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Michels F, Dewyn T, Bogaerts K, De Waele C, Hamers D. The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study. Foot Ankle Surg 2024:S1268-7731(24)00102-4. [PMID: 38714452 DOI: 10.1016/j.fas.2024.04.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 04/03/2024] [Accepted: 04/28/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain. METHODS A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test. RESULTS All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50-80) at 6 weeks to 90 (72-100) at 3 months, to 97 (82-100) at 6 months to 100 (90-100) at 9 months, to 100 (100-100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. CONCLUSION The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies. LEVEL OF EVIDENCE Level II (prospective cohort study).
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; Department of Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Tim Dewyn
- Department of Emergency and Sports Medicine, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Kris Bogaerts
- KU Leuven, Department of public health and critical care, I-BioStat, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium.
| | - Camille De Waele
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - Delphine Hamers
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
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Tare D, Coenen S, De Sutter A, Heytens S, Devroey D, Buret L, Schoenmakers B, Delvaux N, Verbakel JY, Bogaerts K, van den Bruel A. The DAWN antivirals trial: process evaluation of a COVID-19 trial in general practice. BJGP Open 2024:BJGPO.2023.0109. [PMID: 37984980 DOI: 10.3399/bjgpo.2023.0109] [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: 06/09/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The DAWN antivirals trial was a multicentric, randomised placebo-controlled trial evaluating antiviral medication for COVID-19 in general practice. The trial was prematurely terminated because of insufficient recruitment. AIM To explore which factors contributed to the premature termination. DESIGN & SETTING General practice in Belgium. METHOD Patients were randomised to camostat or placebo (patients and physicians blinded) between June 2021 and July 2022; a third arm evaluating molnupiravir (open label) was opened in March 2022. The outcome assessor was blinded for all comparisons except for the patient reported outcomes in case of molnupiravir. The authors analysed available trial data and evaluated trial context, implementation, and mechanisms of impact based on semi-structured interviews with trial stakeholders. RESULTS The trial recruited 44 participants; 19 were allocated to camostat (median age 55 years), 8 to molnupiravir (median age 60 years), and 17 to placebo (median age 56 years). There were no serious adverse events in either group. Most difficulties were related to the pandemic context: disruption to routine clinical services; multiple changes to the service model for COVID-19 patients; overwhelmed clinical staff; delays of trial medication; and staff shortages in the sponsor and clinical team. In addition, regulatory approval processes were lengthy and led to additional study procedures. It was felt that the trial started too late, when vaccinations had already begun. CONCLUSION The DAWN antivirals trial was stopped prematurely. Although many barriers were related to the pandemic itself, hurdles such as a small and inexperienced sponsor and clinical teams, delays in regulatory processes, and research capacity in routine settings could be overcome by established research infrastructure and standardisation of processes.
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Affiliation(s)
- Dajana Tare
- Academic Centre for General Practice, KU Leuven, Belgium
| | - Samuel Coenen
- Centre for General Practice, Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerpen, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, KU Leuven, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Ghent University, KU Leuven, Belgium
| | - Dirk Devroey
- Primary Care, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Laetitia Buret
- Department of General Medicine, University of Liège, Liège, Belgium
| | | | | | - Jan Y Verbakel
- Academic Centre for General Practice, KU Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Leuven, Belgium
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De Smedt J, Aura C, Van Kelst S, Janssen L, Marasigan V, Boecxstaens V, Stas M, Bogaerts K, Belmans A, Cleynen I, Vanderschueren D, Vandenberghe K, Bechter O, Nikkels A, Strobbe T, Emri G, Lambrechts D, Garmyn M. Clinical and genetic determinants of vitamin D receptor expression in cutaneous melanoma patients. Melanoma Res 2024; 34:125-133. [PMID: 38348498 PMCID: PMC10906192 DOI: 10.1097/cmr.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/02/2023] [Indexed: 03/02/2024]
Abstract
Decrease of vitamin D receptor (VDR) expression is observed in melanocytic naevi and melanoma compared to normal skin. Little is known about factors influencing VDR expression in cutaneous melanoma (CM). We investigated the correlation of VDR expression in CM with 25-hydroxy vitamin D (25OHD) levels, demographic/clinical parameters, genetic variants of VDR and pathology of the primary tumor. Demographic/clinical parameters were recorded in 407 prospectively recruited CM patients of a multi-center controlled study (ViDMe trial). We determined VDR expression both in the nucleus and in the cytoplasm by semi-quantitative assessment in CM tissue using histochemistry in 279 patients, expressed in percentages and histoscore (H-score). Genomic DNA from 332 patients was extracted to genotype thirteen VDR single nucleotide polymorphisms (SNPs) using TaqMan. VDR expression in CM tissue from 279 patients was correlated with clinical/demographic parameters and 25OHD levels (univariable and multivariable analysis), VDR SNPs (univariable analysis) and pathology parameters of primary CM tissue (univariable analysis). Cytoplasmic VDR expression was increased in patients who stated to have a high sun exposure during their life compared to patients with low sun exposure (p H-score,univariable : 0.001, p H-score,multivariable : 0.004). The A allele of the genetic VDR polymorphism Fok1 was associated with a higher expression of the VDR in the cytoplasm (p cytoplasmic, univariable : 0.001 and p H-score, univariable : 0.02). In the primary tumor, presence of mitosis (p nucleus,%, univariable : 0.002) and perineural invasion (p nucleus,%,univariable : 0.03) were significantly associated with low nuclear VDR expression. ClinicalTrials.gov Identifier: NCT01748448.
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Affiliation(s)
- Julie De Smedt
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Claudia Aura
- Conway Institute of Biomolecular and Biomedical Research, Pathology, University College Dublin, Dublin
| | - Sofie Van Kelst
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Laudine Janssen
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Vivien Marasigan
- Department of Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Veerle Boecxstaens
- Oncological and Vascular Access Surgery, Department of Surgical Oncology
| | - Marguerite Stas
- Oncological and Vascular Access Surgery, Department of Surgical Oncology
| | - Kris Bogaerts
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)
| | - Ann Belmans
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)
| | - Isabelle Cleynen
- Laboratory for Complex Genetics, Department of Human Genetics, KU Leuven
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronical Illness and Metabolism, KU Leuven, UZ Leuven
| | | | - Oliver Bechter
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, UZ Leuven, Leuven
| | - Arjen Nikkels
- Department of Dermatology, CHU Sart Tilman, University of Liège, Liège
| | - Tinne Strobbe
- Department of Dermatology, Imeldaziekenhuis, Bonheiden, Belgium
| | - Gabriella Emri
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dieter Lambrechts
- Laboratory for Translational Genetics, Department of Oncology, KU Leuven
- Center for Cancer Biology (VIB), Leuven, Belgium
| | - Marjan Garmyn
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
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De Greef Y, Bogaerts K, Sofianos D, Buysschaert I. Impact of Diagnosis-to-Ablation Time on AF Recurrence: Pronounced the First 3 Years, Irrelevant Thereafter. JACC Clin Electrophysiol 2023; 9:2263-2272. [PMID: 37656100 DOI: 10.1016/j.jacep.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Diagnosis-to-ablation time (DAT) strongly predicts recurrence of atrial fibrillation (AF) after ablation. Whether this association holds with any lower and/or upper limits is unknown. OBJECTIVES The goal of this study was to assess the impact of DAT on AF recurrence in search of lower and upper DAT thresholds. METHODS A total of 2,000 patients with AF from 2 cohorts of 1,000 patients each (69% male; age 62 ± 10 years) undergoing pulmonary vein isolation (PVI) between 2005-2014 and 2017-2019 were followed up for 3 years. RESULTS Clinical success was achieved in 61.7% of patients. Median DAT decreased over time from 36 months (Q1-Q3: 12-72 months) in the first cohort to 12 months (Q1-Q3: 5-48 months) in the second cohort (P < 0.001). A multivariable Cox proportional hazards fitted model of AF recurrence rate in relation to DAT (range: 0-288 months) showed a steep rise in AF recurrence, from 27% to 40% in the first 36 months (d%/dt = 0.36), with a first inflection point at 36 months, and a less steep rise to 45% until 90 months (d%/dt = 0.09), with flattening beyond 90 months (d%/dt = 0.026). Rise in AF recurrence rate in the first 36 months was higher in patients with persistent AF (from 40% to 54%; d%/dt = 0.39) than in patients with paroxysmal AF (19% to 29%; d%/dt = 0.28). CONCLUSIONS The association between DAT and AF recurrence has no lower limit ("the shorter the better"), whereas little gain is to be expected beyond 36 months ("the longer the more irrelevant"). Our data advocate for performing PVI as early as possible, certainly within 3 years of AF diagnosis, and even more so in persistent AF.
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Affiliation(s)
- Yves De Greef
- Department of Cardiology, ZNA Heart Centre, Antwerp, Belgium; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
| | - Kris Bogaerts
- KU Leuven, Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium
| | - Dimitrios Sofianos
- Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ian Buysschaert
- Department of Cardiology, Heart Centre AZ Sint Jan, Bruges, Belgium
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Oosterbos C, Rummens S, Bogaerts K, Van Hoylandt A, Hoornaert S, Weyns F, Dubuisson A, Ceuppens J, Schuind S, Groen JL, Lemmens R, Theys T. A randomized controlled trial comparing conservative versus surgical treatment in patients with foot drop due to peroneal nerve entrapment: results of an internal feasibility pilot study. Pilot Feasibility Stud 2023; 9:181. [PMID: 37908016 PMCID: PMC10617035 DOI: 10.1186/s40814-023-01407-x] [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: 01/06/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Based on the lack of literature to support any treatment strategy in patients with foot drop due to peroneal nerve entrapment, a prospective study randomizing patients between surgery and conservative treatment is warranted. Since studies comparing surgery to no surgery are often challenging, we first examined the feasibility of such a randomized controlled trial. METHODS/DESIGN An internal feasibility pilot study was conducted to assess several aspects of process, resource, management, and scientific feasibility. The main objective was the assessment of the recruitment rate. The criterion to embark on a full study was the recruitment of at least 14 patients in 6 participating centers within 6 months. Cross-over rate, blinding measures, training strategies, and trial assessments were evaluated. The trial was entirely funded by the KCE Trials public funding program of the Belgian Health Care Knowledge Centre (ID KCE19-1232). RESULTS The initial duration was prolonged due to the COVID-19 pandemic. Between April 2021 and October 2022, we included 19 patients of which 15 were randomized. Fourteen patients were treated as randomized. One drop-out occurred after randomization, prior to surgery. We did not document any cross-over or accidental unblinding. Training strategies were successful. Patients perceived the quality of life questionnaire as the least relevant assessment. Assessment of ankle dorsiflexion range of motion was prone to interobserver variability. All other trial assessments were adequate. DISCUSSION Recruitment of the anticipated 14 patients was feasible although slower than expected. The Short-Form Health Survey (SF-36) and assessment of ankle dorsiflexion range of motion will no longer be included in the full-scale FOOTDROP trial. CONCLUSION The FOOTDROP study is feasible. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT04695834 . Registered 4 January 2021.
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Affiliation(s)
- Christophe Oosterbos
- Research Group experimental Neurosurgery and Neuroanatomy KULeuven and the Leuven Brain Institute, Leuven, Belgium.
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Critical Care, I-BioStat, KU Leuven, Belgium and I-BioStat, UHasselt, Belgium
| | - Anaïs Van Hoylandt
- Research Group experimental Neurosurgery and Neuroanatomy KULeuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Hoornaert
- Research Group experimental Neurosurgery and Neuroanatomy KULeuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Frank Weyns
- Department of Neurosurgery, Ziekenhuis-Oost Limburg, Genk, Belgium
- Neurosciences, Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals Liège, Liège, Belgium
| | - Jeroen Ceuppens
- Department of Neurosurgery, Algemeen Ziekenhuis Groeninge, Kortrijk, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Justus L Groen
- Leiden Nerve Center, Department of Neurosurgery, University of Leiden, Leiden, the Netherlands
| | - Robin Lemmens
- KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group experimental Neurosurgery and Neuroanatomy KULeuven and the Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Zeymer U, Freund A, Hochadel M, Ostadal P, Belohlavek J, Rokyta R, Massberg S, Brunner S, Lüsebrink E, Flather M, Adlam D, Bogaerts K, Banning A, Sabaté M, Akin I, Jobs A, Schneider S, Desch S, Thiele H. Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials. Lancet 2023; 402:1338-1346. [PMID: 37643628 DOI: 10.1016/s0140-6736(23)01607-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. METHODS Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). FINDINGS Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079). INTERPRETATION VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. FUNDING Foundation Institut für Herzinfarktforschung.
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Affiliation(s)
- Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany; Klinikum Ludwigshafen, Ludwigshafen, Germany.
| | - Anne Freund
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | | | - Petr Ostadal
- Department of Cardiology, Na Homolce Hospital, Department of Cardiology and University Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Belohlavek
- Department of Medicine II, General University Hospital and 1st Medical School, Charles University, Prague, Czech Republic
| | - Richard Rokyta
- Cardiology Department, University Hospital and Faculty of Medicine Pilsen, Charles University, Czech Republic
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Kris Bogaerts
- KU Leuven, Department of Public Health and Primary Care, I-BioStat, Leuven and UHasselt, Hasselt, Belgium
| | - Amerjeet Banning
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Manel Sabaté
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Ibrahim Akin
- University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Jobs
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | | | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany.
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Van de Werf F, Ristić AD, Averkov OV, Arias-Mendoza A, Lambert Y, Kerr Saraiva JF, Sepulveda P, Rosell-Ortiz F, French JK, Musić LB, Vandenberghe K, Bogaerts K, Westerhout CM, Pagès A, Danays T, Bainey KR, Sinnaeve P, Goldstein P, Welsh RC, Armstrong PW. STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation 2023; 148:753-764. [PMID: 37439219 DOI: 10.1161/circulationaha.123.064521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND ST-segment-elevation myocardial infarction (STEMI) guidelines recommend pharmaco-invasive treatment if timely primary percutaneous coronary intervention (PCI) is unavailable. Full-dose tenecteplase is associated with an increased risk of intracranial hemorrhage in older patients. Whether pharmaco-invasive treatment with half-dose tenecteplase is effective and safe in older patients with STEMI is unknown. METHODS STREAM-2 (Strategic Reperfusion in Elderly Patients Early After Myocardial Infarction) was an investigator-initiated, open-label, randomized, multicenter study. Patients ≥60 years of age with ≥2 mm ST-segment elevation in 2 contiguous leads, unable to undergo primary PCI within 1 hour, were randomly assigned (2:1) to half-dose tenecteplase followed by coronary angiography and PCI (if indicated) 6 to 24 hours after randomization, or to primary PCI. Efficacy end points of primary interest were ST resolution and the 30-day composite of death, shock, heart failure, or reinfarction. Safety assessments included stroke and nonintracranial bleeding. RESULTS Patients were assigned to pharmaco-invasive treatment (n=401) or primary PCI (n=203). Median times from randomization to tenecteplase or sheath insertion were 10 and 81 minutes, respectively. After last angiography, 85.2% of patients undergoing pharmaco-invasive treatment and 78.4% of patients undergoing primary PCI had ≥50% resolution of ST-segment elevation; their residual median sums of ST deviations were 4.5 versus 5.5 mm, respectively. Thrombolysis In Myocardial Infarction flow grade 3 at last angiography was ≈87% in both groups. The composite clinical end point occurred in 12.8% (51/400) of patients undergoing pharmaco-invasive treatment and 13.3% (27/203) of patients undergoing primary PCI (relative risk, 0.96 [95% CI, 0.62-1.48]). Six intracranial hemorrhages occurred in the pharmaco-invasive arm (1.5%): 3 were protocol violations (excess anticoagulation in 2 and uncontrolled hypertension in 1). No intracranial bleeding occurred in the primary PCI arm. The incidence of major nonintracranial bleeding was low in both groups (<1.5%). CONCLUSIONS Halving the dose of tenecteplase in a pharmaco-invasive strategy in this early-presenting, older STEMI population was associated with electrocardiographic changes that were at least comparable to those after primary PCI. Similar clinical efficacy and angiographic end points occurred in both treatment groups. The risk of intracranial hemorrhage was higher with half-dose tenecteplase than with primary PCI. If timely PCI is unavailable, this pharmaco-invasive strategy is a reasonable alternative, provided that contraindications to fibrinolysis are observed and excess anticoagulation is avoided. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02777580.
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Affiliation(s)
- Frans Van de Werf
- Department of Cardiovascular Sciences, KU Leuven, Belgium (F.V.d.W., K.V., P.S.)
