseases Hospital were co-opted into CCM roles from other specialties with little to no CCM training. We have a very small core of Pediatric Surgical Critical Care Medicine staff that was formally trained in PCCM outside of Guyana. This core was instrumental in establishing a unique and formal Pediatric Critical-Care Medicine Micro-Modular Fellowship (PCCM-MMF) program that allowed the creation of Guyana's only Pediatric ICU. A significant number of that core are also involved in Guyana‘s National COVID Task Force. Given that all graduates of our PCCM-MMF program are extensively trained in Lung Protective Ventilation, it was very appropriate to utilize them to augment Adult critical care capacity. Thirty physicians with primarily adult practices and little to no previous knowledge of ventilator management were enrolled in a multi-modal triphasic mechanical ventilation short course facilitated by PCCM staff. Results We were able to rapidly enable two cohorts of 15 Adult clinicians to competently address critical knowledge deficits and staffing shortfalls. We improved morbidity and mortality amongst our mechanically ventilated adult COVID-19 patients, as well as relieved significant multifactorial caregiver strain. Conclusion Our successful utilization of PCCM staff as Mechanical Ventilation didactic and clinical educators for an Adult patient population carries implications for cross disciplinary Knowledge Translation and Implementation Science in a wide variety of practice milieus. We are actively pursuing research opportunities to further experiment with other skill sets incorporated in our PCCM Micro-Modular Fellowship and welcome potential collaborators.
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15
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Davidson T, Yakobi Y, Nayruz K, Levin G, Korach J, Perri T. Early prediction of urinary retention following radical hysterectomy by 18FFDG PET/CT Imaging. Minerva Obstet Gynecol 2021; 75:243-250. [PMID: 34904588 DOI: 10.23736/s2724-606x.21.05008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Radical hysterectomy for early cervical cancer is associated with post-operative bladder dysfunction. Post-operative imaging by 18F-FDG PET/CT scanning is often performed to rule out recurrence. Since women are instructed to empty the bladder before imaging, we aim to study if scanned abnormal residual bladder volume is associated with future urinary symptoms. METHODS Women who underwent radical hysterectomy for cervical cancer between July 2010 and January 2019 were included in the study. Multi-Modality Tumor Tracking® (MMTT) was used to measure residual urinary volume on 18F-FDG PET/CT scans before and after hysterectomy. Demographic, clinical parameters, and urinary tract signs and symptoms, were evaluated among the cohort. RESULTS Overall, 64 patients were included. Among those, in 24 (38%) the bladder volume reached ≥150 cm3 on postoperative 18F-FDG PET/CT scans. Of these, 9 (37.5%) had voiding difficulties of some degree. In 3 (12.5%) women, the 18F-FDG PET/CT scan has preceded their complaints of voiding difficulties by 2-4 months. Of the 40 women (62%) whose postoperative bladder volumes were <150 cm3, only 1 (2.5%) had urinary retention. Rate of symptomatic voiding difficulties was higher in the post-void volume ≥150 cm3 group; 13 (54.1%) vs. 6 (15.0%), p<0.002, Odds Ratio 95% Confidence Interval 6.6 (2.0-21.8), p=0.001. CONCLUSIONS Measuring bladder volume on postoperative 18F-FDG PET/CT may facilitate early identification of urinary retention, possibly enabling early treatment and possibly preventing complications.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yonatan Yakobi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Knaana Nayruz
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Jacob Korach
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Perri
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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16
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Tocut M, Davidson T, Leibu R, Amital H, Shoenfeld Y, Shovman O. Immunoglobulin G4-related Disease and Pancreatic Malignancy: An Association or Two Independent Processes? Isr Med Assoc J 2021; 23:748-750. [PMID: 34811994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Milena Tocut
- Department of Internal Medicine C, Wolfson Medical Center, Holon, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rebecca Leibu
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
| | - Howard Amital
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Ariel University, Ariel, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of the Mosaics of Autoimmunity, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Ora Shovman
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Ben Shimol J, Guzman-Prado Y, Karlinskaya M, Davidson T. Effectiveness and safety of immune checkpoint inhibitors in combination with palliative radiotherapy in advanced melanoma: A systematic review. Crit Rev Oncol Hematol 2021; 167:103499. [PMID: 34687896 DOI: 10.1016/j.critrevonc.2021.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/08/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Radiotherapy is frequently added to immune checkpoint inhibitors (ICI) when treating melanoma. We sought to describe the efficacy of combination ICI and palliative radiotherapy (pRT) and assess safety, focusing on immune related adverse events (irAE). METHODS A systematic search for studies investigating the combination of pRT and ICI was conducted. RESULTS Five hundred-two articles were identified; nine met inclusion criteria. Improvements in objective response rate (p = 0.02), complete response (p = 0.04), and one-year local control (p < 0.005) were demonstrated when pRT was added to ICI. While some studies revealed improved overall and progression free survival, findings were mixed. No significant increases in adverse events or irAE were seen with the combined treatment compared with ICI alone. CONCLUSION The included studies revealed that the addition of pRT to ICI is effective and safe in patients with advanced melanoma. Measures of survival varied. More studies are warranted to identify optimal conditions for combination treatment.
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Affiliation(s)
- Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yuli Guzman-Prado
- Department of Clinical Research, International Centre for Medical Research, Dorset, United Kingdom
| | | | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
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18
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Nissan E, Amit U, Baron L, Zabatani A, Urban D, Barshack I, Davidson T. The usefulness of [18F]FDG-PET/CT in detecting and managing cancers with unknown primary site depends on histological subtype. Sci Rep 2021; 11:17732. [PMID: 34489490 PMCID: PMC8421436 DOI: 10.1038/s41598-021-96451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/05/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the role of [18F]FDG-PET/CT in identifying and managing cancer of unknown primary site (CUP syndrome). We reviewed [18F]FDG-PET/CT scans of individuals with CUP syndrome recorded in clinical referral letters from 2012 to 2019. We evaluated the identification of primary tumor (PT) by [18F]FDG-PET/CT, according to histological subtype, and the impact on clinical management. The median age was 65 years, 36/64 males (56%). PTs were detected in 28/64 (44%) patients. Detection was significantly lower in patients with squamous cell carcinoma (SCC) than with other histologies combined, p = 0.034. Mean age, mean SUVmax (10.6 ± 6.0) and organ involvement were similar between patients with and without discovered PTs; and between patients with SCC and with other histologies combined. However, those with SCC were less likely than the others to present with multi-lesion involvement, p < 0.001. [18F]FDG-PET/CT interpretations apparently affected treatment of 8/28 (29%) patients with PT detected, and in none of the 35 whose PT was not discovered, p < 0.001. [18F]FDG-PET/CT appeared helpful in detecting PT in almost half the patients with CUP syndrome; the lowest rate was for patients with SCC pathology. PET/CT showed limited overall value in guiding clinical management, however benefited those with discovered PT.
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Affiliation(s)
- Ella Nissan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amit
- Radiation Oncology Department, Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Leo Baron
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Zabatani
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Damien Urban
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Barshack
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Sadetski I, Eshet Y, Kaidar-Person O, Amit U, Domachevsky L, Davidson T, Weiss I, Ben Ayun M, Symon Z. PSMA PET/CT to evaluate response to SBRT for prostate cancer bone metastases. Rep Pract Oncol Radiother 2021; 26:528-534. [PMID: 34434568 DOI: 10.5603/rpor.a2021.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background In the current study we evaluated 68Ga PSMA PET/ CT to measure local control of bone metastasis in oligometastatic prostate cancer patients treated with SBRT. Materials and methods After the institutional review board approval, a retrospective review of medical records of consecutive prostate cancer patients treated between 2014 and 2018 was conducted. Only medical records of patients that were treated with SBRT for bone metastasis and had pre-and post-SBRT 68Ga PSMA PET/CT scans were included in our study. Data extracted from the medical files included patient-related (age), disease-related (Gleason score, site of metastasis), and treatment-related factors and outcomes. Results During the study period, a total of 12 patients (15 lesions) were included, with a median age of 73 years. The median follow-up was 26.5 months (range 13-45 months). Median time of 68Ga PSMA PET/ CT follow up was 17.0 months (range 3-39 months). The median pre-treatment PSA was 2 ng/mL (range 0.56-44 ng/mL) vs. post treatment PSA nadir of 0.01 ng/mL (0.01-4.32) with a median time to nadir of 7 months (range, 2-12). Local control was 93% during the follow up period and there was correlation with PS MA avidity on PE T. None patients developed recurrences in the treated bone. None of the patients had grade 3 or more toxicities during follow-up. Conclusions SBRT is a highly effective and safe method for treatment of prostate cancer bone metastases. More studies are required to determine if SBRT provides greater clinical benefit than standard fractionation for oligometastatic prostate cancer patients. 68Ga PSMA PET/CT should be further investigated for delineation and follow-up.
