Αρχειοθήκη ιστολογίου

Δευτέρα 15 Αυγούστου 2022

Incidence and characteristics of pseudoprogression in IDH-mutant high-grade gliomas: a POLA network study

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Abstract
Background
Incidence and characteristics of pseudoprogression in isocitrate dehydrogenase-mutant high-grade gliomas (IDHmt HGG) remain to be specifically described.
Methods
We analyzed pseudoprogression characteristics and explored the possibility of pseudoprogression misdiagnosis in IDHmt HGG patients, treated with radiotherapy (with or without chemotherapy), included in the French POLA network. Pseudoprogression was analyzed in patients with MRI available for review (reference cohort, n=200). Pseudoprogression misdiagnosis was estimated in this cohort and in an independent cohort (control cohort, n=543) based on progression free survival before and after first progression.
Results
In the reference cohort, 38 patients (19%) presented a pseudoprogression after a median time of 10.5 months after radiotherapy. Pseudoprogression characteristics were similar across IDHmt HGG subtypes. In most patients, it consisted in the appearance of one or several infracentimetric, asymptomatic, contrast-enhanced lesions occurring within 2 years after radiotherapy. The only factor associated with pseudoprogression occurrence was adjuvant PCV chemotherapy. Among patients considered as having a first true progression, 7 out of 41 (17%) in the reference cohort and 35 out of 203 (17%) in the control cohort were retrospectively suspected to have a misdiagnosed pseudoprogression. Patients with a misdiagnosed pseudoprogression were characterized by a time to event and an outcome similar to that of patients with a pseudoprogression but presented with larger and more symptomatic lesions.
Conclusion
In patients with an IDHmt HGG, pseudoprogression occurs later than in IDH-wildtype glioblastomas and seems not only frequent but also frequently misdiagnosed. Within the first 2 years after radiotherapy, the possibility of a pseudoprogression should be carefully considered.
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Optimized dual therapy for treatment‐naive patients of Helicobacter pylori infection: A large‐scale prospective, multicenter, open‐label, randomized controlled study

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Abstract

Background

The efficacy and safety of high-dose amoxicillin (AMX) and proton pump inhibitors (PPI) dual therapy raises much more attention in recent years. Comparative studies among the dual therapies are required to explore more suitable regimens. This study compared the efficacy, adverse events, and patient compliance of three different high-dose dual regimens in treatment-naive patients of Helicobacter pylori (H. pylori) infection.

Materials and Methods

The study was a prospective, multicenter, open-label, randomized controlled trial, including H. pylori-infected treatment-naive patients at 12 tertiary hospitals in China. The eligible subjects received high-dose AMX and esomeprazole (ESO) dual therapy of different regimens. They were randomly assigned to group A (ESO 20 mg plus AMX 750 mg, Qid for 14 days), group B (ESO 40 mg Bid plus AMX 1 g Tid for 14 days), or group C (ESO 20 mg plus AMX 1 g, Tid for 14 days). The eradication rates, adverse events, and patient compliance of the three groups were compared.

Results

Between April 2021 and January 2022, a total of 1080 subjects were screened and 945 were randomized. The eradication rates in groups A, B, and C were 88.6% (95% CI 84.5%–91.9%), 84.4% (95% CI 80.0%–88.3%), and 86.7% (95% CI 82.4%–90.2%; p = .315), respectively, based on intention-to-treat analysis; 90.3% (95% CI 86.4%–93.3%), 85.5% (95% CI 81.1%–89.2%), and 87.8% (95% CI 83.6%–91.2%; p = .197), respectively, according to modified intention-to-treat analysis; and 90.4% (95% CI 86.5%–93.5%), 85.8% (95% CI 81.4%–89.5%), and 88.3% (95% CI 84.1%–91.7%; p = .202) in per-protocol analysis. History of antibiotics use in 2 years reduced eradication effect in group B (ESO 40 mg Bid, AMX 1 g Tid). The modified intention-to-treat eradication rates were 81.4% vs 90.0% among those with or without a history of antibiotics use in group B (p = .031). The adverse event rates were 13.7%, 12.7%, and 12.1% i n groups A, B, and C, respectively (p = .834). Patient compliance of the three groups was similar.