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Center of Serbia, University of Belgrade, Serbia (A.D.R)
| | - Oleg V Averkov
- Pirogov Russian National Research Medical University and City Clinical Hospital #15, Moscow, Russian Federation (O.V.A.)
| | | | - Yves Lambert
- Centre Hospitalier de Versailles, SAMU 78 and Mobile Intensive Care Unit, France (Y.L.)
| | - José F Kerr Saraiva
- Cardiology Discipline, Pontifical Catholic University of Campinas School of Medicine, Brazil (J.F.K.S.)
| | | | | | - John K French
- School of Medicine, University of New South Wales, Sydney, Department of Cardiology, Liverpool Hospital, Sydney, School of Medicine, Western Sydney University, New South Wales, Australia (J.K.F.)
| | - Ljilja B Musić
- Cardiology Clinic, University Clinical Center of Montenegro, University of Podgorica, Medical Faculty (L.B.M.)
| | - Katleen Vandenberghe
- Department of Cardiovascular Sciences, KU Leuven, Belgium (F.V.d.W., K.V., P.S.)
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), KU Leuven, Leuven and University Hasselt, Belgium (K.B.)
| | - Cynthia M Westerhout
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton (C.M.W., K.R.B., R.C.W., P.W.A.)
| | - Alain Pagès
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany (A.P.)
| | | | - Kevin R Bainey
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton (C.M.W., K.R.B., R.C.W., P.W.A.)
| | - Peter Sinnaeve
- Department of Cardiovascular Sciences, KU Leuven, Belgium (F.V.d.W., K.V., P.S.)
| | - Patrick Goldstein
- Emergency Department and SAMU, Lille University Hospital, France (P.G.)
| | - Robert C Welsh
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton (C.M.W., K.R.B., R.C.W., P.W.A.)
| | - Paul W Armstrong
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton (C.M.W., K.R.B., R.C.W., P.W.A.)
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Banning AS, Sabaté M, Orban M, Gracey J, López-Sobrino T, Massberg S, Kastrati A, Bogaerts K, Adriaenssens T, Berry C, Erglis A, Haine S, Myrmel T, Patel S, Buera I, Sionis A, Vilalta V, Yusuff H, Vrints C, Adlam D, Flather M, Gershlick AH. Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EUROINTERVENTION 2023; 19:482-492. [PMID: 37334659 PMCID: PMC10436068 DOI: 10.4244/eij-d-23-00204] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Cardiogenic shock (CGS) occurs in 10% of patients presenting with acute myocardial infarction (MI), with in-hospital mortality rates of 40-50% despite revascularisation. AIMS The EURO SHOCK trial aimed to determine if early use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) could improve outcomes in patients with persistent CGS following primary percutaneous coronary intervention (PPCI). METHODS This multicentre, pan-European trial randomised patients with persistent CGS 30 minutes after PPCI of the culprit lesion to receive either VA-ECMO or continue with standard therapy. The primary outcome measure was 30-day all-cause mortality in an intention-to-treat analysis. Secondary endpoints included 12-month all-cause mortality and 12-month composite of all-cause mortality or rehospitalisation due to heart failure. RESULTS Due to the impact of the COVID-19 pandemic, the trial was stopped before completion of recruitment, after randomisation of 35 patients (standard therapy n=18, VA-ECMO n=17). Thirty-day all-cause mortality occurred in 43.8% of patients randomised to VA-ECMO and in 61.1% of patients randomised to standard therapy (hazard ratio [HR] 0.56, 95% confidence interval [CI]: 0.21-1.45; p=0.22). One-year all-cause mortality was 51.8% in the VA-ECMO group and 81.5% in the standard therapy arm (HR 0.52, 95% CI: 0.21-1.26; p=0.14). Vascular and bleeding complications occurred more often in the VA-ECMO arm (21.4% vs 0% and 35.7% vs 5.6%, respectively). CONCLUSIONS Due to the limited number of patients recruited to the trial, no definite conclusions could be drawn from the available data. Our study demonstrates the feasibility of randomising patients with CGS complicating acute MI but also illustrates the challenges. We hope these data will inspire and inform the design of future large-scale trials.
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Affiliation(s)
- Amerjeet S Banning
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Manel Sabaté
- Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Jay Gracey
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Teresa López-Sobrino
- Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Steffen Massberg
- Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart Alliance, Munich, Germany
| | - Kris Bogaerts
- Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium
| | - Tom Adriaenssens
- University Hospitals Leuven, Leuven, Belgium and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Colin Berry
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK and Robertson Centre for Biostatistics, Glasgow, UK
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia and the University of Latvia, Riga, Latvia
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Truls Myrmel
- Universitetssykehuset Nord-Norge, Tromsø, Norway
| | - Sameer Patel
- King's College Hospital and Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Irene Buera
- Hospital Universitario Vall d'Hebron, VHIR, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alessandro Sionis
- Cardiology Department, Intensive Cardiac Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain and Universitat Autònoma de Barcelona, Barcelona, Spain and Centro de Investigación Biomèdica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Vilalta
- Interventional Cardiology Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Hakeem Yusuff
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christiaan Vrints
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Marcus Flather
- University of East Anglia, Norwich, UK and Norfolk and Norwich University Hospitals, Norwich, UK
| | - Anthony H Gershlick
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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9
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Spaulding C, Krackhardt F, Bogaerts K, Urban P, Meis S, Morice MC, Eccleshall S. Comparing a strategy of sirolimus-eluting balloon treatment to drug-eluting stent implantation in de novo coronary lesions in all-comers: Design and rationale of the SELUTION DeNovo Trial. Am Heart J 2023; 258:77-84. [PMID: 36642225 DOI: 10.1016/j.ahj.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Drug eluting stents (DES) are associated with a 2% to 4% annual rate of target lesion failure through 5-to-10-year follow-up. The presence of a metallic protheses is a trigger for neo-atherosclerosis and very late stent thrombosis. A "leave nothing behind" strategy using Drug Coated Balloons has been suggested; however, paclitaxel coated balloons are only recommended in selected indications. Recently a novel sirolimus eluting balloon, the SELUTION SLR TM 014 PTCA balloon (SEB) (M.A. MedAlliance SA, Nyon, Switzerland) has been developed. HYPOTHESIS A strategy of percutaneous coronary intervention (PCI) with SEB and provisional DES is non-inferior to a strategy of systematic DES on target vessel failure (TVF) at one and five years. If non-inferiority is met at 5 years, superiority will be tested. DESIGN SELUTION DeNovo is a multi-center international open-label randomized trial. Subjects meeting eligibility criteria are randomized 1:1 to treatment of all lesions with either SEB and provisional DES or systematic DES. Major inclusion criteria are PCI indicated for ≥1 lesion considered suitable for treatment by either SEB or DES and clinical presentation with chronic coronary syndrome, unstable angina or non-ST segment elevation myocardial infarction (NSTEMI). There is no limitation in the number of lesions to be treated. Target lesions diameters are between 2 and 5 mm. Major exclusion criteria are lesions in the left main artery, chronic total occlusions, ST segment elevation myocardial infarction and unstable non-ST segment elevation myocardial infarction. Three thousand three hundred twenty six patients will be included in 50 sites in Europe and Asia. TVF rates and their components will be determined at 30 days, 6 months and annually up to 5 years post-intervention. Among secondary endpoints, bleeding events, cost-effectiveness data and net clinical benefits will be assessed. SUMMARY SELUTION DeNovo trial is an open-label, multi-center international randomized trial comparing a strategy of PCI with SEB and provisional DES to a strategy of PCI with systematic DES on TVF at one and five years. Non-inferiority will be tested at one and five years. If non-inferiority is met at five years, superiority will be tested.
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Affiliation(s)
- Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité and INSERM U 970, Paris, France.
| | | | - Kris Bogaerts
- Department of public health and critical care, I-BioStat, KU Leuven, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Susanne Meis
- MedAlliance CardioVascular SA, Nyon, Switzerland
| | - Marie-Claude Morice
- Cardiovascular European Research Centre (CERC) and Ramsay Générale de Santé, Massy, France
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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Vanlerberghe B, Vrij C, Bogaerts K, Vermeersch P, Lagrou K, Molenberghs G, Rega F, Ceulemans LJ, van Raemdonck D, Jochmans I, Monbaliu D, Pirenne J, Vanuytsel T, Gillard P, Schoemans H, Cleemput JV, Kuypers D, Vos R, Nevens F, Verbeek J. SARS-CoV-2 vaccine antibody response and breakthrough infections in transplant recipients. J Med Virol 2023; 95:e28736. [PMID: 37185854 DOI: 10.1002/jmv.28736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/07/2023] [Revised: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
Rates and modulators of SARS-CoV-2 vaccine nonresponse and breakthrough infections remain unclear in serially vaccinated transplant recipients. In a prospective, mono-centric, observational study, 1878 adult solid organ and hematopoietic cell transplant recipients, with prior SARS-CoV-2 vaccination, were included between March 2021 and February 2022. SARS-CoV-2 anti-spike IgG antibodies were measured at inclusion and details on SARS-CoV-2 vaccine doses and infection were collected. No life-threatening adverse events were reported after a total of 4039 vaccine doses. In transplant recipients without prior SARS-CoV-2 infection (n = 1636), antibody response rates ranged widely, from 47% in lung transplant to 90% in liver transplant and 91% in hematopoietic cell transplant recipients after third vaccine dose. Antibody positivity rate and levels increased after each vaccine dose in all types of transplant recipients. In multivariable analysis, older age, chronic kidney disease and daily dose of mycophenolate and corticosteroids were negatively associated with antibody response rate. Overall rate of breakthrough infections was 25.2% and mainly (90.2%) occurred after third and fourth vaccine dose. Lung transplant recipients had the highest rates of severe breakthrough infection (10.5%) and death (2.5%). In multivariable analysis, older age, daily dose of mycophenolate and corticosteroids were associated with severe breakthrough infection. Transplant recipients with infection before first vaccine dose (n = 160) had higher antibody response rates and levels after each vaccine dose, and a significantly lower overall rate of breakthrough infections compared to those without prior infection. Antibody response after SARS-CoV-2 vaccination and rate of severe breakthrough infections vary largely between different transplant types and are modulated by specific risk factors. The observed heterogeneity supports a tailored approach against COVID-19 in transplant recipients.
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Affiliation(s)
- Benedict Vanlerberghe
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Casper Vrij
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Critical Care, I-BioStat, KU Leuven & University Hasselt, Leuven & Hasselt, Belgium
| | - Pieter Vermeersch
- Department of Laboratory Medicine, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Department of Public Health and Critical Care, I-BioStat, KU Leuven & University Hasselt, Leuven & Hasselt, Belgium
| | - Filip Rega
- Laboratory of Cardiovascular Sciences, Department of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Thoracic Surgery, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Dirk van Raemdonck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Thoracic Surgery, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Ina Jochmans
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Laboratory of Microbiology, Immunology and Transplantation, Department of Abdominal Transplant Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Laboratory of Clinical and Experimental Endocrinology, Department of Endocrinology, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Hélène Schoemans
- Department of Public Health and Primary Care, Department of Hematology, University Hospitals Leuven, ACCENT VV, KU Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Laboratory of Cardiovascular Sciences, Department of Cardiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Laboratory of Microbiology, Immunology and Transplantation, Department of Nephrology and Renal Transplantation, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Respiratory Diseases, University Hospitals Leuven, CHROMETA, KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology, Laboratory of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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11
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Pellegrini C, Garot P, Morice MC, Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Schramm R, Cockburn J, Cunnington M, Wolf A, Barbanti M, Tchétché D, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Bogaerts K, Hengstenberg C, Capodanno D, Joner M. Permanent pacemaker implantation and left bundle branch block with self-expanding valves - a SCOPE 2 subanalysis. EUROINTERVENTION 2023; 18:e1077-e1087. [PMID: 36128956 PMCID: PMC9909458 DOI: 10.4244/eij-d-22-00558] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND No detailed data on left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) exist from randomised clinical trials comparing the ACURATE neo and CoreValve Evolut devices. AIMS Our aim was to assess the incidence and impact of new LBBB and PPI with self-expanding prostheses from a powered randomised comparison. METHODS From the SCOPE 2 trial, 648 patients with no previous pacemaker were analysed for PPI at 30 days, and 426 patients without previous LBBB were adopted for analysis of LBBB at 30 days. Results: At 30 days, 16.5% of patients required PPI; rates were higher in CoreValve Evolut compared to ACURATE neo recipients (21.0% vs 12.3%; p=0.004). Previous right bundle branch block (odds ratio [OR] 6.11, 95% confidence interval [CI]: 3.19-11.73; p<0.001) was associated with an increased risk of PPI at 30 days, whereas the use of the ACURATE neo (OR 0.50, 95% CI: 0.31-0.81; p=0.005) was associated with a decreased risk. One-year mortality was similar in patients with and without new PPI. A total of 9.4% of patients developed persistent LBBB at 30 days, with higher incidences in CoreValve Evolut recipients (13.4% vs 5.5%; p=0.007). New LBBB at 30 days was associated with lower ejection fraction at 1 year (65.7%±11.0 vs 69.1%±7.6; p=0.041). CONCLUSIONS New LBBB and PPI rates were lower in ACURATE neo compared to CoreValve Evolut recipients. The ACURATE neo valve was associated with a lower risk of PPI at 30 days. No effect on 1-year mortality was determined for PPI at 30 days, while LBBB at 30 days was associated with reduced ejection fraction at 1 year.
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Affiliation(s)
- Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - S. Marco" - University of Catania, Catania, Italy
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Smita Scholtz
- Department of Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - James Cockburn
- Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexander Wolf
- Department of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular diseases and transplantation, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kris Bogaerts
- KU Leuven, Faculty of Medicine, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - S. Marco" - University of Catania, Catania, Italy
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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12
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De Jaeghere EA, Tuyaerts S, Van Nuffel AMT, Belmans A, Bogaerts K, Baiden-Amissah R, Lippens L, Vuylsteke P, Henry S, Trinh XB, van Dam PA, Aspeslagh S, De Caluwé A, Naert E, Lambrechts D, Hendrix A, De Wever O, Van de Vijver KK, Amant F, Vandecasteele K, Denys HG. Pembrolizumab, radiotherapy, and an immunomodulatory five-drug cocktail in pretreated patients with persistent, recurrent, or metastatic cervical or endometrial carcinoma: Results of the phase II PRIMMO study. Cancer Immunol Immunother 2023; 72:475-491. [PMID: 35960332 PMCID: PMC9870976 DOI: 10.1007/s00262-022-03253-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023]
Abstract
A phase II study (PRIMMO) of patients with pretreated persistent/recurrent/metastatic cervical or endometrial cancer is presented. Patients received an immunomodulatory five-drug cocktail (IDC) consisting of low-dose cyclophosphamide, aspirin, lansoprazole, vitamin D, and curcumin starting 2 weeks before radioimmunotherapy. Pembrolizumab was administered three-weekly from day 15 onwards; one of the tumor lesions was irradiated (8Gyx3) on days 15, 17, and 19. The primary endpoint was the objective response rate per immune-related response criteria (irORR) at week 26 (a lower bound of the 90% confidence interval [CI] of > 10% was considered efficacious). The prespecified 43 patients (cervical, n = 18; endometrial, n = 25) were enrolled. The irORR was 11.1% (90% CI 2.0-31.0) in cervical cancer and 12.0% (90% CI 3.4-28.2) in endometrial cancer. Median duration of response was not reached in both cohorts. Median interval-censored progression-free survival was 4.1 weeks (95% CI 4.1-25.7) in cervical cancer and 3.6 weeks (95% CI 3.6-15.4) in endometrial cancer; median overall survival was 39.6 weeks (95% CI 15.0-67.0) and 37.4 weeks (95% CI 19.0-50.3), respectively. Grade ≥ 3 treatment-related adverse events were reported in 10 (55.6%) cervical cancer patients and 9 (36.0%) endometrial cancer patients. Health-related quality of life was generally stable over time. Responders had a significantly higher proportion of peripheral T cells when compared to nonresponders (p = 0.013). In conclusion, PRIMMO did not meet its primary objective in both cohorts; pembrolizumab, radiotherapy, and an IDC had modest but durable antitumor activity with acceptable but not negligible toxicity.Trial registration ClinicalTrials.gov (identifier NCT03192059) and EudraCT Registry (number 2016-001569-97).
