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Vazquez Quino L.A.,Cancer Therapy and Research Center | Chen X.,Fox Chase Cancer Center | Fitzpatrick M.,Cancer Therapy and Research Center | Shi C.,Saint Vincent Medical Center | And 6 more authors.
Technology in Cancer Research and Treatment

A software program [MU-EPID], has been developed to perform patient specific pre-treatment quality assurance (QA) verification for intensity modulated radiation therapy (IMRT) using fluence maps measured with an electronic portal imaging device (EPID). The software converts the EPID acquired images of each IMRT beam, to fluence maps that are equivalent to those calculated by the treatment planning system (TPS). The software has the capability to process Varian, Elekta and Siemens EPID DICOM images. In the present investigation, several IMRT plans for different treatment sites were used to validate the software using the Varian a-Si 1000 EPID with the Pinnacle TPS. A total of 20 IMRT plans of different treatment sites were analyzed. Isodose distributions, dose profiles, dose volume histograms (DVH's) and gamma analysis comparisons were performed to evaluate the accuracy of our method. A gamma index analysis of the isocenter coronal plane was done for each plan and showed an average of 97.44% of gamma passing rate using a 3% and 3 mm gamma criterion. Isodose, DVH and dose profile comparisons were conducted between the original calculated plan and the measured reconstructed plan from the EPID images processed through the MU-EPID software. The results suggest that MU-EPID can be used clinically for patient specific IMRT QA, providing a comprehensive 3D dosimetric evaluation through DVH comparison as well as an option for a 2D gamma analysis. © Adenine Press (2014). Source

Sampaio M.S.,Mendez National Institute of Transplantation | Cho Y.W.,Mendez National Institute of Transplantation | Shah T.,Mendez National Institute of Transplantation | Shah T.,Saint Vincent Medical Center | And 3 more authors.
Nephrology Dialysis Transplantation

Background Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation. Methods Using the OPTN/UNOS database, primary kidney recipients (20002009) were stratified according to transplant type (deceased donor, DD or living donor, LD), donor (D) and recipient (R) EpsteinBarr virus (EBV) serostatus (R+; D/R-and D-/R-) and recipient age. Incidence and adjusted risk of PTLD and death were compared. Results Of the 137 939 primary kidney recipients transplanted between 2000 and 2009, 913 subsequently developed PTLD. In 90 208 recipients with known EBV serostatus, we found a trend toward a decrease in PTLD incidence in years 20072009 when compared to 20002003. This was due to a significant decrease in PTLD incidence in EBV-recipients. Of those, 61 273 had a known donor serostatus and were further examined. In adults, PTLD incidence (in 1000 person-years) in DD and LD was 7.0 and 7.0 in D +R-; 3.0 and 2.5 in D-/R-and 1.2 and 1.0 in R+, respectively. The hazard ratio (HR) for PTLD (R+ as reference) in D +R-(6.2 in DD and 7.2 in LD) was double to thrice than for D-/R-transplants (2.4 in both DD and LD). In pediatric recipients, PTLD incidence in DD and LD was 15.9 and 17.3 in D +R-; 12 and 18 in D-/R-and 1.2 and 2.2 in R+, respectively. The HR for PTLD was 17.4 and 6.9 in D +R-and 15.9 and 7.6 in D-/R-in DD and LD, respectively. Conclusion A D/R-, compared with a D-/R-transplant, may contribute to an increase in PTLD incidence of 35 and 42% in adult DD and LD transplants, respectively. © 2012 The Author. Source

Jarry J.,Military Hospital Desgenettes | Shekher M.,Saint Vincent Medical Center | Imperato M.,Military Hospital Desgenettes | Michel P.,Military Hospital Desgenettes
Clinics and Research in Hepatology and Gastroenterology

