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Indolent B-Cell Lymphomas Associated with HCV Infection: Clinical and Virological Features and Role of Antiviral Therapy
Luca Arcaini,Michele Merli,Stefano Volpetti,Sara Rattotti,Manuel Gotti,Francesco Zaja
Clinical and Developmental Immunology , 2012, DOI: 10.1155/2012/638185
Abstract: The association between hepatitis C virus (HCV) infection and B-cell non-Hodgkin’s lymphomas (NHL) has been demonstrated by epidemiological studies, in particular in highly endemic geographical areas such as Italy, Japan, and southern parts of United States. In these countries, together with diffuse large B-cell lymphomas, marginal zone lymphomas are the histotypes most frequently associated with HCV infection; in Italy around 20–30% cases of marginal zone lymphomas are HCV positive. Recently, antiviral treatment with interferon with or without ribavirin has been proved to be effective in the treatment of HCV-positive patients affected by indolent lymphoma, prevalently of marginal zone origin. An increasing number of experiences confirmed the validity of this approach in marginal zone lymphomas and in other indolent NHL subtypes like lymphoplasmacytic lymphoma. Across different studies, overall response rate was approximately 75%. Hematological responses resulted significantly associated with the eradication of the virus. This is the strongest evidence of a causative link between HCV and lymphomas. The aim of this paper is to illustrate the relationship between HCV infection and different subtypes of indolent B-cell lymphomas and to systematically summarize the data from the therapeutic studies that reported the use of antiviral treatment as hematological therapy in patients with HCV-associated indolent lymphomas.
Therapeutic Activity of Lenalidomide in Mantle Cell Lymphoma and Indolent Non-Hodgkin’s Lymphomas  [PDF]
Marco Gunnellini,Lorenzo Falchi
Advances in Hematology , 2012, DOI: 10.1155/2012/523842
Abstract: Mantle cell lymphoma (MCL) comprises 3–10% of NHL, with survival times ranging from 3 and 5 years. Indolent lymphomas represent approximately 30% of all NHLs with patient survival largely dependent on validated prognostic scores. High response rates are typically achieved in these patients with current first-line chemoimmunotherapy. However, most patients will eventually relapse and become chemorefractory with poor outcome. Alternative chemoimmunotherapy regimens are often used as salvage strategy and stem cell transplant remains an option for selected patients. However, novel approaches are urgently needed for patients no longer responding to conventional chemotherapy. Lenalidomide is an immunomodulatory drug with activity in multiple myeloma, myelodisplastic syndrome and chronic lymphoproliferative disorders. In phase II studies of indolent NHL and MCL lenalidomide has shown activity with encouraging response rates, both as a single agent and in combination with other drugs. Some of these responses may be durable. Optimal dose of lenalidomide has not been defined yet. The role of lenalidomide in the therapeutic armamentarium of patients with indolent NHL or MCL will be discussed in the present paper. 1. Introduction Non-Hodgkin’s lymphomas (NHLs) are a heterogeneous group of lymphoid malignancies. The annual incidence of NHL in the United States is estimated to be 4.5% of all cancers, and they account for 3% of annual cancer-related deaths [1]. From a clinical and therapeutic standpoint, these neoplasias are subdivided into aggressive and indolent forms. Indolent lymphomas represent approximately 30% of all NHLs. Prognosis is correlated with the stage of the disease at the time of diagnosis, as well as to the international prognostic index (IPI) or other IPI-derived scores [2–5]. The current therapeutic approach for indolent NHL is based on the use of chemoimmunotherapy. Intensive treatments such as high-dose chemotherapy with autologous stem cell transplantation (ASCT) are typically reserved for relapsing patients whose disease is still chemosensitive [1]. Mantle cell lymphoma (MCL) comprises approximately 3 to 10% of NHL. It is a heterogeneous clinical entity with four recognized morphologic variants (i.e., classical, blastoid, pleomorphic and small cell, marginal zone-like). The small cell variant tends to be an indolent lymphoma, whereas both the blastoid and pleomorphic variants are associated with a clinical aggressive course. However, the majority (80%) of MCLs show intermediate characteristics. Thus, the median survival of the majority of
Risk stratification systems in cardiac surgery  [PDF]
Diana Ciurescu, ,,M. Enache,G. Tinic?