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Affiliation(s)
- Emiel A. De Jaeghere
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Sandra Tuyaerts
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, Leuven, Belgium
- Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
- Laboratory for Medical and Molecular Oncology (LMMO), VUB, Brussels, Belgium
| | | | - Ann Belmans
- Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Regina Baiden-Amissah
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, Leuven, Belgium
| | - Lien Lippens
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Vuylsteke
- Department of Hemato-Oncology, Centre Hospitalier Universitaire Université Catholique de Louvain Namur (Sainte-Elisabeth), Namur, Belgium
| | - Stéphanie Henry
- Department of Hemato-Oncology, Centre Hospitalier Universitaire Université Catholique de Louvain Namur (Sainte-Elisabeth), Namur, Belgium
| | - Xuan Bich Trinh
- Department of Gynecologic Oncology and Senology, University Hospital Antwerp, Edegem, Belgium
- Multidisciplinary Oncologic Centre Antwerp (MOCA), University Hospital Antwerp, Edegem, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Edegem, Belgium
| | - Peter A. van Dam
- Department of Gynecologic Oncology and Senology, University Hospital Antwerp, Edegem, Belgium
- Multidisciplinary Oncologic Centre Antwerp (MOCA), University Hospital Antwerp, Edegem, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Edegem, Belgium
| | - Sandrine Aspeslagh
- Department of Medical Oncology, University Hospital Brussels, Brussels, Belgium
| | - Alex De Caluwé
- Department of Radiation Oncology, Jules Bordet Institute, Brussels, Belgium
- Department of Radiation Oncology, General Hospital Sint-Maarten, Mechlin, Belgium
| | - Eline Naert
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | | | - An Hendrix
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Olivier De Wever
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Laboratory of Experimental Cancer Research, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Koen K. Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute and Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Frédéric Amant
- Gynaecologic Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute and Amsterdam Medical Center, Amsterdam, The Netherlands
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Hannelore G. Denys
- Department of Medical Oncology (Route 535), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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13
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Oosterbos C, Rummens S, Bogaerts K, Hoornaert S, Weyns F, Dubuisson A, Lemmens R, Theys T. Conservative versus surgical treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial. Trials 2022; 23:1065. [PMID: 36581937 PMCID: PMC9801603 DOI: 10.1186/s13063-022-07009-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice. METHODS/DESIGN The FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment. DISCUSSION The results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making. TRIAL REGISTRATION ClinicalTrials.gov NCT04695834. Registered on 4 January 2021.
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Affiliation(s)
- Christophe Oosterbos
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Rummens
- grid.410569.f0000 0004 0626 3338Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Locomotor and Neurological disorders, KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- grid.12155.320000 0001 0604 5662Department of public health and critical care, I-BioStat, KU Leuven, Belgium and I-BioStat, UHasselt, Hasselt, Belgium
| | - Sophie Hoornaert
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Frank Weyns
- grid.470040.70000 0004 0612 7379Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium ,grid.12155.320000 0001 0604 5662Neurosciences, Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals Liège, Liège, Belgium
| | - Robin Lemmens
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium ,grid.11486.3a0000000104788040VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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14
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Garot P, Neylon A, Morice MC, Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Schramm R, Cockburn J, Cunnington M, Wolf A, Barbanti M, Tchetché D, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Bogaerts K, Hengstenberg C, Capodanno D. Bleeding risk differences after TAVR according to the ARC-HBR criteria: insights from SCOPE 2. EUROINTERVENTION 2022; 18:503-513. [PMID: 35450838 PMCID: PMC10241269 DOI: 10.4244/eij-d-21-01048] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Academic Research Consortium - High Bleeding Risk (ARC-HBR) initiative defined conditions associated with percutaneous coronary intervention (PCI)-related bleeding. AIMS We sought to further explore these HBR conditions in the setting of transcatheter aortic valve replacement (TAVR). METHODS Patients from the SCOPE 2 trial were stratified by their bleeding risk status based on the ARC-HBR definitions. Baseline and procedural characteristics, as well as key clinical outcomes including Bleeding Academic Research Consortium (BARC) 3-5 bleeding, were compared in ARC-HBR positive (HBR+) and ARC-HBR negative (HBR-) patients. RESULTS Of 787 patients randomised in SCOPE 2 and included in this study, 633 were HBR+ (80.4%). Compared with HBR- patients, those HBR+ were older and more frequently presented with diabetes, a history of coronary artery disease, atrial fibrillation, prior cerebrovascular accident, and a Society of Thoracic Surgeons predicted risk of 30-day mortality (STS-PROM) (4.9±2.9% vs 3.3%±2.1%; p<0.0001). In addition, HBR+ patients were more frequently on oral anticoagulation therapy. At 1 year, HBR+ patients had higher rates of all-cause death (12.4% vs 4.3%, respectively, risk difference 8.09%; 95% confidence interval [CI]: 3.76-12.41; p=0.0002); the rates of BARC 3-5 type bleeding were relatively high but not statistically different compared with HBR- patients (7.7% vs 6.1%, risk difference 1.67%; 95% CI: -2.72 to 6.06; p=0.46). Subgroup analyses for bleeding events showed no significant interaction in terms of STS-PROM score, age, or medications. CONCLUSIONS The ARC-HBR criteria failed to isolate a subgroup of patients at higher bleeding risk in TAVR patients from a randomised trial. These findings have potential implications, especially for the selection of post-TAVR antithrombotic regimens based on individual bleeding-risk profiles. Specific HBR criteria should be defined for TAVR patients.
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Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Antoinette Neylon
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Corrado Tamburino
- Division of Cardiology Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania, Catania, Italy
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhein-Westfalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Smita Scholtz
- Department of Interventional Cardiology, Heart and Diabetes Center North Rhine Westfalia, Bad Oeynhausen, Germany
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Northrhein-Westfalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - James Cockburn
- Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alexander Wolf
- Department of Interventional Cardiology, Elisabeth Hospital Essen, Essen, Germany
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular diseases and transplantation, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Didier Tchetché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | - Eric Van Belle
- Department of Cardiology, Lille University Hospital, Lille, France
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kris Bogaerts
- KU Leuven, Faculty of Medicine, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Davide Capodanno
- Division of Cardiology Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" University of Catania, Catania, Italy
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15
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De Smedt J, Van Kelst S, Janssen L, Marasigan V, Boecxstaens V, Stas M, Vanderschueren D, Guler I, Bogaerts K, Vandenberghe K, Bechter O, Billen J, Nikkels A, Strobbe T, Emri G, Lambrechts D, Garmyn M. Determinants of 25-hydroxyvitamin D Status in a Cutaneous Melanoma Population. Acta Derm Venereol 2022; 102:adv00692. [PMID: 35312026 PMCID: PMC9609978 DOI: 10.2340/actadv.v102.262] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
Vitamin D status is influenced by well-known determinants, but factors associated with low 25-hydroxyvitamin D levels in the cutaneous melanoma population are not well defined. The aim of this study was to confirm the well-known determinants and to assess new determinants for 25-hydroxyvitamin D levels in a cutaneous melanoma population. In a prospectively included cohort of 387 patients with cutaneous melanoma the association of 25-hydroxyvitamin D levels with sex, age, body mass index, time of blood withdrawal, Fitzpatrick phototype, vitamin D supplementation, score for intensity of lifetime sun exposure, smoking, education level, hair and skin colour, eye colour, total number of benign naevi, freckles and parameters of chronic sun damage was investigated. In addition, 25-hydroxyvitamin D levels were correlated with pathological parameters of the primary tumour and melanoma stage (8th edition of the American Joint Committee on Cancer (AJCC). Univariate and multivariate logistic regressions were performed using R software. The following factors had a significant effect on vitamin D status: body mass index, seasonal time of blood sampling, vitamin D supplementation, and a subtype of skin, and hair colour.
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Affiliation(s)
- Julie De Smedt
- School of Biomedical sciences, Department of Oncology, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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16
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Lafont A, Sinnaeve PR, Cuisset T, Cook S, Sideris G, Kedev S, Carrie D, Hovasse T, Garot P, El Mahmoud R, Spaulding C, Helft G, Diaz Fernandez JF, Brugaletta S, Pinar-Bermudez E, Ferre JM, Commeau P, Teiger E, Bogaerts K, Sabate M, Morice MC, Varenne O. Two-year outcomes after percutaneous coronary intervention with drug-eluting stents or bare-metal stents in elderly patients with coronary artery disease. Catheter Cardiovasc Interv 2021; 97:E607-E613. [PMID: 32761890 DOI: 10.1002/ccd.29159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Report the results at 2 years of the patients included in the SENIOR trial. BACKGROUND Patients above 75 years of age represent a fast-growing population in the cathlab. In the SENIOR trial, patients treated by percutaneous coronary intervention (PCI) with drug eluting stent (DES) and a short duration of P2Y12 inhibitor (1 and 6 months for stable and unstable coronary syndromes, respectively) compared with bare metal stents (BMS) was associated with a 29% reduction in the rate of all-cause mortality, myocardial infarction (MI), stroke, and ischaemia-driven target lesion revascularization (ID-TLR) at 1 year. The results at 2 years are reported here. METHODS AND RESULTS We randomly assigned 1,200 patients (596[50%] to the DES group and 604[50%] to the BMS group). At 2 years, the composite endpoint of all-cause mortality, MI, stroke and ID-TLR had occurred in 116 (20%) patients in the DES group and 131 (22%) patients in the BMS group (RR 0.90 [95%CI 0.72-1.13], p = .37). IDTLR occurred in 14 (2%) patients in the DES group and 41 (7%) patients in the BMS group (RR 0.35 [95%CI 0.16-0.60], p = .0002). Major bleedings (BARC 3-5) occurred in 27(5%) patients in both groups (RR 1.00, [95%CI 0.58-1.75], p = .99). Stent thrombosis rates were low and similar between DES and BMS (0.8 vs 1.3%, (RR 0.52 [95%CI 0.01-1.95], p = .27). CONCLUSION Among elderly PCI patients, a strategy combining a DES together with a short duration of DAPT is associated with a reduction in revascularization up to 2 years compared with BMS with very few late events and without any increased in bleeding complications or stent thrombosis.
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Affiliation(s)
- Alexandre Lafont
- Cardiology Department Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and, Université de Paris, Paris, France
| | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Cuisset
- Cardiology Department, Centre Hospitalier Universitaire Timone, Marseille, France
| | - Stéphane Cook
- Cardiology Department, University and Hospital Fribourg, Fribourg, Switzerland
| | - Giorgios Sideris
- Cardiology Department Service de Cardiologie-Institut national de la santé et de la recherche médicale U942, Hôpital Lariboisiere, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Sasko Kedev
- Cardiology Department, University St Cyril and Methodius, Skopje, Macedonia
| | - Didier Carrie
- Service de Cardiologie, Centre hospitalier universitaire Toulouse Rangueil, Université Paul Sabatier, Toulouse, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy, France
| | - Rami El Mahmoud
- Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Christian Spaulding
- Service de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris and Sudden Death Expert Center, Institut national de la santé et de la recherche médicale U990, Paris, France
| | - Gérard Helft
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie et Institut hospitalo-universitaire, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | | | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Josepa Mauri Ferre
- Cardiology department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Philippe Commeau
- Département de Cardiologie Interventionnelle, Polyclinique Les Fleurs, France
| | - Emmanuel Teiger
- Service de Cardiologie, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium, and Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
| | - Manel Sabate
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Olivier Varenne
- Cardiology Department Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and, Université de Paris, Paris, France
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17
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Banning A, Adriaenssens T, Berry C, Bogaerts K, Erglis A, Distelmaier K, Guagliumi G, Haine S, Kastrati A, Massberg S, Orban M, Myrmel T, Vuylsteke A, Alfonso F, Van de Werf F, Verheugt F, Flather M, Sabaté M, Vrints C, Gershlick A. Veno-arterial extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock: rationale and design of the randomised, multicentre, open-label EURO SHOCK trial. EUROINTERVENTION 2021; 16:e1227-e1236. [PMID: 33106225 PMCID: PMC9725005 DOI: 10.4244/eij-d-20-01076] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 11/23/2022]
Abstract
AIMS Cardiogenic shock (CGS) occurs in 6-10% of patients with acute coronary syndromes (ACS). Mortality has fallen over time from 80% to approximately 50% consequent on acute revascularisation but has plateaued since the 1990s. Once established, patients with CGS develop adverse compensatory mechanisms that contribute to the downward spiral towards death, which becomes difficult to reverse. We aimed to test in a robust, prospective, randomised controlled trial whether early support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides clinical benefit by improving mortality and morbidity. METHODS AND RESULTS The EURO SHOCK trial will test the benefit or otherwise of mechanical cardiac support using VA-ECMO, initiated early after acute percutaneous coronary intervention (PCI) for CGS. The trial sets out to randomise 428 patients with CGS complicating ACS, following primary PCI (P-PCI), to either very early ECMO plus standard pharmacotherapy, or standard pharmacotherapy alone. It will be conducted in 39 European centres. The primary endpoint is 30-day all-cause mortality with key secondary endpoints: 1) 12-month all-cause mortality or admission for heart failure, 2) 12-month all-cause mortality, 3) 12-month admission for heart failure. Cost-effectiveness analysis (including quality of life measures) will be embedded. Mechanistic and hypothesis-generating substudies will be undertaken. CONCLUSIONS The EURO SHOCK trial will determine whether early initiation of VA-ECMO in patients presenting with ACS-CGS persisting after PCI improves mortality and morbidity.
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Affiliation(s)
- Amerjeet Banning
- Department of Cardiology, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Tom Adriaenssens
- University Hospitals Leuven, and Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Colin Berry
- University of Glasgow, Institute of Cardiovascular and Medical Sciences and Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - Kris Bogaerts
- Katholieke Universiteit Leuven, Department of Public Health and Primary Care, I-BioStat, and Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Andrejs Erglis
- Paula Stradina Kliniska Universitates Slimnica AS, Department of Cardiovascular Sciences, Riga, Latvia
| | - Klaus Distelmaier
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - Giulio Guagliumi
- Azienda Ospedaliera Papa Giovanni XXIII, Department of Cardiovascular Sciences, Bergamo, Italy
| | - Steven Haine
- Antwerp University Hospital, Department of Cardiology and University of Antwerp, Department of Cardiovascular Diseases, Antwerp, Belgium
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Department of Cardiology, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Truls Myrmel
- The Heart and Lung Clinic, University Hospital North Norway, Tromsø, Norway
| | - Alain Vuylsteke
- Royal Papworth Hospital, Department of Anaesthesia and Intensive Care, Cambridge, United Kingdom
| | - Fernando Alfonso
- Cardiac Department, La Princesa University Hospital, IIS-IP, CIBERCV, Madrid, Spain
| | - Frans Van de Werf
- University Hospitals Leuven, and Katholieke Universiteit Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Freek Verheugt
- Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands
| | - Marcus Flather
- University of East Anglia and Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Manel Sabaté
- Consorci Institut D’Investicacions Biomediques August Pi i Sunyer, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Christiaan Vrints
- Antwerp University Hospital, Department of Cardiology and University of Antwerp, Department of Cardiovascular Diseases, Antwerp, Belgium
| | - Anthony Gershlick
- University of Leicester, University Hospitals of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
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18
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Van Loon E, Giral M, Anglicheau D, Lerut E, Dubois V, Rabeyrin M, Brouard S, Roedder S, Spigarelli MG, Rabant M, Bogaerts K, Naesens M, Thaunat O. Diagnostic performance of kSORT, a blood-based mRNA assay for noninvasive detection of rejection after kidney transplantation: A retrospective multicenter cohort study. Am J Transplant 2021; 21:740-750. [PMID: 32627407 DOI: 10.1111/ajt.16179] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 01/25/2023]
Abstract
The Kidney Solid Organ Response Test (kSORT) blood gene expression assay was developed to noninvasively detect acute rejection (AR) after kidney transplantation. Its performance in a setting with natural disease prevalence has not been evaluated. A retrospective, multicenter cohort study was conducted across all single kidney transplant recipients, transplanted between 2011 and 2015, with samples within the first year after transplantation available in existing biobanks. The primary objective was to determine the diagnostic performance of the kSORT assay to detect AR (T cell-mediated and/or antibody-mediated rejection) as compared to a concomitant renal biopsy. AR was reported on the concomitant biopsy in 188 of 1763 (10.7%) blood samples and any rejection (including borderline changes) in 614 of 1763 (34.8%) blood samples. In 320 of 1763 samples (18.2%) the kSORT risk category was indeterminate. The kSORT assay had no diagnostic value for AR (area under the curve [AUC] 0.51, 95% confidence interval [CI] 0.50-0.56; P = .46) overall, or when considering indication biopsies (N = 487) and protocol-specified biopsies (N = 1276) separately (AUC of 0.53, 95% CI 0.50-0.59, P = .44 and 0.55, 95% CI 0.50-0.61, P = .09, respectively). This large retrospective study utilizing samples obtained under real-world clinical conditions, was unable to validate the kSORT assay for detection of AR in the first year after transplantation.
