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Hahnemann L, Krämer A, Fink C, Jungk C, Thomas M, Christopoulos P, Lischalk J, Meis J, Hörner-Rieber J, Eichkorn T, Deng M, Lang K, Paul A, Meixner E, Weykamp F, Debus J, König L. Fractionated stereotactic radiotherapy of intracranial postoperative cavities after resection of brain metastases - Clinical outcome and prognostic factors. Clin Transl Radiat Oncol 2024; 46:100782. [PMID: 38694237 PMCID: PMC11061678 DOI: 10.1016/j.ctro.2024.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/04/2024] Open
Abstract
Background and Purpose After surgical resection of brain metastases (BM), radiotherapy (RT) is indicated. Postoperative stereotactic radiosurgery (SRS) reduces the risk of local progression and neurocognitive decline compared to whole brain radiotherapy (WBRT). Aside from the optimal dose and fractionation, little is known about the combination of systemic therapy and postoperative fractionated stereotactic radiotherapy (fSRT), especially regarding tumour control and toxicity. Methods In this study, 105 patients receiving postoperative fSRT with 35 Gy in 7 fractions performed with Cyberknife were retrospectively reviewed. Overall survival (OS), local control (LC) and total intracranial brain control (TIBC) were analysed via Kaplan-Meier method. Cox proportional hazards models were used to identify prognostic factors. Results Median follow-up was 20.8 months. One-year TIBC was 61.6% and one-year LC was 98.6%. Median OS was 28.7 (95%-CI: 16.9-40.5) months. In total, local progression (median time not reached) occurred in 2.0% and in 20.4% radiation-induced contrast enhancements (RICE) of the cavity (after median of 14.3 months) were diagnosed. Absence of extracranial metastases was identified as an independent prognostic factor for superior OS (p = <0.001) in multivariate analyses, while a higher Karnofsky performance score (KPS) was predictive for longer OS in univariate analysis (p = 0.041). Leptomeningeal disease (LMD) developed in 13% of patients. Conclusion FSRT after surgical resection of BM is an effective and safe treatment approach with excellent local control and acceptable toxicity. Further prospective randomized trials are needed to establish standardized therapeutic guidelines.
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Affiliation(s)
- L. Hahnemann
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - A. Krämer
- Department of Radiation Oncology, University Hospital of Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - C. Fink
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - C. Jungk
- Department of Neurosurgery, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - M. Thomas
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - P. Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Germany
| | - J.W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health at Long Island, New York, NY, USA
| | - J. Meis
- Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - J. Hörner-Rieber
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - T. Eichkorn
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - M. Deng
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - K. Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - A. Paul
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - E. Meixner
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - F. Weykamp
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - J. Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- Heavy Ion Therapy Center (HIT), Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology (E050), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - L. König
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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2
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Koerber SA, Röhrich M, Walkenbach L, Liermann J, Choyke PL, Fink C, Schroeter C, Spektor AM, Herfarth K, Walle T, Calais J, Kauczor HU, Jaeger D, Debus J, Haberkorn U, Giesel FL. Impact of 68Ga-FAPI PET/CT on Staging and Oncologic Management in a Cohort of 226 Patients with Various Cancers. J Nucl Med 2023; 64:1712-1720. [PMID: 37678928 PMCID: PMC10626373 DOI: 10.2967/jnumed.123.266046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Since the development of fibroblast activation protein-targeted radiopharmaceuticals, 68Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has been found to be suitable for detecting primary and metastatic lesions in many types of tumors. However, there is currently a lack of reliable data regarding the clinical impact of this family of probes. To address this gap, the present study aimed to analyze the clinical impact of 68Ga-FAPI PET/CT by examining a large cohort of patients with various tumors. Methods: In total, 226 patients (137 male and 89 female) were included in this retrospective analysis. Pancreatic cancer and head and neck cancers were the most common tumor types in this cohort. TNM stage and oncologic management were initially determined with gold standard imaging, and these results were compared with 68Ga-FAPI PET/CT. Changes were classified as major and minor. Results: For 42% of all patients, TNM stage was changed by 68Ga-FAPI PET/CT results. Most of these changes resulted in upstaging. A change in clinical management occurred in 117 of 226 patients. Although a major change in management occurred in only 12% of patients, there was a significant improvement in the ability to accurately plan radiation therapy. In general, the highest clinical impact of 68Ga-FAPI PET/CT imaging was found in patients with lung cancer, pancreatic cancer, and head and neck tumors. Conclusion: 68Ga-FAPI PET/CT is a promising imaging probe that has a significant impact on TNM stage and clinical management. 68Ga-FAPI PET/CT promises to be a crucial new technology that will improve on conventional radiologic imaging methods such as contrast-enhanced CT and contrast-enhanced MRI typically acquired for cancer staging.
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Affiliation(s)
- Stefan A Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany;
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - Leon Walkenbach
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Christoph Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Cathrin Schroeter
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Maria Spektor
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Thomas Walle
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Virotherapy, German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Heidelberg, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dirk Jaeger
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center of Radiation Oncology, Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Düsseldorf, Germany; and
- Institute for Radiation Sciences, Osaka University, Osaka, Japan
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3
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Abermann E, Herbst E, Herbort M, Smigielski R, Fink C. Instabilität des Kniegelenks – medial oder anteromedial? Arthroskopie 2022. [DOI: 10.1007/s00142-022-00564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Zusammenfassung
Hintergrund
Verletzungen des medialen Bandkomplexes gehören zu den häufigsten Knieverletzungen. Sie heilen zwar meist mit konservativer Therapie problemlos aus, persistierende Instabilitäten erhöhen aber die Belastung der Kreuzbänder und benötigen speziell bei deren Beteiligung eine adäquate Therapie.
Anatomie und Biomechanik
Der mediale Seitenbandkomplex besteht im Wesentlichen aus dem oberflächlichen Seitenband (sMCL), welches der primäre Stabilisator gegen Valgus ist, dem tiefen Seitenband (dMCL) mit dessen schräg verlaufendem ventralem Anteil (AML), die nur sekundäre Stabilisatoren gegen Valgus darstellen, aber primär gegen Außenrotation stabilisieren, und dem hinteren Schrägband (POL), das in vollständiger Streckung gegen Valgus sowie gegen Innenrotation stabilisiert.
Therapie
Chronische Instabilitäten bzw. höhergradige Verletzungen mit Dislokation der Bandstümpfe oder multiligamentäre Verletzungen bedürfen einer operativen Versorgung. Im Akutstadium zeigen Avulsionsverletzungen bei anatomischer Refixation gutes Heilungspotenzial, während bei intraligamentären Verletzungen zusätzlich zur Naht der Bandanteile eine Augmentation mit Sehnenmaterial empfohlen wird. Bei chronischen Instabilitäten ist die Differenzierung des Instabilitätsmusters ausschlaggebend für die Wahl der Rekonstruktionstechnik (reine sMCL-Rekonstruktion oder kombinierte Rekonstruktion von sMCL und AML). In beiden Fällen kommt die hier beschriebene Technik mit flachem Transplantat der Anatomie näher als bei konventionellen Verfahren.
Diskussion
Rekonstruktionstechniken unter Verwendung flacher Sehnentransplantate, die alle betroffenen Bandanteile adressieren, haben sich biomechanisch als sehr effektiv erwiesen, komplexe mediale Instabilitäten suffizient zu behandeln. Ob diese auch klinisch überlegen sind, werden zukünftige klinische Studien zeigen müssen.
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Abstract
African lions (Panthera leo) and African savanna (Loxodonta africana) and forest (L. cyclotis) elephants pose threats to people, crops, and livestock, and are themselves threatened with extinction. Here, we map these human-wildlife conflicts across Africa. Eighty-two percent of sites containing lions and elephants are adjacent to areas with considerable human pressure. Areas at severe risk of conflict (defined as high densities of humans, crops, and cattle) comprise 9% of the perimeter of these species' ranges and are found in 18 countries hosting, respectively, ~ 74% and 41% of African lion and elephant populations. Although a variety of alternative conflict-mitigation strategies could be deployed, we focus on assessing the potential of high-quality mitigation fences. Our spatial and economic assessments suggest that investments in the construction and maintenance of strategically located mitigation fences would be a cost-effective strategy to support local communities, protect people from dangerous wildlife, and prevent further declines in lion and elephant populations.
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Affiliation(s)
- Enrico Di Minin
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland.
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, Finland.
