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  • 1
    Online Resource
    Online Resource
    Quality‐based pharmacokinetic model selection on DCE‐MRI for characterizing orbital lesions
    Wiley ; 2019
    In:  Journal of Magnetic Resonance Imaging Vol. 50, No. 5 ( 2019-11), p. 1514-1525
    Details
    In: Journal of Magnetic Resonance Imaging, Wiley, Vol. 50, No. 5 ( 2019-11), p. 1514-1525
    Abstract: Although several studies have evaluated dynamic contrast‐enhanced (DCE) MRI in the orbit, showing its utility when detecting and diagnosing orbital lesions, none have evaluated the pharmacokinetic models. Purpose To provide a quality‐based pharmacokinetic model selection for characterizing orbital lesions using DCE‐MRI at 3.0T. Study Type Prospective. Population From December 2015 to April 2017, 151 patients with an orbital lesion underwent MRI prior to surgery, including a high temporal resolution DCE sequence, divided into one training and one test dataset with 100 and 51 patients, respectively. Field Strength/Sequence 3T/DCE. Assessment Six different pharmacokinetic models were tested. Statistical Tests Univariate and multivariate analyses were performed using Wilcoxon‐2‐sample tests and a logistic regression to compare parameters between malignant and benign tumors for each pharmacokinetic model for the whole cohort. Receiver operating characteristic (ROC) curve analyses were performed on the training dataset to determine area under curve (AUC) and optimal cutoff values for each pharmacokinetic model, then validated on the test dataset to calculate sensitivity, specificity, and accuracy. Results Regardless of the model, tissue blood flow and tissue blood volume values were significantly higher in malignant vs. benign lesions: 103.8–195.1 vs. 65–113.8, P [ 〈 10 ‐4 –2.10 ‐4 ] and 21.3–36.9 vs. 15.6–33.6, P [ 〈 10 ‐4 –0.03] respectively. Extracellular volume fraction and permeability–surface area product or transfer constant appeared to be less relevant: 17.3–27.5 vs. 22.8–28.2, P [0.01–0.7], 1.7–4.9, P [0.2–0.9] and 9.5–38.8 vs. 8.1–22.8, P [ 〈 10 ‐4 –0.6], respectively. ROC curves showed no significant differences in AUC between the different models. The two‐compartment exchange (2CX) model ranked first for quality. Data Conclusion DCE MRI pharmacokinetic model‐derived parameters appeared to be useful for discriminating benign from malignant orbital lesions. The 2CX model provided the best quality of modeling and should be recommended. Perfusion‐related DCE parameters appeared to be significantly more relevant to the diagnostic process. Level of Evidence 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1514–1525.
    Type of Medium: Online Resource
    ISSN: 1053-1807 , 1522-2586
    URL: Issue
    URL: Article
    DOI: 10.1002/jmri.v50.5
    DOI: 10.1002/jmri.26747
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1497154-9
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  • 2
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    Complement‐driven hemolytic uremic syndrome
    Wiley ; 2023
    In:  American Journal of Hematology Vol. 98, No. S4 ( 2023-05)
    Details
    In: American Journal of Hematology, Wiley, Vol. 98, No. S4 ( 2023-05)
    Abstract: Overactivation of the complement alternative pathway drives the pathogenesis of primary atypical hemolytic uremic syndrome (aHUS). Genetically‐determined or acquired dysregulation of the complement is frequently identified in patients with aHUS, pregnancy‐related hemolytic uremic syndrome (HUS), and severe hypertension‐associated HUS. In contrast, it is still unclear whether self‐limited complement activation, which frequently occurs in other forms of HUS, provides key mechanistic clues or results from endothelial damage. Development of novel biomarkers is underway to firmly establish complement‐driven pathogenesis. C5 blockade therapy has revolutionized the management of aHUS patients, resulting in a halving of the subpopulation under chronic dialysis over the course of a few years. On the other hand, the efficacy of C5 blockade in secondary forms of HUS, as assessed by small and uncontrolled case series, is less compelling and should be investigated through properly designed prospective clinical trials. The increased risk of meningococcal infection, related to C5 inhibition, must be rigorously addressed with suitable prophylaxis. Treatment duration should be determined based on an individualized benefit/risk assessment.