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Affiliation(s)
- Elisabet Van Loon
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Magali Giral
- CRTI UMR 1064, Inserm, University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France.,Institute for Transplantation Urology Nephrology (ITUN), CHU Nantes, Nantes, France.,Faculty of Medicine, University of Nantes, Nantes, France.,CIC Biotherapy, CHU Nantes, Nantes, France
| | - Dany Anglicheau
- Paris Descartes, University of Paris, INSERM U1151, Paris, France.,Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Evelyne Lerut
- Department of Imaging and Pathology, University Hospitals Leuven, Translational Cell & Tissue Research, Leuven, Belgium
| | - Valérie Dubois
- French National Blood Service (EFS), HLA Laboratory, Décines-Charpieu, France
| | - Maud Rabeyrin
- Department of Pathology, Hospices Civils de Lyon, Bron, France
| | - Sophie Brouard
- CRTI UMR 1064, Inserm, University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France.,Institute for Transplantation Urology Nephrology (ITUN), CHU Nantes, Nantes, France.,Faculty of Medicine, University of Nantes, Nantes, France.,CIC Biotherapy, CHU Nantes, Nantes, France
| | | | | | - Marion Rabant
- Department of Renal Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kris Bogaerts
- KU Leuven, I-BioStat, Leuven, Belgium.,UHasselt, I-BioStat, Hasselt, Belgium
| | - Maarten Naesens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Thaunat
- French National Institute of Health and Medical Research (Inserm) Unit 1111, Lyon, France.,Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital Lyon, Hospices Civils de Lyon, Lyon, France.,Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
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19
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De Neubourg D, Bogaerts K, Anagnostou E, Autin C, Blockeel C, Coetsier T, Delbaere A, Gillain N, Vandekerckhove F, Wyns C. Evolution of cumulative live birth and dropout rates over six complete IVF/ICSI cycles: a large prospective cohort study. Reprod Biomed Online 2021; 42:717-724. [PMID: 33518469 DOI: 10.1016/j.rbmo.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
RESEARCH QUESTION How do cumulative live birth rates (CLBR), cumulative multiple live birth rates (CMLBR) and dropout rates over six IVF and intracytoplasmic sperm injection (ICSI) cycles change over time? DESIGN Prospective longitudinal cohort (n = 16,073 patients; 48,946 cycles) starting a first fresh assisted reproductive technology cycle between 1 January 2014 and 31 December 2016, with follow-up until 31 December 2017. Outcomes between the periods 2014-2017 and 2009-2012 were compared. RESULTS Conservative estimates of CLBR after six complete cycles were significantly higher in women younger than 35 years after every cycle: one to three, adjusted P-value [p adj] < 0.0001; four, p = 0.01; five, p adj = 0.03; six, p adj = 0.04) and after the first cycle in women aged 35-37 years (p adj = 0.04) in 2014-2017 versus 2009-2012. For an optimal estimate, the CLBR was significantly higher after the first three cycles in women younger than 35 years (all p adj < 0.0001) and after the first cycle in women aged 35-37 years (p adj = 0.04). The CMLBR rate decreased from 5.1% ± 0.19 (SE) to 4.1% ± 0.16 for the conservative estimate and from 8.6% ±0.37 (SE) to 6.7% ± 0.30 for the optimal estimate after six complete cycles for the whole cohort. Dropout rates of complete cycles were 26.5% 29.4%, 33.4%, 38.9% and 47.3% after the first to fifth cycle, respectively. Compared with 2009-2012, the dropout rate in the current period was significantly higher for the first (P < 0.0001) and second (P = 0.0124) cycle. CONCLUSION Over six complete IVF/ICSI cycles, CLBR and dropout rates increased and multiple live birth rates decreased when 2014-2017 was compared with 2009-2012.
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Affiliation(s)
- Diane De Neubourg
- Center for Reproductive Medicine, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijkstraat 10, Edegem 2650, Belgium.
| | - Kris Bogaerts
- I-BioStat, Katholieke Universiteit Leuven and Universiteit Hasselt, Belgium
| | | | - Candice Autin
- Centre de Procréation Medicalement Assistée, St Pierre, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Anne Delbaere
- Clinique de Fertilité, Service de Gynécologie-Obstétrique, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Nicolas Gillain
- Nutrition, Environment and Health, University of Liège, Liège, Belgium
| | | | - Christine Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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20
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Tamburino C, Bleiziffer S, Thiele H, Scholtz S, Hildick-Smith D, Cunnington M, Wolf A, Barbanti M, Tchetchè D, Garot P, Pagnotta P, Gilard M, Bedogni F, Van Belle E, Vasa-Nicotera M, Chieffo A, Deutsch O, Kempfert J, Søndergaard L, Butter C, Trillo-Nouche R, Lotfi S, Möllmann H, Joner M, Abdel-Wahab M, Bogaerts K, Hengstenberg C, Capodanno D. Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis. Circulation 2020; 142:2431-2442. [DOI: 10.1161/circulationaha.120.051547] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 12/20/2022]
Abstract
Background:
Few randomized trials have compared bioprostheses for transcatheter aortic valve replacement, and no trials have compared bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and Efficacy Comparison of Two TAVI Systems in a Prospective Randomized Evaluation 2) was designed to compare the clinical outcomes of the ACURATE neo and CoreValve Evolut bioprostheses for transcatheter aortic valve replacement.
Methods:
SCOPE 2 was a randomized trial performed at 23 centers in 6 countries between April 2017 and April 2019. Patients ≥75 years old with an indication for transfemoral transcatheter aortic valve replacement as agreed by the heart team were randomly assigned to receive treatment with either the ACURATE neo (n=398) or the CoreValve Evolut bioprostheses (n=398). The primary end point, powered for noninferiority of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year. The key secondary end point, powered for superiority of the ACURATE neo bioprosthesis, was new permanent pacemaker implantation at 30 days.
Results:
Among 796 randomized patients (mean age, 83.2±4.3 years; mean Society of Thoracic Surgeons Predicted Risk of Mortality score, 4.6±2.9%), clinical follow-up information was available for 778 (98%) patients. Within 1 year, the primary end point occurred in 15.8% of patients in the ACURATE neo group and in 13.9% of patients in the CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95% confidence limit, 6.1%;
P
=0.0549 for noninferiority). The 30-day rates of new permanent pacemaker implantation were 10.5% in the ACURATE neo group and 18.0% in the CoreValve Evolut group (absolute risk difference, –7.5% [95% CI, –12.4 to –2.60];
P
=0.0027). No significant differences were observed in the components of the primary end point. Cardiac death at 30 days (2.8% versus 0.8%;
P
=0.03) and 1 year (8.4% versus 3.9%;
P
=0.01), and moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P
=0.002) were significantly increased in the ACURATE neo group.
Conclusions:
Transfemoral transcatheter aortic valve replacement with the self-expanding ACURATE neo did not meet noninferiority compared with the self-expanding CoreValve Evolut in terms of all-cause death or stroke at 1 year, and it was associated with a lower incidence of new permanent pacemaker implantation. In secondary analyses, the ACURATE neo was associated with more moderate or severe aortic regurgitation at 30 days and cardiac death at 30 days and 1 year.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03192813.
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Affiliation(s)
- Corrado Tamburino
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery (S.B.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Smita Scholtz
- Department of Interventional Cardiology (S.S.), Heart and Diabetes Center Northrhein-Westfalia, Bad Oeynhausen, Germany
| | - David Hildick-Smith
- Department of Cardiology, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom (D.H.-S.)
| | - Michael Cunnington
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals National Health Service Trust, United Kingdom (M.C.)
| | - Alexander Wolf
- Department of Cardiology, Elisabeth Hospital Essen, Germany (A.W.)
| | - Marco Barbanti
- Department of Cardio-Thoracic-Vascular Diseases and Transplantations, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco,” Catania, Italy (M.B.)
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-Sud, Ramsay-Santé, Massy, France (P.G.)
| | - Paolo Pagnotta
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Milano, Italy (P.P.)
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, France (M.G.)
| | - Francesco Bedogni
- Cardiology Department, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy (F.B.)
| | - Eric Van Belle
- Department of Cardiology, University Hospital, Lille, France (E.V.B.)
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (M.V.-N.)
| | - Alaide Chieffo
- Interventional Cardiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy (A.C.)
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Germany (O.D.)
| | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany (J.K.)
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg in Bernau and Brandenburg Medical School, Germany (C.B.)
| | - Ramiro Trillo-Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Spain (R.T.-N.)
| | - Shahram Lotfi
- Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Germany (S.L.)
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital, Dortmund, Germany (H.M.)
| | - Michael Joner
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany (M.J.)
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Germany (H.T., M.A.-W.)
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Belgium (K.B.)
- I-BioStat, Universiteit Hasselt, Belgium (K.B.)
| | | | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Italy (C.T., D.C.)
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21
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Armstrong PW, Bogaerts K, Welsh R, Sinnaeve PR, Goldstein P, Pages A, Danays T, Van de Werf F. The Second Strategic Reperfusion Early After Myocardial Infarction (STREAM-2) study optimizing pharmacoinvasive reperfusion strategy in older ST-elevation myocardial infarction patients. Am Heart J 2020; 226:140-146. [PMID: 32553932 DOI: 10.1016/j.ahj.2020.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The STREAM study demonstrated that a pharmaco-invasive strategy was at least as effective as primary PCI (pPCI) in patients presenting early with ST-elevation myocardial infarction (STEMI). The current trial is a response to the finding that reduced intracranial hemorrhage (ICH) in patients ≥75 years occurred after halving the dose of tenecteplase. Additionally, a subsequent analysis of full dose tenecteplase or alteplase in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT) trials demonstrated a steep increase in bleeding events beginning around the age of 60 years. METHODS STREAM-2 will compare the efficacy and safety of a novel pharmaco-invasive strategy as compared to routine pPCI in STEMI patients ≥60 years presenting within 3 hours from symptom onset. In the pharmaco-invasive arm patients will receive half-dose tenecteplase, as soon as possible before transport to a PCI center. In the pPCI arm, patients will be treated according to optimal standard of care defined by local practice. The key criteria for efficacy will be the number of patients achieving ≥50% ST-segment resolution before and after PCI in lead with maximal ST elevation at baseline and the clinical endpoints of death, congestive heart failure, shock or re-infarction, rescue PCI and aborted myocardial infarction, both singularly and as a composite at 30 days. Key safety criteria are total stroke, ICH and major non-intracranial bleeds. Approximately 600 patients will be randomized (400 to pharmaco-invasive treatment and 200 to pPCI). An interim analysis is planned after 300 patients are enrolled to consider adapting the trial to include a larger sample size aimed at undertaking a formal confirmatory trial. DISCUSSION The study will provide new insights aimed at establishing an effective and safer pharmaco-invasive treatment for the growing population of older STEMI patients who cannot undergo timely pPCI.
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Affiliation(s)
- Paul W Armstrong
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton, Canada
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), KU Leuven, Leuven and University Hasselt, Hasselt, Belgium
| | - Robert Welsh
- The Canadian Virtual Coordinating Centre for Global Collaborative Cardiovascular Research {Canadian VIGOUR Centre}, University of Alberta, Edmonton, Canada
| | | | - Patrick Goldstein
- Emergency Department and SAMU, Lille University Hospital, Lille, France
| | - Alain Pages
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
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22
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Werner GS, Martin-Yuste V, Hildick-Smith D, Boudou N, Sianos G, Gelev V, Rumoroso JR, Erglis A, Christiansen EH, Escaned J, di Mario C, Hovasse T, Teruel L, Bufe A, Lauer B, Bogaerts K, Goicolea J, Spratt JC, Gershlick AH, Galassi AR, Louvard Y. A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions. Eur Heart J 2019; 39:2484-2493. [PMID: 29722796 DOI: 10.1093/eurheartj/ehy220] [Citation(s) in RCA: 326] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Aims The clinical value of percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) is not established by randomized trials. This study should compare the benefit of PCI vs. optimal medical therapy (OMT) on the health status in patients with at least one CTO. Method and results Three hundred and ninety-six patients were enrolled in a prospective randomized, multicentre, open-label, and controlled clinical trial to compare the treatment by PCI with OMT with a 2:1 randomization ratio. The primary endpoint was the change in health status assessed by the Seattle angina questionnaire (SAQ) between baseline and 12 months follow-up. Fifty-two percent of patients have multi-vessel disease in whom all significant non-occlusive lesions were treated before randomization. An intention-to-treat analysis was performed including 13.4% failed procedures in the PCI group and 7.3% cross-overs in the OMT group. At 12 months, a greater improvement of SAQ subscales was observed with PCI as compared with OMT for angina frequency [5.23, 95% confidence interval (CI) 1.75; 8.71; P = 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P = 0.007), reaching the prespecified significance level of 0.01 for the primary endpoint. Physical limitation (P = 0.02) was also improved in the PCI group. Complete freedom from angina was more frequent with PCI 71.6% than OMT 57.8% (P = 0.008). There was no periprocedural death or myocardial infarction. At 12 months, major adverse cardiac events were comparable between the two groups. Conclusion Percutaneous coronary intervention leads to a significant improvement of the health status in patients with stable angina and a CTO as compared with OMT alone. Trial registration NCT01760083.
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Affiliation(s)
- Gerald S Werner
- Klinikum Darmstadt GmbH, Medizinische Klinik I, Grafenstrasse 9, Darmstadt, Germany
| | | | - David Hildick-Smith
- Royal Sussex County Hospital, Sussex Cardiac Centre, Eastern Road, Brighton, UK
| | - Nicolas Boudou
- Hopital de Rangueil CHU Toulouse, Department of Cardiology, 1 avenue Jean Poulhès, Toulouse Cedex 9, France
| | - Georgios Sianos
- AHEPA University Hospital, 1st Department of Cardiology, Stilponos Kyriakidi 1, Thessaloniki, Greece
| | - Valery Gelev
- Cardiology Clinic, MHAT "Tokuda Hospital Sofia", 51B Nikola Vaptsarov Blvd., Sofia, Bulgaria
| | - Jose Ramon Rumoroso
- Hospital Galdakao-Usansolo, Sección de Hemodinámica, barrio de labeaga s/n, Galdakao, Spain
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Institute of Cardiology and Regenerative Medicine, 13 Pilsonu street, Riga, Latvia
| | | | - Javier Escaned
- Hospital Clinico San Carlos, Unidad de Cardiología Intervencionista, Profesor Martin Lagos s/n, Madrid, Spain
| | - Carlo di Mario
- University Hospital Careggi, Division of Structural Interventional Cardiology, Largo Brambilla 3, Florence, Italy
| | - Thomas Hovasse
- Institut Jacques Cartier, 6 avenue Noyer Lambert, Massy, France
| | - Luis Teruel
- Bellvitge University Hospital, Unidad de Hemodinàmica y Cardiologia, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexander Bufe
- HELIOS Klinik Krefeld, Medizinische Klinik I, Lutherplatz 40, Krefeld, Germany
| | - Bernward Lauer
- Zentralklinik Bad Berka, Klinik für Kardiologie, Robert-Koch-Allee 9, Bad Berka, Germany
| | - Kris Bogaerts
- Leuven Biostatistics and Statistical Bioinformatics Centre, L-BioStat. Kapucijnenvoer 35, Leuven, Belgium
| | - Javier Goicolea
- Hospital Universitario Puerta de Hierro, Servicio de hemodinamica y arritmias, Joaquin Rodrigo, 2, Majadahonda, Spain
| | - James C Spratt
- Royal Infirmary of Edinburgh, Department of Cardiology, 51 Little France Crescent, Edinburgh, UK
| | - Anthony H Gershlick
- Glenfield Hospital, Leicester Cardiovascular Biomedical Research Unit, Groby Road, Leicester, UK
| | - Alfredo R Galassi
- Department of Clinical and Experimental Medicine, University of Catania, Via Antonello da Messina 75, Catania, Italy
| | - Yves Louvard
- Institut Jacques Cartier, 6 avenue Noyer Lambert, Massy, France
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23
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Vermeersch K, Belmans A, Bogaerts K, Gyselinck I, Cardinaels N, Gabrovska M, Aumann J, Demedts IK, Corhay JL, Marchand E, Slabbynck H, Haenebalcke C, Vermeersch S, Verleden GM, Troosters T, Ninane V, Brusselle GG, Janssens W. Treatment failure and hospital readmissions in severe COPD exacerbations treated with azithromycin versus placebo - a post-hoc analysis of the BACE randomized controlled trial. Respir Res 2019; 20:237. [PMID: 31665017 PMCID: PMC6819655 DOI: 10.1186/s12931-019-1208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the BACE trial, a 3-month (3 m) intervention with azithromycin, initiated at the onset of an infectious COPD exacerbation requiring hospitalization, decreased the rate of a first treatment failure (TF); the composite of treatment intensification (TI), step-up in hospital care (SH) and mortality. OBJECTIVES (1) To investigate the intervention's effect on recurrent events, and (2) to identify clinical subgroups most likely to benefit, determined from the incidence rate of TF and hospital readmissions. METHODS Enrolment criteria included the diagnosis of COPD, a smoking history of ≥10 pack-years and ≥ 1 exacerbation in the previous year. Rate ratio (RR) calculations, subgroup analyses and modelling of continuous variables using splines were based on a Poisson regression model, adjusted for exposure time. RESULTS Azithromycin significantly reduced TF by 24% within 3 m (RR = 0.76, 95%CI:0.59;0.97, p = 0.031) through a 50% reduction in SH (RR = 0.50, 95%CI:0.30;0.81, p = 0.006), which comprised of a 53% reduction in hospital readmissions (RR = 0.47, 95%CI:0.27;0.80; p = 0.007). A significant interaction between the intervention, CRP and blood eosinophil count at hospital admission was found, with azithromycin significantly reducing hospital readmissions in patients with high CRP (> 50 mg/L, RR = 0.18, 95%CI:0.05;0.60, p = 0.005), or low blood eosinophil count (<300cells/μL, RR = 0.33, 95%CI:0.17;0.64, p = 0.001). No differences were observed in treatment response by age, FEV1, CRP or blood eosinophil count in continuous analyses. CONCLUSIONS This post-hoc analysis of the BACE trial shows that azithromycin initiated at the onset of an infectious COPD exacerbation requiring hospitalization reduces the incidence rate of TF within 3 m by preventing hospital readmissions. In patients with high CRP or low blood eosinophil count at admission this treatment effect was more pronounced, suggesting a potential role for these biomarkers in guiding azithromycin therapy. TRIAL REGISTRATION ClinicalTrials.gov number. NCT02135354 .
