Geisler C.H.,Rigshospitalet |
Van t'Veer M.B.,Daniel Den Hoed Cancer Center |
Jurlander J.,Rigshospitalet |
Walewski J.,Center of Oncology of Poland |
And 11 more authors.
Blood | Year: 2014
The randomized Haemato Oncology Foundation for Adults in The Netherlands 68 phase 3 trial compared front-line chemotherapy with chemotherapy plus the CD52 monoclonal antibody alemtuzumab for high-risk chronic lymphocytic leukemia, defined as at least 1 of the following: unmutated immunoglobulin heavy chain genes, deletion 17p or 11q, or trisomy 12. Fit patients were randomized to receive either 6 28-day cycles of oral FC chemotherapy (days 1 through 3: fludarabine 40 mg/m2 per day and cyclophosphamide 250 mg/m2 per day: n = 139) or FC plus subcutaneous alemtuzumab 30 mg day 1 (FCA, n = 133). FCA prolonged the primary end point, progression-free survival (3-year progression-free survival 53 vs 37%, P = .01), but not the secondary end point, overall survival (OS). However, a post hoc analysis showed that FCA increased OS in patients younger than 65 years (3-year OS 85%vs 76%, P = .035). FCA also increased the overall response rate (88 vs 78%, P = .036), and the bone marrow minimal residual disease-negative complete remission rate (64% vs 43%, P = .016). Opportunistic infections were more frequent following FCA, but without an increase in treatment related mortality (FCA: 3.8%, FC: 4.3%). FCA improves progression-free survival in high-risk chronic lymphocytic leukemia. As anticipated, FCA ismore immunosuppressive than FC, but with due vigilance, does not lead to a higher treatment-related mortality. This study was registered at www.trialregister.nl as trial no. NTR529. © 2014 by The American Society of Hematology.
PubMed | Johannes Wesling Clinic, Charité - Medical University of Berlin, Royal Brisbane & Womens Hospital, Guys And St Thomas Nhs Foundation Trust and 17 more.
Type: Journal Article | Journal: Haematologica | Year: 2016
RESPONSE is an open-label phase 3 study evaluating the Janus kinase 1/Janus kinase 2 inhibitor ruxolitinib versus best available therapy for efficacy/safety in hydroxyurea-resistant or intolerant patients with polycythemia vera. This preplanned analysis occurred when all patients completed the Week 80 visit or discontinued. Objectives included evaluating the durability of the primary response (Week 32 phlebotomy-independent hematocrit control plus 35% spleen volume reduction), its components, and that of complete hematologic remission; and long-term safety. Median exposure was 111 weeks; 91/110 (82.7%) patients randomized to ruxolitinib remained on treatment. No patients continued best available therapy (98/112 [87.5%] crossed over to ruxolitinib, most at/soon after Week 32). At Week 32, primary response was achieved by 22.7% vs. 0.9% of patients randomized to ruxolitinib and best available therapy, respectively (hematocrit control, 60.0% vs. 18.8%; spleen response, 40.0% vs. 0.9%). The probability of maintaining primary and hematocrit responses for 80 weeks was 92% and 89%, respectively; 43/44 spleen responses were maintained until Week 80. Complete hematologic remission at Week 32 was achieved in 23.6% of ruxolitinib-randomized patients; the probability of maintaining complete hematologic remission for 80 weeks was 69%. Among ruxolitinib crossover patients, 79.2% were not phlebotomized, and 18.8% achieved a 35% reduction from baseline in spleen volume after 32 weeks of treatment. New or worsening hematologic laboratory abnormalities in ruxolitinib-treated patients were primarily grade 1/2 decreases in hemoglobin, lymphocytes, and platelets. The thromboembolic event rate per 100 patient-years was 1.8 with randomized ruxolitinib treatment vs. 8.2 with best available therapy. These data support ruxolitinib as an effective long-term treatment option for hydroxyurea-resistant or intolerant patients with polycythemia vera. This trial was registered at clinicaltrials.gov identifier: 01243944.