Conclusions

Two optimized AMX and PPI dual regimens (ESO 40 mg Bid or 20 mg Tid plus AMX 1 g Tid for 14 days) had similar efficacy, safety and compliance as compared with classical dual regimen (ESO 20 mg plus AMX 750 mg Qid for 14 days) in H. pylori-infected treatment-naive patients.
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A Mediterranean and Low‐Fat dietary intervention in Non‐Alcoholic Fatty Liver Disease patients ‐Exploring participant experience and perceptions about dietary change.

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Abstract

Background

A Mediterranean Diet (MD) appears to be beneficial in NAFLD patients in Mediterranean countries, however the acceptability of a MD in non-Mediterranean populations has not been thoroughly explored. This study aimed to explore the acceptability, through understanding the barriers and enablers of MD and low-fat diet (LFD) interventions as perceived by Australian adults from multicultural backgrounds, with NAFLD, who participated.

Methodology

Semi-structured telephone interviews were performed with 23 NAFLD trial participants at the end of a 12-week dietary intervention in a multicentre, parallel, randomised clinical trial. Data was analysed using thematic analysis.

Results

Participants reported that they enjoyed taking part in the MD and LFD interventions and perceived that they had positive health benefits from their participation. Compared to the LFD, the MD group placed greater emphasis on enjoyment and intention to maintain dietary changes. Novelty, convenience and the ability to swap food/meals were key enablers for the successful implementation for both of the dietary interventions. Flavour and enjoyment of food, expressed more prominently by MD intervention participants, were fundamental components of the diets with regard to reported adherence and intention to maintain dietary change.

Conclusions

Participants randomised to the MD reported greater acceptability of the diet than those randomised to the LFD, predominantly related to perceived novelty and palatability of the diet.

This article is protected by copyright. All rights reserved.
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Laryngeal Plasmacytosis Responsive to Inhaled Budesonide

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Laryngeal Plasmacytosis Responsive to Inhaled Budesonide

Laryngeal mucous membrane plasmacytosis is rare and treatment options are limited. We present the case of a patient demonstrating remarkable improvement with the use of nebulized corticosteroid therapy.


Mucous membrane plasmacytosis (MMP) is rare condition characterized by diffuse plasma cell infiltration of upper aero-digestive tract mucosa. It results in epithelial hyperplasia that has a classic papillary appearance. We describe a case of MMP primarily affect laryngeal and oropharyngeal mucosa resulting in progressive airway obstruction. We highlight airway management and histopathology. The patient had near complete clinical response with inhaled budesonide, which has not yet been described as a treatment option in the literature. Laryngoscope, 2022
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A Rare Case of Cochlear Implant Electrode Array Misplacement Into the Posterior Semicircular Canal

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A Rare Case of Cochlear Implant Electrode Array Misplacement Into the Posterior Semicircular Canal

In this report, we present a case of an elderly patient who suffered cochlear implant electrode array misplacement into the posterior semicircular canal, resulting in vestibular symptoms and severe downstream sequelae. The risk of misplacement may be higher in patients with a history of chronic otitis media or prior otologic surgery, and with the use of pre-curved electrode arrays. Electrophysiological testing and intraoperative imaging may allow for early detection and intervention in these cases.