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Affiliation(s)
- Kristina Vermeersch
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, B-3000, Leuven, Belgium
- Universiteit Hasselt, B-3500, Hasselt, Belgium
| | - Kris Bogaerts
- I-BioStat, KU Leuven, B-3000, Leuven, Belgium
- Universiteit Hasselt, B-3500, Hasselt, Belgium
| | - Iwein Gyselinck
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Nina Cardinaels
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Maria Gabrovska
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, B-1000, Brussels, Belgium
| | - Joseph Aumann
- Department of Pneumology, Jessa Ziekenhuis, B-3500, Hasselt, Belgium
| | - Ingel K Demedts
- Department of Respiratory Medicine, AZ Delta Roeselare-Menen, B-8800, Roeselare, Belgium
| | - Jean-Louis Corhay
- Department of Pneumology, Centre Hospitalier Universitaire, site Sart-Tilman, B-4000, Liège, Belgium
| | - Eric Marchand
- Department of Pneumology, CHU-UCL-Namur, site Mont-Godinne, B-5530, Yvoir, Belgium
- Faculty of Medicine, NARILIS, Laboratory of Respiratory Physiology, University of Namur, B-5000, Namur, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, B-2020, Antwerpen, Belgium
| | | | - Stefanie Vermeersch
- Department of Respiratory Medicine, Ghent University Hospital, B-9000, Ghent, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Thierry Troosters
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Ninane
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, B-1000, Brussels, Belgium
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, B-9000, Ghent, Belgium
| | - Wim Janssens
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium.
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24
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Affiliation(s)
- Maarten Vanhaverbeke
- Department of Cardiovascular Sciences (M.V., P.R.S., F.V.d.W.), KU Leuven, Belgium
| | - Kris Bogaerts
- I-BioStat (K.B.), KU Leuven, Belgium.,I-BioStat, UHasselt, Belgium (K.B.)
| | - Peter R Sinnaeve
- Department of Cardiovascular Sciences (M.V., P.R.S., F.V.d.W.), KU Leuven, Belgium
| | - Luc Janssens
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium (L.J.)
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.W.A.)
| | - Frans Van de Werf
- Department of Cardiovascular Sciences (M.V., P.R.S., F.V.d.W.), KU Leuven, Belgium
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25
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Vermeersch K, Gabrovska M, Aumann J, Demedts IK, Corhay JL, Marchand E, Slabbynck H, Haenebalcke C, Haerens M, Hanon S, Jordens P, Peché R, Fremault A, Lauwerier T, Delporte A, Vandenberk B, Willems R, Everaerts S, Belmans A, Bogaerts K, Verleden GM, Troosters T, Ninane V, Brusselle GG, Janssens W. Azithromycin during Acute Chronic Obstructive Pulmonary Disease Exacerbations Requiring Hospitalization (BACE). A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial. Am J Respir Crit Care Med 2019; 200:857-868. [DOI: 10.1164/rccm.201901-0094oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kristina Vermeersch
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing
- Department of Respiratory Diseases and
| | - Maria Gabrovska
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph Aumann
- Department of Pneumology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Ingel K. Demedts
- Department of Respiratory Medicine, AZ Delta Roeselare-Menen, Roeselare, Belgium
| | - Jean-Louis Corhay
- Department of Pneumology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Eric Marchand
- Department of Pneumology, CHU-UCL-Namur, Yvoir, Belgium
- Faculty of Medicine, NARILIS, Laboratory of Respiratory Physiology, University of Namur, Namur, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium
| | | | | | - Shane Hanon
- Department of Pneumology, UZ Brussel, Jette, Belgium
| | - Paul Jordens
- Department of Pneumology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Rudi Peché
- Department of Pneumology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Antoine Fremault
- Department of Pneumology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Tine Lauwerier
- Department of Pneumology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Anja Delporte
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; and
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing
- Department of Respiratory Diseases and
| | - Ann Belmans
- I-BioStat, and
- Universiteit Hasselt, Hasselt, Belgium
| | - Kris Bogaerts
- I-BioStat, and
- Universiteit Hasselt, Hasselt, Belgium
| | - Geert M. Verleden
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing
- Department of Respiratory Diseases and
| | - Thierry Troosters
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Ninane
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Guy G. Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; and
| | - Wim Janssens
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing
- Department of Respiratory Diseases and
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Odnoletkova I, Kindle G, Quinti I, Grimbacher B, Knerr V, Gathmann B, Ehl S, Mahlaoui N, Van Wilder P, Bogaerts K, de Vries E. The burden of common variable immunodeficiency disorders: a retrospective analysis of the European Society for Immunodeficiency (ESID) registry data. Orphanet J Rare Dis 2018; 13:201. [PMID: 30419968 PMCID: PMC6233554 DOI: 10.1186/s13023-018-0941-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [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: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 01/15/2023] Open
Abstract
Background Common variable immunodeficiency disorders (CVID) are a group of rare innate disorders characterized by specific antibody deficiency and increased rates of infections, comorbidities and mortality. The burden of CVID in Europe has not been previously estimated. We performed a retrospective analysis of the European Society for Immunodeficiencies (ESID) registry data on the subset of patients classified by their immunologist as CVID and treated between 2004 and 2014. The registered deaths and comorbidities were used to calculate the annual average age-standardized rates of Years of Life Lost to premature death (YLL), Years Lost to Disability (YLD) and Disability Adjusted Life Years (DALY=YLL + YLD). These outcomes were expressed as a rate per 105 of the CVID cohort (the individual disease burden), and of the general population (the societal disease burden). Results Data of 2700 patients from 23 countries were analysed. Annual comorbidity rates: bronchiectasis, 21.9%; autoimmunity, 23.2%; digestive disorders, 15.6%; solid cancers, 5.5%; lymphoma, 3.8%, exceeded the prevalence in the general population by a factor of 34.0, 7.6, 8.1, 2.4 and 32.6, respectively. The comorbidities of CVID caused 8722 (6069; 12,363) YLD/105 in this cohort, whereas 44% of disability burden was attributable to infections and bronchiectasis. The total individual burden of CVID was 36,785 (33,078, 41,380) DALY/105. With estimated CVID prevalence of ~ 1/ 25,000, the societal burden of CVID ensued 1.5 (1.3, 1.7) DALY/105 of the general population. In exploratory analysis, increased mortality was associated with solid tumor, HR (95% CI): 2.69 (1.10; 6.57) p = 0.030, lymphoma: 5.48 (2.36; 12.71) p < .0001 and granulomatous-lymphocytic interstitial lung disease: 4.85 (1.63; 14.39) p = 0.005. Diagnostic delay (median: 4 years) was associated with a higher risk of death: 1.04 (1.02; 1.06) p = .0003, bronchiectasis: 1.03 (1.01; 1.04) p = .0001, solid tumor: 1.08 (1.04; 1.11) p < .0001 and enteropathy: 1.02 (1.00; 1.05) p = .0447 and stayed unchanged over four decades (p = .228). Conclusions While the societal burden of CVID may seem moderate, it is severe to the individual patient. Delay in CVID diagnosis may constitute a modifiable risk factor of serious comorbidities and death but showed no improvement. Tools supporting timely CVID diagnosis should be developed with high priority. Electronic supplementary material The online version of this article (10.1186/s13023-018-0941-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Odnoletkova
- Plasma Protein Therapeutics Association, Boulevard Brand Whitlock 114b4, 1200, Brussels, Belgium. .,Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium. .,Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, University of Brussels (ULB), Brussels, Belgium.
| | - Gerhard Kindle
- The ESID Registry Working Party.,Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,University Hospital Policlinico Umberto I, Rome, Italy
| | - Bodo Grimbacher
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Immunology and Transplantation, Royal Free Hospital, University College London, London, UK
| | - Viviane Knerr
- The ESID Registry Working Party.,Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Gathmann
- The ESID Registry Working Party.,Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- The ESID Registry Working Party.,Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nizar Mahlaoui
- French National Reference Center for Primary Immune Deficiencies (CEREDIH) and Pediatric Immuno-Haematology and Rheumatology Unit Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Imagine Institute, Paris, France.,INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Paris, France
| | - Philippe Van Wilder
- Centre de recherche en Economie de la Santé, Gestion des Institutions de Soins et Sciences Infirmières, Ecole de Santé Publique, University of Brussels (ULB), Brussels, Belgium
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KU Leuven - University of Leuven, I-BioStat, 3000, Leuven, Belgium.,University Hasselt, I-BioStat, 3500, Hasselt, Belgium
| | - Esther de Vries
- Department Tranzo, Tilburg University, PO Box 90153 (RP219), 5000 LE, Tilburg, the Netherlands.,Laboratory for Microbiology and Immunology, Elisabeth Tweesteden Hospital, PO Box 90151 (route 90), 5000LC, Tilburg, the Netherlands
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Varenne O, Stephane Cook, Sideris G, Kedev S, Carrie D, Hovasse T, Garot P, Helft G, Brugaletta S, Bermudez EP, Mauri J, Commeau P, Teiger E, Bogaerts K, Sabate M, Morice MC, Sinnaeve P. TCT-868 Drug-eluting stents and short duration of DAPT in elderly patients with coronary artery disease. Results of the SENIOR randomized clinical trial at 2 years. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2119] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V, Gliozheni O, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Petrovskaya E, Tishkevich O, Wyns C, Bogaerts K, Balic D, Sibincic S, Antonova I, Vrcic H, Ljiljak D, Pelekanos M, Rezabek K, Markova J, Lemmen J, Sõritsa D, Gissler M, Tiitinen A, Royere D, Tandler—Schneider A, Kimmel M, Antsaklis AJ, Loutradis D, Urbancsek J, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, de Luca R, Lokshin V, Ravil V, Magomedova V, Gudleviciene Z, Belo lopes G, Petanovski Z, Calleja-Agius J, Xuereb J, Moshin V, Simic TM, Vukicevic D, Romundstad LB, Janicka A, Calhaz-Jorge C, Laranjeira AR, Rugescu I, Doroftei B, Korsak V, Radunovic N, Tabs N, Virant-Klun I, Saiz IC, Mondéjar FP, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Gryshchenko M, Baranowski R. ART in Europe, 2014: results generated from European registries by ESHRE†. Hum Reprod 2018; 33:1586-1601. [DOI: 10.1093/humrep/dey242] [Citation(s) in RCA: 314] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ch De Geyter
- Institute of Reproductive Medicine and Gynecological Endocrinology (RME), Vogesenstrasse 134, Basel, Switzerland
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - C Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, Lisboa, Portugal
| | - M S Kupka
- Gynaekologicum Hamburg, Gynaecology and Obstetrics, Altonaer Strasse 59, Hamburg, Germany
| | - C Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, Brussels, Belgium
| | - E Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master's House, Parnell Square, 1 Dublin, Ireland
| | - T Motrenko
- Medical Centre Cetinje, Human Reproduction Department, Vuka Micunovica 4, Cetinje, Montenegro
| | - G Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, Roma, Italy
| | - J Smeenk
- Department of Obstetrics and Gynaecology, St Elisabeth Hospital Tilburg, Hilv, The Netherlands
| | - S Vidakovic
- Institute for Obstetrics and Gynecology, Clinical Center Serbia ‘GAK’, Visegradska 26, Belgrade, Serbia
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen, Belgium
| | - Orion Gliozheni
- University Hospital for Obst&Gynecology, Departement of Obstetrics & Gynecology, Bul.B.Curri, Tirana, Albania. Tel: +355-4-222-3632; Fax: +355-4-225-7688; Mobile: +355-682029313. E-mail:
| | - Heinz Strohmer
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | - Obruca
- Lazarettgasse 16-18, 1090 Wien, Austria. Tel: +43-40-111-1400; Fax: +43-40-111-1401. E-mail:
| | | | | | - Oleg Tishkevich
- Centre For Assisted Reproduction ‘Embryo’ Belivpul, Filimonova Str. 53, 220114 Minsk, Belarus. Tel: +375-29-622-2722; Fax: +375-17-237-6404; Mobile: +375-296222722; E-mail:
| | - Christine Wyns
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Av. Hippocrate, 10, 1200 Brussels, Belgium. Tel. +32-27-64-6576; Fax: +32-27-64-9050; E-mail:
| | - Kris Bogaerts
- I-Biostat, Kapucijnenvoer 35 bus 7001, 3000 Leuven, Belgium. Tel: +32-016-33-6890; Fax: +32-016-33-7015. E-mail:
| | - Devleta Balic
- Zavod za humanu reprodukciju ‘Dr Balic’, Kojsino 25, 75000 Tuzla, Bosnia—Herzegovina. Tel: +387-35-26-0650; Mobile: +387-61140222; E-mail:
| | - Sanja Sibincic
- Health Centre Medico-S, Jevrejska 58/A, 78000 Banja Luka, Bosnia—Herzegovina. Tel: +387-51-232-100; Mobile: +387-65515942; E-mail:
| | - Irena Antonova
- ESHRE certified clinical embryologist (2011), Ob/Gyn Hospital Dr Shechterev, 25-31, Hristo Blagoev Strasse, 1330 Sofia, Bulgaria. Tel: +359-88-712-7651; E-mail:
| | - Hrvoje Vrcic
- Zagreb University Medical School, Obstetrics and Gynecology, Petrova 13, 10000 Zagreb, Croatia. Tel: +385-14-60-4646; Fax: +385-14-63-3512; E-mail:
| | - Dejan Ljiljak
