25 research outputs found
Association of LI-RADS and Histopathologic Features with Survival in Patients with Solitary Resected Hepatocellular Carcinoma
: Background Both Liver Imaging Reporting and Data System (LI-RADS) and histopathologic features provide prognostic information in patients with hepatocellular carcinoma (HCC), but whether LI-RADS is independently associated with survival is uncertain. Purpose To assess the association of LI-RADS categories and features with survival outcomes in patients with solitary resected HCC. Materials and Methods This retrospective study included patients with solitary resected HCC from three institutions examined with preoperative contrast-enhanced CT and/or MRI between January 2008 and December 2019. Three independent readers evaluated the LI-RADS version 2018 categories and features. Histopathologic features including World Health Organization tumor grade, microvascular and macrovascular invasion, satellite nodules, and tumor capsule were recorded. Overall survival and disease-free survival were assessed with Cox regression models. Marginal effects of nontargetoid features on survival were estimated using propensity score matching. Results A total of 360 patients (median age, 64 years [IQR, 56-70 years]; 280 male patients) were included. At CT and MRI, the LI-RADS LR-M category was associated with increased risk of recurrence (CT: hazard ratio [HR] = 1.83 [95% CI: 1.26, 2.66], P = .001; MRI: HR = 2.22 [95% CI: 1.56, 3.16], P < .001) and death (CT: HR = 2.47 [95% CI: 1.72, 3.55], P < .001; MRI: HR = 1.80 [95% CI: 1.32, 2.46], P < .001) independently of histopathologic features. The presence of at least one nontargetoid feature was associated with an increased risk of recurrence (CT: HR = 1.80 [95% CI: 1.36, 2.38], P < .001; MRI: HR = 1.93 [95% CI: 1.81, 2.06], P < .001) and death (CT: HR = 1.51 [95% CI: 1.10, 2.07], P < .010) independently of histopathologic features. In matched samples, recurrence was associated with the presence of at least one nontargetoid feature at CT (HR = 2.06 [95% CI: 1.15, 3.66]; P = .02) or MRI (HR = 1.79 [95% CI: 1.01, 3.20]; P = .048). Conclusion In patients with solitary resected HCC, LR-M category and nontargetoid features were negatively associated with survival independently of histopathologic characteristics. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kartalis and Grigoriadis in this issue
Remarkable resolution of COVID-19-associated cerebral vasculitis with methylprednisolone
International audienc
Recommended from our members
Vascular Abnormalities in the Neck Associated with Intracranial Aneurysms
ABSTRACT In 102 cases of ruptured intracranial aneurysms, the cervical as well as the cranial areas were explored by angiography. Loops in the course of the cervical vessels were present in 28 patients; features of fibromuscular dysplasia were present in 31 patients; and in 50 patients, no abnormalities were observed. In 7 patients, both cervical anomalies were present. Loops were associated with single aneurysms (95%), located primarily on the anterior communicating artery (76%), predominantly in men (M/F = 1.6). Aneurysms with fibromuscular dysplasia affected women more than men (F/M = 7), were frequently multiple (58%), and were located mainly on the intracranial part of the internal carotid and vertebral arteries (51%). These data suggest new concepts of aneurysm formation from inherited diseases and should permit the detection of some aneurysms before rupture
Effects of antibiotic prophylaxis on ventilator-associated pneumonia in severe traumatic brain injury. A post hoc analysis of two trials
International audiencePurpose To investigate the role of antibiotic prophylaxis (AP) in the incidence of ventilator-associated pneumonia (VAP) in patients suffering from traumatic brain injury (TBI). Materials and methods This post hoc analysis was conducted based on data from 2 multicentre double-blind studies that aimed to prevent VAP using hydrocortisone or povidone iodine. Data from TBI patients were extracted and pooled. Patients were classified into 2 groups those who received an AP (AP group) and those who did not (control group). Results 295 patients were included (AP group, n = 146; control group, n = 149). The incidence of VAP was 145 (49%). VAP incidence was lower in the AP group (39% vs 59%, Relative Risk = 0.33, 95%CI, 0.19â0.56, p = 0.001). Time to VAP occurrence was delayed (Hazard Ratio = 0.50, 95%CI 0.36â0.69, p 2 and †5 days) was lower in the AP group (10% vs 32%; p 5 days) did not differ (AP group 29% vs control group 28%; p = 0.811). Length of stay and mortality did not differ between the 2 groups. Conclusions Early use of AP delayed and may prevent the occurrence of VAP in severe TBI patients but did not change length of stay or mortality. © 2018 Elsevier Inc