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Affiliation(s)
- Igor Sadetski
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yael Eshet
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Orit Kaidar-Person
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Uri Amit
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Tima Davidson
- Nuclear Medicine, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ilana Weiss
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Maoz Ben Ayun
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
| | - Zvi Symon
- Radiation Oncology, Chaim Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Israel
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Lewin R, Amit U, Laufer M, Berger R, Dotan Z, Domachevsky L, Davidson T, Portnoy O, Tsvang L, Ben-Ayun M, Weiss I, Symon Z. Salvage re-irradiation using stereotactic body radiation therapy for locally recurrent prostate cancer: the impact of castration sensitivity on treatment outcomes. Radiat Oncol 2021; 16:114. [PMID: 34162398 PMCID: PMC8220691 DOI: 10.1186/s13014-021-01839-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Advances in imaging, biomaterials and precision radiotherapy provide new opportunities to salvage locally recurrent prostate cancer (PC). This study evaluates the efficacy and safety of re-irradiation using stereotactic body radiation therapy (SBRT). We hypothesized that patients with castrate-resistant PC (CRPC) would benefit less from local salvage. Methods A prospective clinical database was reviewed to extract 30 consecutive patients treated with prostate re-irradiation. Gallium prostate specific membrane antigen (PSMA) ligand positron emission tomography was performed following prostate-specific antigen failure in all patients and biopsy was obtained in 18 patients (60%). Re-irradiation was either focal (n = 13) or whole-gland (n = 17). Endo-rectal balloons were used in twenty-two patients and hydrogel spacers in eight patients. The median prescription dose was 5 fractions of 6.5 (range: 6–8) Gray (Gy). Results Median follow-up was 28 months. Failure occurred in 10 (out of 11) CRPC patients versus 6 (out of 19) castrate-sensitive patients (91% vs. 32%, p = 0.008) after a median of 13 and 23 months, respectively. Metastases occurred in 64% (n = 7) of CRPC patients versus 16% (n = 3) of castrate-sensitive patients (p = 0.007). Two patients experienced local in-field recurrence, thus local control was 93%. The 2 and 3-year recurrence-free survival were 84% and 79% for castrate-sensitive patients versus 18% and 9% for CRPC patients (p < 0.001), and 3-year metastasis-free survival was 90% versus 27% (p < 0.01) for castrate-sensitive and CRPC patients, respectively. Acute grade II and III genitourinary (GU) toxicity occurred in 27% and 3%, and late GU toxicity in 30% and 3%, respectively. No ≥ grade II acute gastrointestinal (GI) toxicity occurred, and only one patient (3%) developed late grade II toxicity. Conclusions Early delivery of salvage SBRT for local recurrence is associated with excellent 3-year disease control and acceptable toxicity in the castrate-sensitive phenotype. PSMA imaging for detection of local recurrence and the use of precision radiotherapy with rectal protective devices should be further investigated as a novel salvage strategy for radio-recurrent PC.
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Affiliation(s)
- Ron Lewin
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel.
| | - Uri Amit
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Menachem Laufer
- Institute of Urology, Sheba Medical Center, Ramat-Gan, Israel
| | - Raanan Berger
- Institute of Oncology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Zohar Dotan
- Institute of Urology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Orith Portnoy
- Department of Radiology, Sheba Medical Center, Ramat-Gan, Israel
| | - Lev Tsvang
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Maoz Ben-Ayun
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Ilana Weiss
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Zvi Symon
- Radiation Oncology Department, Sheba Medical Center, 52621, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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21
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Caterson H, Li A, March L, Bannon P, Kench J, Davidson T, Soh HC, Sammel A. POS0804 OUTCOMES OF SURGICALLY RESECTED THORACIC AORTITIS: RESULTS FROM A PROSPECTIVE MULTI-CENTRE REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Inflammatory thoracic aortitis is a cause of aneurysm and is often diagnosed incidentally following aortic replacement surgery. It may be due to systemic diseases such as giant cell arteritis (GCA) and Takayasu arteritis (TAK) or a topographically isolated variant termed clinically isolated aortitis (CIA). While CIA is identified in 2-12% of thoracic aortic surgical pathology,1 its short-term post-operative outcome is unknown.Objectives:This study was undertaken to examine the short-term post-operative mortality and morbidity of patients with surgically resected thoracic aortitis compared to those with non-inflammatory thoracic aortic aneurysms and assess if outcomes varied based on post-operative corticosteroid therapy.Methods:The study was based at three tertiary referral hospitals in Sydney, Australia, for the years 2004-2018. Prospectively collected data was accessed from a national surgical registry for all patients who underwent thoracic aortic aneurysm replacement. Aortitis patients were identified from histopathology records.Inpatient medical records were reviewed to categorise aortitis cases as CIA, GCA, TAK or other aortitis and to audit the use of corticosteroids. Outcomes were compared between aortitis cases and the non-inflammatory cohort using logistic regressions, controlling for age, sex, year of procedure, and hospital.Results:41 aortitis cases were identified from the cohort of 1119 surgical patients (3.7%). 27 (66%) met criteria for CIA, 11 (27%) for GCA, 2 (5%) for TAK, and 1 (2%) for Other. 8 (20%) received corticosteroid therapy for aortitis.Compared with non-inflammatory patients, the aortitis cohort was predominantly female (54% vs 28%, p < 0.01), older (mean 70 vs 62 years, p < 0.01), and had higher rates of hypertension (83% vs 67%, p = 0.03) and pre-operative immunosuppression (10% vs 1%, p < 0.01).There was no difference (p > 0.05) between the aortitis and the non-aortitis groups for 30-day mortality (7% vs 7%), composite significant morbidity (15% vs 22%), composite infection (10% vs 6%), return to theatre for bleeding (7% vs 13%), stroke (5% vs 5%) or readmission (12% vs 10%). Similar results were also seen for CIA and the aortitis subgroup who did not receive corticoid steroid therapy when compared to the non-aortitis group (table 1).Table 1.30-day mortality and morbidityNon-aortitisAll aortitisAortitis, not treated for aortitisCIAn=1078n=41n=33n=27%n%n%n%nMortality770736241Stroke557526241Return to theatre bleed13137736241Composite morbidity22241156155113Composite infection66910493113Readmission10108125124113Note: Differences in outcomes between the aortitis groups and the no aortitis group were modelled using logistic regression, controlling for age, sex, year of procedure, and hospital. There were no statistically significant differences in outcomes (p > 0.05).CIA; clinically isolated aortitis. Composite morbidity; an outcome comprised of return to theatre for bleeding, stroke, new renal failure, acute myocardial infarction or aortic dissection. Composite infection; an outcome comprised of 30-day pneumonia, septicaemia, deep sternal wound infection or deep thoracotomy infection.Conclusion:The finding of thoracic aortitis following aortic replacement surgery does not affect short-term post-operative mortality or morbidity. Corticosteroid therapy in the immediate post-operative period did not impact upon short-term outcomes.References:[1]Quimson L, Mayer A, Capponi S, et al. Comparison of aortitis versus noninflammatory aortic aneurysms among patients who undergo open aortic aneurysm repair. Arthritis Rheum 2020;72:1154-59.Disclosure of Interests:None declared
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Mahajna H, Vaknin K, Ben Shimol J, Watad A, Abu-Much A, Mahroum N, Shovman O, Shoenfeld Y, Amital H, Davidson T. The Utility of 18FDG-PET/CT in Diagnosing Fever of Unknown Origin: The Experience of a Large Tertiary Medical Center. Int J Environ Res Public Health 2021; 18:ijerph18105360. [PMID: 34069883 PMCID: PMC8157390 DOI: 10.3390/ijerph18105360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/14/2022]
Abstract
Fever of unknown origin (FUO) poses a diagnostic challenge, and 18-fluorodexoyglucose positron emission tomography with computed tomography (18FDG-PET/CT) may identify the source. We aimed to evaluate the diagnostic yield of 18FDG-PET/CT in the work-up of FUO. The records of patients admitted to Sheba Medical Center between January 2013 and January 2018 who underwent 18FDG-PET/CT for the evaluation of FUO were reviewed. Following examination of available medical test results, 18FDG-PET/CT findings were assessed to determine whether lesions identified proved diagnostic. Of 225 patients who underwent 18FDG-PET/CT for FUO work-up, 128 (57%) met inclusion criteria. Eighty (62.5%) were males; mean age was 59 ± 20.3 (range: 18-93). A final diagnosis was made in 95 (74%) patients. Of the 128 18FDG-PET/CT tests conducted for the workup of FUO, 61 (48%) were true positive, 26 (20%) false positive, 26 (20%) true negative, and 15 (12%) false negative. In a multivariate analysis, weight loss and anemia were independently associated with having a contributary results of 18FDG-PET/CT. The test yielded a sensitivity of 70%, specificity of 37%, positive predictive value of 70%, and negative predictive value of 37%. 18FDG-PET/CT is a valuable tool in the diagnostic workup of FUO. It proved effective in diagnosing almost half the patients, especially in those with anemia and weight loss.