PubMed | University of Marburg, Catholic University of Leuven and ZNA Stuivenberg
Type: | Journal: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA | Year: 2017
The recently reintroduced bicruciate-retaining Total Knee Arthroplasty (BCR TKA) is an interesting approach in the quest for close replication of knee joint biomechanics and kinematics closer to the native knee. Therefore, this study aimed at providing a detailed biomechanical view on the functional resemblance of BCR TKA to the native knee joint.Seven fresh-frozen full leg cadaver specimens (7610year) were mounted in a 6 degrees-of-freedom kinematic rig that applied a dynamic squatting motion knee flexion. Two motion patterns were performed pre- and post-implantation of a fixed bearing BCR TKA: passive flexion-extension and squatting while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests in triplicate.Overall, differences in tibiofemoral kinematics between native knee and BCR TKA were small. Some minor differences appeared under the load of a squat: less internal tibial rotation and some minor paradoxical anterior translation of the medial femoral condyle during mid-flexion. BCR TKA may slightly elevate the joint line. Knee laxity as measured by the Lachman and varus/valgus tests was not significantly influenced by BCR TKA implantation.As both cruciate ligaments are preserved with BCR TKA the unloaded knee closely resembles native knee kinematics including preserving the rollback mechanism. The loss of the conforming anatomy of menisci and tibial cartilage and replacement via a relatively flat polyethylene inlay may account for the loss of tibial internal rotation and the slight paradoxical AP motion of the medial femoral condyle with BCR TKA. This phenomenon reproduces findings made earlier with fixed bearing unicondylar knee arthroplasty.
Anseeuw K.,ZNA Stuivenberg |
Delvau N.,Cliniques Universitaires Saint Luc |
Burillo-Putze G.,Hospital Universitario Of Canarias |
De Iaco F.,A.S.L. |
And 4 more authors.
European Journal of Emergency Medicine | Year: 2013
Smoke inhalation is a common cause of cyanide poisoning during fires, resulting in injury and even death. In many cases of smoke inhalation, cyanide has increasingly been recognized as a significant toxicant. The diagnosis of cyanide poisoning remains very difficult, and failure to recognize it may result in inadequate or inappropriate treatment. Findings suggesting cyanide toxicity include the following: (a) a history of enclosed-space fire; (b) any alteration in the level of consciousness; (c) any cardiovascular changes (particularly inexplicable hypotension); and (d) elevated plasma lactate. The feasibility and safety of empiric treatment with hydroxocobalamin for fire smoke victims have been reported in the literature. On the basis of a literature review and a panel discussion, a group of European experts has proposed emergency management protocols for cyanide toxicity in fire smoke victims. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Ingels A.-S.,Ghent University |
De Paepe P.,Ghent University |
Anseeuw K.,ZNA Stuivenberg |
Van Sassenbroeck D.,AZ Maria Middelares |
And 4 more authors.
Bioanalysis | Year: 2011
Background: γ-hydroxybutyric acid (GHB), notorious as a club- and date-rape drug, was quantified in dried blood spots (DBS) by punching out a disc, followed by 'on-spot' derivatization and analysis by GC-MS. Results: A homogenous distribution in DBS was demonstrated and accurate results were obtained when analyzing a disc punched out from a 20-35 μl spot, regardless the hematocrit of the blood sample. Validation based on US FDA and European Medicines Agency guidelines was performed, with a calibration range covering 2-100 μg/ml. Conclusion: A sensitive GC-MS method for GHB analysis in DBS was successfully optimized and validated. The successful analysis of DBS collected from GHB abusers suggests the routine applicability of the DBS sampling technique for GHB analysis in toxicological cases. © 2011 Future Science Ltd.
Kenis C.,University Hospitals Leuven |
Bron D.,ULB Institute Bordet |
Libert Y.,ULB Institute Bordet |
Decoster L.,Vrije Universiteit Brussel |
And 14 more authors.