    Type of Medium: Online Resource
    ISSN: 0361-8609 , 1096-8652
    URL: Issue
    URL: Article
    DOI: 10.1002/ajh.v98.S4
    DOI: 10.1002/ajh.26854
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 1492749-4
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  • 3
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    Diagnostic accuracy of Quantitative Colour Doppler Flow imaging in distinguishing Persistent Fetal Vasculature from Retinal Detachment
    Wiley ; 2022
    In:  Acta Ophthalmologica Vol. 100, No. 2 ( 2022-03), p. 196-202
    Details
    In: Acta Ophthalmologica, Wiley, Vol. 100, No. 2 ( 2022-03), p. 196-202
    Abstract: Distinguishing posterior persistent fetal vasculature (PFV) from retinal detachment (RD) may be very challenging clinically and ultrasonographically, as they share common morphological features. However, it is crucial, considering their substantially distinct management and treatment. We aimed to assess the relevance of quantitative colour Doppler flow imaging to distinguish PFV from RD in children. Methods This retrospective bi‐centre study included 66 children (30 females and 36 males, mean age: 244 ± 257 days) with a clinically suspected diagnosis of RD or posterior PFV. All children underwent systematic and standardized conventional ultrasonography and colour Doppler flow imaging under general anaesthesia with a qualitative and quantitative analysis of the retrolental tissue’s vascularization. Peak systolic velocity, end‐diastolic velocity and resistive index were recorded for analysis. Whenever available, surgical findings were deemed gold standard for diagnosis. A Mann–Whitney U ‐test was used to compare quantitative colour Doppler flow imaging data. Results Peak systolic velocity and end‐diastolic velocity were significantly lower in children with PFV versus RD: 2.7 (IQR: 0.5) versus 5.1 (IQR: 2.8), p  〈  0.001, and 0.0 (IQR: 0.0) versus 2.0 (IQR: 1.2), p  〈  0.001, respectively. Resistive index was significantly higher in children with PFV versus RD: 1 (IQR: 0) versus 0.6 (IQR: 0.1), p  〈  0.001. Area under curves (AUCs) were of 0.94, 0.99 and 1, respectively. No differences between PFV and RD were observed on structural ultrasound or qualitative analysis of colour Doppler. Conclusion Quantitative colour Doppler flow imaging has an excellent accuracy in distinguishing PFV from RD in children. It may help to improve management and treatment.
    Type of Medium: Online Resource
    ISSN: 1755-375X , 1755-3768
    URL: Issue
    URL: Article
    DOI: 10.1111/aos.v100.2
    DOI: 10.1111/aos.14793
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2466981-7
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  • 4
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    Online Resource
    Reduction in late onset cytomegalovirus primary disease after discontinuation of antiviral prophylaxis in kidney transplant recipients treated with de novo everolimus
    Wiley ; 2018
    In:  Transplant Infectious Disease Vol. 20, No. 2 ( 2018-04)
    Details
    In: Transplant Infectious Disease, Wiley, Vol. 20, No. 2 ( 2018-04)
    Abstract: Donor (D)+/recipient (R)− serostatus is closely associated with a higher risk of cytomegalovirus ( CMV ) infection and disease. Antiviral prophylaxis is conventionally used in such patients, but late onset CMV infection/disease still occurs after the discontinuation of prophylaxis. Methods We retrospectively analyzed the data of 215 low immunological risk patients who received kidney transplantation in our center between 2011 and 2016. Results Ninety‐seven patients received a combination of everolimus ( EVL )/reduced doses of calcineurin inhibitors ( CNI ) ( EVL group) de novo, and 118 received a combination of mycophenolic acid ( MPA )/standard doses of CNI ( MPA group) de novo. All patients received induction by basiliximab, steroids, and standardized antiviral prophylaxis depending on their CMV D/R serostatus. D+/R− recipients comprised 17% (n = 16) of the EVL group and 19% (n = 22) of the MPA group ( P  = .722). In the D+/R− subgroup, the 1‐year incidence of late onset CMV primary disease after the withdrawal of prophylaxis was lower in the EVL group than in the MPA group (6% vs 41%, P  = .025) while the rate of CMV disease in the D+/R+ group (8% vs 6%, P  = 1) and the D−/R+ group (12% vs 9%, P  = 1) were similar. Kaplan‐Meier analysis of 1‐year CMV primary disease‐free survival in seronegative patients was significantly better in the EVL group ( P  = .029, log‐rank test). Conclusions Our data suggest that de novo use of EVL may reduce late onset CMV primary disease after the withdrawal of antiviral prophylaxis in kidney transplantation patients.