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Rob Slotow
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Christoph Fink
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, Finland
| | - Hans Bauer
- Wildlife Conservation Research Unit, Department of Zoology, The Recanati-Kaplan Centre, University of Oxford, Tubney, UK
| | - Craig Packer
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Ecology, Evolution and Behavior, University of Minnesota, St. Paul, MN, USA
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5
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Correia RA, Ladle R, Jarić I, Malhado ACM, Mittermeier JC, Roll U, Soriano-Redondo A, Veríssimo D, Fink C, Hausmann A, Guedes-Santos J, Vardi R, Di Minin E. Digital data sources and methods for conservation culturomics. Conserv Biol 2021; 35:398-411. [PMID: 33749027 DOI: 10.1111/cobi.13706] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 05/20/2023]
Abstract
Ongoing loss of biological diversity is primarily the result of unsustainable human behavior. Thus, the long-term success of biodiversity conservation depends on a thorough understanding of human-nature interactions. Such interactions are ubiquitous but vary greatly in time and space and are difficult to monitor efficiently at large spatial scales. However, the Information Age also provides new opportunities to better understand human-nature interactions because many aspects of daily life are recorded in a variety of digital formats. The emerging field of conservation culturomics aims to take advantage of digital data sources and methods to study human-nature interactions and thus to provide new tools for studying conservation at relevant temporal and spatial scales. Nevertheless, technical challenges associated with the identification, access, and analysis of relevant data hamper the wider adoption of culturomics methods. To help overcome these barriers, we propose a conservation culturomics research framework that addresses data acquisition, analysis, and inherent biases. The main sources of culturomic data include web pages, social media, and other digital platforms from which metrics of content and engagement can be obtained. Obtaining raw data from these platforms is usually desirable but requires careful consideration of how to access, store, and prepare the data for analysis. Methods for data analysis include network approaches to explore connections between topics, time-series analysis for temporal data, and spatial modeling to highlight spatial patterns. Outstanding challenges associated with culturomics research include issues of interdisciplinarity, ethics, data biases, and validation. The practical guidance we offer will help conservation researchers and practitioners identify and obtain the necessary data and carry out appropriate analyses for their specific questions, thus facilitating the wider adoption of culturomics approaches for conservation applications.
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Affiliation(s)
- Ricardo A Correia
- Department of Geosciences and Geography, Helsinki Lab of Interdisciplinary Conservation Science, University of Helsinki, Helsinki, 00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, 00014, Finland
- CESAM - Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3910-193, Portugal
- Institute of Biological and Health Sciences, Federal University of Alagoas, Maceió, 57072-900, Brazil
| | - Richard Ladle
- Institute of Biological and Health Sciences, Federal University of Alagoas, Maceió, 57072-900, Brazil
- CIBIO/InBio, Centro de Investigação em Biodiversidade e Recursos Genéticos, Laboratório Associado, Universidade do Porto, Porto, 4485-661, Portugal
| | - Ivan Jarić
- Biology Centre of the Czech Academy of Sciences, Institute of Hydrobiology, České Budějovice, 37005, Czech Republic
- Department of Ecosystem Biology, Faculty of Science, University of South Bohemia, České Budějovice, 37005, Czech Republic
| | - Ana C M Malhado
- Institute of Biological and Health Sciences, Federal University of Alagoas, Maceió, 57072-900, Brazil
| | - John C Mittermeier
- School of Geography and the Environment, University of Oxford, Oxford, OX1 3QY, U.K
| | - Uri Roll
- Mitrani Department of Desert Ecology, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Midreshet Ben-Gurion, 8499000, Israel
| | - Andrea Soriano-Redondo
- CIBIO/InBio, Centro de Investigação em Biodiversidade e Recursos Genéticos, Laboratório Associado, Universidade do Porto, Porto, 4485-661, Portugal
- CIBIO/InBio, Centro de Investigação em Biodiversidade e Recursos Genéticos, Laboratório Associado, Instituto Superior de Agronomia, Universidade de Lisboa, Lisboa, 1349-017, Portugal
| | - Diogo Veríssimo
- Department of Zoology, University of Oxford, Oxford, OX1 3SZ, U.K
- Oxford Martin School, University of Oxford, Oxford, OX1 3BD, U.K
- San Diego Zoo Institute for Conservation Research, Escondido, CA, 92027, U.S.A
| | - Christoph Fink
- Department of Geosciences and Geography, Helsinki Lab of Interdisciplinary Conservation Science, University of Helsinki, Helsinki, 00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, 00014, Finland
| | - Anna Hausmann
- Department of Geosciences and Geography, Helsinki Lab of Interdisciplinary Conservation Science, University of Helsinki, Helsinki, 00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, 00014, Finland
| | - Jhonatan Guedes-Santos
- Institute of Biological and Health Sciences, Federal University of Alagoas, Maceió, 57072-900, Brazil
| | - Reut Vardi
- The Albert Katz International School for Desert Studies, The Jacob Blaustein Institutes for Desert Research, Ben-Gurion University of the Negev, Midreshet Ben-GurionDurban, 8499000, Israel
| | - Enrico Di Minin
- Department of Geosciences and Geography, Helsinki Lab of Interdisciplinary Conservation Science, University of Helsinki, Helsinki, 00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, 00014, Finland
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
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Di Minin E, Fink C, Hausmann A, Kremer J, Kulkarni R. How to address data privacy concerns when using social media data in conservation science. Conserv Biol 2021; 35:437-446. [PMID: 33749044 DOI: 10.1111/cobi.13708] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 06/12/2023]
Abstract
Social media data are being increasingly used in conservation science to study human-nature interactions. User-generated content, such as images, video, text, and audio, and the associated metadata can be used to assess such interactions. A number of social media platforms provide free access to user-generated social media content. However, similar to any research involving people, scientific investigations based on social media data require compliance with highest standards of data privacy and data protection, even when data are publicly available. Should social media data be misused, the risks to individual users' privacy and well-being can be substantial. We investigated the legal basis for using social media data while ensuring data subjects' rights through a case study based on the European Union's General Data Protection Regulation. The risks associated with using social media data in research include accidental and purposeful misidentification that has the potential to cause psychological or physical harm to an identified person. To collect, store, protect, share, and manage social media data in a way that prevents potential risks to users involved, one should minimize data, anonymize data, and follow strict data management procedure. Risk-based approaches, such as a data privacy impact assessment, can be used to identify and minimize privacy risks to social media users, to demonstrate accountability and to comply with data protection legislation. We recommend that conservation scientists carefully consider our recommendations in devising their research objectives so as to facilitate responsible use of social media data in conservation science research, for example, in conservation culturomics and investigations of illegal wildlife trade online.
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Affiliation(s)
- Enrico Di Minin
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, FI-00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, FI-00014, Finland
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Christoph Fink
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, FI-00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, FI-00014, Finland
| | - Anna Hausmann
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, FI-00014, Finland
- Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, Helsinki, FI-00014, Finland
| | - Jens Kremer
- Faculty of Law, University of Helsinki, Helsinki, FI-00014, Finland
| | - Ritwik Kulkarni
- Helsinki Lab of Interdisciplinary Conservation Science, Department of Geosciences and Geography, University of Helsinki, Helsinki, FI-00014, Finland
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7
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Haenssle HA, Fink C, Toberer F, Winkler J, Stolz W, Deinlein T, Hofmann-Wellenhof R, Lallas A, Emmert S, Buhl T, Zutt M, Blum A, Abassi MS, Thomas L, Tromme I, Tschandl P, Enk A, Rosenberger A. Man against machine reloaded: performance of a market-approved convolutional neural network in classifying a broad spectrum of skin lesions in comparison with 96 dermatologists working under less artificial conditions. Ann Oncol 2021; 31:137-143. [PMID: 31912788 DOI: 10.1016/j.annonc.2019.10.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Convolutional neural networks (CNNs) efficiently differentiate skin lesions by image analysis. Studies comparing a market-approved CNN in a broad range of diagnoses to dermatologists working under less artificial conditions are lacking. MATERIALS AND METHODS One hundred cases of pigmented/non-pigmented skin cancers and benign lesions were used for a two-level reader study in 96 dermatologists (level I: dermoscopy only; level II: clinical close-up images, dermoscopy, and textual information). Additionally, dermoscopic images were classified by a CNN approved for the European market as a medical device (Moleanalyzer Pro, FotoFinder Systems, Bad Birnbach, Germany). Primary endpoints were the sensitivity and specificity of the CNN's dichotomous classification in comparison with the dermatologists' management decisions. Secondary endpoints included the dermatologists' diagnostic decisions, their performance according to their level of experience, and the CNN's area under the curve (AUC) of receiver operating characteristics (ROC). RESULTS The CNN revealed a sensitivity, specificity, and ROC AUC with corresponding 95% confidence intervals (CI) of 95.0% (95% CI 83.5% to 98.6%), 76.7% (95% CI 64.6% to 85.6%), and 0.918 (95% CI 0.866-0.970), respectively. In level I, the dermatologists' management decisions showed a mean sensitivity and specificity of 89.0% (95% CI 87.4% to 90.6%) and 80.7% (95% CI 78.8% to 82.6%). With level II information, the sensitivity significantly improved to 94.1% (95% CI 93.1% to 95.1%; P < 0.001), while the specificity remained unchanged at 80.4% (95% CI 78.4% to 82.4%; P = 0.97). When fixing the CNN's specificity at the mean specificity of the dermatologists' management decision in level II (80.4%), the CNN's sensitivity was almost equal to that of human raters, at 95% (95% CI 83.5% to 98.6%) versus 94.1% (95% CI 93.1% to 95.1%); P = 0.1. In contrast, dermatologists were outperformed by the CNN in their level I management decisions and level I and II diagnostic decisions. More experienced dermatologists frequently surpassed the CNN's performance. CONCLUSIONS Under less artificial conditions and in a broader spectrum of diagnoses, the CNN and most dermatologists performed on the same level. Dermatologists are trained to integrate information from a range of sources rendering comparative studies that are solely based on one single case image inadequate.