Cochlear implant electrode array misplacement is a rare but serious complication that may result in failure of hearing rehabilitation, non-auditory percepts, vestibular disturbance, or damage to adjacent neurovascular structures. We present a case of an elderly patient who suffered electrode array misplacement into the posterior semicircular canal, resulting in vestibular symptoms and severe downstream sequelae. The risk of misplacement may be higher in patients with a history of chronic otitis media or prior otologic surgery, and with the use of pre-curved electrode arrays. Electrophysiological testing and intraoperative imaging may allow for early detection and intervention in these cases. Laryngoscope, 2022
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Dynamic Prediction of Survival for Sinonasal Extranodal Natural Killer/T‐cell Lymphoma

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Dynamic Prediction of Survival for Sinonasal Extranodal Natural Killer/T-cell Lymphoma

This study developed a prognostic model and a web-based calculator specifically focussed on SN-ENKTL for otolaryngologists to use to facilitate timely treatment decisions for the disease.


Background

Extranodal natural killer/ T-cell lymphoma (ENKTL) is a rare malignant tumor. This study aimed to develop a predictive nomogram and a web-based survival rate calculator for dynamically predicting the survival of patients with sinonasal ENKTL (SN-ENKTL).

Methods

This study investigated patients (n = 134) with SN-ENKTL who had been initially treated in our hospital between Jan 2008 and Dec 2016. The patients were randomly divided into training and validation cohorts, in a 7:3 ratio. Independent prognostic factors were identified and integrated to build a predictive nomogram and a web-based calculator using the Cox-regression model. The nomogram was evaluated by consistency index and calibration curve.

Results

Age, lactate dehydrogenase, hemoglobin, Epstein–Barr virus DNA, and Ann Arbor stage were identified as independent risk factors. We constructed a predictive nomogram for survival and a web-based calculator (https://taiqinwang.shinyapps.io/DynNomapp/).

Conclusion

This study developed a prognostic model and a web-based calculator specifically focused on SN-ENKTL for otolaryngologists to use to facilitate timely treatment decisions for the disease.

Level of Evidence

4 Laryngoscope, 2022
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Understanding Variation in Rotavirus Vaccine Effectiveness Estimates in the United States: The Role of Rotavirus Activity and Diagnostic Misclassification

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imageBackground: Estimates of rotavirus vaccine effectiveness (VE) in the United States appear higher in years with more rotavirus activity. We hypothesized rotavirus VE is constant over time but appears to vary as a function of temporal variation in local rotavirus cases and/or misclassified diagnoses. Methods: We analyzed 6 years of data from eight US surveillance sites on 8- to 59-month olds with acute gastroenteritis symptoms. Children's stool samples were tested via enzyme immunoassay (EIA); rotavirus-positive results were confirmed with molecular testing at the US Centers for Disease Control and Prevention. We defined rotavirus gastroenteritis cases by either positive on-site EIA results alone or positive EIA with Centers for Disease Control and Prevention confirmation. For each case definition, we estimated VE against any rotavirus gastroenteritis, moderate-to-severe disease, and hospitalization using two mixed-effect regression models: the first including year plus a year–vaccination interaction, and the second including the annual percent of rotavirus-positive tests plus a percent positive–vaccination interaction. We used multiple overimputation to bias-adjust for misclassification of cases defined by positive EIA alone. Results: Estimates of annual rotavirus VE against all outcomes fluctuated temporally, particularly when we defined cases by on-site EIA alone and used a year–vaccination interaction. Use of confirmatory testing to define cases reduced, but did not eliminate, fluctuations. Temporal fluctuations in VE estimates further attenuated when we used a percent positive–vaccination interaction. Fluctuations persisted until bias-adjustment for diagnostic misclassification. Conclusions: Both controlling for time-varying rotavirus activity and bias-adjusting for diagnostic misclassification are critical for estimating the most valid annual rotavirus VE.
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Complexity analysis of head movements in autistic toddlers

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Background

Early differences in sensorimotor functioning have been documented in young autistic children and infants who are later diagnosed with autism. Previous research has demonstrated that autistic toddlers exhibit more frequent head movement when viewing dynamic audiovisual stimuli, compared to neurotypical toddlers. To further explore this behavioral characteristic, in this study, computer vision (CV) analysis was used to measure several aspects of head movement dynamics of autistic and neurotypical toddlers while they watched a set of brief movies with social and nonsocial content presented on a tablet.

