Common variable immunodeficiency (CVID) is characterized by low levels of circulating immunoglobulins and compromised specific antibody response leading to frequent infections. Cytokines play an important role in the orchestration of the antibody response. Several previous studies have attempted to identify distinct cytokines responsible for the inflammatory changes and different manifestations of CVID, but there are conflicting results regarding the cytokine profiles in CVID patients. In light of this, an extensive review regarding the level of various cytokines and their potential therapeutic role in CVID patients was performed. This review delineates the contribution of interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12, IL-21, interferons, tumor necrosis factor (TNF)-α, IL-17, APRIL (a proliferation inducing ligand) and BAFF (B cell activating factor) in CVID disease and outline their potential therapeutic implications in these patients.
• Imaging-based tumour response can assist in therapeutic decisions. • Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker. • Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI. • Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE. • Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.
Purpose To determine the performance of magnetic resonance (MR) imaging-based tumor metrics for evaluation of response to transarterial chemoembolization (TACE) in patients with unresectable intrahepatic cholangiocarcinoma (ICCA). Materials and Methods Ninety-four patients with unresectable ICCA underwent baseline and follow-up MR imaging after TACE and were followed up until death or end of study duration. Lesions were analyzed for anatomic (Response Evaluation Criteria in Solid Tumors [RECIST] and tumor volume) and functional (viable tumor volume, viable tumor burden, and apparent diffusion coefficient [ADC]) volumetric MR parameters by using semiautomatic software. Response was assessed by using changes in viable tumor volume by using modified RECIST (mRECIST)-derived thresholds (three-dimensional mRECIST), viable tumor burden, and ADC. Overall survival was the primary endpoint. Cox-regression and Kaplan-Meier survival analysis were used. Results Tumor volume did not change after TACE (P = .07) whereas RECIST diameter showed a small change (-2.6%; P = .02). There was an increase in ADC (20.7%) and a decrease in viable tumor volume (-29.3%) and viable tumor burden (-29.1%; P < .001 for all). Higher overall survival was noted among responders by using thresholds of 25% increase in ADC, 66% decrease in viable tumor volume, and 50% decrease in viable tumor burden (log-rank test, P < .05). Hazard ratio for nonresponders by using ADC, three-dimensional mRECIST, and viable tumor burden at multivariable analysis was 2.9 (P = .004), 4.1 (P = .009), and 4.0 (P = .002), respectively. Survival differences were noted for patients who showed response by using all three parameters (ADC, three-dimensional mRECIST, and viable tumor burden) versus those who showed response by using either one or two of these parameters versus those who showed no response (P < .001). Conclusion Changes in volumetric ADC, viable tumor volume, and viable tumor burden at MR imaging provide prognostic information among patients with unresectable ICCA who undergo TACE. RSNA, 2018 Online supplemental material is available for this article.
Multiple sclerosis (MS) is a multifaceted disease in which genetic and environmental factors are involved. Although neurodegeneration aspect of MS has major influence in patients' disability, none of the available treatments have been shown to obviously reduce neurodegeneration. Recently, the role of Erythropoietin (EPO) as a neuroprotective and anti-inflammatory agent has been attracted tremendous interest. In the present randomized double-blind pilot study, we combined EPO with methylprednisolone (MPred) in severe motor relapsing-remitting MS (RR-MS) patients to target both inflammatory and neurodegenerative aspects of disease. Twenty patients with RR-MS in relapse phase were randomized into two groups. The case group (10 patients) received intravenous MPred (1,000 mg/24 h) and intravenous EPO (20,000 U/24 h) for five consecutive days, and the control group (10 patients) received just MPred at the same dose as the case group, and a placebo. Both groups were followed for 3 months by ambulatory index (AI), Expanded Disability Status Scale (EDSS) and by magnetic resonance imaging (MRI) parameters. Improvement in maximal distance walking, reflected by reduction in AI and EDSS, was observed in EPO group after second month and continued after 3 months. Furthermore, MRI data analysis showed significant reduction in the number of T2WI lesions in EPO group without any significant change in contrast enhancing and black hole lesions. There was no major side effect in EPO group. The results of this first therapeutic pilot trial in RR-MS patients are promising, but need to be validated in larger trials.
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