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Affiliation(s)
- H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | - C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - F Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - W Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Munich, Germany
| | - T Deinlein
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - R Hofmann-Wellenhof
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - S Emmert
- Department of Dermatology, University of Rostock, Rostock, Germany
| | - T Buhl
- Department of Dermatology, University of Göttingen, Göttingen, Germany
| | - M Zutt
- Department of Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
| | - A Blum
- Office Based Clinic of Dermatology, Konstanz, Germany
| | - M S Abassi
- Faculty of Computer Science and Mathematics, University of Passau, Passau, Germany
| | - L Thomas
- Department of Dermatology, Lyons Cancer Research Center, Lyon 1 University, Lyon, France
| | - I Tromme
- Department of Dermatology, Université Catholique de Louvain, St Luc University Hospital, Brussels, Belgium
| | - P Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Rosenberger
- Department of Genetic Epidemiology, University of Goettingen, Goettingen, Germany
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8
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Blum A, Bosch S, Haenssle HA, Fink C, Hofmann-Wellenhof R, Zalaudek I, Kittler H, Tschandl P. [Artificial intelligence and smartphone program applications (Apps) : Relevance for dermatological practice]. Hautarzt 2020; 71:691-698. [PMID: 32720165 DOI: 10.1007/s00105-020-04658-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI) With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.
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Affiliation(s)
- A Blum
- Hautarzt- und Lehrpraxis, Augustinerplatz 7, 78462, Konstanz, Deutschland.
| | - S Bosch
- Hautarztpraxis, Ludwigsburg, Deutschland
| | - H A Haenssle
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - C Fink
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - R Hofmann-Wellenhof
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Graz, Österreich
| | - I Zalaudek
- Dermatology Clinic, University Hospital of Trieste, Hospital Maggiore, Trieste, Italien
| | - H Kittler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - P Tschandl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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9
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Hausmann A, Toivonen T, Fink C, Heikinheimo V, Kulkarni R, Tenkanen H, Di Minin E. Understanding sentiment of national park visitors from social media data. People and Nature 2020. [DOI: 10.1002/pan3.10130] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anna Hausmann
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Tuuli Toivonen
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Christoph Fink
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Vuokko Heikinheimo
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Ritwik Kulkarni
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
| | - Henrikki Tenkanen
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Enrico Di Minin
- Department of Geosciences and Geography University of Helsinki Helsinki Finland
- Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
- School of Life Sciences University of KwaZulu‐Natal Durban South Africa
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10
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Fink C. Dermatofluoroskopie – Ist angeregtes Melanin anregend? Akt Dermatol 2020. [DOI: 10.1055/a-1072-7313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDie Technologie der Dermatofluoroskopie beruht auf einer selektiven Anregung der Melaninfluoreszenz durch stufenweise 2-Photonen-Absorption. Hierbei wird das Melanin in einer Spektralregion angeregt, in der keine andere Hautkomponente absorbiert. Dadurch wird die Melaninfluoreszenz erstmals messbar. Unter Verwendung dieser Technik wird die Läsion Punkt für Punkt abgetastet. Die Fluoreszenzsignale werden dann mithilfe eines auf künstlicher Intelligenz basierten Algorithmus analysiert und das Ergebnis Score-basiert dargestellt. In Studien zeigte die Dermatofluoroskopie eine hohe diagnostische Genauigkeit mit guter Sensitivität und Spezifität. Das Medizinprodukt DermaFC® der Klasse IIa ist seit 2017 CE-zertifiziert und für den Einsatz als Diagnoseunterstützung bei melanozytären melanomverdächtigen Läsionen zugelassen. Nicht geeignet ist die Dermatofluoroskopie bei schwach pigmentierten Läsionen sowie schlecht zugänglichen Lokalisationen.
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Affiliation(s)
- C. Fink
- Universitätshautklinik Heidelberg
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11
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Manzanarez B, Lopez K, Lipton-Inga M, Fink C, Radzik M, Buxton R, Gonzalez J, Davis C, Vidmar AP. Kids N Fitness: A Group-based Pediatric Weight Management Curriculum Adapted for a Clinical Care Model. J Pediatr Child Health Care 2020; 5:1028. [PMID: 32844162 PMCID: PMC7444754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The current AAP clinical practice guidelines for the management of pediatric obesity recommend a structured, comprehensive, multi-disciplinary clinical intervention. However, there is a gap in the current literature on standardized curriculums for implementation of such programs. The objective of the present study is to adapt an evidenced-based, family- centered, weekly, weight management curriculum that addresses nutritional, physical activity and behavioral topics for a clinical care model at a tertiary care children's hospital. METHODS The curriculum was adapted for use in six individual sessions offered monthly by a multidisciplinary team, including a health educator, physician, dietitian, physical therapist and psychologist. Each provider offered specific feedback and curriculum adaptation based on their specialty. All team members completed training with scheduled treatment fidelity monitoring during implementation. To evaluate the effectiveness of the adapted curriculum, 60 adolescents, ages 14-18 years, with overweight or obesity, and at least one family member, will complete the six month intervention. The primary outcome is mean change in zBMI and %BMIp95 at six month and 18 months. Secondary outcomes include retention, satisfaction, effect on metabolic factors and activity level. CONCLUSION There is a paucity of literature on utilizing a standard curriculum in clinical weight management programs. Drawing from evidenced-based curriculum to strengthen clinical care creates an opportunity to improve existing clinical programs and potentially increase access and implementation of the current treatment recommendations for this high risk population.
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Affiliation(s)
- B Manzanarez
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - K Lopez
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - M Lipton-Inga
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - C Fink
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - M Radzik
- Diabetes & Obesity Program and Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - R Buxton
- Physical Therapy and Rehabilitation Services, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - J Gonzalez
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - C Davis
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
| | - A P Vidmar
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of USC, USA
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Fink C, Blum A, Buhl T, Mitteldorf C, Hofmann-Wellenhof R, Deinlein T, Stolz W, Trennheuser L, Cussigh C, Deltgen D, Winkler JK, Toberer F, Enk A, Rosenberger A, Haenssle HA. Diagnostic performance of a deep learning convolutional neural network in the differentiation of combined naevi and melanomas. J Eur Acad Dermatol Venereol 2020; 34:1355-1361. [PMID: 31856342 DOI: 10.1111/jdv.16165] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Deep learning convolutional neural networks (CNN) may assist physicians in the diagnosis of melanoma. The capacity of a CNN to differentiate melanomas from combined naevi, the latter representing well-known melanoma simulators, has not been investigated. OBJECTIVE To assess the diagnostic performance of a CNN when used to differentiate melanomas from combined naevi in comparison with dermatologists. METHODS In this study, a CNN with regulatory approval for the European market (Moleanalyzer-Pro, FotoFinder Systems GmbH, Bad Birnbach, Germany) was used. We attained a dichotomous classification (benign, malignant) in dermoscopic images of 36 combined naevi and 36 melanomas with a mean Breslow thickness of 1.3 mm. Primary outcome measures were the CNN's sensitivity, specificity and the diagnostic odds ratio (DOR) in comparison with 11 dermatologists with different levels of experience. RESULTS The CNN revealed a sensitivity, specificity and DOR of 97.1% (95% CI [82.7-99.6]), 78.8% (95% CI [62.8-89.1.3]) and 34 (95% CI [4.8-239]), respectively. Dermatologists showed a lower mean sensitivity, specificity and DOR of 90.6% (95% CI [84.1-94.7]; P = 0.092), 71.0% (95% CI [62.6-78.1]; P = 0.256) and 24 (95% CI [11.6-48.4]; P = 0.1114). Under the assumption that dermatologists use the CNN to verify their (initial) melanoma diagnosis, dermatologists achieve an increased specificity of 90.3% (95% CI [79.8-95.6]) at an almost unchanged sensitivity. The largest benefit was observed in 'beginners', who performed worst without CNN verification (DOR = 12) but best with CNN verification (DOR = 98). CONCLUSION The tested CNN more accurately classified combined naevi and melanomas in comparison with trained dermatologists. Their diagnostic performance could be improved if the CNN was used to confirm/overrule an initial melanoma diagnosis. Application of a CNN may therefore be of benefit to clinicians.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Blum
- Public, Private and Teaching Practice, Konstanz, Germany
| | - T Buhl
- Department of Dermatology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - C Mitteldorf
- Department of Dermatology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - R Hofmann-Wellenhof
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - T Deinlein
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - W Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - L Trennheuser
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Cussigh
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - D Deltgen
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - F Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Rosenberger
- Department of Genetic Epidemiology, University Medical Center of Goettingen, Goettingen, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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13
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Haenssle HA, Fink C, Rosenberger A, Uhlmann L. Reply to the letter to the editor 'Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists' by H. A. Haenssle et al. Ann Oncol 2019; 30:854-857. [PMID: 30689691 DOI: 10.1093/annonc/mdz015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg.
