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West Jerusalem, Israel

Agency: Cordis | Branch: H2020 | Program: RIA | Phase: PHC-18-2015 | Award Amount: 6.00M | Year: 2016

The incidence of paediatric onset Inflammatory Bowel Diseases (PIBD) has risen dramatically in recent decades. Compared to adult forms, PIBD reflects a more severe disease, more often requiring aggressive treatment with immunomodulators, and thereby exposing children to a life-long risk of serious disease and treatment-related adverse events, such as infections and malignancies. Therefore, there is an urgent need to develop strategies which balance, on an individual basis, therapeutic effectiveness with risks of treatment. The overall goal of this proposal is to develop and validate a treatment algorithm for PIBD based on high or low risk predictors for early complicated or relapsing disease. This will improve effectiveness, while reducing treatment related risks and life-long complications due to uncontrolled disease progression. To attain this goal 3 specific aims are proposed under the umbrella of an international network, the PIBD-net: 1) Development of an accessible and feasible risk-stratified treatment algorithm for new onset paediatric IBD on an existing inception cohort and validation in an independent cohort 2) Generation of a prospective large longterm real world inception cohort in a registry designed to analyze effectiveness and safety signals and correlate them to individual risk factors 3) Design and performance of a risk algorithm-based prospective large-scale multicenter randomized clinical trial (RCT) (stratification into high or low risk groups based on specific aim#1) in order to provide optimal personalized therapy : low risk azathioprine vx. methotrexate, high risk : methotrexate vx. adalimumab This project will translate into the first risk-stratified PIBD treatment algorithms allowing optimization of medical therapy while minimizing treatment-related risk (personalized medicine).

Nesher G.,Shaare Zedek Medical Center | Nesher G.,Hebrew University of Jerusalem
Journal of Autoimmunity | Year: 2014

Giant-cell arteritis (GCA) involves the major branches of the aorta with predilection for the extracranial branches of the carotid artery. It occurs in individuals older than 50 years and the incidence increases with age. The signs and symptoms of giant cell arteritis can be classified into four subsets: cranial arteritis, extracranial arteritis, systemic symptoms and polymyalgia rheumatica. Patients may develop any combination of these manifestations, associated with laboratory evidence of an acute-phase reaction. The only test that confirms GCA diagnosis is a temporal artery biopsy, showing vasculitis with mononuclear cell inflammatory infiltrates, often with giant cells. Due to the focal and segmental nature of the infiltrates, areas of inflammation may be missed by the biopsy and the histological examination is normal in about 15% of the cases. Some imaging modalities may aid in the diagnosis of GCA. Among those, color duplex ultrasonography of the temporal arteries is more commonly used. There are no independent validating criteria to determine whether giant cell arteritis is present when a temporal artery biopsy is negative. The American College of Rheumatology criteria for the classification of giant cell arteritis may assist in the diagnosis. However, meeting classification criteria is not equivalent to making the diagnosis in individual patients, and the final diagnosis should be based on all clinical, laboratory, imaging and histological findings. Glucocorticoids are the treatment of choice for GCA. The initial dose is 40-60mg/day for most uncomplicated cases. Addition of low-dose aspirin (100mg/d) has been shown to significantly decrease the rate of vision loss and stroke during the course of the disease. © 2014 Elsevier Ltd. Source

Cherny N.,Shaare Zedek Medical Center
Cancer Journal | Year: 2010

Given that such a substantial proportion of oncology patients have advanced and/or incurable cancer oncologists invariably face enormous challenges in maintaining or improving the quality of life of this cohort of their practice. The provision of supportive and palliative care for these patients is a core element of quality cancer care. As the primary professional health care provider to the cancer patient, the oncologist has a special, significant, and challenging role in the care of these patients and their families. This article addresses the scope of these responsibilities and challenges and provides some introductory insights relating to practice that will be elaborated upon in the other contributions in this special issue of the Cancer Journal. Copyright © 2010 by Lippincott Williams & Wilkins. Source

Hershko C.,Shaare Zedek Medical Center
Annals of the New York Academy of Sciences | Year: 2010

In thalassemia major, iron overload is the joint outcome of multiple blood transfusions and an inappropriately increased iron absorption associated with ineffective erythropoiesis. Threshold values for iron toxicity are a liver iron concentration exceeding 440 mmolesg dry weight, serum ferritin >2500 ngmL, DFO urinary iron excretion >20 mgday, and transferrin saturation >75%. The outpouring of catabolic iron that exceeds the iron-carrying capacity of transferrin results in the emergence of non-transferrin-bound iron (NTBI). NTBI is cleared preferentially by the liver and myocardium at a rate exceeding 200 times that of transferrin iron. NTBI catalyzes the formation of free radicals, resulting in oxidative stress and damage to mitochondria, lysosomes, lipid membranes, proteins, and DNA. The long-term consequences of iron toxicity, including cirrhosis, myocardiopathy, and endocrine disorders, are preventable and mostly reversible by effective iron chelation therapy. Recent technologic advances in the documentation of organ-specific siderosis and the improved efficiency of iron chelating programs resulted in a spectacular improvement in the prevention of iron-induced end-organ failure and improved survival in thalassemic patients. © 2010 New York Academy of Sciences. Source

Silberman S.,Shaare Zedek Medical Center
The Journal of heart valve disease | Year: 2013

A comparison was made of the outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) in high-risk patients. All patients aged > 75 years that underwent a procedure for severe aortic stenosis with or without coronary revascularization at the authors' institution were included in the study; thus, 64 patients underwent TAVI and 188 underwent AVR. Patients in the TAVI group were older (mean age 84 +/- 5 versus 80 +/- 4 years; p < 0.0001) and had a higher logistic EuroSCORE (p = 0.004). Six patients (9%) died during the procedure in the TAVI group, and 23 (12%) died in the AVR group (p = 0.5). Predictors for mortality were: age (p < 0.0001), female gender (p = 0.02), and surgical valve replacement (p = 0.01). Gradients across the implanted valves at one to three months postoperatively were lower in the TAVI group (p < 0.0001). Actuarial survival at one, two and three years was 78%, 64% and 64%, respectively, for TAVI, and 83%, 78% and 75%, respectively, for AVR (p = 0.4). Age was the only predictor for late mortality (p < 0.0001). TAVI patients were older and posed a higher predicted surgical risk. Procedural mortality was lower in the TAVI group, but mid-term survival was similar to that in patients undergoing surgical AVR. Age was the only predictor for late survival. These data support the referral of high-risk patients for TAVI. Source

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