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Streck LE, Gaal C, Gohlke F, Rudert M, List K. Does radiolucency really predict loose components in revision shoulder arthroplasty? Skeletal Radiol 2023; 52:1759-1765. [PMID: 37074496 PMCID: PMC10348936 DOI: 10.1007/s00256-023-04330-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE The number of shoulder arthroplasties is increasing along with the need for revision surgeries. Determining the stability of the implant is crucial in preoperative planning. This study aims to investigate whether radiolucent lines (RLL) in preoperative radiographs predict component loosening. MATERIALS AND METHODS Preoperative radiographs of 93 cases in 88 patients who underwent shoulder arthroplasty revision were evaluated regarding the presence of RLL. Correlation analyses were performed for radiographic findings and demographic factors (age, gender, BMI, prior surgeries) compared to intraoperative findings. RESULTS The presence of RLL around the humeral component correlated with loosening (p < 0.001, Phi 0.511), and the distal zones 3 and 5 showed the strongest correlation (Phi 0.536). While RLL in only one zone did not predict loosening (p = 0.337), RLL present in two or more zones showed correlation with loosening (p < 0.001). Risk factors associated with loosening were a higher age at the time of revision surgery (p = 0.030) and the number of zones with RLL (p < 0.001). The glenoid component was loose in 39.0% of the cases; 5.5% of the glenoid components with RLL were stable. Nevertheless, the presence of RLL was highly associated with loosening (p < 0.001, Phi 0.603). A longer time between implantation and revision correlated with loosening of the glenoid component (p = 0.046). CONCLUSION While RLL do not predict loosening of the implant in general, occurrence in more than one zone correlates with loosening. If located in distal zones and with increasing number of zones with RLL, the correlation becomes even stronger and loosening is more likely.
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Affiliation(s)
- Laura E Streck
- Koenig-Ludwig-Haus, Department of Orthopedic Surgery, University of Wuerzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Chiara Gaal
- Koenig-Ludwig-Haus, Department of Orthopedic Surgery, University of Wuerzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Frank Gohlke
- Department of Shoulder Surgery, Rhoen Clinics, Bad Neustadt, Germany
| | - Maximilian Rudert
- Koenig-Ludwig-Haus, Department of Orthopedic Surgery, University of Wuerzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Kilian List
- Koenig-Ludwig-Haus, Department of Orthopedic Surgery, University of Wuerzburg, Brettreichstrasse 11, 97074, Würzburg, Germany.
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List K, Streck LE, Gaal C, Achenbach L, Dines D, Rudert M. Patient-specific articulating spacer for two-stage shoulder arthroplasty exchange. Oper Orthop Traumatol 2023:10.1007/s00064-023-00801-1. [PMID: 37133809 DOI: 10.1007/s00064-023-00801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Two-stage exchange with an antibiotic-loaded polymethylmethacrylate (PMMA) spacer is standard treatment for chronic periprosthetic joint infection of the shoulder. We present a safe and simple technique for patient-specific spacer implants. INDICATION (Chronic) periprosthetic joint infection of the shoulder. RELATIVE CONTRAINDICATIONS Known allergy against components of PMMA bone cements. Inadequate compliance for two-stage exchange. Patient is unfit to undergo two-stage exchange. SURGICAL TECHNIQUE Hardware removal, histologic and microbiologic samples, and debridement. Preparation of targeted or calculated antibiotic-loaded PMMA. Tailoring of patient-specific spacer. Spacer implantation. POSTOPERATIVE MANAGEMENT Rehabilitation protocol. Antibiotic treatment. Reimplantation after successful eradication of infection.
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Affiliation(s)
- Kilian List
- Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074, Wuerzburg, Germany.