| | - C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg
| | - A Rosenberger
- Department of Genetic Epidemiology, University of Goettingen, Goettingen
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Haenssle HA, Fink C, Schneiderbauer R, Toberer F, Buhl T, Blum A, Kalloo A, Hassen ABH, Thomas L, Enk A, Uhlmann L, Alt C, Arenbergerova M, Bakos R, Baltzer A, Bertlich I, Blum A, Bokor-Billmann T, Bowling J, Braghiroli N, Braun R, Buder-Bakhaya K, Buhl T, Cabo H, Cabrijan L, Cevic N, Classen A, Deltgen D, Fink C, Georgieva I, Hakim-Meibodi LE, Hanner S, Hartmann F, Hartmann J, Haus G, Hoxha E, Karls R, Koga H, Kreusch J, Lallas A, Majenka P, Marghoob A, Massone C, Mekokishvili L, Mestel D, Meyer V, Neuberger A, Nielsen K, Oliviero M, Pampena R, Paoli J, Pawlik E, Rao B, Rendon A, Russo T, Sadek A, Samhaber K, Schneiderbauer R, Schweizer A, Toberer F, Trennheuser L, Vlahova L, Wald A, Winkler J, Wölbing P, Zalaudek I. Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists. Ann Oncol 2019; 29:1836-1842. [PMID: 29846502 DOI: 10.1093/annonc/mdy166] [Citation(s) in RCA: 562] [Impact Index Per Article: 112.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Deep learning convolutional neural networks (CNN) may facilitate melanoma detection, but data comparing a CNN's diagnostic performance to larger groups of dermatologists are lacking. Methods Google's Inception v4 CNN architecture was trained and validated using dermoscopic images and corresponding diagnoses. In a comparative cross-sectional reader study a 100-image test-set was used (level-I: dermoscopy only; level-II: dermoscopy plus clinical information and images). Main outcome measures were sensitivity, specificity and area under the curve (AUC) of receiver operating characteristics (ROC) for diagnostic classification (dichotomous) of lesions by the CNN versus an international group of 58 dermatologists during level-I or -II of the reader study. Secondary end points included the dermatologists' diagnostic performance in their management decisions and differences in the diagnostic performance of dermatologists during level-I and -II of the reader study. Additionally, the CNN's performance was compared with the top-five algorithms of the 2016 International Symposium on Biomedical Imaging (ISBI) challenge. Results In level-I dermatologists achieved a mean (±standard deviation) sensitivity and specificity for lesion classification of 86.6% (±9.3%) and 71.3% (±11.2%), respectively. More clinical information (level-II) improved the sensitivity to 88.9% (±9.6%, P = 0.19) and specificity to 75.7% (±11.7%, P < 0.05). The CNN ROC curve revealed a higher specificity of 82.5% when compared with dermatologists in level-I (71.3%, P < 0.01) and level-II (75.7%, P < 0.01) at their sensitivities of 86.6% and 88.9%, respectively. The CNN ROC AUC was greater than the mean ROC area of dermatologists (0.86 versus 0.79, P < 0.01). The CNN scored results close to the top three algorithms of the ISBI 2016 challenge. Conclusions For the first time we compared a CNN's diagnostic performance with a large international group of 58 dermatologists, including 30 experts. Most dermatologists were outperformed by the CNN. Irrespective of any physicians' experience, they may benefit from assistance by a CNN's image classification. Clinical trial number This study was registered at the German Clinical Trial Register (DRKS-Study-ID: DRKS00013570; https://www.drks.de/drks_web/).
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Affiliation(s)
- H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | - C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - R Schneiderbauer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - F Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - T Buhl
- Department of Dermatology, University of Göttingen, Göttingen, Germany
| | - A Blum
- Office Based Clinic of Dermatology, Konstanz, Germany
| | - A Kalloo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Ben Hadj Hassen
- Faculty of Computer Science and Mathematics, University of Passau, Passau, Germany
| | - L Thomas
- Department of Dermatology, Lyons Cancer Research Center, Lyon 1 University, Lyon, France
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Hausmann A, Toivonen T, Fink C, Heikinheimo V, Tenkanen H, Butchart SHM, Brooks TM, Di Minin E. Assessing global popularity and threats to Important Bird and Biodiversity Areas using social media data. Sci Total Environ 2019; 683:617-623. [PMID: 31150882 DOI: 10.1016/j.scitotenv.2019.05.268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/29/2019] [Accepted: 05/18/2019] [Indexed: 06/09/2023]
Abstract
Understanding worldwide patterns of human use of sites of international significance for biodiversity conservation is crucial for meeting global conservation targets. However, robust global datasets are scarce. In this study, we used social media data, mined from Flickr and Twitter, geolocated in Important Bird and Biodiversity Areas (IBAs) to assess i) patterns of popularity; ii) relationships of this popularity with geographical and biological variables; and iii) identify sites under high pressure from visitors. IBAs located in Europe and Asia, and in temperate biomes, had the highest density of users. Sites of importance for congregatory species, which were also more accessible, more densely populated and provided more tourism facilities, received higher visitation than did sites richer in bird species. We found 17% of all IBAs assessed to be under very high threat also received high visitation. Our results show in which IBAs enhanced monitoring should be implemented to reduce potential visitation risks to sites of conservation concern for birds, and to harness the potential benefits of tourism for conservation.
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Affiliation(s)
- Anna Hausmann
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland.
| | - Tuuli Toivonen
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland
| | - Christoph Fink
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland
| | - Vuokko Heikinheimo
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland
| | - Henrikki Tenkanen
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland
| | - Stuart H M Butchart
- BirdLife International, David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK; Department of Zoology, University of Cambridge, Downing Street, Cambridge CB2 3EJ, UK
| | - Thomas M Brooks
- International Union for Conservation of Nature, 28 Rue Mauverney, 1196 Gland, Switzerland; World Agroforestry Center (ICRAF), University of the Philippines Los Baños, Laguna 4031, Philippines; Institute for Marine & Antarctic Studies, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - Enrico Di Minin
- Department of Geosciences and Geography, University of Helsinki, FI-00014, Finland; Helsinki Institute of Sustainability Science (HELSUS), University of Helsinki, FI-00014, Finland; School of Life Sciences, University of KwaZulu-Natal, South Africa
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Haenssle HA, Fink C, Stolz W, Braun RP, Hofmann-Wellenhof R, Deinlein T, Kreusch J, Zalaudek I, Blum A. Dermatoskopie in Sonderlokalisationen. Hautarzt 2019; 70:295-311. [DOI: 10.1007/s00105-019-4372-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Agnese R, Aralis T, Aramaki T, Arnquist IJ, Azadbakht E, Baker W, Banik S, Barker D, Bauer DA, Binder T, Bowles MA, Brink PL, Bunker R, Cabrera B, Calkins R, Cartaro C, Cerdeño DG, Chang YY, Cooley J, Cornell B, Cushman P, Di Stefano PCF, Doughty T, Fascione E, Figueroa-Feliciano E, Fink C, Fritts M, Gerbier G, Germond R, Ghaith M, Golwala SR, Harris HR, Hong Z, Hoppe EW, Hsu L, Huber ME, Iyer V, Jardin D, Jena C, Kelsey MH, Kennedy A, Kubik A, Kurinsky NA, Lawrence RE, Leyva JV, Loer B, Lopez Asamar E, Lukens P, MacDonell D, Mahapatra R, Mandic V, Mast N, Miller EH, Mirabolfathi N, Mohanty B, Morales Mendoza JD, Nelson J, Orrell JL, Oser SM, Page WA, Partridge R, Pepin M, Phipps A, Ponce F, Poudel S, Pyle M, Qiu H, Rau W, Reisetter A, Reynolds T, Roberts A, Robinson AE, Rogers HE, Romani RK, Saab T, Sadoulet B, Sander J, Scarff A, Schnee RW, Scorza S, Senapati K, Serfass B, So J, Speller D, Stanford C, Stein M, Street J, Tanaka HA, Toback D, Underwood R, Villano AN, von Krosigk B, Watkins SL, Wilson JS, Wilson MJ, Winchell J, Wright DH, Yellin S, Young BA, Zhang X, Zhao X. Erratum: First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector [Phys. Rev. Lett. 121, 051301 (2018)]. Phys Rev Lett 2019; 122:069901. [PMID: 30822060 DOI: 10.1103/physrevlett.122.069901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 06/09/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.121.051301.