- Clinical Hospital Centre ‘Sestre milosrd’, Department for Biology of Human Reproduction, Ob/Gyn Clinic, Vinogradska c. 29, 10000 Zagreb, Croatia. Tel: +385-378-7597; Fax: +385-13-76-8272; Mobile: +385-378-7125; E-mail:
| | - Michael Pelekanos
- Fertility Centre Aceso, 1, Pavlou Nirvana str., 3021 Limassol, Cyprus. Tel: +357-99-64-5333; Fax: +357-25-82-4477; Mobile +30-6944248433; E-mail:
| | - Karel Rezabek
- Medical Faculty, University Hopsital, CAR-Assisited Reproduction Centre, Gyn/Ob departement, Apolinarska 18, 12000 Prague, Czech Republic. Tel: +420-22-496-7479; Fax: +420-22-492-2545; Mobile: +420-724685276; E-mail:
| | - Jitka Markova
- Institute of Health Information and Statistics of the Czech Republic, Palackeho namesti 4, 12801 Prague, Czech Republic. Tel: +420-22-497-2832; Mobile: +420-72-182-7532; E-mail:
| | - Josephine Lemmen
- Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Tel: +45-35-450-934; Fax: +45-35-454-945; Mobile: +45-30285712; E-mail:
| | - Deniss Sõritsa
- Tartu University Hospital and Elitre Clinic, Tartu, Estonia. Tel: +372-740-9930; Fax: +372-740-9931; E-mail:
| | - Mika Gissler
- THL National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Tel: +385-29-524-7279; E-mail:
| | - Aila Tiitinen
- Helsinki University Central Hospital, Dept. of Ob/Gyn, Haartmaninkatu, 2, PO Box 140, 00029 HUS—Helsinki, Finland. Tel: + 358-50-427-1217; E-mail:
| | - Dominique Royere
- Agence de la Biomédecine, 1 Av du stade de France, 93212 Saint-Denis La Plaine Cedex, France.Tel.: +33-15-593-6555; Fax: +33-15-593-6561; E-mail:
| | - Andreas Tandler—Schneider
- Fertility Centre Berlin; Spandauer damm 130; 14050 Berlin; Germany. Tel: +49-30-23-320-8110; Fax: +49-30-23-320-8119; E-mail:
| | - Markus Kimmel
- D.I.R. Geschäftsstelle, Torstrasse 140, D-10119 Berlin, Germany. Tel: +49-303-980-0743; E-mail:
| | - Aris J Antsaklis
- Professor of Obstetrics and Gynecology, University of Athens, President Hellenic Authority of Assisted Human Reproduction. Tel: +30-694-429-9699; E-mail:
| | - Dimitris Loutradis
- Athens Medical School, 1st Department of OB/GYN, 62, Sirinon Street, 17561 P. Faliro, Athens, Greece. Tel: +30-19-83-3576; Fax: +30-19-88-3834; Mobile: +30-693-242-1747; E-mail:
| | - Janos Urbancsek
- Semmelweis University, 1st Dept. of Ob/Gyn, Baross utca 27, 1088 Budapest, Hungary. Tel: +36-12-66-0115; Fax: +36-12-66-0115; E-mail:
| | - G Kosztolanyi
- University of Pecs, Dept. of Medical Genetics and Child Development, Jozsef A.u.7., 7623 Pecs, Hungary. Tel: +36-72-53-5977; Fax: +36-72-53-5972; E-mail:
| | - Hilmar Bjorgvinsson
- Art Medica, Baejarlind 12, 201 Kopavogur, Iceland. Tel: +354-515-8100; Fax: +354-515-8103; E-mail:
| | - Edgar Mocanu
- Human Assisted Reproduction Ireland Rotunda Hospital, HARI Unit, Master’s House, Parnell Square, 1 Dublin, Ireland. Tel: +353-18-07-2732; Mobile: +353-86-81-8839; Fax: +353-18-72-7831; E-mail:
| | - Giulia Scaravelli
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-49-90-4050; Fax: +39-49-90-4324; E-mail:
| | - Roberto de Luca
- Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161 Roma. Tel: +39-064-990-4320; E-mail:
| | - Vyacheslav Lokshin
- The Urban Centre of Human Reproduction, Tole Be Street 99, 50012 Almaty, Kazakhstan. Tel: +7-727-234-3434; Fax: +7-727-264-6615; Mobile: +7-7017558209; E-mail:
| | - Valiyev Ravil
- The Scientific Centre for Obstetrics, Gynecology and Perinatology, Dostyk street 125, 050020 Almaty, Kazakhstan. Tel: +7-727-300-4530; Fax: +7-727-300-4529; Mobile: +7-7772258189; E-mail:
| | - Valeria Magomedova
- Jusu Arsti Private Clinic, Apuzes 14, 1046 Riga, Latvia. Tel: +371-67-87-0029; E-mail:
| | - Zivile Gudleviciene
- Baltic American Clinic, IVF Laboratory, Nemencines rd 54 A, 10103 Vilnius, Lithuania. Tel: + 370-52-34-2020; Mobile: +370-68682417; E-mail:
| | - Giedre Belo lopes
- Northway Medical Centre, S. Žukausko g. 19, Vilnius 08234, Lithuania. Tel: + 370-529-8290; E-mail:
| | - Zoranco Petanovski
- Re-medika Hospital; Jane dandaniski 87/1/4, 1000 Skopje, Macedonia. Tel: +389-23-07-3335; Mobile: +389-72443114; E-mail:
| | - Jean Calleja-Agius
- University of Malta, 12, Mon Nid, Gianni Faure Street, TXN2421 Tarxien, Malta. Tel: +356-21-69-3041; Mobile: +356-99-55-3653; E-mail:
| | - Josephine Xuereb
- Mater Dei Hospital Malta, Apt 1 Hampton Place, BKR 104 B’Kara, Malta. Tel: +356-99-99-2382; E-mail:
| | - Veaceslav Moshin
- Medical Director at Repromed Moldova, Centre of Mother @ Child protection, State Medical and Pharmaceutical University ‘N.Testemitanu’, Bd. Cuza Voda 29/1, Chisinau, Republic of Moldova. Tel: +373-22-26-3855; Mobile: +373-69724433; E-mail:
| | - Tatjana Motrenko Simic
- Medical Centre Cetinje, Human Reproduction Departement, Vuka Micunovica 4, 81310 Cetinje, Montenegro. Tel: +382-41-23-2690; Fax: +382-41-23-1212; Mobile: +382-69-05-2331; E-mail:
| | - Dragana Vukicevic
- Hospital ‘Danilo I’, Humana reprodukcija, Vuka Micunovica bb, 86000 Cetinje, Montenegro. Tel: +382-67-55-1371; E-mail:
| | - Liv Bente Romundstad
- St. Olavs Hospital, Postboks 3250 Sluppen, Olav Kyrres gt.17, 7006 Trondheim, Norway. Tel: +47-73-86-8000; Fax: +47-73-86-7602; Mobile: +47-90-55-0207; E-mail: ,
| | - Anna Janicka
- VitroLive, Kasprzaka 2 A, 71-074 Szczecin, Poland. Tel: +48-69-167-6305; E-mail:
| | - Carlos Calhaz-Jorge
- CNPMA, assembleia da Republica, Palacio de Sao Bento, 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ana Rita Laranjeira
- CNPMA, Assembleia da Republica, Palaio de Sao Bento 1249-068 Lisboa, Portugal. Tel: +351-21-391-9303; Fax: +351-21-391-7502; E-mail:
| | - Ioana Rugescu
- Gen Secretary of AER Embryologist association and Representative for Human Reproduction Romanian Society. Tel: +40-74-450-0267; E-mail:
| | - Bogdan Doroftei
- Univ. of Medicine and Pharmacy Iasi; Teaching Hospital Obgyn ‘Cuza Voda’; Cuza Voda Str. 34; 700038 Iasi; Romania. Tel: + 40-23-221-3000/int. 176; Mobile: +40-744515297; E-mail: ;
| | - Vladislav Korsak
- International Centre for Reproductive Medicine, General Director, Liniya 11, Building 18B, Vasilievsky Island, 199034 St-Petersburg, Russia C.I.S. Tel: +7-812-328-2251; Fax: +7-812-327-1950; Mobile: +7-921-965-1977; E-mail:
| | - Nebosja Radunovic
- Institute for Obstetrics and Gynecology, Visegradska 26, 11000 Belgrade, Serbia. Tel: +38-111-361-5592; Fax: +38-111-361-5603; Mobile: +381-63200204; E-mail:
| | - Nada Tabs
- Klinika za ginekologiju i akuserstvo, Klinicki centar Vojvodine, Branimira Cosica 37, 21000 Novi Sad, Serbia. Mobile: +381-63508185; E-mail:
| | - Irma Virant-Klun
- University Medical Centre Ljubljana, Departement of Obstetrics and Gynecology, Slajmerjeva 3, 1000 Ljubljana, Slovenia. Tel: +386-1-522-6013; Fax: +386-1-431-4355; Mobile:+386-31625774; E-mail:
| | - Irene Cuevas Saiz
- Hospital General de Alicante, Infertility Dept., Av Pintor Baeza, 12, 03010 Valencia, Spain;. Tel: +34-96-197-2000; Fax: +34-91-799-4407; Mobile +34-677245650; E-mail:
| | - Fernando Prados Mondéjar
- Hospital de Madrid-Montepríncipe, HM Fertility Centre Monteprincipe, C/Montepríncipe 25, 28660 Boadilla del Monte, Spain. Tel: +34-91-708-9931; Mobile +34-646737237; E-mail:
| | - Christina Bergh
- Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Bla Straket 6, 413 45 Göteborg, Sweden. Tel: +46-31-342-1000, +46-73-688-9325; Fax: +46-31-41-8717; Mobile +46-736889325; E-mail:
| | - Maya Weder
- Administration FIVNAT, Postfach 754, 3076 Worb, Switzerland. Tel: +41-031-819-7602; Fax + 41-031-819-8920; E-mail:
| | - Christian De Geyter
- University Women’s Hospital of Basel, Abteilungsleiter gyn. Endokrinologie und Reproduktionsmedizin, Spitalstrasse 21, 4031 Basel, Switzerland. Tel: +41-61-265-9315; Fax: + 41-61-265-9194; E-mail:
| | - Jesper M J Smeenk
- St Elisabeth Hospital Tilburg, Dept. of obstetrics and Gynaecology, Hilv, The Netherlands. Tel: +31-13-539-3108; Mobile: +31-622753853; E-mail:
| | - Mykola Gryshchenko
- IVF Clinic Implant Ltd, Academician V.I.Gryshchenko Clinic for Reproductive Medicine, 25 Karl Marx Str., 61000 Kharkiv, Ukraine. Tel: +380-57-12-4522; Fax: +380-57-70-507-0703; Mobile +380-57705070703; E-mail:
| | - Richard Baranowski
- Deputy Information Manager, Human Fertilization and Embryology Authority (HFEA), Finsbury Tower, 103-105 Bunhill Row, London EC1 Y 8HF, UK. Tel: +44-020-7539-3329; Fax: +44-020-7377-1871; E-mail:
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Walsh SJ, Hanratty CG, Watkins S, Oldroyd KG, Mulvihill NT, Hensey M, Chase A, Smith D, Cruden N, Spratt JC, Mylotte D, Johnson T, Hill J, Hussein HM, Bogaerts K, Morice MC, Foley DP. Culotte stenting for coronary bifurcation lesions with 2nd and 3rd generation everolimus-eluting stents: the CELTIC Bifurcation Study. EUROINTERVENTION 2018; 14:e318-e324. [DOI: 10.4244/eij-d-18-00346] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Van Binnebeek S, Koole M, Terwinghe C, Baete K, Vanbilloen B, Haustermans K, Clement P, Bogaerts K, Verbruggen A, Nackaerts K, Van Cutsem E, Verslype C, Mottaghy F, Deroose C. Dynamic 68Ga-DOTATOC PET/CT and static image in NET patients. Nuklearmedizin 2018; 55:104-14. [DOI: 10.3413/nukmed-0742-15-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
SummaryPurpose: To investigate the relationship between the dynamic parameters (Ki) and static image-derived parameters of 68Ga-DOTATOC-PET, to determine which static parameter best reflects underlying somatostatin-receptor-expression (SSR) levels on neuroendocrine tumours (NETs). Patients, methods: 20 patients with metastasized NETs underwent a dynamic and static 68Ga-DOTATOC-PET before PRRT and at 7 and 40 weeks after the first administration of 90Y-DOTATOC (in total 4 cycles were planned); 175 lesions were defined and analyzed on the dynamic as well as static scans. Quantitative analysis was performed using the software PMOD. One to five target lesions per patient were chosen and delineated manually on the baseline dynamic scan and further, on the corresponding static 68Ga-DOTATOC-PET and the dynamic and static 68Ga-DOTATOC-PET at the other time-points; SUVmax and SUVmean of the lesions was assessed on the other six scans. The input function was retrieved from the abdominal aorta on the images. Further on, Ki was calculated using the Patlak-Plot. At last, 5 reference regions for normalization of SUVtumour were delineated on the static scans resulting in 5 ratios (SUVratio). Results: SUVmax and SUVmean of the tumoural lesions on the dynamic 68Ga-DO-TATOC-PET had a very strong correlation with the corresponding parameters in the static scan (R²: 0.94 and 0.95 respectively). SUVmax, SUVmean and Ki of the lesions showed a good linear correlation; the SUVratios correlated poorly with Ki. A significantly better correlation was noticed between Ki and SUVtumour(max and mean) (p < 0.0001). Conclusions: As the dynamic para meter Ki correlates best with the absolute SUVtumour, SUVtumour best reflects underlying SSR-levels in NETs.
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Varenne O, Cook S, Sideris G, Kedev S, Cuisset T, Carrié D, Hovasse T, Garot P, El Mahmoud R, Spaulding C, Helft G, Diaz Fernandez JF, Brugaletta S, Pinar-Bermudez E, Mauri Ferre J, Commeau P, Teiger E, Bogaerts K, Sabate M, Morice MC, Sinnaeve PR. Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet 2018; 391:41-50. [PMID: 29102362 DOI: 10.1016/s0140-6736(17)32713-7] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Elderly patients regularly receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of double antiplatelet therapy (DAPT). The aim of this study was to compare outcomes between these two types of stents with a short duration of DAPT in such patients. METHODS In this randomised single-blind trial, we recruited patients from 44 centres in nine countries. Patients were eligible if they were aged 75 years or older; had stable angina, silent ischaemia, or an acute coronary syndrome; and had at least one coronary artery with a stenosis of at least 70% (≥50% for the left main stem) deemed eligible for percutaneous coronary intervention (PCI). Exclusion criteria were indication for myocardial revascularisation by coronary artery bypass grafting; inability to tolerate, obtain, or comply with DAPT; requirement for additional surgery; non-cardiac comorbidities with a life expectancy of less than 1 year; previous haemorrhagic stroke; allergy to aspirin or P2Y12 inhibitors; contraindication to P2Y12 inhibitors; and silent ischaemia of less than 10% of the left myocardium with a fractional flow reserve of 0·80 or higher. After the intended duration of DAPT was recorded (1 month for patients with stable presentation and 6 months for those with unstable presentation), patients were randomly allocated (1:1) by a central computer system (blocking used with randomly selected block sizes [two, four, eight, or 16]; stratified by site and antiplatelet agent) to either a DES or similar BMS in a single-blind fashion (ie, patients were masked), but those assessing outcomes were masked. The primary outcome was to compare major adverse cardiac and cerebrovascular events (ie, a composite of all-cause mortality, myocardial infarction, stroke, or ischaemia-driven target lesion revascularisation) between groups at 1 year in the intention-to-treat population, assessed at 30 days, 180 days, and 1 year. This trial is registered with ClinicalTrials.gov, number NCT02099617. FINDINGS Between May 21, 2014, and April 16, 2016, we randomly assigned 1200 patients (596 [50%] to the DES group and 604 [50%] to the BMS group). The primary endpoint occurred in 68 (12%) patients in the DES group and 98 (16%) in the BMS group (relative risk [RR] 0·71 [95% CI 0·52-0·94]; p=0·02). Bleeding complications (26 [5%] in the DES group vs 29 [5%] in the BMS group; RR 0·90 [0·51-1·54]; p=0·68) and stent thrombosis (three [1%] vs eight [1%]; RR 0·38 [0·00-1·48]; p=0·13) at 1 year were infrequent in both groups. INTERPRETATION Among elderly patients who have PCI, a DES and a short duration of DAPT are better than BMS and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI. FUNDING Boston Scientific.