| | - Laura Elisa Streck
- Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074, Wuerzburg, Germany
| | - Chiara Gaal
- Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074, Wuerzburg, Germany
| | - Leonard Achenbach
- Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074, Wuerzburg, Germany
| | - David Dines
- Hospital for Special Surgery, 525 East 71st Street, 10021, New York, NY, USA
| | - Maximilian Rudert
- Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, Brettreichstraße 11, 97074, Wuerzburg, Germany
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Carpier JM, Talpin A, Kulakowski G, Dos Santos Leite A, Laviolette K, Noguerol J, Mersceman T, Garnier A, Gaal C, Pereira Oliveira C, Calderon C, Boullerot L, Malfroy M, Strozzi F, Gouttefangeas C, Adotevi O, Joffre O, Gamelas Magalhaes J, Chêne L, Bonny C. 180P Recalling pre-existing microbiota-specific T cells to target tumors. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rieckmann M, Delgobo M, Gaal C, Büchner L, Steinau P, Reshef D, Gil-Cruz C, Horst ENT, Kircher M, Reiter T, Heinze KG, Niessen HW, Krijnen PA, van der Laan AM, Piek JJ, Koch C, Wester HJ, Lapa C, Bauer WR, Ludewig B, Friedman N, Frantz S, Hofmann U, Ramos GC. Myocardial infarction triggers cardioprotective antigen-specific T helper cell responses. J Clin Invest 2019; 129:4922-4936. [PMID: 31408441 DOI: 10.1172/jci123859] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
T cell autoreactivity is a hallmark of autoimmune diseases but can also benefit self-maintenance and foster tissue repair. Herein, we investigated whether heart-specific T cells exert salutary or detrimental effects in the context of myocardial infarction (MI), the leading cause of death worldwide. After screening more than 150 class-II-restricted epitopes, we found that myosin heavy chain alpha (MYHCA) was a dominant cardiac antigen triggering post-MI CD4+ T cell activation in mice. Transferred MYHCA614-629-specific CD4+ T (TCR-M) cells selectively accumulated in the myocardium and mediastinal lymph nodes (med-LN) of infarcted mice, acquired a Treg phenotype with a distinct pro-healing gene expression profile, and mediated cardioprotection. Myocardial Treg cells were also detected in autopsies from patients who suffered a MI. Noninvasive PET/CT imaging using a CXCR4 radioligand revealed enlarged med-LNs with increased cellularity in MI-patients. Notably, the med-LN alterations observed in MI patients correlated with the infarct size and cardiac function. Taken together, the results obtained in our study provide evidence showing that MI-context induces pro-healing T cell autoimmunity in mice and confirms the existence of an analogous heart/med-LN/T cell axis in MI patients.
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Affiliation(s)
- Max Rieckmann
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany
| | - Murilo Delgobo
- Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Chiara Gaal
- Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Lotte Büchner
- Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Steinau
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany
| | - Dan Reshef
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Cristina Gil-Cruz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ellis N Ter Horst
- Heart Center, Amsterdam UMC, location AMC, Amsterdam, Netherlands.,Department of Pathology and Cardiac Surgery, Amsterdam UMC, location VUmc, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Malte Kircher
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Theresa Reiter
- Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Katrin G Heinze
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany
| | - Hans Wm Niessen
- Department of Pathology and Cardiac Surgery, Amsterdam UMC, location VUmc, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Paul Aj Krijnen
- Department of Pathology and Cardiac Surgery, Amsterdam UMC, location VUmc, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Jan J Piek
- Heart Center, Amsterdam UMC, location AMC, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Charlotte Koch
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technical University Munich, Munich, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang R Bauer
- Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nir Friedman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Stefan Frantz
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany.,Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany.,Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Gustavo Campos Ramos
- Department of Internal Medicine III, University Clinic Halle, Halle, Germany.,Department of Internal Medicine I, and.,Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
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Somlo G, Frankel P, Yeon C, Yuan Y, Yim J, Kruper L, Taylor L, Mortimer J, Waisman J, Jones V, Vito C, Paz B, Huria A, Li D, Gaal C, Tong T, Tumyan L. Abstract P4-21-35: Phase II trial of pertuzumab, trastuzumab, and nab-paclitaxel in patients (pts) with HER2 overexpressing (HER2+) locally advanced or inflammatory breast cancer (LABC) or untreated stage IV metastatic breast cancer (MBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-35] [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: 11/16/2022]
Abstract
Abstract
Background: Pathologic complete response (pCR) to HER2-targeting neoadjuvant therapy (NT) predicts for improved survival (Cortazar et al, Lancet, 2014). The addition of pertuzumab to trastuzumab and docetaxel increased pCR rates, and, as first line treatment for MBC led to longer overall survival ([OS] Swain et al, NEJM 2015). Avoidance of anthracyclines in the adjuvant setting for HER2+ BC reduced the risk of secondary hematologic malignancies without a detriment to OS (Slamon et al, NEJM, 20111). Finally, nab-paclitaxel (nab) might provide an advantage over other taxanes via decreased use of steroids and may lead to increased response rates (RR). We designed a study of pertuzumab (pert), trastuzumab (trast), and nab, testing the feasibility and efficacy of this regimen in the LABC and metastatic breast cancer settings.