Annals of Oncology | Year: 2013
Background: To evaluate the large-scale feasibility and usefulness of geriatric screening and assessment in clinical oncology practice by assessing the impact on the detection of unknown geriatric problems, geriatric interventions and treatment decisions. Patients and methods: Eligible patients who had a malignant tumour were ≥70 years old and treatment decision had to be made. Patients were screened using G8; if abnormal (score ≤14/17) followed by Comprehensive Geriatric Assessment (CGA). The assessment results were communicated to the treating physician using a predefined questionnaire to assess the topics mentioned above. Results: One thousand nine hundred and sixty-seven patients were included in 10 hospitals. Of these patients, 70.7% had an abnormal G8 score warranting a CGA. Physicians were aware of the assessment results at the time of treatment decision in two-thirds of the patients (n = 1115; 61.3%). The assessment detected unknown geriatric problems in 51.2% of patients. When the physician was aware of the assessment results at the time of decision making, geriatric interventions were planned in 286 patients (25.7%) and the treatment decision was influenced in 282 patients (25.3%). Conclusion: Geriatric screening and assessment in older patients with cancer is feasible at large scale and has a significant impact on the detection of unknown geriatric problems, leading to geriatric interventions and adapted treatment. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Malbrain M.L.N.G.,ZNA Stuivenberg |
De Potter T.J.R.,ZNA Stuivenberg |
Dits H.,ZNA Stuivenberg |
Reuter D.A.,University of Hamburg
Acta Anaesthesiologica Scandinavica | Year: 2010
Background: Volumetric monitoring with right ventricular end-diastolic volume indexed (RVEDVi) and global end-diastolic volume indexed (GEDVi) is increasingly being suggested as a superior preload indicator compared with the filling pressures central venous pressure (CVP) or the pulmonary capillary wedge pressure (PCWP). However, static monitoring of these volumetric parameters has not consistently been shown to be able to predict changes in cardiac index (CI). The aim of this study was to evaluate whether a correction of RVEDVi and GEDVi with a measure of the individual contractile reserve, assessed by right ventricular ejection fraction (RVEF) and global ejection fraction, improves the ability of RVEDVi and GEDVi to monitor changes in preload over time in critically ill patients. Methods: Hemodynamic measurements, both by pulmonary artery and by transcardiopulmonary thermodilution, were performed in 11 mechanically ventilated medical ICU patients. Correction of volumes was achieved by normalization to EF deviation from normal EF values in an exponential fashion. Data before and after fluid administration were obtained in eight patients, while data before and after diuretics were obtained in seven patients. Results: No correlation was found between the change in cardiac filling pressures (δCVP, δPCWP) and δCI (R2 0.01 and 0.00, respectively). Further, no correlation was found between δRVEDVi or δGEDVi and δCI (R2 0.10 and 0.13, respectively). In contrast, a significant correlation was found between δRVEDVi corrected to RVEF (δcRVEDVi) and δCI (R2 0.64), as well as between δcGEDVi and δCI (R2 0.59). An increase in the net fluid balance with +844 ± 495 mlm2 resulted in a significant increase in CI of 0.5 ± 0.3 lminm2; however, only δcRVEDVi (R2 0.58) and δcGEDVi (R2 0.36) correlated significantly with δCI. Administration of diuretics resulting in a net fluid balance of -942 ± 658 mlm2 caused a significant decrease in CI with 0.7 ± 0.5 lminm2; however, only δcRVEDVi (R2 0.80) and δcGEDVi (R2 0.61) correlated significantly with δCI. Conclusion: Correction of volumetric preload parameters by measures of ejection fraction improved the ability of these parameters to assess changes in preload over time in this heterogeneous group of critically ill patients. © 2010 The Acta Anaesthesiologica Scandinavica Foundation.