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Di Minin E, Fink C, Hiippala T, Tenkanen H. A framework for investigating illegal wildlife trade on social media with machine learning. Conserv Biol 2019; 33:210-213. [PMID: 29528136 PMCID: PMC7379580 DOI: 10.1111/cobi.13104] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/18/2017] [Accepted: 02/23/2018] [Indexed: 05/29/2023]
Abstract
Article impact statement: Machine learning can be used to automatically monitor and assess illegal wildlife trade on social media platforms.
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Affiliation(s)
- Enrico Di Minin
- Digital Geography Lab, Department of Geosciences and GeographyUniversity of HelsinkiHelsinkiFI 00014Finland
- Helsinki Institute of Sustainability ScienceUniversity of HelsinkiHelsinkiFI 00014Finland
- School of Life SciencesUniversity of KwaZulu‐NatalKwaZulu‐NatalDurban 4000South Africa
| | - Christoph Fink
- Digital Geography Lab, Department of Geosciences and GeographyUniversity of HelsinkiHelsinkiFI 00014Finland
- Helsinki Institute of Sustainability ScienceUniversity of HelsinkiHelsinkiFI 00014Finland
| | - Tuomo Hiippala
- Digital Geography Lab, Department of Geosciences and GeographyUniversity of HelsinkiHelsinkiFI 00014Finland
- Helsinki Institute of Sustainability ScienceUniversity of HelsinkiHelsinkiFI 00014Finland
- Department of LanguagesUniversity of HelsinkiHelsinkiFI 00014Finland
| | - Henrikki Tenkanen
- Digital Geography Lab, Department of Geosciences and GeographyUniversity of HelsinkiHelsinkiFI 00014Finland
- Helsinki Institute of Sustainability ScienceUniversity of HelsinkiHelsinkiFI 00014Finland
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Haenssle HA, Fink C, Uhlmann L. Reply to the letter to the Editor "Reply to 'Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists' by H. A. Haenssle et al. " by L. Oakden-Rayner. Ann Oncol 2019; 30:339. [PMID: 32089167 DOI: 10.1093/annonc/mdy520] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vidmar AP, Pretlow R, Borzutzky C, Wee CP, Fox DS, Fink C, Mittelman SD. An addiction model-based mobile health weight loss intervention in adolescents with obesity. Pediatr Obes 2019; 14:e12464. [PMID: 30117309 PMCID: PMC6338524 DOI: 10.1111/ijpo.12464] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical approaches to treating childhood obesity can be expensive and poorly reimbursed, and often produce suboptimal results. It has been theorized that overeating may have addictive qualities, and a sizable number of adolescents with obesity endorse addictive habits. Interestingly, few weight management interventions have tested techniques founded in addiction medicine principles. We therefore performed a pilot study of an addiction model based mHealth weight loss intervention in adolescents. METHODS Adolescents with obesity were recruited from an multidisciplinary weight management clinic (EMPOWER). Adolescents without significant obesity comorbidities, who exhibited signs of addictive eating, based on the Yale Food Addiction Scale, were enrolled in a pilot study of an interactive, addiction-based, weight loss smartphone app with coaching (http://clinicaltrials.gov: NCT02689154). The app was designed to help subjects omit problem foods, avoid snacking and reduce meal size. A contemporary cohort of adolescents who completed the EMPOWER program were evaluated. Feasibility of recruitment, adherence, retention rates, BMI change and cost of intervention were examined. RESULTS Eighteen participants were recruited to app intervention. App participants had higher retention (100% vs. 37%) and lower total cost per patient ($855.15 vs. $1428.00) than the EMPOWER clinic participants. App participants exhibited a significant decrease in zBMI and %BMIp95 over the 6 months (p < 0.001 and p = 0.001), which was comparable to the age-matched EMPOWER program completers (p = 0.31 and p = 0.06). CONCLUSIONS An addiction medicine-based mHealth intervention targeted for adolescents was feasible to implement, resulted in high retention and adherence rates, and reduced zBMI and %BMIp95 in a more cost-effective manner than an in-clinic intervention.
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Affiliation(s)
- A. P. Vidmar
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCAUSA
| | | | - C. Borzutzky
- Division of Adolescent and Young Adult MedicineChildren's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCAUSA
| | - C. P. Wee
- CTSI Biostatics CoreSaban Research InstituteLos AngelesCAUSA
| | - D. S. Fox
- Department of Pharmaceutical and Health EconomicsSchool of Pharmacy of the University of Southern CaliforniaLos AngelesCAUSA
| | - C. Fink
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCAUSA
| | - S. D. Mittelman
- Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern CaliforniaLos AngelesCAUSA
- Present address:
Department of Pediatrics, Division of Endocrinology at the UCLA Children's Discovery and Innovation Institute, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
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Vidmar AP, Fink C, Torres B, Manzanarez B, Mittelman SD, Wee CP, Borzutzky C. Energy Management for Personalized Weight Reduction (EMPOWER) Program: Three-Year Outcome Data. Adv Clin Endocrinol Metab 2019; 2:47-54. [PMID: 32699839 PMCID: PMC7375743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current consensus guidelines for management of pediatric obesity recommend clinic-based, family-centered, multi-disciplinary interventions. It is well reported that these programs often only lead to modest improvements in BMI status. The individual factors that differentiate which patient's BMI status will improve vs. worsen remains understudied. A retrospective cohort study was conducted to evaluate the outcomes of EMPOWER clinic and identify the participant specific characteristics that predicted BMI status improvement in this population. METHODS Youth who completed at least 6 visits in EMPOWER were included. Paired t-test was utilized to evaluate the mean change in zBMI, modified BMIz and %BMIp95 from baseline to 6th visit, and multivariate mixed effect models were utilized to analyze effect of baseline characteristics on change in BMI status. RESULTS 92 participants were included in the analysis, 87% with severe obesity and 66% Hispanic. At the 6th visit, there was a significant reduction in zBMI (-0.09 SD, p <0.001) and modified BMIz (-0.0003 SD, p = 0.04) with a small reduction in %BMIp95 (-1.15 %, p = 0.20). Lower BMI status (p < 0.001) and absence of a comorbidity (p < 0.05) at baseline were predictors of BMI status improvement whereas age, gender, ethnicity, family history of obesity and insurance status were not significant predictors. CONCLUSIONS Given that implementation of the current guidelines for management of obesity in pediatrics only results in modest BMI status reduction, further investigation is required to understand how the determinants of obesity-related health outcomes can guide development of more innovative, effective interventions for this high risk population.
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Affiliation(s)
- AP Vidmar
- Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,Correspondence: Alaina P Vidmar, The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA, Tel: (323) 3613385; Fax: (323) 3611301;
| | - C Fink
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - B Torres
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - B Manzanarez
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA
| | - SD Mittelman
- The Diabetes & Obesity Program, Children’s Hospital Los Angeles and The Saban Research Institute, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, USA,Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - CP Wee
- CTSI Biostatics Core, Saban Research Institute, Los Angeles, USA
| | - C Borzutzky
- The Diabetes & Obesity Program, Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, USA
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Pallavidino M, Arango Uribe D, Baskaran S, Saqib A, Elmesserey M, Onsy A, Fathi EM, Fink C, Ramaiah AKH. Accidental Pyrethroid Ingestion in Toddler: Near-Fatal Atypical Presentation and Successful Recovery. Front Pediatr 2019; 7:542. [PMID: 31998671 PMCID: PMC6965312 DOI: 10.3389/fped.2019.00542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
We are reporting a case of pyrethroid poisoning with atypical presentation in a 21-month-old toddler who was transferred to us from a peripheral center. Signs and symptoms at presentation were predominantly of cardiopulmonary dysfunction contrary to more common presenting features of gastrointestinal and neurological impairment. The reason for this seems to be the aspiration pneumonitis as a consequence of vomiting induced by parents at home, rather than the toxin itself even though a rather rapid progression of lung injury does not rule out the possibility. He had developed decreased level of consciousness and increased work of breathing after ingestion, which had progressed to Acute Respiratory Distress Syndrome, septic shock, and multi organ failure. He even had a brief cardiac arrest with Return of Spontaneous Circulation after 5 min of cardiopulmonary resuscitation, immediately after arrival at our unit, which seemed more likely to be a consequence of inappropriate management during transfer of the child. In addition to antibiotics and vasopressors, he required high frequency oscillatory ventilation and prone positioning initially, and lung-protective conventional ventilation later. His cardiopulmonary status improved gradually and he was successfully extubated after 12 days. Other organ systems also showed complete recovery. Even though Magnetic Resonance Imaging of brain done a few days after cardiac arrest showed features suggestive of hypoxic-ischemic encephalopathy he showed complete neurological recovery. He was thriving well at three-month follow-up with no neurological deficits, good exercise tolerance, and normal renal and liver function. Atypical presentation of pyrethroid poisoning is associated with significant morbidities and there seems to no reliable parameters in children to identify the risk of the same. Considering that there is no specific antidote, prompt, and aggressive supportive therapy is necessary for a favorable outcome. This case highlights several important aspects in the care of the pediatric patient after ingestion of insecticides. First, attempt to induce emesis, especially outside of a healthcare facility is not only ineffective but also highly dangerous, and should not be done. Second, unstable patients require inter and intrahospital transfer by experienced and trained personnel; and lastly, management for these complex and atypical cases should be done as early as possible in a center which is equipped to provide high level of circulatory and ventilatory support while prioritizing neuro-protective measures, and neurologic recovery and rehabilitation.