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Affiliation(s)
- Hussein Mahajna
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Keren Vaknin
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Jennifer Ben Shimol
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Medicine, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Arsalan Abu-Much
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Naim Mahroum
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Ora Shovman
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Howard Amital
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Correspondence: ; Tel.: +972-3-5302986
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Danylesko I, Shouval R, Shem-Tov N, Yerushalmi R, Jacoby E, Besser MJ, Shimoni A, Davidson T, Beider K, Mevorach D, Fried S, Nagler A, Avigdor A. Immune imitation of tumor progression after anti-CD19 chimeric antigen receptor T cells treatment in aggressive B-cell lymphoma. Bone Marrow Transplant 2021; 56:1134-1143. [PMID: 33268830 PMCID: PMC8113054 DOI: 10.1038/s41409-020-01156-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 12/31/2022]
Abstract
We present three patients with aggressive non-Hodgkin's B-cell lymphoma (NHL) who received anti-CD19 chimeric antigen receptor T (CAR T) cells therapy after failure of several lines of chemotherapy that developed pseudo-progression. One-week clinical and radiological findings were consistent with tumor progression. Positron emission tomography-computed tomography (PET-CT) at 1 month post CAR T cells administration was consistent with treatment response. The rapid tumor growth and subsequent resolution are suggestive of tumor pseudo-progression mediated secondary to infiltration and immune activation of CAR T cells. Overall, 56 adult patients with NHL were enrolled in a phase 1b/2 in house clinical study with CD19 CAR T cells. Out of them 22/56 patients progressed as per PET-CT the 1 month post CAR T cells. In 14 patients, signs of progression started 7-10 days after CAR T cells infusion. In 11/14 patients, it was true progression, while in 3 it was pseudo-progression. Additional studies are warranted to describe the extent of this phenomenon and evaluate correlation with the CAR T activity and long-term disease control.
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Affiliation(s)
- Ivetta Danylesko
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roni Shouval
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Shem-Tov
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Yerushalmi
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Jacoby
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Michal J Besser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Avichai Shimoni
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Katia Beider
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mevorach
- Department of Medicine, Rheumatology Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shalev Fried
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Davidson T, Nissan J, Krichmar M, Lotan E, Shrot S, Gluck I, Lawson P, Yahalom R, Duvdevani S. 18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation. Dentomaxillofac Radiol 2021; 50:20200574. [PMID: 33882254 DOI: 10.1259/dmfr.20200574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre. METHODS Fourteen patients (10 males), aged 22-84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. RESULTS Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3-4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed.CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles ("sponge appearance") and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions.No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17). CONCLUSIONS: Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Johnatan Nissan
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Maria Krichmar
- Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Lotan
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shai Shrot
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Gluck
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Paul Lawson
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ran Yahalom
- Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shay Duvdevani
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Otolaryngology Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Davidson T, Domachevsky L, Giladi Y, Fridman E, Dotan Z, Rosenzweig B, Leibowitz R, Ben Shimol J. Penile secondary lesions: a rare entity detected by PET/CT. Sci Rep 2021; 11:5912. [PMID: 33723317 PMCID: PMC7960694 DOI: 10.1038/s41598-021-85300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/26/2021] [Indexed: 11/09/2022] Open
Abstract
While penile metastases are rare, PET/CT has facilitated their detection. We aimed to describe penile secondary lesions (PSL) identified by PET/CT. We reviewed 18F-FDG and Ga68-PSMA PET/CT records performed in a single center during May 2012-March 2020, for PSL. Of 16,774 18F-FDG and 1,963 Ga68-PSMA-PET scans, PSL were found in 24(0.13%) men with a mean age of 74. PSMA detected PSL in 12 with prostate cancer; FDG identified PSL in 4 with lymphoma, 3 with colorectal cancer, 2 with lung cancer, and one each with bladder cancer, pelvic sarcoma, and leukemia. Mean SUVmax of PSL was 7.9 ± 4.2 with focal uptake in 13(54%). Mean lesion size was 16.5 ± 6.8 mm; 8 at the penile root, 4 along the shaft, and 1 at the glans. CT detected loss of the penile texture in 15(63%). PSL were observed only during relapse or follow-up of disseminated disease. Among those with prostate cancer, PSA varied widely. Fifteen (62.5%) died, at a mean 13.3 ± 15.9 months following PSL demonstration, nine had non-prostate malignancies. PET/CT identified and characterized PSL in a fraction of cancer patients, most commonly those with prostate cancer. PSL universally surfaced in advanced disease, and signaled high mortality, especially in non-prostate cancers.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Derech Sheba 2, 52621, Ramat Gan, Tel-Hashomer, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Derech Sheba 2, 52621, Ramat Gan, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel
| | - Yogev Giladi
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel
| | - Eddie Fridman
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Pathology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Zohar Dotan
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Urology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Urology, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Raya Leibowitz
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Oncology Institute, Shamir Medical Center, 70300, Zerifin, Israel
| | - Jennifer Ben Shimol
- Sackler Faculty of Medicine, Tel-Aviv University, 6997801, Tel-Aviv, Israel.,Department of Medicine, E. Wolfson Medical Center, 5822012, Holon, Israel
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Kearsey C, Davidson T, Singh V, Balachandran B, Koppana N, Kalaiselvan R, Rajaganashan R. The right to take risk: are we practising informed consent during the COVID pandemic? Br J Surg 2021; 108:e217-e218. [PMID: 33713108 DOI: 10.1093/bjs/znab067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/12/2022]
Affiliation(s)
- C Kearsey
- Institute of Translation Medicine, University of Liverpool, Liverpool, UK
| | - T Davidson
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
| | - V Singh
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
| | - B Balachandran
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
| | - N Koppana
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
| | - R Kalaiselvan
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
| | - R Rajaganashan
- Department of Surgery, St Helens and Knowsley NHS Trust, Rainhill, Prescot, UK
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Danylesko I, Shem-Tov N, Yerushalmi R, Shimoni A, Davidson T, Beider K, Mevorach D, Besser MJ, Toren A, Avigdor A, Nagler A. Interleukin-8 Serum Levels - a Surrogate Marker for Pseudo-Tumor Progression Post Anti-CD19 Chimeric Antigen Receptor T Cells Treatment in Aggressive B-Cell Lymphoma. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00252-9] [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: 11/25/2022]
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28
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Kanana N, Ben David MA, Nissan N, Yagil Y, Shalmon A, Halshtok O, Gotlieb M, Faermann R, Klang E, Samoocha D, Yassin M, Davidson T, Zippel D, Madorsky Feldman D, Friedman E, Kaidar-Person O, Sklair Levy M. Post-mastectomy surveillance of BRCA1/BRCA2 mutation carriers: Outcomes from a specialized clinic for high-risk breast cancer patients. Breast J 2021; 27:441-447. [PMID: 33576117 DOI: 10.1111/tbj.14190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
Female BRCA1/BRCA2 mutation carriers may elect bilateral risk-reducing mastectomy. There is a paucity of data on yield of imaging surveillance after risk-reducing mastectomy. This retrospective study focused on female BRCA1/BRCA2 mutation carriers who underwent bilateral mastectomy either as primary preventative, or as secondary preventative, after breast cancer diagnosis. All participants underwent breast imaging at 6- to 12-month intervals after mastectomy. Data on subsequent breast cancer diagnosis and timing were collected and compared between the groups. Overall, 184 female mutation carriers (134 BRCA1, 45 BRCA2, 5 both BRCA genes) underwent bilateral mastectomy after initial breast cancer diagnosis, between April 1, 2009 and August 31, 2018. During a mean follow-up of 6.2 ± 4.2 years, 13 (7.06%) were diagnosed with breast cancer; 12 ipsilateral (range: 0.4-28.8 years) and 1 contralateral breast cancer, 15.9 years after surgery. On the contrary, among asymptomatic BRCA1 (n = 40) and BRCA2 (n = 13) mutation carriers who underwent primary risk-reducing mastectomy (mean age at surgery 39.5 ± 8.4 years); none has developed breast cancer after a mean follow-up of 5.4 ± 3.4 years. BRCA1/BRCA2 mutation carriers with prior disease who underwent risk-reducing mastectomy after breast cancer diagnosis are still prone for developing ipsi or contralateral breast cancer, and therefore may benefit from continues clinical and imaging surveillance, unlike BRCA1/BRCA2 mutation carriers who undergo primary preventative bilateral mastectomy.
