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Dandois V.,Catholic University of Louvain | Rommel D.,Catholic University of Louvain | Renard L.,Catholic University of Louvain | Jamart J.,Cliniques Universitaires Of Mont Godinne | Cosnard G.,Catholic University of Louvain
Journal of Neuroradiology | Year: 2010

Purpose: Our aim was to compare perfusion magnetic resonance imaging (MRI) and positron emission tomography (PET) using carbon-11 labelled methionine (MET) in gliomas and their value in differentiating tumour recurrence from necrosis. Materials and methods: We retrospectively reviewed 28 patients with a high-grade glioma. A total of 33. MR perfusions and MET-PET were ultimately analysable for comparison between the relative cerebral blood volume (rCBV) and MET-PET examinations. Intra- and interobserver reproducibility was assessed and diagnostic value of rCBV compared to MET-PET and histology was assessed by the area under the receiver operating characteristic (ROC) curve. Results: ROC curve analysis showed that rCBV had at least equal performances in differentiating tumour recurrence and necrosis than MET-PET. Cut-off value of rCBV for differentiating tumour from necrosis was 182% with a sensitivity of 81.5% and a specificity of 100%. Conclusion: In clinical practice, perfusion MRI could replace MET-PET for differentiating necrosis from tumour recurrence. © 2009 Elsevier Masson SAS.

Ruers T.,Netherlands Cancer Institute | Punt C.,University of Amsterdam | Van coevorden F.,Netherlands Cancer Institute | Pierie J.P.E.N.,Leeuwarden Medical Center | And 25 more authors.
Annals of Oncology | Year: 2012

Background: This study investigates the possible benefits of radiofrequency ablation (RFA) in patients with non-resectable colorectal liver metastases. Methods: This phase II study, originally started as a phase III design, randomly assigned 119 patients with non-resectable colorectal liver metastases between systemic treatment (n = 59) or systemic treatment plus RFA (± resection) (n = 60). Primary objective was a 30-month overall survival (OS) rate >38% for the combined treatment group. Results: The primary end point was met, 30-month OS rate was 61.7% [95% confidence interval (CI) 48.2-73.9] for combined treatment. However, 30-month OS for systemic treatment was 57.6% (95% CI 44.1-70.4), higher than anticipated. Median OS was 45.3 for combined treatment and 40.5 months for systemic treatment (P = 0.22). PFS rate at 3 years for combined treatment was 27.6% compared with 10.6% for systemic treatment only (hazard ratio = 0.63, 95% CI 0.42-0.95, P = 0.025). Median progression-free survival (PFS) was 16.8 months (95% CI 11.7-22.1) and 9.9 months (95% CI 9.3-13.7), respectively. Conclusions: This is the first randomized study on the efficacy of RFA. The study met the primary end point on 30-month OS; however, the results in the control arm were in the same range. RFA plus systemic treatment resulted in significant longer PFS. At present, the ultimate effect of RFA on OS remains uncertain. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Mouthuy J.,Cliniques Universitaires St Luc | Mouthuy J.,Catholic University of Louvain | Detry B.,Catholic University of Louvain | Sohy C.,Catholic University of Louvain | And 5 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2011

Rationale: Intrinsic asthma was described by Rackemann as asthma without allergy. Local IgE production has been documented in intrinsic asthma, but antigen specificity of this response remains elusive. Objectives: We investigated (1) the presence of dust mite-specific IgE in sputum of patients with intrinsic asthma, (2) their clinical/immunological relevance, and (3) their functionality. Methods: Specific IgE to Dermatophagoides pteronyssinus (Der p) and to recombinant major allergens (rDer p1 and rDer p2) were assayed by ELISA in sputum samples from patients with intrinsic versus atopic asthma and control subjects. Whole-lung challenge was performed with Der p for clinical and inflammatory readouts. Functionality of local IgE to trigger effector cells was assessed using basophil activation test (surface expression of CD203c). Measurements and Main Results: Both total IgE and Der p-specific IgE levels are increased in patients with intrinsic asthma compared with healthy nonatopic patients. However, no immediate asthmatic responses were observed in patients with intrinsic asthma after Der p exposure. These sputum Der p-specific IgE do, however, recognize major allergens Der p1 and Der p2 and are able to trigger activation of blood basophils from atopic donors. Conclusions: We confirm that IgE production occurs in intrinsic asthma and show that part of this IgE recognizes Der p antigens. However, this IgE reactivity does not translate into clinical responses to Der p exposure, despite specificity to major allergens and functionality to activate effector cells in vitro. We postulate that a second signal that promotes IgE-mediated asthmatic responses through FceRI is lacking in intrinsic asthma.