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Affiliation(s)
- Olivier Varenne
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiology Department, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France.
| | - Stéphane Cook
- Cardiology Department, University and Hospital Fribourg, Fribourg, Switzerland
| | - Georgios Sideris
- Service de Cardiologie-Institut national de la santé et de la recherche médicale U942, Hôpital Lariboisiere, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Sasko Kedev
- Cardiology Department, University St Cyril and Methodius, Skopje, Macedonia
| | - Thomas Cuisset
- Département de Cardiologie, Centre hospitalier universitaire Timone, Marseille, France
| | - Didier Carrié
- Service de Cardiologie, Centre hospitalier universitaire Toulouse Rangueil, Université Paul Sabatier, Toulouse, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy and Quincy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy and Quincy, France
| | - Rami El Mahmoud
- Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Christian Spaulding
- Service de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Descartes University and Sudden Death Expert Center, Institut national de la santé et de la recherche médicale U990, Paris, France
| | - Gérard Helft
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie et Institut hospitalo-universitaire, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | | | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | | | - Philippe Commeau
- Département de Cardiologie Interventionnelle, Polyclinique Les Fleurs, Ollioules, France
| | - Emmanuel Teiger
- Service de Cardiologie, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
| | - Manel Sabate
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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Calhaz-Jorge C, De Geyter C, Kupka MS, de Mouzon J, Erb K, Mocanu E, Motrenko T, Scaravelli G, Wyns C, Goossens V, Gliozheni O, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Petrovskaya E, Tishkevich O, Wyns C, Bogaerts K, Antonova I, Vrcic H, Ljiljak D, Pelekanos M, Rezabek K, Markova J, Lemmen J, Erb K, Sõritsa D, Gissler M, Tiitinen A, Royere D, Tandler A, Kimmel M, Loutradis D, Antsaklis AJ, Urbancsek J, Kosztolanyi G, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Ravil V, Magomedova V, Gudleviciene Z, Belo lopes G, Petanovski Z, Calleja-Agius J, Moshin V, Motrenko Simic T, Vukicevic D, Romundstad LB, Janicka A, Calhaz-Jorge C, Laranjeira AR, Rugescu I, Doroftei B, Korsak V, Radunovic N, Tabs N, Tomazevic T, Virant-Klun I, Hernandez JH, Alcalá JAC, Bergh C, Weder M, De Geyter C, Smeenk JM, Gryshchenko M, Baranowski R. Assisted reproductive technology in Europe, 2013: results generated from European registers by ESHRE†. Hum Reprod 2017; 32:1957-1973. [DOI: 10.1093/humrep/dex264] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - C Calhaz-Jorge
- Faculdade de Medicina de Universidade de Lisboa, Portugal
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C De Geyter
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- University Women's Hospital of Basel, Abteilungsleiter gyn. Endokrinologie und Reproduktionsmedizin, Switzerland
| | - M S Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Kinderwunschzentrum Altonaer Strasse im Gynaekologicum Hamburg, Germany
| | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- INSERM, France
| | - K Erb
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Odense University Hospital, Fertility Clinic, Denmark
| | - E Mocanu
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- HARI Unit, Rotunda Hospital, Ireland
| | - T Motrenko
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- Human Reproduction Centre Budva, Montenegro
| | - G Scaravelli
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- National Health Institute, Woman, Child and Adolescent Health Unit, Italy
| | - C Wyns
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
- UCLouvain, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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De Smedt J, Van Kelst S, Boecxstaens V, Stas M, Bogaerts K, Vanderschueren D, Aura C, Vandenberghe K, Lambrechts D, Wolter P, Bechter O, Nikkels A, Strobbe T, Emri G, Marasigan V, Garmyn M. Vitamin D supplementation in cutaneous malignant melanoma outcome (ViDMe): a randomized controlled trial. BMC Cancer 2017; 17:562. [PMID: 28835228 PMCID: PMC5569491 DOI: 10.1186/s12885-017-3538-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/09/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous studies have investigated the protective effect of vitamin D serum levels, at diagnosis and during the follow-up period after treatment, on melanoma outcome. In the present study we assess whether vitamin D supplementation, in the follow-up period after diagnosis and surgical resection of the primary tumor, has a protective effect on relapse of cutaneous malignant melanoma and whether this protective effect correlates with vitamin D levels in serum and Vitamin D Receptor immunoreactivity in the primary tumor. METHODS/DESIGN This study is a multicenter randomized double blind placebo- controlled phase III trial. Patients between the age of 18 and 80 years diagnosed and treated surgically for a melanoma stage IB-III are eligible for randomization in a 1:1 ratio to active treatment or placebo. The study drug is taken each month and consists of either 100,000 International Unit cholecalciferol or arachidis oleum raffinatum used as a placebo. The primary endpoint is relapse free survival. The secondary endpoints are 25 hydroxyvitamin D3 serum levels at diagnosis and at 6 month intervals, melanoma subtype, melanoma site and stage of melanoma at diagnosis according to the 2009 American Joint Committee on Cancer melanoma staging and classification. At randomization a bloodsample is taken for DNA analysis. The study is approved by the local Ethics Committees. DISCUSSION If we can confirm our hypothesis that vitamin D supplementation after removal of the tumor has a protective effect on relapse of cutaneous malignant melanoma we may reduce the burden of CMM at several levels. Patients, diagnosed with melanoma may have a better clinical outcome and improved quality of life. There will be a decrease in health care costs related to treatment of metastatic disease and there will be a decrease in loss of professional years, which will markedly reduce the economic burden of the disease. TRIAL REGISTRATION Clinical Trial.gov, NCT01748448 , 05/12/2012.
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Affiliation(s)
- J. De Smedt
- Laboratory of Dermatology, Department of oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - S. Van Kelst
- Laboratory of Dermatology, Department of oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - V. Boecxstaens
- Oncological and vascular access surgery, Department of surgical oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of oncology, KU Leuven, 3000 Leuven, Belgium
| | - M. Stas
- Oncological and vascular access surgery, Department of surgical oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of oncology, KU Leuven, 3000 Leuven, Belgium
| | - K. Bogaerts
- KU Leuven, Faculty of Medicine, I-BioStat, 3000 Leuven, Belgium
- Hasselt University, I-BioStat, 3590 Diepenbeek, Belgium
| | - D. Vanderschueren
- Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - C. Aura
- Translational Cell & Tissue Research, Department of Imaging & Pathology, KU Leuven, 3000 Leuven, Belgium
- Department of Pathology, University Hospitals of Leuven, 3000 Leuven, Belgium
| | - K. Vandenberghe
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - D. Lambrechts
- Laboratory for Translational Genetics, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Vesalius Research Center, VIB, 3000 Leuven, Belgium
| | - P. Wolter
- Department of Hematology and Oncology, CHR Verviers East Belgium, 4800 Verviers, Belgium
| | - O. Bechter
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, 3000 Leuven, Belgium
| | - A. Nikkels
- Department of Dermatology, CHU Sart Tilman, University of Liège, 4000 Liège, Belgium
| | - T. Strobbe
- Department of Dermatology, University Hospital Antwerp, 2650 Edegem, Belgium
| | - G. Emri
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, 4012 Hungary
| | - V. Marasigan
- Laboratory of Dermatology, Department of oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - M. Garmyn
- Laboratory of Dermatology, Department of oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
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Díaz Rodríguez R, Van Hoeck B, De Gelas S, Blancke F, Ngakam R, Bogaerts K, Jashari R. Determination of residual dimethylsulfoxide in cryopreserved cardiovascular allografts. Cell Tissue Bank 2017; 18:263-270. [DOI: 10.1007/s10561-016-9607-0] [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: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Varenne O, Cuisset T, Chaïb A, Morice MC, Sabaté M, Koh TH, Durand-Zaleski I, Hanon O, Bogaerts K, Sinnaeve P. The SYNERGY II Everolimus elutiNg stent In patients Older than 75 years undergoing coronary Revascularisation associated with a short dual antiplatelet therapy (SENIOR) trial: rationale and design of a large-scale randomised multicentre study. EUROINTERVENTION 2017; 12:1614-1622. [DOI: 10.4244/eijy15m12_02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vermeersch K, Gabrovska M, Deslypere G, Demedts IK, Slabbynck H, Aumann J, Ninane V, Verleden GM, Troosters T, Bogaerts K, Brusselle GG, Janssens W. The Belgian trial with azithromycin for acute COPD exacerbations requiring hospitalization: an investigator-initiated study protocol for a multicenter, randomized, double-blind, placebo-controlled trial. Int J Chron Obstruct Pulmon Dis 2016; 11:687-96. [PMID: 27099485 PMCID: PMC4820219 DOI: 10.2147/copd.s95501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/23/2022] Open
Abstract
Background Long-term use of macrolide antibiotics is effective to prevent exacerbations in chronic obstructive pulmonary disease (COPD). As risks and side effects of long-term intervention outweigh the benefits in the general COPD population, the optimal dose, duration of treatment, and target population are yet to be defined. Hospitalization for an acute exacerbation (AE) of COPD may offer a targeted risk group and an obvious risk period for studying macrolide interventions. Methods/design Patients with COPD, hospitalized for an AE, who have a smoking history of ≥10 pack-years and had ≥1 exacerbation in the previous year will be enrolled in a multicenter, randomized, double-blind, placebo-controlled trial (NCT02135354). On top of a standardized treatment of systemic corticosteroids and antibiotics, subjects will be randomized to receive either azithromycin or placebo during 3 months, at an uploading dose of 500 mg once a day for 3 days, followed by a maintenance dose of 250 mg once every 2 days. The primary endpoint is the time-to-treatment failure during the treatment phase (ie, from the moment of randomization until the end of intervention). Treatment failure is a novel composite endpoint defined as either death, the admission to intensive care or the requirement of additional systemic steroids or new antibiotics for respiratory reasons, or the diagnosis of a new AE after discharge. Discussion We investigate whether azithromycin initiated at the onset of a severe exacerbation, with a limited duration and at a low dose, might be effective and safe in the highest risk period during and immediately after the acute event. If proven effective and safe, this targeted approach may improve the treatment of severe AEs and redirect the preventive use of azithromycin in COPD to a temporary intervention in the subgroup with the highest unmet needs.
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Affiliation(s)
- Kristina Vermeersch
- KU Leuven, Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine, Leuven, Belgium
| | - Maria Gabrovska
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Griet Deslypere
- Department of Pneumology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Ingel K Demedts
- Department of Respiratory Medicine, AZ Delta Roeselare-Menen, Roeselare, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium
| | - Joseph Aumann
- Department of Pneumology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Vincent Ninane
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Geert M Verleden
- KU Leuven, Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine, Leuven, Belgium
| | - Thierry Troosters
- KU Leuven, Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine, Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
| | - Kris Bogaerts
- KU Leuven, Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium; Hasselt University, Hasselt, Belgium
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Wim Janssens
- KU Leuven, Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine, Leuven, Belgium
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Sinnaeve PR, Danays T, Bogaerts K, Van de Werf F, Armstrong PW. Drug Treatment of STEMI in the Elderly: Focus on Fibrinolytic Therapy and Insights from the STREAM Trial. Drugs Aging 2016; 33:109-18. [PMID: 26849132 DOI: 10.1007/s40266-016-0345-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Elderly patients constitute a large and growing proportion of ST-elevation myocardial infarction (STEMI) patients, yet they have been under-represented or even excluded from reperfusion trials. Despite evidence that fibrinolysis improves outcomes irrespective of age, many elderly STEMI patients still remain undertreated or subject to major delays to primary percutaneous coronary intervention (PCI). The fear of an excessive risk of intracranial hemorrhage (ICH) in these patients can lead to avoidance of potentially life-saving reperfusion treatment, despite the fact that current STEMI guidelines do not exclude the elderly from a pharmaco-invasive strategy. Age-specific dose reductions have been succesfully made to antithrombotic drugs such as clopidogrel and enoxaparin as an adjunct to fibrinolysis, but until recently no dose adjustments for elderly patients have been applied to the fibrinolytic agents. In the pharmaco-invasive STREAM trial, halving the bolus of tenecteplase for patients aged >75 years because of an unacceptably high ICH rate in the elderly was associated with a more favorable safety/efficacy profile. Whether a pharmaco-invasive strategy including half-dose tenecteplase, age- and weight-adjusted enoxaparin, and a tailored P2Y12 inhibitor followed by routine angiography represents a safe and efficacious alternative reperfusion therapy for elderly patients remains to be prospectively assessed in a clinical trial in this age group.
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Affiliation(s)
| | | | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven and University Hasselt, Hasselt, Belgium
| | | | - Paul W Armstrong
- The Canadian Virtual Coordinating Centre for Global Colloborative Cardiovascular Research, University of Alberta, Edmonton, AB, Canada.
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Krausch-Hofmann S, Bogaerts K, Hofmann M, de Almeida Mello J, Fávaro Moreira NC, Lesaffre E, Declerck D, Declercq A, Duyck J. Missing Oral Health-Related Data in the interRAI-HC - Associations with Selected Variables of General Health and the Effect of Multiple Imputation on the Relationship between Oral and General Health. PLoS One 2015; 10:e0146065. [PMID: 26716689 PMCID: PMC4696854 DOI: 10.1371/journal.pone.0146065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Missing data within the comprehensive geriatric assessment of the interRAI suite of assessment instruments potentially imply the under-detection of conditions that require care as well as the risk of biased statistical results. Impaired oral health in older individuals has to be registered accurately as it causes pain and discomfort and is related to the general health status. Objective This study was based on interRAI-Home Care (HC) baseline data from 7590 subjects (mean age 81.2 years, SD 6.9) in Belgium. It was investigated if missingness of the oral health-related items was associated with selected variables of general health. It was also determined if multiple imputation of missing data affected the associations between oral and general health. Materials and Methods Multivariable logistic regression was used to determine if the prevalence of missingness in the oral health-related variables was associated with activities of daily life (ADLH), cognitive performance (CPS2) and depression (DRS). Associations between oral health and ADLH, CPS2 and DRS were determined, with missing data treated by 1. the complete-case technique and 2. by multiple imputation, and results were compared. Results The individual oral health-related variables had a similar proportion of missing values, ranging from 16.3% to 17.2%. The prevalence of missing data in all oral health-related variables was significantly associated with symptoms of depression (dental prosthesis use OR 1.66, CI 1.41–1.95; damaged teeth OR 1.74, CI 1.48–2.04; chewing problems OR 1.74, CI 1.47–2.05; dry mouth OR 1.65, CI 1.40–1.94). Missingness in damaged teeth (OR 1.27, CI 1.08–1.48), chewing problems (OR 1.22, CI 1.04–1.44) and dry mouth (OR 1.23, CI 1.05–1.44) occurred more frequently in cognitively impaired subjects. ADLH was not associated with the prevalence of missing data. When comparing the complete-case technique with the multiple imputation approach, nearly identical odds ratios characterized the associations between oral and general health. Conclusion Cognitively impaired and depressive individuals had a higher risk of missing oral health-related information. Associations between oral health and ADLH, CPS2 and DRS were not influenced by multiple imputation of missing data. Further research should concentrate on the mechanisms that mediate the occurrence of missingness to develop preventative strategies.
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Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, KU Leuven and Hasselt University I-BioStat, KU Leuven, Leuven, Belgium
| | - Michael Hofmann
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology, KU Leuven, Leuven, Belgium
| | | | | | - Emmanuel Lesaffre
- Department of Public Health and Primary Care, KU Leuven and Hasselt University I-BioStat, KU Leuven, Leuven, Belgium
| | - Dominique Declerck
- Department of Oral Health Sciences, Population Studies in Oral Health, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS, Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials, KU Leuven, Leuven, Belgium
- * E-mail:
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Díaz Rodríguez R, Van Hoeck B, Mujaj B, Ngakam R, Fan Y, Bogaerts K, Jashari R. Bacteriology testing of cardiovascular tissues: comparison of transport solution versus tissue testing. Cell Tissue Bank 2015; 17:211-8. [DOI: 10.1007/s10561-015-9537-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022]
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De Neubourg D, Bogaerts K, Blockeel C, Coetsier T, Delvigne A, Devreker F, Dubois M, Gillain N, Gordts S, Wyns C. How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries? Hum Reprod 2015; 31:93-9. [PMID: 26537922 DOI: 10.1093/humrep/dev270] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 06/12/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries? SUMMARY ANSWER Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications. WHAT IS KNOWN ALREADY In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered. STUDY DESIGN, SIZE, DURATION A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles). PARTICIPANTS, MATERIALS, SETTINGS, METHODS CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications. MAIN RESULTS AND ROLE OF CHANCE The CLBR was age dependent and declined from 62.9% for women <35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women <35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole population were 5.1 and 8.6% for the conservative and optimal estimate, respectively. LIMITATIONS, REASONS FOR CAUTION Conservative and optimal estimates use assumptions for the whole ART population and do not take the individual patient into account. WIDER IMPLICATIONS OF THE FINDINGS These data reinforce the validity of the Belgian model of coupling reimbursement of ART costs to a restriction in the number of embryos transferred. Our data can improve decision-making in medical ART practice both on the patient level and for society at large and could provide health care takers and insurance companies with a valid model. STUDY FUNDING COMPETING INTERESTS none.