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Affiliation(s)
- Nayroz Kanana
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Meirav A Ben David
- The Oncology Institute, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Noam Nissan
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Yael Yagil
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Anat Shalmon
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Osnat Halshtok
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Michael Gotlieb
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Renata Faermann
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Eyal Klang
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - David Samoocha
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Mohammad Yassin
- Radiology Department, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel
| | - Dov Zippel
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Dana Madorsky Feldman
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel
| | - Eitan Friedman
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel.,The Susanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Sheba Tel Ha'shomer, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel.,GROW-School for Oncology and Developmental Biology (Maastro, Maastricht University, Maastricht, The Netherlands
| | - Miri Sklair Levy
- Meirav High Risk Clinic, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat-gan, Israel.,The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
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Pilbrow A, Rademaker M, Ellmers L, Palmer S, Davidson T, Mbikou P, Scott N, Charles C, Endre Z, Richards A. Transcriptomic responses associated with kidney injury and repair in acute decompensated heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The discovery of new markers for acute kidney injury (AKI) in acute decompensated heart failure (ADHF) has been hampered by an incomplete understanding of the pathological processes underlying AKI in ADHF.
Purpose
In a sheep model of ADHF, we investigated changes in kidney gene expression in response to the development of, and recovery from, ADHF.
Methods
We collected serial kidney biopsies from 6 sheep prior to rapid cardiac pacing (day 0), after development of ADHF (pacing @220bpm for 14 days), and at the end of a 25-day (non-pacing) recovery period. Serial biopsies were supplemented with kidney samples collected post-mortem from animals undergoing a similar pacing/recovery protocol, giving a total of 11 “baseline” (B), 13 “heart failure” (HF) and 8 “recovery” (R) samples. We prepared RNA-Sequencing libraries using total RNA and Illumina TruSeq stranded mRNA library kits. Hormonal, haemodynamic, biochemical and urine measurements were also performed in all sheep before, during, and after development of ADHF. The study followed the principles of laboratory animal care and was approved by our institution's Animal Ethics Committee.
Results
We observed profound changes in hormonal, haemodynamic, biochemical and urine measures of cardio-renal injury in all sheep, confirming simulation of the peripheral consequences of ADHF, including clinically-relevant kidney dysfunction. This occurred in conjunction with altered kidney expression of 982 genes during ADHF development and 1,807 genes during ADHF recovery (p adj.<0.05, Fig 1). During ADHF development, changes in kidney gene expression were associated with activation of the pro-inflammatory p38 MAPK pathway and repression of several anti-inflammatory and reno-protective pathways, including eNOS signalling (all p adj.<0.001). In contrast, during ADHF recovery, changes in kidney gene expression were associated with reactivation of reno-protective pathways repressed during ADHF development, activation of anti-fibrotic pathways (including PTEN signalling) and repression of pathways that mediate inflammation and renal injury (including NF-kB signalling, all p adj.<0.001). Among 431 ADHF “responsive” genes (i.e. those that increased during ADHF development and decreased during ADHF recovery, or vice versa, Fig. 1), 37 genes encoded proteins detectable in plasma or urine and may represent markers of kidney repair in ADHF. Although most gene expression changes were transient, 192 genes remained altered after 4-weeks recovery (p adj.<0.05, Fig 1). Of these, 13 genes were predicted to encode proteins detectable in plasma or urine and may represent persistent markers of kidney injury in ADHF.
Conclusion
Our data provide the first insight into the gene pathways associated with kidney injury and repair in ADHF, in an established ovine model. Understanding the pathological processes underlying AKI in ADHF may enable discovery of novel markers for monitoring kidney injury and repair in ADHF.
Figure 1. Genes altered in the kidney in ADHF
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Health Research Council of New Zealand, Heart Foundation of New Zealand
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Affiliation(s)
- A Pilbrow
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - M.T Rademaker
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - L.J Ellmers
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - S.C Palmer
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - T Davidson
- Prince of Wales Hospital, Anatomical Pathology, Sydney, Australia
| | - P Mbikou
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - N.J Scott
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - C.J Charles
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - Z.H Endre
- University of New South Wales, Nephrology, Sydney, Australia
| | - A.M Richards
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
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Abstract
18F-FDG PET/CT occupies a growing role in the diagnosis of large vessel vasculitis (LVV), illustrating enhanced uptake in the lining of large vessels. A retrospective single center study was conducted of patients who underwent 18F-FDG PET/CT scans between 2009 and 2019 at Sheba Medical Center, Israel. The imaging results were analyzed for evidence of LVV. We reviewed the PET/CT scans of 126 patients and identified 57 studies that either showed evidence of active LVV or that had been performed in patients previously treated for systemic vasculitis. In 6 patients with fevers of unknown origin and elevated inflammatory markers, PET/CT revealed LVV. Six of 13 patients previously treated for systemic vasculitis demonstrated persistent large vessel uptake. LVV was identified in 8 patients with other autoimmune diseases, and in 4 diagnosed with infectious aortitis. In 26 patients who underwent malignancy surveillance, PET/CT revealed more localized large vessel wall inflammation. Our results illustrate that PET/CT may identify large vessel wall inflammation in patients with a suspicion of LVV, and incidentally in patients who undergo malignancy surveillance. PET/CT may also help delineate the presence and extent of vessel inflammation in patients with LVV and in those with other autoimmune diseases.