Claes F.,University of Antwerp |
Berger J.,ZNA Stuivenberg |
Stassijns G.,University of Antwerp
Human Factors | Year: 2015
Objective: The aim of this study was to evaluate the prevalence of upper-body-quadrant pain among ultrasonographers and to evaluate the association between individual ergonomics, musculoskeletal disorders, and occurrence of neck pain. Method: A hundred and ten (N = 110) Belgian and Dutch male and female hospital ultrasonographers were consecutively enrolled in the study. Data on work-related ergonomic and musculoskeletal disorders were collected with an electronic inquiry, including questions regarding ergonomics (position of the screen, high-low table, and ergonomic chair), symptoms (neck pain, upper-limb pain), and work-related factors (consecutive working hours a day, average working hours a week). Results: Subjects with the screen on their left had significantly more neck pain (odds ratio [OR] = 3.6, ρ = .0286). Depending on the workspace, high-low tables increased the chance of developing neck pain (OR = 12.9, ρ = .0246). A screen at eye level caused less neck pain (OR = .22, ρ = .0610). Employees with a fixed working space were less susceptible to arm pain (OR = 0.13, ρ = .0058). The prevalence of arm pain was significantly higher for the vascular department compared to radiology, urology, and gynecology departments (OR = 9.2, ρ = .0278). Conclusions: Regarding prevention of upper-limb pain in ultrasonograph, more attention should be paid to the work environment and more specialty to the ultrasound workstation layout. Primary ergonomic prevention could provide a painless work situation for the ultrasonographer. Application: Further research on the ergonomic conditions of ultrasonography is necessary to develop ergonomic solutions in the work environment that will help to alleviate neck and arm pain. © 2014, Human Factors and Ergonomics Society.
Gheuens E.,ZNA Stuivenberg |
Daelemans R.,ZNA Stuivenberg |
Mesens S.,Clinical Pharmacology Unit
Investigative Radiology | Year: 2014
OBJECTIVE: This study was designed to evaluate the dialysability of gadoteric acid in patients with end-stage renal disease (ESRD) requiring hemodialysis. Gadoteric acid is used for magnetic resonance imaging. It is cleared from the blood exclusively by glomerular filtration. In an attempt to decrease the occurrence of nephrogenic systemic fibrosis, hemodialysis has been advocated immediately after injection of gadolinium-based contrast agents in patients with ESRD. METHODS: Ten patients with ESRD underwent 3 consecutive 4-hour hemodialysis sessions after a single intravenous injection (0.1 mmol/kg) of gadoteric acid. Blood samples were drawn from the vascular access just before and immediately after the end of each 4-hour session. Additional sampling was performed during session 1. RESULTS: Gadoteric acid was efficiently eliminated, with mean (95% confidence interval) clearance values (mL/min) of 224.6 (216.0-233.9) at 0.5 hours and 225.9 (215.6-237.2) at 1.5 hours during session 1. The gadolinium concentration decrease after a 4-hour hemodialysis (vs the corresponding predialysis values) was 97% after session 1. The decrease in gadolinium concentration after session 3 was 99.7% compared with the predialysis concentration of session 1. These percentages are similar to those reported after hemodialysis for other gadolinium-based contrast agents. No adverse effects related to gadoteric acid were reported. CONCLUSION: Although no unconfounded case of nephrogenic systemic fibrosis has been reported so far after injection of gadoteric acid, hemodialysis can be efficiently used to remove this molecule in patients with ESRD already undergoing long-term hemodialysis. © 2014 by Lippincott Williams & Wilkins.
Van Craenenbroeck A.H.,ZNA Stuivenberg |
Camps K.,ZNA Stuivenberg |
Zachee P.,ZNA Stuivenberg |
Wu K.L.,ZNA Stuivenberg
Journal of Clinical Microbiology | Year: 2011
We report a case of apparent malaria infection presented with a syndrome of painless, generalized lymphadenopathy without granulomas shortly after exposure to fresh water in rural West Africa. Residual infection with Massilia timonae was diagnosed and successfully treated with co-trimoxazole. Copyright © 2011, American Society for Microbiology. All Rights Reserved.