Jurnalul de Chirurgie , 2012,
Abstract: n medicine, as in any other field, quality is a prerequisite of competitiveness. In this paper we do a brief description and definition of commonly used preoperative risk scores for heart surgery with regard to their predictive values and clinical applicability for current population. Although most of the selected score systems were primarily designed to predict mortality, postoperative morbidity has been acknowledged as the major determinant of hospital cost and quality of life after surgery. Any method of evaluation and optimization of quality is based on a risk stratification system. Risk system development and their application in current medical practice have become increasingly popular in the recent years because of the many therapeutic options available for some cardiovascular diseases, which until now were considered difficult to address, due to technical advances that are enabling risk taking. Risk stratification is a powerful decision-making tool and should represent an incumbent part of the cardiac surgical practice, just like the knowledge of anatomy and the practice of surgical techniques. These models also play an increasingly important role in risk management and performance measurement processes like quality analysis, meaningful comparison of outcomes, and identifying the optimal relationship between cost, quality of medical care and efficiency.
Medulloblastomas: New directions in risk stratification  [cached]
Sarkar Chitra,Deb Prabal,Sharma Mehar
Neurology India , 2006,
Abstract: Medulloblastomas (MBs) are the most common malignant brain tumors in children. Current therapeutic approaches combine surgery, radiotherapy, and chemotherapy. Although, there has been significant improvement in long-term survival rates, the tumor remains incurable in about a third of patients while cognitive deficits and other sequelae of therapy are common among long-term survivors. Hence a major challenge remains to differentiate high-from low-risk patients and to tailor therapy based on the degree of biological aggressiveness. A clinical risk-stratification system has been widely used in MBs based on age, extent of resection and the Chang staging system. However, recent reports indicate that these clinical variables are inadequate methods of defining disease risk. This has prompted search for new markers for MB stratification. Recent studies indicate that the classification of MBs according to profiles of histopathology and molecular abnormalities possibly help better risk-stratification of patients, thereby rationalizing approaches to therapy, increasing cure rate, reducing long-term side effects and developing novel therapeutic strategies. The most accurate outcome prediction till date has been obtained through microarray gene expression profiling. In this article, the current histopathological classification and the recent advances in molecular genetics of MBs are reviewed. Global efforts to translate this knowledge of disease biology into clinical practice especially as outcome predictors are highlighted.
Risk Stratification Prior to Heart Transplantation
J. Franke,Ch. Zugck
Transplantationsmedizin , 2011,
Abstract: Over the past years, the growing burden of heart failure has had a major impact on health economics. Due to demographic developments and advances in the treatment of the underlying cardiac diseases, statistical projections await an increase of heart failure patients of up to 60% over the next 30 years. Though the number of affected patients is rapidly increasing, the number of heart transplantations stagnates due to the limited number of donated organs currently available. Thus, the decision on which patient to give preference to remains one of the largest challenges of heart transplantation medicine. This article reviews novel developments in the field of risk stratification before heart transplantation, discusses both benefits and pitfalls of currently available tools for risk assessment and demonstrates their practical applications in the daily routine of an outpatient heart failure clinic of a University hospital.
Risk stratification ahead of heart transplantation
Ch. Zugck
Transplantationsmedizin , 2010,
Abstract: In heart transplantation, attempts to risk stratification prior to surgery are an important aspect for improving outcome of heart failure patients. The present paper focuses on the question which patient and at what specific time-point would profit most from transplantation. At present, clinicians mainly adhere to the recommendations of Butler et al. and ISHLT recommending that after cardiac decompensation, heart failure patients should first be recompensated and treated pharmacologically. As soon as patients are clinically stabilized, VO2max and Heart Failure Survival Score should be determined in order to decide on whether the patient should be listed for transplantation. Further parameters like NTproBNP, pulmonary artery resistance etc. should also be regarded by the interdisciplinary treatment team during decision-making.
New Methods for the Analysis of Heartbeat Behavior in Risk Stratification  [PDF]
Leon Glass,Claudia Lerma
Frontiers in Physiology , 2011, DOI: 10.3389/fphys.2011.00088
Abstract: Developing better methods for risk stratification for tachyarrhythmic sudden cardiac remains a major challenge for physicians and scientists. Since the transition from sinus rhythm to ventricular tachycardia/fibrillation happens by different mechanisms in different people, it is unrealistic to think that a single measure will be adequate to provide a good index for risk stratification. We analyze the dynamical properties of ventricular premature complexes over 24 h in an effort to understand the underlying mechanisms of ventricular arrhythmias and to better understand the arrhythmias that occur in individual patients. Two dimensional density plots, called heartprints, correlate characteristic features of the dynamics of premature ventricular complexes and the sinus rate. Heartprints show distinctive characteristics in individual patients. Based on a better understanding of the natures of transitions from sinus rhythm to sudden cardiac and the mechanisms of arrhythmia prior to cardiac arrest, it should be possible to develop better methods for risk stratification.