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Affiliation(s)
- Jennifer Ben Shimol
- Department of Medicine, E. Wolfson Medical Center, Holon, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Howard Amital
- Department of Medicine, 'B' and Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Saint Petersburg Research Institute of Phthisiopulmonology, Saint-Petersburg, Russian Federation
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nissan N, Sandler I, Eifer M, Eshet Y, Davidson T, Bernstine H, Groshar D, Sklair-Levy M, Domachevsky L. Physiologic and hypermetabolic breast 18-F FDG uptake on PET/CT during lactation. Eur Radiol 2020; 31:163-170. [PMID: 32749586 DOI: 10.1007/s00330-020-07081-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the patterns of breast cancer-related and lactation-related 18F-FDG uptake in breasts of lactating patients with pregnancy-associated breast cancer (PABC) and without breast cancer. METHODS 18F-FDG-PET/CT datasets of 16 lactating patients with PABC and 16 non-breast cancer lactating patients (controls) were retrospectively evaluated. Uptake was assessed in the tumor and non-affected lactating tissue of the PABC group, and in healthy lactating breasts of the control group, using maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), and breast-SUVmax/liver-SUVmean ratio. Statistical tests were used to evaluate differences and correlations between the groups. RESULTS Physiological uptake in non-breast cancer lactating patients' breasts was characteristically high regardless of active malignancy status other than breast cancer (SUVmax = 5.0 ± 1.7, n = 32 breasts). Uptake correlated highly between the two breasts (r = 0.61, p = 0.01), but was not correlated with age or lactation duration (p = 0.24 and p = 0.61, respectively). Among PABC patients, the tumors demonstrated high 18F-FDG uptake (SUVmax = 7.8 ± 7.2, n = 16), which was 326-643% higher than the mostly low physiological FDG uptake observed in the non-affected lactating parenchyma of these patients (SUVmax = 2.1 ± 1.1). Overall, 18F-FDG uptake in lactating breasts of PABC patients was significantly decreased by 59% (p < 0.0001) compared with that of lactating controls without breast cancer. CONCLUSION 18F-FDG uptake in lactating tissue of PABC patients is markedly lower compared with the characteristically high physiological uptake among lactating patients without breast cancer. Consequently, breast tumors visualized by 18F-FDG uptake in PET/CT were comfortably depicted on top of the background 18F-FDG uptake in lactating tissue of PABC patients. KEY POINTS • FDG uptake in the breast is characteristically high among lactating patients regardless of the presence of an active malignancy other than breast cancer. • FDG uptake in non-affected lactating breast tissue is significantly lower among PABC patients compared with that in lactating women who do not have breast cancer. • In pregnancy-associated breast cancer patients, 18F-FDG uptake is markedly increased in the breast tumor compared with uptake in the non-affected lactating tissue, enabling its prompt visualization on PET/CT.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Sandler
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eifer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Tima Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
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Leibowitz R, Davidson T, Gadot M, Aharon M, Malki A, Levartovsky M, Oedegaard C, Saad A, Sandler I, Ben-Haim S, Domachevsky L, Berger R. A Retrospective Analysis of the Safety and Activity of Lutetium-177-Prostate-Specific Membrane Antigen Radionuclide Treatment in Older Patients with Metastatic Castration-Resistant Prostate Cancer. Oncologist 2020; 25:787-792. [PMID: 32430954 DOI: 10.1634/theoncologist.2020-0100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/13/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prostate cancer is a common malignancy of the elderly, and with the aging of the population, the need is growing for therapies suitable for this age group. Lutetium-177-prostate-specific membrane antigen (Lu-PSMA), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen, enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer (mCRPC). In a recent single-arm phase II trial and a subsequent expansion cohort, a prostate-specific antigen (PSA) decline of ≥50% was observed in approximately 60% of patients receiving Lu-PSMA. Taking into account the specific challenges and potential toxicities of Lu-PSMA administration in elderly men, we sought to retrospectively analyze the safety and activity of Lu-PSMA in men aged older than 75 years with mCRPC. PATIENTS AND METHODS The electronic medical records of 24 patients aged older than 75 years treated with Lu-PSMA "off-trial" were reviewed, and clinical data were extracted. Clinical endpoints were toxicity and activity, defined as a PSA decline ≥50%. Descriptive statistics were performed using Excel. RESULTS The median age at treatment start was 81.7 years (range 75.1-91.9). The median number of previous treatment lines was four. The number of treatment cycles ranged from one to four; the mean administered radioactivity was 6 GBq per cycle. Treatment was generally tolerable; side effects included fatigue (n = 8, 33%), anemia (n = 7, 29%), thrombocytopenia (n = 5, 21%), and anorexia/nausea (n = 3, 13%). Clinical benefit was observed in 12 of 22 patients (54%); PSA decline above 50% was observed in 11 patients (48%) and was associated with significantly longer overall survival. CONCLUSION Our results indicate that Lu-PSMA is safe and active in elderly patients with mCRPC. IMPLICATIONS FOR PRACTICE Lutetium-177-prostate-specific membrane antigen (Lu-PSMA), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen, enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer (mCRPC). The recently published single-arm phase II trial with Lu-PSMA, describing its safety and activity, did not include patients aged older than 75 years. In this study, Lu-PSMA activity was retrospectively analyzed in patients aged older than 75 years and results indicate that treatment was tolerable and similarly active in this age group, with no new emerging safety signals. Despite the small cohort size, this analysis suggests that Lu-PSMA can serve as an advanced palliative treatment line in mCRPC in elderly patients.
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Affiliation(s)
- Raya Leibowitz
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Margalit Aharon
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avraham Malki
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | - Akram Saad
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Israel Sandler
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | - Simona Ben-Haim
- Department of Biophysics and Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel
- Institute of Nuclear Medicine, University College London and University College London Hospitals, National Health Service Trust, London, United Kingdom
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | - Raanan Berger
- Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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33
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Gadot M, Davidson T, Aharon M, Atenafu EG, Malki A, Levartovsky M, Saad A, Domachevsky L, Berger R, Leibowitz R. Clinical Variables Associated with PSA Response to Lutetium-177-PSMA ([177Lu]-PSMA-617) Radionuclide Treatment in Men with Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2020; 12:cancers12051078. [PMID: 32357427 PMCID: PMC7281592 DOI: 10.3390/cancers12051078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Lutetium-177-PSMA ([177Lu]-PSMA-617), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen (PSMA), enabling targeted radiation therapy to metastatic prostate lesions. Our objective was to retrospectively analyze the activity of [177Lu]-PSMA-617 given off-trial to men with metastatic castration resistant prostate cancer (mCRPC) and identify clinical factors associated with PSA response. Electronic medical records of all men treated with [177Lu]-PSMA-617 were reviewed and analyzed. Overall survival was calculated using the Kaplan-Meier method. The association between potential variables and PSA response was analyzed by univariate analysis, using either logistic regression or χ2/Fisher's exact test. Multivariable analysis was carried out using logistic regression on all categorical variables with a P-value of <0.1 on univariate analysis. Variables found to be statistically significant were then used to define a categorical score. A total of 52 patients received at least one cycle of [177Lu]-PSMA-617. Clinical benefit was observed in 28 patients (52%). PSA decline ≥20% and ≥50% was observed in 26 (50%) and 18 patients (35%), respectively. Achievement of any PSA decline at first measurement was significantly associated with survival. There was a negative association between the number of previous chemotherapy lines and PSA decline above 20%. Univariate analysis followed by multivariable analysis showed that older age and higher hemoglobin were significantly associated with a PSA decline >20%. A score combining these two parameters was significantly associated with PSA response. In summary, [177Lu]-PSMA-617 is active in the 'real-life' setting of heavily pretreated men with mCRPC.
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Affiliation(s)
- Moran Gadot
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Margalit Aharon
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Eshetu G. Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Avraham Malki
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | | | - Akram Saad
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - Raanan Berger
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (R.B.); (R.L.); Tel.:+972-8-9779715 (R.L.); Fax: +972-8-9779714 (R.L.)
| | - Raya Leibowitz
- Oncology Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Correspondence: (R.B.); (R.L.); Tel.:+972-8-9779715 (R.L.); Fax: +972-8-9779714 (R.L.)
