Search

Lung transplant candidates who are highly sensitized against human leucocyte antigen have a lower likelihood of graft allocation and a higher risk of dying while on the waiting list. C1-esterase inhibitor, an inhibitor of the classical and lectin pathways of complement activation, has been used successfully to prevent and treat acute antibody-mediated rejection in kidney and heart transplantation. Here, we report 3 cases of C1-esterase inhibitors used perioperatively in highly sensitized lung transplant candidates, with successful bilateral lung transplants despite severe primary graft dysfunction and/or hyperacute antibody-mediated rejection.

ABSTRACTBackgroundThere is a growing number of patients with ventricular paced rhythm, who present to the emergency department with chest pain. The diagnosis of ST-segment elevation myocardial infarction (STEMI) and subsequent percutaneous coronary intervention (PCI) is often postponed, as the 12 leads-electrocardiogram (ECG) is discarded as not interpretable. There is a growing body of literature that suggests that Smith-modified Sgarbossa criteria can be applied for the diagnosis of STEMI in patients with paced rhythms. These criteria were originally developed for the interpretation of ECGs in patients with a left bundle branch block (LBBB) and chest pain, but have been expanded to paced ECGs.MethodologyWe present three case reports with chest pain and right ventricular or biventricular pacing.FindingsIn all three cases, the Smith-modified Sgarbossa was positive and the diagnosis of STEMI could have been made early on.ImplicationsIt remains important to look for ST-segment deviations and to compare the symptomatic ECG with previous asymptomatic ECGs. As the number of patients with potential acute myocardial infarction (AMI) and paced rhythms is likely to rise in the future, these criteria should be known to emergency physicians and cardiologists.

Lung transplant candidates who are highly sensitized against human leucocyte antigen present an ongoing challenge with regards to finding immunologically acceptable donors. Desensitization strategies aimed at reducing preformed donor-specific antibodies have a number of limitations. Imlifidase, an IgG-degrading enzyme derived from Streptococcus pyogenes, is a novel agent that has been used to convert positive crossmatches to negative in kidney transplant candidates, allowing transplantation to occur. We present the first case of imlifidase use for antibody depletion in a highly sensitized lung transplant candidate who went on to undergo a successful bilateral lung transplant.

Chemotherapy‐induced toxicities frequently occur in non‐small cell lung cancer (NSCLC) patients treated with platinum‐based chemotherapy. Low skeletal muscle mass (SMM) has been associated with a higher incidence of toxicities for several types of cancers and cytostatics. The aim of this study was to evaluate the association between skeletal muscle measures and chemotherapy‐induced toxicity in a large cohort of NSCLC patients. A multicentre prospective follow‐up study (PGxLUNG, NTR number NL5373610015) in NSCLC patients was conducted. Included were patients diagnosed with NSCLC (stage II–IV) treated with first‐line platinum‐based (cisplatin or carboplatin) chemotherapy of whom pretreatment imaging was available. Skeletal muscle area (SMA) segmentation was performed on abdominal imaging at the level of the third lumbar vertebra (L3). SMA at the level of L3 was corrected for squared height (m2) to yield the lumbar skeletal muscle mass index (LSMI). Skeletal muscle density (SMD) was calculated as the mean Hounsfield Unit (HU) of the segmented SMA. SMM and SMD were categorized as low, intermediate, and high, based on LSMI and mean HU tertiles, respectively. Chemotherapy‐induced toxicity was scored using CTCAE v4.03 and categorized into haematological (anaemia, leukocytopenia, neutropenia, and thrombocytopenia), non‐haematological (nephrotoxicity, neurotoxicity, and esophagitis), and dose‐limiting toxicity (DLT) (treatment switch, delay, de‐escalation, discontinuation, or hospitalization). The relationship between SMM, SMD, and toxicities was assessed with logistic regression modelling taking into account potential confounders like gender and body mass index (BMI). In total, 297 patients (male n= 167, median age 64 years) were included. Haematological toxicity grade 3/4 was experienced in 36.6% (n= 108) of the patients, 24.6% (n= 73) experienced any non‐haematological toxicity grade ≥2, and 55.6% (n= 165) any DLT. Multivariate logistic regression analysis showed that low SMM (ORadj 2.41, 95% CI 1.31–4.45, P= 0.005) and age at diagnosis >65 years (ORadj 1.76, 95% CI 1.07–2.90, P= 0.025) were statistically significantly associated with overall haematological toxicity grade 3/4. No statistically significant associations were found between low SMM or low SMD and non‐haematological toxicities. Low SMM (ORadj 2.23, 95% CI 1.23–4.04, P= 0.008) and high SMD (ORadj 0.41, 95% CI 0.23–0.74, P= 0.003) were statistically significantly associated with a higher respectively lower risk of DLT. Non‐small cell lung cancer patients with pretreatment low SMM are at significant higher risk for haematological toxicities grade 3/4 and DLT. NSCLC patients with high SMD are at significant lower risk for DLT. Further studies should be aimed to investigate whether platinum dosing based on skeletal muscle measurements and/or improvement of pretreatment SMM/SMD could reduce the risk of toxicity without compromising efficacy.

•Multiplex PCR systems have been increasingly developed for the diagnosis of infectious diseases, as well as for osteo-articular infections. It is crucial to evaluate the performances of these available methods in order to guide the choices of clinicians and microbiologists. The first version of the Unyvero i60 ITI which displayed moderate agreement with culture was improved and a second version was developed. Our work documented the performance of the second version of this automated-multiplex-PCR PCR ITI G2 test for the first time. Our results have shown that this test enables OAI diagnosis in 62% of cases, with an 89.3% concordance rate for antimicrobial resistance. The performances of this second version, ITIG2, should thus be further enhanced, especially by lowering the high failure rate observed. To date, this test can complement, but not replace conventional culture.

Organoids are in vitrothree-dimensional structures that can be grown from patient tissue. Head and neck cancer (HNC) is a collective term used for multiple tumor types including squamous cell carcinomas and salivary gland adenocarcinomas.

Background. Sinonasal teratocarcinosarcoma is a rare, aggressive malignancy located almost exclusively in the nasal cavity, paranasal sinuses, or anterior skull base. Histopathological diagnosis can be challenging due to the heterogeneous composition. Methods. Retrospective analysis of 3 patients with sinonasal teratocarcinosarcoma diagnosed and treated at the University Medical Center Utrecht was conducted. Results. Patients presented with nasal obstruction, epistaxis, headaches, or behavioral changes. All three patients had locally advanced disease, and one had lymph node metastases. Two patients underwent surgery followed by radiotherapy, and one underwent neoadjuvant chemotherapy followed by surgery. The follow-up duration ranged from 3 to 32 months. All three patients died due to progression of their disease. Conclusion. Sinonasal teratocarcinosarcoma is characterized by rapid, aggressive local expansion. The prognosis is poor due to a high risk of metastases and locally recurrent disease. Multimodality treatment consisting of surgery, followed by (chemo)‐radiotherapy, is essential for optimizing outcomes. Neoadjuvant therapy offers a promising treatment option.