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Rituximab has improved response rates and overall survival in diffuse large B-cell lymphoma. Radiotherapy is an effective treatment modality for lymphomas, but there is uncertainty on its use as consolidation after chemo-immunotherapy mainly in advanced stages. We evaluated its efficacy with a comprehensive meta-analysis and a systematic search of Pubmed, Embase, Cochrane, and abstracts from the American Society of Clinical Oncology, American Society of Hematology, European Society for Medical Oncology and American Society of Radiation Oncology published from June 1966 and December 2018. We identified 11 trials that evaluated consolidation radiotherapy following chemotherapy in a randomized fashion in 4,584 patients. The primary endpoint of this meta-analysis was progression-free survival (PFS). As three of the 11 trials were retracted, this data is based on 2,414 patients. For the primary endpoint, PFS, we found a hazard ratio (HR) 0.77 (95% Confidence Interval [CI]: 0.51-1.17), pooled (tau2: 0.25; I2: 85%), and a HR 0.80 (95% CI: 0.53-1.21), pooled in a bivariate metaanalysis and for the secondary endpoint, overall survival, a HR 0.93 (range, 0.61-1.40), pooled (tau2: 0.25; I2: 74%) and a HR 0.86 (95% CI: 0.58-1.27) in a bivariate meta-analysis. The lack of benefit did not change over time (P=0.95 (tau2: 0.32; I2: 88%), and was also absent for PFS when stratifying for i) chemotherapy, ii) the use of rituximab, iii) age, iv) the dose of radiotherapy and v) application to patients in complete remission with bulky disease. None of the trials used a positron emission tomography- guided approach. This meta-analysis revealed no survival benefit when consolidation radiotherapy is given to unselected diffuse large Bcell lymphoma patients following chemotherapy. These results need to be considered in future trials in the positron emission tomography-computed tomography era.

Cardiac implantable electronic device-related infection is clinically challenging. Curative treatment commonly includes system removal. A case caused by Granulicatella adiacens occurred in a 32-year-old woman. Clinical course, literature review, and biofilm investigations enabled successful antibiotic management without system removal.

BACKGROUND The term “predisposition” is used as an indication of antimicrobial prophylaxis to prevent infective endocarditis and as a criterion for diagnosing infective endocarditis according to the modified Duke criteria. The criterion for diagnosing infective endocarditis in native valves is not well defined. OBJECTIVES To identify conditions that increase the risk for infective endocarditis in native valves, for the diagnosis of infective endocarditis according to the modified Duke criteria. In parallel, we compared the results with the year of patient inclusion for each study and echocardiographic techniques. RESULTS Our systematic review included 207 studies published from January 1970 to August 2015. Studies that focused on mitral valve prolapse (112 studies), prior infective endocarditis (96) and bicuspid aortic valve (78) provided the most data. However, only six (5.3%), three (3.1%) and one (1.3%) of these studies, respectively, used analytical statistical methods. Three (2.7%), two (2.1%) and one (1.3%), respectively, were graded as good quality studies. Odds ratios (ORs) for developing infective endocarditis were 3.5–8.2 for mitral valve prolapse, and 2.2 and 2.8 for prior infective endocarditis. The hazard ratio for developing infective endocarditis was 6.3 for bicuspid aortic valve. The mean prevalence proportion of infective endocarditis in patients with these three heart conditions were 8.5% (mitral valve prolapse), 8.3% (prior infective endocarditis) and 8.8% (bicuspid aortic valve). The proportions of publications prior to the publication of the modified Duke criteria were 81.8, 75.6 and 74%, respectively. Evolution of the imaging method and echocardiographic technique was estimated to be considerable for mitral valve prolapse. The literature review on aortic valve stenosis (46 studies), mitral valve insufficiency (41) and aortic valve insufficiency (39) provided two analytical studies for aortic stenosis. One study was graded as good quality and reported a hazard ratio 4.9. The mean prevalence of these heart conditions in patients with infective endocarditis were 7.3, 19.9 and 10.2%, respectively. The proportions of publications prior to the publication of the modified Duke criteria were 78, 75.6 and 79.5%, respectively. The evolution of both the echocardiographic technique and the categorisation of valve disease severity was considerable for all three entities. CONCLUSIONS The evidence for native valve heart conditions predisposing to infective endocarditis is mainly based on studies with only descriptive statistics published prior to the release of the modified Duke criteria. Mitral valve prolapse, prior infective endocarditis and bicuspid aortic valve are frequently cited as predisposing heart conditions for infective endocarditis. The evolution in echocardiographic techniques over the past decades and its influence on diagnosis was considerable for mitral valve prolapse, aortic stenosis, mitral insufficiency and aortic insufficiency.

Introduction The term “predisposing heart condition” is used as an indication of antimicrobial prophylaxis to prevent infective endocarditis (IE) and as a criterion for diagnosing IE according to modified Duke criteria. The purpose of this survey was to elaborate clinician’s knowledge and opinion on relevant heart conditions as a Duke minor criterion for the diagnosis of IE. Methods A questionnaire was created that consisted of two knowledge and two opinion questions on the term predisposing heart condition. The survey included results from 318 questionnaires with responses from specialists in the field of internal medicine, infectious diseases, and cardiology. Results The answers of what participants believed to be currently a Duke minor criterion and what they thought should be minor criterion were very distributed with a median accordance of 33%. Conclusion The survey indicates that there is significant uncertainty regarding what is encountered as a Duke minor criterion predisposing heart condition in a native valve. Electronic supplementary material The online version of this article (doi:10.1007/s40119-016-0074-2) contains supplementary material, which is available to authorized users.