    Type of Medium: Online Resource
    ISSN: 1398-2273 , 1399-3062
    URL: Issue
    URL: Article
    DOI: 10.1111/tid.2018.20.issue-2
    DOI: 10.1111/tid.12846
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2010983-0
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  • 5
    Online Resource
    Online Resource
    Vascular origin in acute transient visual disturbance: A prospective study
    Wiley ; 2021
    In:  European Journal of Neurology Vol. 28, No. 12 ( 2021-12), p. 4098-4108
    Details
    In: European Journal of Neurology, Wiley, Vol. 28, No. 12 ( 2021-12), p. 4098-4108
    Abstract: This study was undertaken to validate a clinical score of vascular origin in patients with acute transient visual disturbances (TVDs) without diplopia. Methods We conducted a prospective study in an ophthalmology emergency department and a transient ischemic attack (TIA) clinic. Patients underwent clinical evaluation including a tailored questionnaire, brain, vascular, and ophthalmologic investigations, and 3‐month follow‐up. TVDs were classified according to vascular or nonvascular origin by three independent experts based on all clinical, cerebrovascular, and ophthalmologic investigations, but blind to the questionnaire results. A clinical score was derived based on clinical variables independently associated with a vascular origin, and was externally validated in an independent cohort. Results An ischemic origin of TVD was found in 45% (67/149) of patients in the derivation cohort. Age and six questions were independently associated with an ischemic origin. A nine‐point score (≥70 years old = 2; monocular visual loss = 2; black or white vision = 1; single episode = 1; lack of headache = 2; diffuse, constricted, altitudinal, or lateralized visual loss pattern on drawings = 1) showed good discriminative power in identifying ischemic origin ( c ‐statistic = 0.82) and was replicated in the validation cohort ( n  = 130, 25% of ischemic origin, c ‐statistic = 0.75). With a score ≥ 4, sensitivity was 85% (95% confidence interval = 68−95) and specificity was 52% (95% confidence interval = 41−62). In both cohorts, ophthalmologic evaluation found a vascular cause in 4% and was noncontributive in 85%. After 3 months, no patients had a stroke, TIA, or retinal infarct. Conclusions Our score may assist in predicting a vascular origin of TVD. Ophthalmologic evaluation, when not readily available, should not delay the neurovascular evaluation.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    URL: Article
    DOI: 10.1111/ene.v28.12
    DOI: 10.1111/ene.15074
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2020241-6
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  • 6
    Online Resource
    Online Resource
    B12 deficiency or thrombotic microangiopathy? The key is in the peripheral smear
    Wiley ; 2023
    In:  eJHaem Vol. 4, No. 1 ( 2023-02), p. 280-281
    Details
    In: eJHaem, Wiley, Vol. 4, No. 1 ( 2023-02), p. 280-281
    Type of Medium: Online Resource
    ISSN: 2688-6146 , 2688-6146
    URL: Issue
    URL: Article
    DOI: 10.1002/jha2.v4.1
    DOI: 10.1002/jha2.644
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 3021452-X
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