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Davidson T, Avigdor A, Oksman Y, Nissan E, Zlotnick M, Chikman B, Nissan J, Goshen E, Ben-Haim S, Benjamini O. PET/CT in Disease Detection and Follow-up of Subcutaneous Involvement in Marginal Zone Lymphoma. Clin Lymphoma Myeloma Leuk 2020; 20:252-259. [PMID: 32115401 DOI: 10.1016/j.clml.2019.09.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/09/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The value of positron emission tomography/computed tomography (PET/CT) in the staging and assessment of treatment response in marginal zone lymphoma (MZL) lymphomas remains controversial. We investigated radiologic characteristics of subcutaneous MZL as imaged on PET/CT scans. PATIENTS AND METHODS From the records of a single medical center, for the years 2008 and 2017, we identified subcutaneous lesions in PET/CT scans of patients with histopathologically confirmed MZL in sites other than subcutaneous tissue. RESULTS Of 571 scans of 178 patients, subcutaneous lesions were found in 20 (11%). Lesions were located in soft tissue structures, mainly along the lateral aspects of the buttocks, thighs and lower and upper back areas, the flank, and the shoulders. Median lengths of the long and short axes of the lesions were 2.0 (range, 1.1-6.0) cm and 0.8 (range, 0.3-2.0) cm, respectively. Median standardized maximum uptake value was 2.3 (range, 0.9-7.6). In 12 patients (60%), MZL was diagnosed at an early stage; 15 (75%) had lymph node involvement and 10 (50%) extranodal involvement. One had spleen and 2 had cutaneous involvement; none had gastric findings. CONCLUSION The findings of this study support the usefulness of PET/CT in the detection of subcutaneous MZL as well as in staging and treatment decisions.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Abraham Avigdor
- Department of Hematology and Bone-Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yakov Oksman
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ella Nissan
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Maya Zlotnick
- Department of Hematology and Bone-Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Bar Chikman
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Johnatan Nissan
- Technion, Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel; Institute of Nuclear Medicine, University College London and UCL Hospitals, NHS Trust, London, UK
| | - Ohad Benjamini
- Department of Hematology and Bone-Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Lotan E, Friedman KP, Davidson T, Shepherd TM. Brain 18F-FDG-PET: Utility in the Diagnosis of Dementia and Epilepsy. Isr Med Assoc J 2020; 22:178-184. [PMID: 32147984] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The authors reviewed the two most common current uses of brain 18F-labeled fluoro-2-deoxyglucose positron emission tomography (FDG-PET) at a large academic medical center. For epilepsy patients considering surgical management, FDG-PET can help localize epileptogenic lesions, discriminate between multiple or discordant EEG or MRI findings, and predict prognosis for post-surgical seizure control. In elderly patients with cognitive impairment, FDG-PET often demonstrates lobar-specific patterns of hypometabolism that suggest particular underlying neurodegenerative pathologies, such as Alzheimer's disease. FDG-PET of the brain can be a key diagnostic modality and contribute to improved patient care.
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Affiliation(s)
- Eyal Lotan
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Kent P Friedman
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Tima Davidson
- Departments of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Timothy M Shepherd
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
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Avigdor A, Davidson T, Shimoni A, Yerushalmi R, Shem-Tov N, Danylesko I, Itzhaki O, Toren A, Jacoby E, Besser M, Nagler A. BASELINE CLINICAL AND PET-CT TUMOR BURDEN PARAMETERS DO NOT PREDICT OUTCOME OF RELAPSE/REFRACTORY AGGRESSIVE B CELL LYMPHOMA PATIENTS TREATED WITH ANTI-CD19 CAR T-CELLS. Hematol Oncol 2019. [DOI: 10.1002/hon.188_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Avigdor
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - T. Davidson
- Department of Nuclear Medicine; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - A. Shimoni
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - R. Yerushalmi
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - N. Shem-Tov
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - I. Danylesko
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - O. Itzhaki
- Ella Lemelbaum Institute for Immuno Oncology; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - A. Toren
- Department of Pediatric Hematology-Oncology; Safra Children's Hospital, Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - E. Jacoby
- Department of Pediatric Hematology-Oncology; Safra Children's Hospital, Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - M. Besser
- Ella Lemelbaum Institute for Immuno Oncology; Chaim Sheba Medical Center and Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
| | - A. Nagler
- Division of Hematology and Bone Marrow Transplantation; Chaim Sheba Medical Center and Sackler School of Medicine, Tel Aviv University; Tel Hashomer Israel
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Berlin H, List T, Ridell K, Davidson T, Toft D, Klingberg G. Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars. Eur Arch Paediatr Dent 2019; 20:545-555. [PMID: 30963511 DOI: 10.1007/s40368-019-00425-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI ≥ 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.
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Affiliation(s)
- H Berlin
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden.
| | - T List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - K Ridell
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
| | - T Davidson
- Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - D Toft
- Colosseum Smile Dental Group, Malmö, Sweden
| | - G Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
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Shrot S, Abebe-Campino G, Toren A, Ben-Haim S, Hoffmann C, Davidson T. Fluorodeoxyglucose Detected Changes in Brain Metabolism After Chemotherapy in Pediatric Non-Hodgkin Lymphoma. Pediatr Neurol 2019; 92:37-42. [PMID: 30630683 DOI: 10.1016/j.pediatrneurol.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Potential neurocognitive dysfunction after chemotherapy is a worrisome long-term outcome. Our objective was to evaluate the effect on brain metabolism in pediatric patients with non-central nervous system cancer treated with chemotherapy by analyzing brain data from serial whole-body fluorodeoxyglucose positron emission tomography/computed-tomography (FDG-PET/CT) scans taken before and sequentially after therapy. METHODS Fourteen pediatric patients diagnosed with lymphoma and treated with systemic and prophylactic intrathecal chemotherapy were included. All patients had baseline pretreatment whole-body FDG-PET/CT and at least one post-therapy study preformed as part of standard surveillance. Brain positron emission tomography data were quantitatively analyzed for normalized fluorodeoxyglucose uptake in various brain regions. A generalized estimating equation approach was used to evaluate temporal changes after chemotherapy. RESULTS Median time of follow-up surveillance positron emission tomography-computed-tomography was 456 days after chemotherapy course. Various brain regions demonstrated significant changes in fluorodeoxyglucose uptake as a function of time passed since chemotherapy. Increased fluorodeoxyglucose uptake was noted in the parietal and cingulate cortexes. Decreased fluorodeoxyglucose uptake was demonstrated in deep gray matter nuclei and in the brainstem. CONCLUSIONS Our study provides novel insights into long-standing and progressive changes in regional glucose metabolism after chemotherapy in pediatric cancer population, lasting long after the end of therapy and reaching clinical remission. Expanding the utility of regular surveillance fluorodeoxyglucose positron emission tomography to a detailed quantitative assessment of regional brain metabolism after chemotherapy can provide valuable information on individual chemotherapy-related neuromodulation and facilitate the development of strategies to minimize neurocognitive side effects.
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Affiliation(s)
- Shai Shrot
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gadi Abebe-Campino
- Department of Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel; Institute of Nuclear Medicine, University College London, UCL Hospitals, NHS Trust, London, UK
| | - Chen Hoffmann
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tima Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Keidar Z, Gill R, Goshen E, Israel O, Davidson T, Morgulis M, Pirmisashvili N, Ben-Haim S. 68Ga-PSMA PET/CT in prostate cancer patients - patterns of disease, benign findings and pitfalls. Cancer Imaging 2018; 18:39. [PMID: 30382889 PMCID: PMC6211573 DOI: 10.1186/s40644-018-0175-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background 68Ga-PSMA PET/CT has an important role in assessment of prostate cancer patients with biochemical recurrence and is evolving in staging high- and intermediate risk disease. The aim of present study was to describe the metastatic patterns and frequency of involved sites of prostate cancer and to assess the incidence of benign Ga68-PSMA avid PET/CT findings in a large patient population. Methods 68Ga-PSMA PET/CT studies performed in two tertiary medical centers over a period of 24 months were retrospectively reviewed. The incidence and location of pathological 68Ga-PSMA avid foci, suspicious to represent malignancy, as well as those of unexpected benign foci of increased 68Ga-PSMA activity were documented and analyzed. Results There were 445 68Ga-PSMA studies in 438 men (mean age 72.4, range 51–92 years) with prostate cancer referred for biochemical failure (n = 270, 61%), staging high-risk disease (n = 112, 25%), response assessment (n = 30, 7%), follow-up (n = 22, 5%) and suspected bone metastases (n = 11, 2%). 68Ga-PSMA avid disease sites were observed in 319 studies (72%), in 181 studies (67%) for biochemical recurrence, 94 studies for staging (84%) (p < 0.05), in 22 studies for response assessment (73%), 10 follow up studies (45%) and in five patients with suspected bone metastases (45%). 68Ga-PSMA avid lesions were most commonly detected in the prostate (n = 193, 43%), loco-regional spread (n = 51, 11%), abdomino-pelvic nodes (n = 129, 29%) and distant metastases (n = 158, 36%), including bone metastases (n = 11, 25%), distant lymphadenopathy (n = 29, 7%) and other organs (n = 18, 4%). Distant 68Ga-PSMA-avid metastases were commonly seen in patients with biochemical recurrence (14/21 lesions), but were not seen in patient referred for staging (p < 0.013). There were 96 non-malignant 68Ga-PSMA avid foci in 81 studies, most common in reactive lymph nodes (n = 36, 38%), nonmalignant bone lesions (n = 21, 22%), thyroid nodules (n = 9, 9%), ganglions (n = 9, 9%) and lung findings (n = 8, 8%). Conclusion The distribution of 68Ga-PSMA avid metastatic lesions is similar to data previously reported mainly from autopsy with comparable detection rates, indicating 68Ga-PSMA PET/CT is an accurate detection tool in patients with metastatic prostate cancer. If confirmed by further prospective studies 68Ga-PSMA PET/CT should be included in the guidelines to evaluate disease extent in these patients.