Cardiac risk stratification: Role of the coronary calcium score  [cached]
Rakesh K Sharma,Rajiv K Sharma,Donald J Voelker,et al
Vascular Health and Risk Management , 2010,
Abstract: Rakesh K Sharma1, Rajiv K Sharma1, Donald J Voelker1, Vibhuti N Singh2, Deepak Pahuja3, Teresa Nash1, Hanumanth K Reddy11Medical Center of South Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Bayfront Medical Center, St Petersburg, Florida; 3Saint Vincent Health Center, Erie, PA, USAAbstract: Coronary artery calcium (CAC) is an integral part of atherosclerotic coronary heart disease (CHD). CHD is the leading cause of death in industrialized nations and there is a constant effort to develop preventative strategies. The emphasis is on risk stratification and primary risk prevention in asymptomatic patients to decrease cardiovascular mortality and morbidity. The Framingham Risk Score predicts CHD events only moderately well where family history is not included as a risk factor. There has been an exploration for new tests for better risk stratification and risk factor modification. While the Framingham Risk Score, European Systematic Coronary Risk Evaluation Project, and European Prospective Cardiovascular Munster study remain excellent tools for risk factor modification, the CAC score may have additional benefit in risk assessment. There have been several studies supporting the role of CAC score for prediction of myocardial infarction and cardiovascular mortality. It has been shown to have great scope in risk stratification of asymptomatic patients in the emergency room. Additionally, it may help in assessment of progression or regression of coronary artery disease. Furthermore, the CAC score may help differentiate ischemic from nonischemic cardiomyopathy.Keywords: coronary calcium scoring, coronary artery disease, CAC, cardiomyopathy, angiography, chest pain, Framingham, risk stratification, risk factors
Cardiac risk stratification: Role of the coronary calcium score
Rakesh K Sharma, Rajiv K Sharma, Donald J Voelker, et al
Vascular Health and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/VHRM.S8753
Abstract: rdiac risk stratification: Role of the coronary calcium score Review (5684) Total Article Views Authors: Rakesh K Sharma, Rajiv K Sharma, Donald J Voelker, et al Published Date July 2010 Volume 2010:6 Pages 603 - 611 DOI: http://dx.doi.org/10.2147/VHRM.S8753 Rakesh K Sharma1, Rajiv K Sharma1, Donald J Voelker1, Vibhuti N Singh2, Deepak Pahuja3, Teresa Nash1, Hanumanth K Reddy1 1Medical Center of South Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Bayfront Medical Center, St Petersburg, Florida; 3Saint Vincent Health Center, Erie, PA, USA Abstract: Coronary artery calcium (CAC) is an integral part of atherosclerotic coronary heart disease (CHD). CHD is the leading cause of death in industrialized nations and there is a constant effort to develop preventative strategies. The emphasis is on risk stratification and primary risk prevention in asymptomatic patients to decrease cardiovascular mortality and morbidity. The Framingham Risk Score predicts CHD events only moderately well where family history is not included as a risk factor. There has been an exploration for new tests for better risk stratification and risk factor modification. While the Framingham Risk Score, European Systematic Coronary Risk Evaluation Project, and European Prospective Cardiovascular Munster study remain excellent tools for risk factor modification, the CAC score may have additional benefit in risk assessment. There have been several studies supporting the role of CAC score for prediction of myocardial infarction and cardiovascular mortality. It has been shown to have great scope in risk stratification of asymptomatic patients in the emergency room. Additionally, it may help in assessment of progression or regression of coronary artery disease. Furthermore, the CAC score may help differentiate ischemic from nonischemic cardiomyopathy.
Risk stratification of patients with atrial fibrillation: Biomarkers and other future perspectives  [cached]
Rui Providência,Luís Paiva,Sérgio Barra
World Journal of Cardiology , 2012, DOI: 10.4330/wjc.v4.i6.195
Abstract: Risk stratification of atrial fibrillation (AF) and adequate thromboembolism prophylaxis is the cornerstone of treatment in patients with AF. Current risk stratification schemes such as the CHADS2 and CHA2DS2-VASc scores are based on clinical risk factors and suboptimally weight the risk/benefit of anticoagulation. Recently, the potential of biomarkers (troponin and NT-proBNP) in the RE-LY biomarker sub-analysis has been demonstrated. Echocardiography is also being evaluated as a possible approach to improve risk score performance. The authors present an overview on AF risk stratification and discuss future potential developments that may be introduced into our current risk stratification schemes.
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