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Affiliation(s)
- Marco Pallavidino
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Diego Arango Uribe
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Subashini Baskaran
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Aqdas Saqib
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Mohamed Elmesserey
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Ahmed Onsy
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Emad M Fathi
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Christoph Fink
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Anil Kumar H Ramaiah
- Department of Paediatric Intensive Care Medicine, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle H. Precision and reproducibility of automated computer‐guided Psoriasis Area and Severity Index measurements in comparison with trained physicians. Br J Dermatol 2018; 180:390-396. [DOI: 10.1111/bjd.17200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 01/05/2023]
Affiliation(s)
- C. Fink
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Alt
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - L. Uhlmann
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Klose
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - A. Enk
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - H.A. Haenssle
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
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Agnese R, Aralis T, Aramaki T, Arnquist IJ, Azadbakht E, Baker W, Banik S, Barker D, Bauer DA, Binder T, Bowles MA, Brink PL, Bunker R, Cabrera B, Calkins R, Cartaro C, Cerdeño DG, Chang YY, Cooley J, Cornell B, Cushman P, Di Stefano PCF, Doughty T, Fascione E, Figueroa-Feliciano E, Fink C, Fritts M, Gerbier G, Germond R, Ghaith M, Golwala SR, Harris HR, Hong Z, Hoppe EW, Hsu L, Huber ME, Iyer V, Jardin D, Jena C, Kelsey MH, Kennedy A, Kubik A, Kurinsky NA, Lawrence RE, Leyva JV, Loer B, Lopez Asamar E, Lukens P, MacDonell D, Mahapatra R, Mandic V, Mast N, Miller EH, Mirabolfathi N, Mohanty B, Morales Mendoza JD, Nelson J, Orrell JL, Oser SM, Page WA, Partridge R, Pepin M, Phipps A, Ponce F, Poudel S, Pyle M, Qiu H, Rau W, Reisetter A, Reynolds T, Roberts A, Robinson AE, Rogers HE, Romani RK, Saab T, Sadoulet B, Sander J, Scarff A, Schnee RW, Scorza S, Senapati K, Serfass B, So J, Speller D, Stanford C, Stein M, Street J, Tanaka HA, Toback D, Underwood R, Villano AN, von Krosigk B, Watkins SL, Wilson JS, Wilson MJ, Winchell J, Wright DH, Yellin S, Young BA, Zhang X, Zhao X. First Dark Matter Constraints from a SuperCDMS Single-Charge Sensitive Detector. Phys Rev Lett 2018; 121:051301. [PMID: 30118251 DOI: 10.1103/physrevlett.121.051301] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/20/2018] [Indexed: 06/08/2023]
Abstract
We present the first limits on inelastic electron-scattering dark matter and dark photon absorption using a prototype SuperCDMS detector having a charge resolution of 0.1 electron-hole pairs (CDMS HVeV, a 0.93 g CDMS high-voltage device). These electron-recoil limits significantly improve experimental constraints on dark matter particles with masses as low as 1 MeV/c^{2}. We demonstrate a sensitivity to dark photons competitive with other leading approaches but using substantially less exposure (0.49 g d). These results demonstrate the scientific potential of phonon-mediated semiconductor detectors that are sensitive to single electronic excitations.
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - T Aralis
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - T Aramaki
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - I J Arnquist
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - E Azadbakht
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - W Baker
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - S Banik
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Jatni-752050, India
| | - D Barker
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Binder
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M A Bowles
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R Bunker
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R Calkins
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - C Cartaro
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - D G Cerdeño
- Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
- Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Y-Y Chang
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - P Cushman
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - P C F Di Stefano
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - E Fascione
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - E Figueroa-Feliciano
- Department of Physics and Astronomy, Northwestern University, Evanston, Illinois 60208-3112, USA
| | - C Fink
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - M Fritts
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - G Gerbier
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R Germond
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M Ghaith
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - S R Golwala
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - H R Harris
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - Z Hong
- Department of Physics and Astronomy, Northwestern University, Evanston, Illinois 60208-3112, USA
| | - E W Hoppe
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
- Department of Electrical Engineering, University of Colorado Denver, Denver, Colorado 80217, USA
| | - V Iyer
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Jatni-752050, India
| | - D Jardin
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - C Jena
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Jatni-752050, India
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Kennedy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Kubik
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - N A Kurinsky
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R E Lawrence
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - J V Leyva
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B Loer
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - E Lopez Asamar
- Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
| | - P Lukens
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D MacDonell
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - R Mahapatra
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Mast
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E H Miller
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - N Mirabolfathi
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - B Mohanty
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Jatni-752050, India
| | - J D Morales Mendoza
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - J Nelson
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J L Orrell
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - S M Oser
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - W A Page
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - F Ponce
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Poudel
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - T Reynolds
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A Roberts
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - A E Robinson
- Département de Physique, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - H E Rogers
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - R K Romani
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - A Scarff
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - R W Schnee
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - S Scorza
- SNOLAB, Creighton Mine #9, 1039 Regional Road 24, Sudbury, Ontario P3Y 1N2, Canada
| | - K Senapati
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Jatni-752050, India
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J So
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - C Stanford
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Stein
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - J Street
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - H A Tanaka
- Department of Physics, University of Toronto, Toronto, Ontario M5S 1A7, Canada
| | - D Toback
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - R Underwood
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A N Villano
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B von Krosigk
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - S L Watkins
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J S Wilson
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - M J Wilson
- Department of Physics, University of Toronto, Toronto, Ontario M5S 1A7, Canada
| | - J Winchell
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - X Zhang
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - X Zhao
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
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Fink C, Herbort M. Anatomische Rekonstruktion des vorderen Kreuzbands. Arthroskopie 2018. [DOI: 10.1007/s00142-018-0220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Winkler JK, Fink C, Enk A, Toberer F. Hyperkeratotische Papeln mit retikulärem Muster am Dekolleté. Hautarzt 2018; 69:606-608. [DOI: 10.1007/s00105-018-4133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Forschner A, Keim U, Hofmann M, Spänkuch I, Lomberg D, Weide B, Tampouri I, Eigentler T, Fink C, Garbe C, Haenssle HA. Diagnostic accuracy of dermatofluoroscopy in cutaneous melanoma detection: results of a prospective multicentre clinical study in 476 pigmented lesions. Br J Dermatol 2018; 179:478-485. [PMID: 29569229 DOI: 10.1111/bjd.16565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early detection is a key factor in improving survival from melanoma. Today, the clinical diagnosis of cutaneous melanoma is based mostly on visual inspection and dermoscopy. Preclinical studies in freshly excised or paraffin-embedded tissue have shown that the melanin fluorescence spectra after stepwise two-photon excitation, a process termed dermatofluoroscopy, differ between cutaneous melanoma and melanocytic naevi. However, confirmation from a larger prospective clinical study is lacking. OBJECTIVES The primary end point of this study was to determine the diagnostic accuracy of dermatofluoroscopy in melanoma detection. Secondary end points included the collection of data for improving the computer algorithm that classifies skin lesions based on melanin fluorescence and the assessment of safety aspects. METHODS This was a prospective, blinded, multicentre clinical study in patients with pigmented skin lesions (PSLs) indicated for excision either to rule out or to confirm cutaneous melanoma. All included lesions underwent dermoscopy and dermatofluoroscopy in vivo before lesions were excised and subjected to histopathological examination. RESULTS In total, 369 patients and 476 PSLs were included in the final analysis. In 101 of 476 lesions (21·2%) histopathology revealed melanoma. The observed sensitivity of dermatofluoroscopy was 89·1% (90 of 101 melanomas identified), with an observed specificity of 44·8%. The positive and negative predictive values were 30·3% and 93·9%, respectively. No adverse events occurred. CONCLUSIONS Dermatofluoroscopy is a safe and accurate diagnostic method to aid physicians in diagnosing cutaneous melanoma. Limitations arise from largely amelanotic or regressing lesions lacking sufficient melanin fluorescence.