Characteristics and outcome of varicella-zoster virus central nervous system infections in adults
International audienceWe conducted an observational retrospective study of all adults hospitalized for documented varicella-zoster virus (VZV) meningitis or encephalitis during years 2000-2015 in one referral centre. Thirty-six patients (21 males, 15 females) were included, with meningitis (n = 21), or meningoencephalitis (n = 15). Median age was 51 years [interquartile range, 35-76], and 6 patients (17%) were immunocompromised. Aciclovir was started in 32 patients (89%), with a median dose of 11 mg/kg/8 h [10-15]. No patient died, but 12 (33%) had neurological sequelae at discharge. Age was the only variable associated with adverse outcome (OR 1.98 [1.17-3.35] per 10-year increment, P = 0.011)
Symptomatic T2 Vertebral Hemangioma in a Pregnant Woman Treated by One Stage Combination Surgery; Posterior Stabilization and Anterior Subtotal Tumor Resection -Case Report-
Molecular networking for drug toxicities studies: The case of hydroxychloroquine in covid-19 patients
International audienceUsing drugs to treat COVID-19 symptoms may induce adverse effects and modify patient outcomes. These adverse events may be further aggravated in obese patients, who often present different illnesses such as metabolic-associated fatty liver disease. In Rennes University Hospital, several drug such as hydroxychloroquine (HCQ) have been used in the clinical trial HARMONICOV to treat COVID-19 patients, including obese patients. The aim of this study is to determine whether HCQ metabolism and hepatotoxicity are worsened in obese patients using an in vivo/in vitro approach. Liquid chromatography high resolution mass spectrometry in combination with untargeted screening and molecular networking were employed to study drug metabolism in vivo (patientâs plasma) and in vitro (HepaRG cells and RPTEC cells). In addition, HepaRG cells model were used to reproduce pathophysiological features of obese patient metabolism, i.e., in the condition of hepatic steatosis. The metabolic signature of HCQ was modified in HepaRG cells cultured under a steatosis condition and a new metabolite was detected (carboxychloroquine). The RPTEC model was found to produce only one metabolite. A higher cytotoxicity of HCQ was observed in HepaRG cells exposed to exogenous fatty acids, while neutral lipid accumulation (steatosis) was further enhanced in these cells. These in vitro data were compared with the biological parameters of 17 COVID-19 patients treated with HCQ included in the HARMONICOV cohort. Overall, our data suggest that steatosis may be a risk factor for altered drug metabolism and possibly toxicity of HCQ. © 2021 by the authors. Licensee MDPI, Basel, Switzerland
Intra-Arterial Thrombus Visualized on T2* Gradient Echo Imaging in Acute Ischemic Stroke
Impact des échanges plasmatiques au cours des hémorragies alvéolaires graves associées aux vascularites associées aux ANCA
International audienceIntroductionLes hĂ©morragies intra-alvĂ©olaires (HIA) sont responsables dâune mortalitĂ© Ă©levĂ©e au cours des vascularites associĂ©es aux ANCA (VAA) [1]. Les Ă©changes plasmatiques (EP) ont Ă©tĂ© proposĂ©s en traitement dâinduction des VAA graves en association au traitement standard, en particulier pour les glomĂ©rulonĂ©phrites rapidement progressives et les HIA graves. Lâessai PEXIVAS nâa pas montrĂ© de supĂ©rioritĂ© des EP sur la mortalitĂ© chez les patients prĂ©sentant une VAA sĂ©vĂšre avec insuffisance rĂ©nale et/ou HIA [2]. NĂ©anmoins, seuls 27 % des patients inclus avaient une HIA et moins de 9 % dâentre eux avaient une HIA sĂ©vĂšre dĂ©finie par une SpO2 < 85 % en air ambiant ou le recours Ă la ventilation mĂ©canique. Cette population de patients graves pourrait bĂ©nĂ©ficier des EP comme