Methods

Data were collected from 457 toddlers, 17–36 months old, during their well-child visit to four pediatric primary care clinics. Forty-one toddlers were subsequently diagnosed with autism. An application (app) displayed several brief movies on a tablet, and the toddlers watched these movies while sitting on their caregiver's lap. The front-facing camera in the tablet recorded the toddlers' behavioral responses. CV was used to measure the participants' head movement rate, movement acceleration, and complexity using multiscale entropy.

Results

Autistic toddlers exhibited significantly higher rate, acceleration, and complexity in their head movements while watching the movies compared to neurotypical toddlers, regardless of the type of movie content (social vs. nonsocial). The combined features of head movement acceleration and complexity reliably distinguished the autistic and neurotypical toddlers.

Conclusions

Autistic toddlers exhibit differences in their head movement dynamics when viewing audiovisual stimuli. Higher complexity of their head movements suggests that their movements were less predictable and less stable compared to neurotypical toddlers. CV offers a scalable means of detecting subtle differences in head movement dynamics, which may be helpful in identifying early behaviors associated with autism and providing insight into the nature of sensorimotor differences associated with autism.
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Accuracy of reverse‐transcription polymerase chain reaction and loop‐mediated isothermal amplification in diagnosing severe fever with thrombocytopenia syndrome: A systematic review and meta‐analysis

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Abstract

Background

Nucleic acid molecular diagnostic technology plays an important role in the detection of severe fever with thrombocytopenia syndrome (SFTS). However, no relevant reports have been published on the accuracy of reverse-transcription polymerase chain reaction (RT-PCR) and reverse-transcription loop-mediated isothermal amplification (RT-LAMP) in the diagnosis of SFTS. Thus, we conducted a meta-analysis and systematic review to evaluate the accuracy of the two methods.

Methods

On June 19, 2022, we comprehensively searched the PubMed, Embase, Cochrane Library, Web of Science, Scoups, Ovid, Proquest, China National Knowledge Infrastructure Database, Wan Fang Data, Traditional Chinese Medicine Database (Sinomed), VIP Database and Reading Showing Database for articles on nucleic acid diagnostic techniques, such as RT-PCR and RT-LAMP, used to diagnose SFTS. Statistical analysis was performed using STATA 14.0 and Meta-Disc 1.4.

Results

Sixteen a rticles involving 2942 clinical blood samples were included in the analysis. RT-PCR and RT-LAMP were used as index tests, whereas RT-PCR or other detection methods were used as reference standards. The pooled values for the sensitivity, specificity, positive and negative likelihood ratios of the RT-PCR test were 0.97 (95% CI: 0.92, 0.99), 1.00 (95% CI: 0.98, 1.00), 483.87 (95% CI: 58.04, 4033.76), and 0.03 (95% CI:0.01, 0.08) respectively. Those for the RT-LAMP test were 0.95 (95% CI: 0.91, 0.97), 0.99 (95% CI: 0.93, 1.00), 111.18 (95% CI: 13.96, 885.27), and 0.05 (95% CI: 0.03, 0.09), respectively.

Conclusion

Both RT-PCR and RT-LAMP have high diagnostic value in SFTS and can be applied in different scenarios for laboratory confirmation or on-site screening.

This article is protected by copyright. All rights reserved.
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ELANE neutropenia and solid tumors: Four cases from the French severe chronic neutropenia registry

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Abstract

Neutropenia related to ELANE gene mutations predisposes patients to infection and leukemia/myelodysplasia, but little is known about the predisposition to cancer. Among a cohort of 147 patients, we identified four with malignant solid tumors (papillary thyroid cancer, anal squamous cell cancer, papillary renal cell carcinoma, and adrenocortical carcinoma), all aged 25–50 years. Three occurred with cyclic neutropenia, and one occurred with severe chronic neutropenia. Previous radiotherapy was identified as a risk factor in one patient. No genetic predisposition was identified in the three other patients.
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