Dangoisse V.,Catholic University of Leuven | Guedes A.,Catholic University of Leuven | Guedes A.,Cliniques Universitaires Of Mont Godinne | Gabriel L.,Catholic University of Leuven | And 4 more authors.
EuroIntervention | Year: 2013

Aims: The transradial approach (TRA) for percutaneous coronary intervention (PCI) recently emerged as a safer vascular access with a similar rate of MACE but a lower success rate requiring crossover to another approach when compared to the transfemoral approach (TFA). Methods and results: In our hospital the introduction of the TRA in November 2003 resulted in a progressive decline of TFA use. Over the five years of conversion to TRA, from 2002 (100% TFA) to 2007 (98% TRA), major adverse cardiac events (MACE) and all in-hospital vascular and bleeding events, related or not to vascular access, were prospectively collected to assess performances of each approach in the specific setting of PCI (percutaneous coronary interventions). Data of 1,928 TFA and 1,672 TRA for a total of 3,600 consecutive PCI procedures are reported. PCI success rate was unchanged by TRA (96.1% versus 95.3% for TFA, NS). TRA was associated with a reduction in the rate of post-PCI myocardial infarction (2.3% versus 3.6% for TFA, p=0.023) and with a significant reduction of MACE (3.8% versus 5.2% for TFA, p=0.041). TRA use was also associated with a marked reduction of blood transfusion and surgery for post-PCI bleeding (0.2% versus 1.5% for TFA, p<0.001), despite more frequent prescription of downstream glycoprotein IIb/IIIa inhibitors (23.7% versus 7.4% for TFA, p<0.001). Thus, TRA resulted in a rapid and significant reduction of all major in-hospital adverse events, cardiac as well as non-cardiac, pooled in a "Net Adverse Clinical Event (NACE) index" of non-desirable events: death, myocardial infarction, stroke, urgent CABG surgery, surgery for bleeding and vascular events and blood transfusion. Such events occurred in 4.1% of TRA (n=69) as compared to 7% of TFA (n=134) (p<0.001), accounting for a 41% relative reduction of this NACE index by TRA. By multivariate analysis, TRA was related to a better in-hospital outcome (OR 0.64, 95% confidence interval [CI] 0.47-0.87; p=0.005). Conclusions: TRA for PCI provides the same success rate as TFA but significantly reduces post hoc related complications. © Europa Digital and Publishing 2013. All rights reserved.

Polosukhin V.V.,Vanderbilt University | Cates J.M.,Vanderbilt University | Lawson W.E.,Vanderbilt University | Zaynagetdinov R.,Vanderbilt University | And 11 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2011

Rationale: Although airway inflammation can persist for years after smoking cessation in patients with chronic obstructive pulmonary disease (COPD), the mechanisms of persistent inflammation are largely unknown. Objectives: We investigated relationships between bronchial epithelial remodeling, polymeric immunoglobulin receptor (pIgR) expression, secretory IgA (SIgA), airway inflammation, and mural remodeling in COPD. Methods: Lung tissue specimens and bronchoalveolar lavage were obtained from lifetime nonsmokers and former smokers with or without COPD. Epithelial structural changes were quantified by morphometric analysis. Expression of pIgR was determined by immunostaining and real-time polymerase chain reaction. Immunohistochemistry was performed for IgA, CD4 and CD8 lymphocytes, and cytomegalovirus and Epstein-Barr virus antigens. Total IgA and SIgA were measured by ELISA and IgA transcytosis was studied using cultured human bronchial epithelial cells. Measurements and Main Results: Areas of bronchial mucosa covered by normal pseudostratified ciliated epithelium were characterized by pIgR expression with SIgA present on the mucosal surface. In contrast, areas of bronchial epithelial remodeling had reduced pIgR expression, localized SIgA deficiency, and increased CD4+ and CD8+ lymphocyte infiltration. In small airways (<2 mm), these changes were associated with presence of herpesvirus antigens, airway wall remodeling, and airflow limitation in patients with COPD. Patients with COPD had reduced SIgA in bronchoalveolar lavage. Air-liquid interface epithelial cell cultures revealed that complete epithelial differentiation was required for normal pIgR expression and IgA transcytosis. Conclusions: Our findings indicate that epithelial structural abnormalities lead to localized SIgA deficiency in COPD airways. Impaired mucosal immunity may contribute to persistent airway inflammation and progressive airway remodeling in COPD.

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