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Affiliation(s)
- A Forschner
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - U Keim
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - M Hofmann
- University Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - I Spänkuch
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - D Lomberg
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - B Weide
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - I Tampouri
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - T Eigentler
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - C Fink
- Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440,, 69120, Heidelberg, Germany
| | - C Garbe
- Centre of Dermatooncology, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440,, 69120, Heidelberg, Germany
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Castiglia L, Husain RA, Marquardt I, Fink C, Liehr T, Serino D, Elia M, Coci EG. 7q11.23 microduplication syndrome: neurophysiological and neuroradiological insights into a rare chromosomal disorder. J Intellect Disabil Res 2018; 62:359-370. [PMID: 29266505 DOI: 10.1111/jir.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/09/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The phenotypical consequence of the heterozygous chromosome 7q11.23 interstitial microdeletion is the Williams-Beuren syndrome, a very well-known genetic multi-systemic disorder. Much less is known about the reverse condition, the heterozygous interstitial microduplication of 7q11.23 region. The first molecular cytogenetic description was published in 2005, and only after several years were the reported patients numerous enough to attempt a description of a common phenotype. METHOD By using a broad multidisciplinary approach, we investigated 12 patients with this rare genetic anomaly. Ten of them harboured the duplication of the classical Williams-Beuren syndrome region and two a slightly larger duplication. Upon a detailed description of the clinical and psychological features, we used electroencephalography and magnetic resonance imaging to explore neurophysiological function and brain structures. RESULTS We analysed the clinical, psychological, neuroradiological and neurophysiological features of 12 yet-unpublished individuals affected by this rare genetic anomaly, focusing specifically on the last two aspects. Several structural abnormalities of the central nervous system were detected, like ventriculomegaly, hypotrophic cerebellum, hypotrophic corpus callosum and hypoplastic temporal lobes. Although only one of 12 individuals suffered from seizures during childhood, three others had abnormal electroencephalography findings prominent in the anterior brain regions, without any visible seizures to date. CONCLUSION Taken together, we enlarged the yet-underrepresented cohort in the literature of patients affected by 7q11.23 microduplication syndrome and shed further light on neuroradiological and neurophysiological aspects of this rare genetic syndrome.
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Affiliation(s)
- L Castiglia
- Oasi Institute for Research on Mental Retardation and Brain, Troina, Enna, Italy
| | - R A Husain
- Department of Neuropediatrics, Universitätsklinikum Jena, Jena, Thuringia, Germany
| | - I Marquardt
- Department of Neuropediatrics, Klinikum Oldenburg, Oldenburg, Lower Saxony, Germany
| | - C Fink
- Department of Radiology, Allgemeines Krankenhaus Celle, Celle, Lower Saxony, Germany
| | - T Liehr
- Institute of Human Genetics, Friedrich-Schiller-Universität Jena, Jena, Thuringia, Germany
| | - D Serino
- Department of Pediatric Neuro-Psichiatry, ASL CN1, Cuneo, Piedmont, Italy
| | - M Elia
- Oasi Institute for Research on Mental Retardation and Brain, Troina, Enna, Italy
| | - E G Coci
- Department of Paediatrics, Städtisches Klinikum Braunschweig, Braunschweig, Lower Saxony, Germany
- Department of Neuropediatrics, Universitaetsklinikum Bochum, Ruhr-Universitaet Bochum, Bochum, North Rhine-Westphalia, Germany
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle HA. Intra- and interobserver variability of image-based PASI assessments in 120 patients suffering from plaque-type psoriasis. J Eur Acad Dermatol Venereol 2018; 32:1314-1319. [PMID: 29569769 DOI: 10.1111/jdv.14960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Psoriasis Area and Severity Index (PASI) is the standard for psoriasis severity assessment. However, PASI measurement is complex and subjective, frequently leading to a high intra- and interobserver variability. To date, the precise extent of variability in PASI measurements and its underlying causes remain unknown. OBJECTIVE To determine the inter- and intrarater variability of image-based PASI measurements by calculating Intra-Class-Correlation-Coefficients (ICCs) and to investigate the impact of the different PASI components and specific anatomic regions on the extent of variability. METHODS First, the methodology of 'image-based' vs. commonly used 'live' PASI measurements was validated in a pilot study. Next, in an observational cohort study, PASI scores of 120 patients affected by plaque psoriasis were prospectively evaluated by three formally trained physicians by means of total body images (TBI). Each observer independently performed two rounds of image-based PASI calculations in all patients at two different time points. RESULTS Overall, 720 image-based PASI scores were calculated with a mean PASI of 8.8 (range 0.7-34.8). An interrater variability with an ICC of 0.895 and mean absolute difference (MAD) of 3.3 PASI points were observed. Intrarater variability showed a mean ICC of 0.877 and a MAD of 2.2 points. When considering specific PASI components, the highest agreement was found for the assessment of the involved body surface area (BSA), while the lowest ICCs were calculated for severity scoring of 'scaling' and 'induration'. As BSA scores serve as a multiplier in the calculation of PASI, minor inaccuracies were capable of inducing a large share of variability. CONCLUSION The overall inter- and intrarater reliability of image-based PASI measurements in this study was good. However, physicians were formally trained and experienced, which frequently is not the case in a real-life clinical setting. Therefore, new strategies for higher standardization and objectivity of PASI calculations are needed.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Alt
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Menzer C, Stolz W, Nilles M, Toberer F, Fink C, Haenssle HA. [Dermoscopically conspiciuous pigmented lesion on the forehead of a young male patient]. Hautarzt 2017; 68:1028-1030. [PMID: 28983642 DOI: 10.1007/s00105-017-4059-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Menzer
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - W Stolz
- Klinik Thalkirchner Straße, Städtisches Klinikum München, München, Deutschland
| | - M Nilles
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - F Toberer
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - C Fink
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - H A Haenssle
- Universitätshautklinik Heidelberg, Ruprecht-Karls-Universität, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
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Müller J, Fink C, Rabini S, Kelber O, Nieber K, Kraft K, Storr MA. The herbal medicine STW 5 is efficacious in functional dyspepsia also in the elderly – a meta-analysis of randomized controlled trials. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Müller
- Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany, Darmstadt, Germany
| | - C Fink
- Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany, Darmstadt, Germany
| | - S Rabini
- Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany, Darmstadt, Germany
| | - O Kelber
- Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany, Darmstadt, Germany
| | - K Nieber
- Pharmaceutical Institute, Leipzig University, Leipzig, Germany, Leipzig, Germany
| | - K Kraft
- Chair for Naturopathy, Center for Internal Medicine, University Medicine Rostock, Rostock, Germany, Rostock, Germany
| | - MA Storr
- Center for Endoscopy, Starnberg, Germany
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Fink C, Müller J, Kelber O, Nieber K, Kraft K. Dry cough associated with pharyngeal irritation: Survey on Althea officinalis L. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Fink
- Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany
| | - J Müller
- Medical and Clinical Affairs Phytomedicines, Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany
| | - O Kelber
- Innovation and Development, Phytomedicines Supply and Development Center, Bayer Consumer Health Division, Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany
| | - K Nieber
- Pharmaceutical Institute, Leipzig University, Leipzig, Germany
| | - K Kraft
- Chair for Naturopathy, Center for Internal Medicine, University Medicine Rostock, Rostock, Germany
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Abstract
BACKGROUND While the excisional biopsy and histological examination of suspicious lesions remains the current gold standard for diagnosing cutaneous melanoma (CM), there is a demand for more objective and non-invasive examination methods that may support clinicians in their decision when to biopsy or not. METHODS This review is based on publications and guidelines retrieved by a selective search in PubMed and MEDLINE and focused on non-invasive diagnostic strategies for detecting melanoma. RESULTS Ten different non-invasive techniques were compared with regard to applicability, status of development, and resources necessary for introduction into clinical routine (dermoscopy, sequential digital dermoscopy, total body photography, computer-aided multispectral digital analysis, electrical impedance spectroscopy, Raman spectroscopy, reflectance confocal microscopy, multiphoton tomography, stepwise two-photon-laser spectroscopy, quantitative dynamic infrared imaging). In an effort to create a classification based on our analyses, we suggest to differentiate i) tools for screening of patients in daily clinical routine, ii) tools for examination of a restricted number of preselected lesions that produce an automated diagnostic score, iii) tools for examination of a restricted number of preselected lesions at specialized centers requiring extensive training, iv) devices at an experimental stage of development. CONCLUSION None of the discussed examination techniques is able to provide a definite and final diagnosis or to completely replace the histopathological examination. Up to date, the need for fully automated devices offering a complete skin cancer screening has not been satisfied.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Fink C, Haenssle HA. [Singular skin-colored nodule on the trunk of an 18-month-old girl]. Hautarzt 2017; 68:674-676. [PMID: 28361251 DOI: 10.1007/s00105-017-3976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Fink
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - H A Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
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Trojan M, Müller-Eschner M, Kotelis D, MD Partovi S, Karmonik C, Fink C, Tengg-Koblink H, Ruhparwar A, Böckler D, Kauczor H, Rengier F. Dynamische 3D-MR-Angiografie bei Patienten mit Aortendissektion als Risikofaktor für eine chronische Expansion. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Trojan
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - M Müller-Eschner
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - D Kotelis
- Universitätsklinikum Heidelberg, Gefäßchirurgie, Heidelberg
| | - S MD Partovi
- University Hospitals Case Medical Center Cleveland, Radiology, Cleveland, Ohio USA
| | - C Karmonik
- Houston Methodist, Neurosurgery, Houston, Texas USA
| | - C Fink
- AKH Celle, Radiologie, Celle
| | - H Tengg-Koblink
- Universitätsspital Bern, Inselspital, Diagnostische, Interventionelle und pädiatrische Radiologie, Bern, Schweiz
| | - A Ruhparwar
- Universitätsklinikum Heidelberg, Herzchirurgie, Heidelberg
| | - D Böckler
- Universitätsklinikum Heidelberg, Gefäßchirurgie, Heidelberg
| | - H Kauczor
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - F Rengier
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
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Tschandl P, Hofmann L, Fink C, Kittler H, Haenssle HA. Melanomas vs. nevi in high-risk patients under long-term monitoring with digital dermatoscopy: do melanomas and nevi already differ at baseline? J Eur Acad Dermatol Venereol 2017; 31:972-977. [PMID: 27896853 DOI: 10.1111/jdv.14065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND What lesions to select for a most efficient dermatoscopic monitoring of patients with multiple nevi remains an unresolved issue. OBJECTIVE To compare the grade of atypia of melanomas and nevi of the same patient at baseline. METHODS Prospective observational study using 236 dermatoscopic baseline images (59 quartets from 59 patients, each including one melanoma detected during follow-up and three nevi). Dermatologists (n = 26) were asked to assess the 'grade of dermatoscopic atypia' on a numerical scale and to identify the melanomas. RESULTS On average, each dermatologist identified 24 of 59 melanomas (40%, range: 11-37). The number of correct picks was greater for dermatologists with moderate (mean: 28) or high (mean: 28) experience compared to beginners (mean 17; P < 0.001). In three of the 59 sets, none of the 26 dermatologists identified the melanoma. The mean grade of dermatoscopic atypia was 2.5 for nevi (95% CI: 2.4-2.6) and 3.0 for melanomas (95% CI: 2.9-3.1, P < 0.001). LIMITATIONS Rating dermatologists were informed that each quartet of images included one melanoma creating substantial deviation from a real-life situation. CONCLUSION A significant proportion of melanomas detected during follow-up cannot be differentiated from nevi at baseline. This necessitates the additional inclusion of less atypical lesions for monitoring.