Materials and Methods: Pts with Stages II-III LABC received six cycles of NT with pert (day 1 q 21 days), trast, and nab 100 mg/m2 (both given IV, weekly). Pts with untreated MBC received the same regimen until progression, toxicities, or patient or physician preference led to stopping therapy. Primary endpoints included pCR (LABC) and RR and progression-free survival (PFS) in MBC. Forty pts with LABC and 25 pts with MBC were to be accrued. The study was designed to test whether the pCR rate of Neosphere (Gianni et al, Lancet Oncol, 2012, > 45.8%) and the PFS rate of CLEOPATRA (median of > 18.5 months) can be matched or exceeded. Procurement of serial samples for assessment of tumor gene expression, circulating tumor cells, miRNA, and serum DNA profiling for exploratory biomarker analysis was carried out.
Results:Twenty-two of 28 already enrolled pts with LABC (clinical stage II:15, stage III: 7) completed NT. The median age was 53 (34-77). The pCR rate was 86% (6/7) for hormone receptor negative (HR-) and 40% (6/15) for HR+ pts, with an overall pCR of 55%. Three pts without pCR following NT had residual BC with a HER2 negative phenotype. Eighteen of 22 pts required nab dose modifications. The most frequent toxicities following NT included elevated liver function tests:27%, peripheral neuropathy:23%, hematological toxicities:17%, diarrhea:18%, infusion reactions:18%. In the MBC cohort there were 13 of 16 enrolled pts with > 2 months of follow-up. The median age was 47 (31-65), 62% had HR+ disease. A CR rate of 4/13 (31%) and confirmed RR of 77% were observed. The median number of cycles with pert, trast, nab was 9 (3+ to 41); 11 of 13 pts required dose modifications or delays (3 of the delays were due to primary breast surgery performed upon response to treatment). At a median follow-up of 19 months, PFS and OS estimates are 63% (95% CI 0.09-0.93), and 89% (95% CI 0.61-1.0).
Conclusion: The non-anthracycline-containing regimen of pertuzumab, trastuzumab, and nab-paclitaxel induced a high pCR rate in HER2+ BC. PFS is encouraging in MBC. Outcome of the fully accrued cohorts inclusive of residual cancer burden scores in the LABC cohort, and correlative data with exploratory biomarker analysis will be presented.
Citation Format: Somlo G, Frankel P, Yeon C, Yuan Y, Yim J, Kruper L, Taylor L, Mortimer J, Waisman J, Jones V, Vito C, Paz B, Huria A, Li D, Gaal C, Tong T, Tumyan L. Phase II trial of pertuzumab, trastuzumab, and nab-paclitaxel in patients (pts) with HER2 overexpressing (HER2+) locally advanced or inflammatory breast cancer (LABC) or untreated stage IV metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-35.
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Affiliation(s)
- G Somlo
- City of Hope Cancer Center, Duarte, CA
| | - P Frankel
- City of Hope Cancer Center, Duarte, CA
| | - C Yeon
- City of Hope Cancer Center, Duarte, CA
| | - Y Yuan
- City of Hope Cancer Center, Duarte, CA
| | - J Yim
- City of Hope Cancer Center, Duarte, CA
| | - L Kruper
- City of Hope Cancer Center, Duarte, CA
| | - L Taylor
- City of Hope Cancer Center, Duarte, CA
| | | | - J Waisman
- City of Hope Cancer Center, Duarte, CA
| | - V Jones
- City of Hope Cancer Center, Duarte, CA
| | - C Vito
- City of Hope Cancer Center, Duarte, CA
| | - B Paz
- City of Hope Cancer Center, Duarte, CA
| | - A Huria
- City of Hope Cancer Center, Duarte, CA
| | - D Li
- City of Hope Cancer Center, Duarte, CA
| | - C Gaal
- City of Hope Cancer Center, Duarte, CA
| | - T Tong
- City of Hope Cancer Center, Duarte, CA
| | - L Tumyan
- City of Hope Cancer Center, Duarte, CA
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