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Affiliation(s)
- Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel. .,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Ronit Gill
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Maryna Morgulis
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Simona Ben-Haim
- Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.,University College London and UCL Hospitals, NHS Trust, London, UK
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Davidson T, Priel E, Schiby G, Raskin S, Chikman B, Nissan E, Benjamini O, Nissan J, Goshen E, Ben-Haim S, Salomon O, Avigdor A. Low rate of spleen involvement in sporadic Burkitt lymphoma at staging on PET-CT. Abdom Radiol (NY) 2018; 43:2369-2374. [PMID: 29460043 DOI: 10.1007/s00261-017-1454-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Burkitt lymphoma is a highly aggressive B cell non-Hodgkin lymphoma. Cross-sectional imaging techniques that are used to detect liver and spleen involvement by lymphoma have high rates of false negative and false positive findings, and as such may reduce the accuracy of staging. PURPOSE This retrospective study evaluated the use of FDG PET-CT in determining splenic involvement at staging, in a relatively large cohort of adult patients with the sporadic form of Burkitt lymphoma (SBL). PATIENTS AND METHODS All adult patients who underwent FDG PET-CT for staging of SBL at one medical center during 2005-2014 were enrolled for this retrospective study. RESULTS Data were analyzed of 20 patients, with median age 49 years; 17 were male. PET-CT revealed highly intense FDG uptake, mean SUV max 11.4 ± 7.49 (range 4.3-38) in various tissues. None of the 20 patients had either focal or diffuse increased uptake of FDG in the spleen parenchyma. In 2 patients, there were highly FDG-avid soft tissue masses adjacent to the spleen, both in the context of direct peritoneal disease extension. CONCLUSION The spleen is rarely involved in SBL at the time of staging, according to PET-CT, except in cases with direct extension from adjacent peritoneal mass. The low rate of spleen involvement according to PET-CT may serve as a specific characteristic of SBL. Larger-scale clinical studies incorporating PET-CT scans in SBL are needed to confirm our observation.
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Davidson T, Komisar O, Korach J, Felder S, Apter S, Ben-Haim S, Perri T. Physiologic uptake of 18F-FDG in transposed ovaries may mimic metastasis on 18F-FDG PET/CT imaging. Nucl Med Commun 2018; 39:171-178. [PMID: 29215392 DOI: 10.1097/mnm.0000000000000785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ovarian transposition is aimed at preserving ovarian function before irradiation in pelvic malignancies. The extrapelvic location of the ovaries and their physiologic fluorine-18-fluorodeoxyglucose (F-FDG)-uptake is a potential source of misdiagnosis as metastasis on F-FDG PET/CT. We describe the F-FDG PET/CT characteristics of transposed ovaries and their changes over time. PATIENTS AND METHODS We reviewed F-FDG PET/CT studies of all consecutive women with pelvic malignancies who underwent ovarian transposition between 2007 and 2013. Studies were grouped according to the time period over which they were carried out. Findings were categorized by location, size, appearance (solid/mixed/cystic), presence of surgical clips, ovarian F-FDG uptake (maximum standardized uptake value), and attenuation values on CT (Hounsfield units). Group time-period differences were assessed. RESULTS Seventy-nine F-FDG PET/CT studies were reviewed, 30 before and 49 after transposition. Time-period groups after transposition were up to 4 months (18 studies), 4.1-12 months (n=14), and more than 12 months (n=17). After transposition, ovaries were located mainly in the paracolic gutter (n=32) and subhepatic regions (n=18). Surgical clips were present in 67%. Both ovaries appeared more solid 1 year after surgery than preoperatively (13.7% before vs. 61.3% after surgery; P<0.001). Transient F-FDG-avidity was observed in 11 ovaries. Hounsfield unit values were higher within 4 months after surgery than preoperatively, reverting thereafter to preoperative values. CONCLUSION After ovarian transposition, nonanatomic location, loss of cysts formation in favor of solid appearance over time, and intermittent F-FDG uptake of functioning transposed ovaries might mimic metastatic lesions. Careful interpretation of F-FDG PET/CT findings is mandatory in women with pelvic malignancies who have undergone ovarian transposition.
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Affiliation(s)
- Tima Davidson
- Departments of Nuclear Medicine.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Komisar
- Diagnostic Imaging.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Korach
- Gynecologic Oncology.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Felder
- Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Diagnostic Imaging.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simona Ben-Haim
- Departments of Nuclear Medicine.,Institute of Nuclear Medicine, University College London and UCH Hospitals, London, UK
| | - Tamar Perri
- Gynecologic Oncology.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Davidson T, Ravid MM, Nissan E, Sklair-Levy M, Nissan J, Chikman B. Correlations Between Core Needle Biopsy and Excisional Biopsy Findings in Suspected Breast Lesions: A Single Center Study. Isr Med Assoc J 2018; 20:401-404. [PMID: 30109786] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND When a breast lesion is suspected based on a physical exam, mammography, or ultrasound, a stereotactic core needle biopsy (CNB) is usually performed to help establish a definitive diagnosis. CNBs are far less invasive than excisional biopsies, with no need for general anesthetics or hospitalization, and no recovery period. However, since only samples of the mass are removed in a CNB and not the whole mass, sampling errors can occur. OBJECTIVES To compare the degree of agreement between the pathological data from CNBs and excisional biopsies from a single tertiary referral hospital. METHODS The concordance of pathological data was compared in patients who underwent CNBs and had their surgical procedures at the same medical center. RESULTS From the 894 patients who underwent CNBs, 254 (28.4%) underwent subsequent excisional biopsies at our medical center. From the total of 894 patients, 227 (25.3%) who underwent a CNB were diagnosed with a malignancy, with the rest of the CNBs being diagnosed as benign pathologies. The pathological findings in the CNBs and in the excisional biopsies concurred in 232/254 (91.3%) of the cases. CONCLUSIONS A CNB to confirm mammographic or clinical findings of breast lesions is an accurate method to establish a pathological diagnosis of breast lesions. The accuracy is higher for invasive carcinomas than for non-invasive cancers. Excisional biopsies are necessary for lesions with anticipated sampling errors or when the core needle biopsy findings are discordant with clinical or mammographic findings.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal M Ravid
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Ella Nissan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mirriam Sklair-Levy
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johnatan Nissan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Chikman
- Division of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Avigdor A, Shouval R, Jacoby E, Davidson T, Shimoni A, Besser M, Nagler A. CAR T cells induce a complete response in refractory Burkitt Lymphoma. Bone Marrow Transplant 2018; 53:1583-1585. [PMID: 29795432 DOI: 10.1038/s41409-018-0235-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Abraham Avigdor
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Roni Shouval
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Jacoby
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tima Davidson
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avichai Shimoni
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Besser
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Davidson T, Ben-David M, Galper S, Haskin T, Howes M, Scaife R, Kanana N, Amit U, Weizman N, Chikman B, Goshen E, Ben-Haim S, Symon Z, Goldstein J. Use of 18 F-FDG PET-CT imaging to determine internal mammary lymph node location for radiation therapy treatment planning in breast cancer patients. Pract Radiat Oncol 2017; 7:373-381. [DOI: 10.1016/j.prro.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