lâont suggĂ©rĂ© des rĂ©sultats ancillaires de lâessai PEXIVAS, avec une mortalitĂ© Ă 90 jours de 16,1 % dans le groupe EP versus 30 % dans le groupe sans EP [3]. Lâobjectif de cette Ă©tude est dâĂ©tudier lâeffet des EP sur la mortalitĂ© des patients hospitalisĂ©s pour une VAA avec HIA grave.Patients et mĂ©thodesIl sâagit dâune Ă©tude rĂ©trospective multicentrique française incluant des patients ayant prĂ©sentĂ© une HIA grave au cours dâune poussĂ©e de granulomatose avec polyangĂ©ite (GPA) ou polyangĂ©ite microscopique (PM) au cours des 10 derniĂšres annĂ©es. Le critĂšre de jugement principal Ă©tait la mortalitĂ© Ă 30 jours (J30). Les analyses univariĂ©es ont Ă©tĂ© rĂ©alisĂ©es avec un test du Ï2 ou de Fisher pour les variables catĂ©gorielles, ou un test de Mann-Whitney pour les variables quantitatives. Lâanalyse du critĂšre de jugement principal a Ă©tĂ© rĂ©alisĂ©e par un modĂšle de Cox pour prendre en compte les donnĂ©es censurĂ©es, avec ajustement sur les facteurs de confusion dĂ©finis a priori.RĂ©sultatsNous avons inclus 186 patients issus de 40 centres (88 GPA et 91 PM, Ăąge mĂ©dian 66 ans [53; 75], 46,7 % dâhommes). Les ANCA Ă©taient positifs chez tous les patients (anti-PR3 46,2 %, anti-MPO 54,3 %). En plus du traitement standard, 144 patients ont reçu des EP (77,4 %) et 42 nâen ont pas reçu (22,6 %). Les patients traitĂ©s par EP Ă©taient plus sĂ©vĂšres que les patients sans EP avec une atteinte rĂ©nale significativement plus frĂ©quente dans le groupe EP (94,2 vs. 84,6 %, p < 0,05) et un dĂ©bit de filtration glomĂ©rulaire significativement infĂ©rieur chez les patients traitĂ©s par EP (DFG mĂ©dian Ă 25 mL/min/1,73 m2 vs 41 mL/min/1,73 m2, p < 0,05). La ventilation mĂ©canique nâĂ©tait pas significativement plus utilisĂ©e dans le groupe EP (52,1 % vs 41,5 % p = 0,23). Les patients du groupe EP recevaient significativement plus souvent des bolus de mĂ©thylprednisolone (97,2 % vs 88,1 %, p < 0,05) et du cyclophosphamide (78,5 % vs 54,8 %, p < 0,01). Le score BVAS Ă©tait en revanche comparable entre les groupes (23,1 dans le groupe EP vs 21,4 dans le groupe sans EP, p = 0,18).Sans ajustement sur les facteurs associĂ©s Ă lâutilisation des EP, la mortalitĂ© Ă J30 Ă©tait comparable entre les 2 groupes (14,1 % vs 14,3 %, p = 0,97), avec un hazard ratio pour la mortalitĂ© Ă J30 de lâadmission en rĂ©animation Ă 1,2 [IC95 % 0,4â3,1], p = 0,8), de mĂȘme que la mortalitĂ© Ă J90, J180 et aux derniĂšres nouvelles. AprĂšs ajustement sur les facteurs de confusion (valeur maximale de crĂ©atininĂ©mie, Ăąge, score de gravitĂ© Ă lâadmission et nĂ©cessitĂ© dâune ventilation invasive), la rĂ©alisation dâEP nâĂ©tait toujours pas associĂ©e Ă la survie dans cette Ă©tude (HR 0,9 [IC95 % 0,3â2,4], p = 0,8).ConclusionDans cette large Ă©tude, nous observons que les EP restent largement utilisĂ©s en France dans les HIA sĂ©vĂšres au cours des VAA. Cette premiĂšre analyse avec ajustement ne retrouve pas dâimpact des EP sur la mortalitĂ© prĂ©coce, mais une analyse avec Ă©mulation est en cours pour prĂ©ciser ces rĂ©sultats
Comparative immune profiling of acute respiratory distress syndrome patients with or without SARS-CoV2 infection
International audienceAcute respiratory distress syndrome (ARDS) is the main complication of coronavirus disease 2019 (COVID-19), requiring admission to the intensive care unit (ICU). Despite extensive immune profiling of COVID-19 patients, to what extent COVID-19-associated ARDS differs from other causes of ARDS remains unknown. To address this question, here, we build 3 cohorts of patients categorized in COVID-19ARDS, COVID-19ARDS, and COVID-19ARDS, and compare, by high-dimensional mass cytometry, their immune landscape. A cell signature associating S100A9/calprotectin-producing CD169 monocytes, plasmablasts, and Th1 cells is found in COVID-19ARDS, unlike COVID-19ARDS patients. Moreover, this signature is essentially shared with COVID-19ARDS patients, suggesting that severe COVID-19 patients, whether or not they experience ARDS, display similar immune profiles. We show an increase in CD14HLA-DR and CD14CD16 monocytes correlating to the occurrence of adverse events during the ICU stay. We demonstrate that COVID-19-associated ARDS displays a specific immune profile and may benefit from personalized therapy in addition to standard ARDS management