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Affiliation(s)
- D De Neubourg
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - K Bogaerts
- I-BioStat, KU Leuven, 3000 Leuven and Universiteit Hasselt, 3500 Hasselt, Belgium
| | - C Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
| | - T Coetsier
- Fertility Centre, AZ St Lucas, 9000 Ghent, Belgium
| | - A Delvigne
- Centre de Procréation Médicalement Assistée, Clinique Saint-Vincent, 4000 Liège, Belgium
| | - F Devreker
- Laboratoire de Procréation Médicalement Assistée, Université Libre de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - M Dubois
- Centre de Procréation Médicalement Assistée, Université de Liège, 4000 Liège, Belgium
| | - N Gillain
- Nutrition, Environment and Health, University of Liège, 4000 Liège, Belgium
| | - S Gordts
- Leuven Institute for Fertility and Embryology, 3000 Leuven, Belgium
| | - C Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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Bogaerts K, Lavrenova A, Spoelstra AB, Boyard N, Goderis B. Curing kinetics and morphology of a nanovesicular epoxy/stearyl-block-poly(ethylene oxide) surfactant system. Soft Matter 2015; 11:6212-6222. [PMID: 26144526 DOI: 10.1039/c5sm01051a] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Brittle epoxy based thermosets can be made tougher by introducing structural inhomogeneities at the micro- or nanoscale. In that respect, nano vesicles and worm-like micelles from self-assembling blockcopolymers have been shown to be very effective. This paper describes the curing kinetics and morphology of an epoxy composed of diglycidyl ether of bisphenol A (DGEBA) and 4,4'-methylenedianiline (MDA), modified by 20% of the surfactant stearyl-block-poly(ethylene oxide). Time resolved, synchrotron small-angle X-ray scattering demonstrates that at any time during the epoxy curing process, the surfactant predominantly adopts a bilayer vesicular nano-morphology. Transmission electron microscopy on fully cured systems reveals the coexistence of spherical and worm-like micelles. Differential scanning calorimetry experiments prove that the presence of surfactant reduces the epoxy curing rate but that ultimately full curing is accomplished. The material glass transition temperature falls below that of the pure resin due to plasticization. It is suggested that favorable secondary interactions between the PEO segments and the epoxy resin are responsible for the observed phenomena.
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Affiliation(s)
- K Bogaerts
- Polymer Chemistry & Materials, KU Leuven, Celestijnenlaan 200F, P.O. Box 2404, 3001 Heverlee, Belgium.
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Van Binnebeek S, Vanbilloen B, Baete K, Terwinghe C, Koole M, Mottaghy FM, Clement PM, Mortelmans L, Bogaerts K, Haustermans K, Nackaerts K, Van Cutsem E, Verslype C, Verbruggen A, Deroose CM. Comparison of diagnostic accuracy of (111)In-pentetreotide SPECT and (68)Ga-DOTATOC PET/CT: A lesion-by-lesion analysis in patients with metastatic neuroendocrine tumours. Eur Radiol 2015; 26:900-9. [PMID: 26162577 DOI: 10.1007/s00330-015-3882-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [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: 10/15/2014] [Revised: 05/04/2015] [Accepted: 06/08/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy of (111)In-pentetreotide-scintigraphy with (68)Ga-DOTATOC-positron emission tomography (PET)/computed tomography (CT) in patients with metastatic-neuroendocrine tumour (NET) scheduled for peptide receptor radionuclide therapy (PRRT). Incremental lesions (ILs) were defined as lesions observed on only one modality. METHODS Fifty-three metastatic-NET-patients underwent (111)In-pentetreotide-scintigraphy (24 h post-injection; planar+single-photon emission CT (SPECT) abdomen) and whole-body (68)Ga-DOTATOC-PET/CT. SPECT and PET were compared in a lesion-by-lesion and organ-by-organ analysis, determining the total lesions and ILs for both modalities. RESULTS Significantly more lesions were detected on (68)Ga-DOTATOC-PET/CT versus (111)In-pentetreotide-scintigraphy. More specifically, we observed 1,098 lesions on PET/CT (range: 1-105; median: 15) versus 660 on SPECT (range: 0-73, median: 9) (p<0.0001), with 439 PET-ILs (42/53 patients) and one SPECT-IL (1/53 patients). The sensitivity for PET/CT was 99.9 % (95 % CI, 99.3-100.0), for SPECT 60.0 % (95 % CI, 48.5-70.2). The organ-by-organ analysis showed that the PET-ILs were most frequently visualized in liver and skeleton. CONCLUSION Ga-DOTATOC-PET/CT is superior for the detection of NET-metastases compared to (111)In-pentetreotide SPECT. KEY POINTS Somatostatin receptor PET is superior to SPECT in detecting NET metastases. PET is the scintigraphic method for accurate depiction of NET tumour burden. The sensitivity of PET is twofold higher than the sensitivity of SPECT.
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Affiliation(s)
- S Van Binnebeek
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - B Vanbilloen
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - K Baete
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - C Terwinghe
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - M Koole
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - F M Mottaghy
- Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - P M Clement
- Medical Oncology, University Hospitals Leuven and Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - L Mortelmans
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - K Bogaerts
- Department of Public Health and Primary Care (I-BioStat), KU Leuven and UHasselt, Leuven, Belgium
| | - K Haustermans
- Radiation Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium
| | - K Nackaerts
- Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - E Van Cutsem
- Division of Digestive Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium
| | - C Verslype
- Division of Digestive Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium
| | - A Verbruggen
- Laboratory for Radiopharmacy, KU Leuven, Leuven, Belgium
| | - C M Deroose
- Nuclear Medicine, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. .,Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.
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Van den Bergh L, Lerut E, Haustermans K, Deroose CM, Oyen R, Isebaert S, Budiharto T, Ameye F, Mottaghy FM, Bogaerts K, Van Poppel H, Joniau S. Final analysis of a prospective trial on functional imaging for nodal staging in patients with prostate cancer at high risk for lymph node involvement. Urol Oncol 2015; 33:109.e23-31. [PMID: 25655681 DOI: 10.1016/j.urolonc.2014.11.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 05/14/2014] [Revised: 10/29/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE Accurate staging modalities to diagnose lymph node involvement in patients with prostate cancer (PCa) are lacking. We wanted to prospectively assess sensitivity, specificity, and positive predictive value (PPV) and negative predictive value of (11)C-choline positron emission tomography (PET)-computed tomography (CT) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for nodal staging in patients with PCa at high risk for lymph node involvement. MATERIAL AND METHODS In total, 75 patients with a risk≥10% but<35% for lymph node (LN) metastases (Partin tables) who had N0 lesions based on the findings of contrast-enhanced CT scans were included. Patients underwent (11)C-choline PET-CT and DW MRI before surgery, which consisted of a superextended lymph node dissection followed by radical prostatectomy. LNs were serially sectioned and histopathologically examined after pankeratin staining. These results were used as the gold standard to compare with the imaging results. RESULTS Of 1,665 resected LNs (median = 21, range: 7-49), 106 affected LNs (median = 2, range: 1-10) were found in 37 of 75 patients (49%). On a region-based analysis, we found a low sensitivity of 8.2% and 9.5% and a PPV of 50.0% and 40.0% for (11)C-choline PET-CT and DW MRI, respectively. The patient-based analysis showed a sensitivity of 18.9% and 36.1% for and a PPV of 63.6% and 86.7% (11)C-choline PET-CT and DW MRI, respectively. Even when both imaging modalities were combined, sensitivity values remained too low to be clinically useful. CONCLUSIONS Because of the low sensitivity, there is no indication for routine clinical use of either (11)C-choline PET-CT or DW MRI for LN staging in patients with PCa, in whom CT scan findings were normal.
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Affiliation(s)
- Laura Van den Bergh
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Evelyne Lerut
- Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Radiology, University Hospitals Leuven, Belgium
| | - Sofie Isebaert
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Tom Budiharto
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Department of Radiotherapy, Catharinaziekenhuis Eindhoven, Eindhoven, the Netherlands
| | - Filip Ameye
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Felix M Mottaghy
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Hendrik Van Poppel
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Steven Joniau
- Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Kupka MS, Ferraretti AP, de Mouzon J, Erb K, D'Hooghe T, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V, Strohmer H, Obruca, Kreuz-Kinderwunschzentrum SPG, Bogaerts K, Biostat I, D'Hooghe T, Kyurkchiev S, Antonova I, Rezabek K, Markova J, Erb K, Gissler M, Tiitinen A, Royere D, Buhler K, Uszkoriet M, Loutradis D, Tarlatzis BC, Kosztolanyi G, Urbancsek J, Bjorgvinsson H, Mocanu E, Scaravelli G, Lokshin V, Ravil V, Gudleviciene Z, Matkeviciute G, Lazarevski S, Moshin V, Simic TM, Vukicevic D, Hazekamp JT, Kurzawa R, Calhaz--Jorge C, Laranjeira AR, Rugescu I, Korsak V, Radunovic N, Tabs N, Tomazevic T, Virant-Klun I, Hernandez JH, Castilla Alcala JA, Bergh C, Weder M, De Geyter C, Smeenk JMJ, Lambalk C, Veselovsky V, Baranowski R. Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE. Hum Reprod 2014; 29:2099-113. [DOI: 10.1093/humrep/deu175] [Citation(s) in RCA: 306] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Van Binnebeek S, Baete K, Vanbilloen B, Terwinghe C, Koole M, Mottaghy FM, Clement PM, Mortelmans L, Haustermans K, Van Cutsem E, Verbruggen A, Bogaerts K, Verslype C, Deroose CM. Individualized dosimetry-based activity reduction of ⁹⁰Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 2014; 41:1141-57. [PMID: 24668274 DOI: 10.1007/s00259-013-2670-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Assessment of kidney function evolution after (90)Y-DOTATOC peptide receptor radionuclide therapy (PRRT) with capped activity administration based on a 37-Gy threshold of biological effective dose (BED) to the kidney. METHODS In a prospective phase II study, patients with metastasized neuroendocrine tumours were evaluated for therapy using 185 MBq (111)In-pentetreotide with amino acid coinfusion. Planar whole-body images were acquired at four time-points after injection and kidney volumes were measured using CT/MRI. BED to the kidneys was estimated using an extended BED formula and biexponential renal clearance. Based on published BED dose-toxicity relationships, we allowed a maximal kidney BED of 37 Gy; if the calculated BED exceeded 37 Gy, treatment activity was reduced accordingly. Kidney function was assessed at baseline and at 18 months, predominantly using (51)Cr-EDTA. The rate of renal function decline was expressed as annual glomerular filtration rate loss (aGFRL). RESULTS Only 22 of 50 patients reached the 18-months time-point, with most missing patients having died due to disease progression. In the 22 patients who reached 18 months, no rapid kidney function deterioration was observed over the 18 months, aGFRL >33% was not seen, and only three patients showed an increase of one toxicity grade and one patient an increase of two grades. No significant correlations between kidney volume (p = 0.35), baseline GFR (p = 0.18), risk factors for renal function loss (p = 0.74) and aGFRL were observed. Among the 28 patients who did not reach 18 months, one developed grade 4 kidney toxicity at 15 months after PRRT. CONCLUSION Prospective dosimetry using a 37 Gy BED as the threshold for kidney toxicity is a good guide for (90)Y-DOTATOC PRRT and is associated with a low risk of rapid renal function deterioration and evolution to severe nephrotoxicity.
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De Neubourg D, Bogaerts K, Wyns C, Camus M, Delbaere A, Delvigne A, De Sutter P, Dubois M, Gordts S, Lejeune B, Leroy F, Vandekerckhove F, D'Hooghe T. Reply: the danger of ignoring pregnancy and delivery rates in ART. Hum Reprod 2014; 29:1830-1. [PMID: 24491298 DOI: 10.1093/humrep/deu010] [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: 11/12/2022] Open
Affiliation(s)
- D De Neubourg
- LUFC - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - K Bogaerts
- I-BioStat, Katholieke Universiteit Leuven and Universiteit Hasselt, Leuven, Belgium
| | - C Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M Camus
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - A Delbaere
- Fertility Clinic, Dept Ob/Gyn, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Delvigne
- Centre de PMA, Clinique Saint-Vincent, Liège, Belgium
| | - P De Sutter
- Department of Reproductive Medicine, University Hospital Gent, Gent, Belgium
| | - M Dubois
- Centre de Procréation Médicalement Assistée, Université de Liège, Liège, Belgium
| | - S Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - B Lejeune
- Centre de Procréation Médicalement Assistée, Centre Hospitalier Inter Régional Edith Cavell, Braine l'Alleud, Belgium
| | - F Leroy
- Department of Obstetrics and Gynaecology, Université Libre de Bruxelles, Brussels, Belgium
| | - F Vandekerckhove
- Department of Reproductive Medicine, University Hospital Gent, Gent, Belgium
| | - T D'Hooghe
- LUFC - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Van den Branden S, Van den Broucke S, Leroy R, Declerck D, Bogaerts K, Hoppenbrouwers K. Effect evaluation of an oral health promotion intervention in preschool children. Eur J Public Health 2013; 24:893-8. [PMID: 24367066 DOI: 10.1093/eurpub/ckt204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study evaluates the effectiveness of a multi-component oral health intervention in preschool children in a non-randomized intervention study with a complementary baseline control. METHODS Participants in the main study were 2137 children born between October 2003 and July 2004 in Flanders, Belgium. In the intervention group (50.5% of participants), an oral health education program was added to a standard preventive care program during the first 3 years of life. Oral health examinations were performed by trained dentists when the children were 3 (2007) and 5 (2009) years old. Data on dietary habits, oral hygiene habits and dental attendance were obtained through structured questionnaires. Regression analyses were applied to compare the results of the intervention and control group with baseline measurements obtained before the intervention (2003) in other cohorts of 3- (N = 1291) and 5-year-olds (N = 1325) living in the same regions. RESULTS The prevalence of caries experience was generally lower in the main study compared with the baseline cohorts, with little differences between the intervention and control group. For the oral health-related behaviours, the control group scored mostly better. Nevertheless, compared with baseline, limited differences were observed in dental attendance, tooth brushing, helping with tooth brushing and consuming in-between drinks (P < 0.05). CONCLUSION The study illustrates that a multi-component, theory-based intervention at community level had only a limited and temporary effect on oral health-related behaviours in the community under study. Further research is needed to determine how oral health in young children can be improved in the long term.
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Affiliation(s)
- Sigrid Van den Branden
- 1 Department of Public Health and Primary Care, Centre for Youth Health Care, KU Leuven, 3000 Leuven, Belgium
| | - Stephan Van den Broucke
- 2 Psychological Sciences Research Institute, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Roos Leroy
- 3 Department of Oral Health Sciences, KU Leuven, 3000 Leuven, Belgium 4 Department of Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dominique Declerck
- 3 Department of Oral Health Sciences, KU Leuven, 3000 Leuven, Belgium 4 Department of Dentistry, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kris Bogaerts
- 5 Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KU Leuven, 3000 Leuven, & UHasselt, 3500 Hasselt, Belgium
| | - Karel Hoppenbrouwers
- 1 Department of Public Health and Primary Care, Centre for Youth Health Care, KU Leuven, 3000 Leuven, Belgium
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Vandewalle G, Baeten M, Bogaerts K, Vandekerckhove P, Compernolle V. Evaluation of 6 years of confidential unit exclusion at the Belgian Red Cross Flanders Blood Service. Vox Sang 2013; 106:354-60. [DOI: 10.1111/vox.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 12/01/2022]
Affiliation(s)
- G. Vandewalle
- Belgian Red Cross Flanders Blood Service; Mechelen Belgium
| | - M. Baeten
- Belgian Red Cross Flanders Blood Service; Mechelen Belgium
| | - K. Bogaerts
- Belgian Red Cross Flanders Blood Service; Mechelen Belgium
| | | | - V. Compernolle
- Belgian Red Cross Flanders Blood Service; Mechelen Belgium
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De Neubourg D, Bogaerts K, D'Hooghe T. Reply: Legislation of embryo transfer affected the denominator, not the numerator! Hum Reprod 2013; 29:382. [PMID: 24282118 DOI: 10.1093/humrep/det416] [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: 11/13/2022] Open
Affiliation(s)
- Diane De Neubourg
- LUFC, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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Decramer M, Janssens W, Derom E, Joos G, Ninane V, Deman R, Van Renterghem D, Liistro G, Bogaerts K. Contribution of four common pulmonary function tests to diagnosis of patients with respiratory symptoms: a prospective cohort study. The Lancet Respiratory Medicine 2013; 1:705-13. [DOI: 10.1016/s2213-2600(13)70184-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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