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Davidson T, Druyan A, Goshen E, Lidar M. The PET-CT Radiological Appearance of Facial Cosmetic Injections: A Pitfall in the Evaluation of the Oncological Patient. Isr Med Assoc J 2017; 19:679-681. [PMID: 29185280] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Facial rejuvenation using different dermal and sub-dermal injectable compounds is a popular cosmetic procedure which may pose a diagnostic dilemma to the radiologist. OBJECTIVES To describe the appearance of cosmetic facial fillers on PET-CT. METHODS All PET-CT exams performed between January 2015 and May 2017 in which findings suggestive of prior facial filler procedures was evident and where anamnestic confirmation with the patient was possible were reviewed. RESULTS We describe five females who had undergone facial filler procedures leading to calcifications around the mouth and nasolabial triangle. CONCLUSIONS Familiarity with the appearance of such cosmetic procedures on PET-CT is of paramount importance in order to avoid misinterpretation of the findings leading to unnecessary apprehension and work-up.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Druyan
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Häggman-Henrikson B, Alstergren P, Davidson T, Högestätt ED, Östlund P, Tranaeus S, Vitols S, List T. Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis. J Oral Rehabil 2017; 44:800-826. [DOI: 10.1111/joor.12539] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 01/11/2023]
Affiliation(s)
- B. Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Faculty of Odontology; Health Technology Assessment - Odontology (HTA-O); Malmö University; Malmö Sweden
| | - P. Alstergren
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skåne University Hospital; Malmö Sweden
| | - T. Davidson
- Faculty of Odontology; Health Technology Assessment - Odontology (HTA-O); Malmö University; Malmö Sweden
- Department of Medical and Health Sciences; Division of Health Care Analysis; Linköping University; Linköping Sweden
| | - E. D. Högestätt
- Department of Laboratory Medicine; Clinical Chemistry and Pharmacology; Lund University; Lund Sweden
| | - P. Östlund
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
| | - S. Tranaeus
- Department of Odontology/Clinical Oral Physiology; Umeå University; Umeå Sweden
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
| | - S. Vitols
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); Stockholm Sweden
- Department of Medicine; Division of Clinical Pharmacology; Karolinska Institute; Stockholm Sweden
| | - T. List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
- Department of Rehabilitation Medicine; Skåne University Hospital; Malmö Sweden
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Davidson T, Kedmi M, Avigdor A, Komisar O, Chikman B, Lidar M, Goshen E, Tzila Zwas S, Ben-Haim S. FDG PET-CT evaluation in neurolymphomatosis: imaging characteristics and clinical outcomes. Leuk Lymphoma 2017; 59:348-356. [PMID: 28750592 DOI: 10.1080/10428194.2017.1352096] [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] [Indexed: 10/19/2022]
Abstract
Neurolymphomatosis (NL) often represents unidentified non-Hodgkin lymphoma relapses. Considering its severity, early detection and treatment are crucial. We outline one hospital's 18F-FDG-PET-CT imaging findings of NL, along with the patients' clinical characteristics. Clinical records and imaging findings of 19 NL patients, PET-CT diagnosed, were retrospectively reviewed. Patient data, FDG-PET-CT findings and the presence of coexisting diseases, especially CNS involvement, were documented. Available MRI and clinical data verified the findings. All cases had increased linear FDG uptake along anatomic nerve sites. CTs showed varying degrees of corresponding soft-tissue-thickening. Clinical correlations also contributed to the diagnosis. In 4/19 patients, lymphoma presented with NL, in 15/19 it appeared with disease recurrence/progression. In 9/19, clinical symptoms suggested neural involvement while 10/19 had nonspecific symptoms. Eleven died of lymphoma within 0.9 years of diagnosis despite directed-therapy. Eight, however, survived up to 7.82 years post-diagnosis. Whole-body FDG-PET-CT can assist in early NL diagnosis, possibly enhancing survival.
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Affiliation(s)
- Tima Davidson
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - Meirav Kedmi
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Abraham Avigdor
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Orna Komisar
- d Department of Diagnostic Imaging , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Bar Chikman
- e Division of Surgery , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Merav Lidar
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,f Rheumatology Unit , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Elinor Goshen
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - S Tzila Zwas
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - Simona Ben-Haim
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,g Institute of Nuclear Medicine , University College London and UCL Hospitals, NHS Trust , London , UK
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Pianta T, Succar L, Davidson T, Buckley N, Endre Z. Monitoring treatment of acute kidney injury with damage biomarkers. Toxicol Lett 2017; 268:63-70. [DOI: 10.1016/j.toxlet.2017.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/29/2016] [Accepted: 01/01/2017] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Childhood adversity predicts adolescent suicidal ideation but there are few studies examining whether the risk of childhood adversity extends to suicidal ideation in midlife. We hypothesized that childhood adversity predicts midlife suicidal ideation and this is partially mediated by adolescent internalizing disorders, externalizing disorders and adult exposure to life events and interpersonal difficulties. METHOD At 45 years, 9377 women and men from the UK 1958 British Birth Cohort Study participated in a clinical survey. Childhood adversity was prospectively assessed at the ages of 7, 11 and 16 years. Suicidal ideation at midlife was assessed by the depressive ideas subscale of the Revised Clinical Interview Schedule. Internalizing and externalizing disorders were measured by the Rutter scales at 16 years. Life events, periods of unemployment, partnership separations and alcohol dependence were measured through adulthood. RESULTS Illness in the household, paternal absence, institutional care, parental divorce and retrospective reports of parental physical and sexual abuse predicted suicidal ideation at 45 years. Three or more childhood adversities were associated with suicidal ideation at 45 years [odds ratio (OR) 4.31, 95% confidence interval (CI) 2.67-6.94]. Psychological distress at 16 years partially mediated the associations of physical abuse (OR 3.41, 95% CI 2.29-5.75), sexual abuse (OR 4.99, 95% CI 2.90-11.16) with suicidal ideation. Adult life events partially mediated the association of parental divorce (OR 6.34, 95% CI -7.16 to 36.75) and physical (OR 9.59, 95% CI 4.97-27.88) and sexual abuse (OR 6.59, 95% CI 2.40-38.36) with suicidal ideation at 45 years. CONCLUSIONS Adversity in childhood predicts suicidal ideation in midlife, partially mediated by adolescent internalizing and externalizing disorders, adult life events and interpersonal difficulties. Understanding the pathways from adversity to suicidal ideation can inform suicide prevention and the targeting of preventive interventions.
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Affiliation(s)
- S. A. Stansfeld
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Clark
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - M. Smuk
- Centre for Psychiatry,
Wolfson Institute of Preventive Medicine, Barts and the
London School of Medicine and Dentistry, Queen Mary University of
London, London EC1M 6BQ, UK
| | - C. Power
- Population, Policy and
Practice, University College London,
Institute of Child Health, 30 Guilford
Street, London WC1N 1EH, UK
| | - T. Davidson
- Centre for Gambling Research,
School of Sociology, Beryl Rawson Building,
The Australian National University,
Acton, ACT 2601, Australia
| | - B. Rodgers
- School of Demography, The
Australian National University, Acton, ACT
2601, Australia
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Davidson T, Ben-David M, Galper S, Haskin T, Howes M, Scaife R, Kanana N, Amit U, Weizman N, Chikman B, Goshen E, Ben-Haim S, Symon Z, Goldstein J. The Use of Positron Emission Tomography/Computed Tomography Imaging to Determine Internal Mammary Lymph Node Involvement and Location for Radiation Therapy Treatment Planning in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.353] [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: 12/01/2022]
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