Acute appendicitis is the most frequent emergency in gastrointestinal surgery. Obstruction of the appendiceal lumen appears to be one of the most common physiologic mechanisms for the development of acute appendicitis. Once obstructed, the dilatation of the lumen causes ischemia and necrosis of the wall. The most common organisms involved in appendicitis are Escherichia coli, Peptostreptococcus, Bacillus fragilis and Pseudomonas. Rarely, Actinomyces is involved in this process. In this case report, we report a case of actinomycosis of the appendix vermiformis occurring in a 19-year-old male with no predisposing factors. Along with a review of the literature, we will define the risk factors, clinical characteristics, diagnostic methods, and treatment of actinomycosis. © 2011 Elsevier Masson SAS. Source

Majid A.,Beth Israel Deaconess Medical Center | Gaurav K.,Beth Israel Deaconess Medical Center | Gaurav K.,Thomas Jefferson University | Sanchez J.M.,Beth Israel Deaconess Medical Center | And 6 more authors.
Annals of the American Thoracic Society

Objectives: Dynamic flexible bronchoscopy is the "gold standard" for assessing changes in airway luminal size associated with tracheobronchomalacia, but the procedure has not been adequately validated. The present study was designed to test th e validity of diagnosing tracheobronchomalacia by dynamic flexible bronchoscopy through assessing inter- and intraobserver agreements in estimating degree of central airway collapse associated with tracheobronchomalacia. Methods: This prospective observational pilot study enrolledconsecutive patients with suspected tracheobronchomalacia scheduled for dynamic flexible bronchoscopy. Images of the airway lumen were obtained at five different sites in the tracheobronchial tree during forced inspiration and expiration and were evaluated by 23 pulmonologists (not involved in the care of study patients) with different levels of training and experience at baseline (interobserver agreement) and 8 days later (intraobserver agreement). The degree of airway collapse was visually estimated by each examiner and expressed as a percentage of narrowing. A multirater generalized kappa-type statistical method was used to calculate the correlation coefficients and to assess reliability of the measurements obtained during dynamic flexible bronchoscopy. Measurements and Main Results: Between September 1 and 30, 2009, 10 patients (median age, 65 yr) underwent dynamic flexible bronchoscopy. The correlation coef ficients for inter- and intraobserver agreement were favorable and ranged for the five airway sites from 0.68 to 0.92 and from 0.80 to 0.96, respectively. Conclusions: The favorable inter- and intraobserver agreements among 23 pulmonologists using dynamic flexible bronchoscopy to estimate the degree of dynamic central airway collapse provide additional evidence that dynamic fl exible bronchoscopy is a reliable diagnostic tool for tracheobronchomalacia. Copyright © 2014 by the American Thoracic Society Source

Corrales-Tellez E.,Nova Southeastern University | Vu D.,Mendez National Institute of Transplantation | Vu D.,Western University of Health Sciences | Vu D.,Saint Vincent Medical Center | And 7 more authors.
Clinical Transplantation

Granzyme B (GZMB) and perforin 1 gene (PRF1) are key effector molecules of cytotoxic T lymphocytes, in causing acute and chronic solid organ transplant rejection. In this study, we analyzed the impact of GZMB and PRF1 polymorphism on kidney allograft outcomes. In all, 527 de novo kidney Hispanic allograft recipients were genotyped for PRF1 (rs10999426, rs35947132) and GZMB (rs8192917, rs7144366). PRF1 (rs10999426, rs35947132) G alleles and GG genotypes were negatively associated with allograft rejection, demonstrating protection against allograft rejection (OR = 0.61, p = 0.005 for rs1099946; OR = 0.4, p = 0.01 for rs 35947132). On the other hand, the GA heterozygosity of PRF1 was found marginally associated with the rejection group (OR = 1.53, p = 0.05 for rs10999426; OR = 2.24, p = 0.07 for rs35947132). There was a significant increase in allograft survival in time period studied for the PRF1 (rs10999426) GG genotype, while the GA heterozygosity was associated with graft failure. We found no association for polymorphic markers in GZMB gene with allograft rejection. Survival was significantly improved for patients who were homozygous TT for the GZMB (rs8192917) (TT vs. CC/TT, p = 0.041). The result suggests that PRF1 and GZMB gene polymorphisms may determine the incidence of acute rejection or graft survival among Hispanic allograft recipients. © 2013 John Wiley & Sons A/S. Source

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