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Affiliation(s)
- P Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L Hofmann
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C Fink
- Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - H Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - H A Haenssle
- Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Fink C, Kallsen K, Bhandari A, Roeder T. Dysregulation of epithelial JAK/STAT-signaling leads to malformation of the fruit fly's airways. Pneumologie 2016. [DOI: 10.1055/s-0036-1584608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thiedmann M, Prange R, Bhandari A, Kallsen K, Fink C, Roeder T. Cigarette smoke exposure induces substantial changes in the airway epithelium of a Drosophila COPD model. Pneumologie 2016. [DOI: 10.1055/s-0036-1584642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bossen J, Uliczka K, Thiedmann M, Mai M, Fink C, Heine H, Roeder T. Ectopic activation of EGFR signaling in the airway epithelium of Drosophila induces lung cancer-like phenotypes. Pneumologie 2016. [DOI: 10.1055/s-0036-1584607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fink C, Uhlmann L, Enk A, Gholam P. Pain management in photodynamic therapy using a nitrous oxide/oxygen mixture: a prospective, within-patient, controlled clinical trial. J Eur Acad Dermatol Venereol 2016; 31:70-74. [PMID: 27393707 DOI: 10.1111/jdv.13788] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Photodynamic therapy is an effective treatment for actinic keratoses. Nevertheless, severe pain during the procedure is a serious adverse effect, which leads to interruption or even termination. Complete pain relief remains a difficult challenge. OBJECTIVE To evaluate the effect of a nitrous oxide/oxygen mixture on pain intensity during photodynamic therapy. METHODS This clinical trial has been designed as a prospective, single-centre, explorative, controlled, observational study. RESULTS We were able to detect a significant overall pain reduction of 55.2% after application of a nitrous oxide/oxygen mixture by means of an intra-individual comparison. Furthermore, the total number of therapy interruption significantly decreased by 82% after the inhalation analgesia. Additionally, treatment satisfaction ranged from 'extremely to very satisfied'. CONCLUSIONS This study shows that analgesia by means of a nitrous oxide/oxygen mixture is a very effective and well-tolerated method for achieving significant pain reduction during photodynamic therapy.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - P Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Affiliation(s)
- C Fink
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - H A Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
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Rengier F, Wörz S, Melzig C, Ley S, Fink C, Fink C, Rohr K, Grünig E, Kauczor H. Automatisierte 3D-MRT-Volumetrie der Pulmonalarterien: Prädiktion der pulmonalen Hypertonie und Auswerter-Übereinstimmung. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ruedl G, Helle K, Tecklenburg K, Schranz A, Fink C, Posch M, Burtscher M. [Impact of Self-Reported Fatigue on ACL Injuries in Alpine Skiing: A Sex Comparison]. Sportverletz Sportschaden 2015; 29:226-30. [PMID: 26689190 DOI: 10.1055/s-0041-106948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In recreational alpine skiing, about one third of all injuries affect the knee joint, and the most common diagnosis in adult male and female skiers is a tear of the anterior cruciate ligament (ACL), which makes up 15 - 21 % of all injuries. General preventive recommendations to reduce the incidence of ski injuries include avoiding fatigue. However, it seems unclear to what extent ACL injuries in male and female recreational skiers are related to perceived fatigue. METHODS This study was conducted as a prospective questionnaire-based investigation in two Austrian ski injury clinics during the five winter seasons between 2009/2010 and 2013/2014. In total, 588 skiers (67.9 % females) with a mean age of 42.1 ± 10.9 years were interviewed about demographics, skiing ability, skiing behaviour, fitness, day and time of accident, skiing duration and perceived fatigue at the moment of accident. RESULTS ACL injured males reported a significantly higher skiing ability and fitness level as well as a more risky behaviour on ski slopes compared to females. About one third of males and females injured their ACL within the first day of the ski trip and about 57 % within the first two days, with no sex differences. However, a significantly higher number of female skiers sustained an ACL injury during the first hour of skiing (28 vs. 17 %) as well as during the first two hours of skiing compared to males (52 vs. 44 %). About 81 % of males and females felt no fatigue or just a trace of fatigue in their legs at the time of accident, with no sex differences. CONCLUSION Based on the findings of this study, fatigue does not seem to be a major risk factor for an ACL injury among male and female recreational skiers.
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Affiliation(s)
- G Ruedl
- Institut für Sportwissenschaft Innsbruck, Österreich
| | - K Helle
- medalp sportclinic sölden - imst, Imst, Österreich
| | | | - A Schranz
- medalp sportclinic sölden - imst, Imst, Österreich
| | - C Fink
- Gelenkpunkt - Zentrum für Sport- und Gelenkchirurgie, Innsbruck, Österreich
| | - M Posch
- Institut für Sportwissenschaft Innsbruck, Österreich
| | - M Burtscher
- Institut für Sportwissenschaft Innsbruck, Österreich
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Gholam P, Fink C, Bosselmann I, Enk A. Retrospective analysis evaluating the effect of a keratolytic and physical pretreatment with salicylic acid, urea and curettage on the efficacy and safety of photodynamic therapy of actinic keratoses with methylaminolaevulinate. J Eur Acad Dermatol Venereol 2015; 30:619-23. [DOI: 10.1111/jdv.13449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Gholam
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - C. Fink
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - I. Bosselmann
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - A.H. Enk
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
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46
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Fink C, Happle R, Enk A, Haenssle H. Phacomatosis spilorosea: visual diagnosis and associated pathologies of a rare entity. J Eur Acad Dermatol Venereol 2015; 30:e69-e70. [DOI: 10.1111/jdv.13312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Fink
- Department of Dermatology, Venerology, and Allergology; University Medical Center; Ruprecht-Karl University; Heidelberg Germany
| | - R. Happle
- Department of Dermatology; Freiburg University Medical Center; University of Freiburg; Freiburg Germany
| | - A. Enk
- Department of Dermatology, Venerology, and Allergology; University Medical Center; Ruprecht-Karl University; Heidelberg Germany
| | - H.A. Haenssle
- Department of Dermatology, Venerology, and Allergology; University Medical Center; Ruprecht-Karl University; Heidelberg Germany
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47
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Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U. Stereotactic body radiotherapy for central lung tumours: Author reply. Br J Radiol 2015; 88:20150532. [PMID: 26151618 PMCID: PMC4743584 DOI: 10.1259/bjr.20150532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- S Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site, Freiburg, Germany
| | | | - E Shash
- EORTC Headquarters, Brussels, Belgium
| | - M Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - C Le Pechoux
- Department of Radiation Oncoiogy, Gustave Roussy, Paris Sud University, Villejuif, France
| | - C Faivre-Finn
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - D De Ruysscher
- Department of Radiation Oncology, KU Leuven—University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - H Peulen
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - J Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - C Fink
- Department of Radiology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - U Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site, Freiburg, Germany
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48
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Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U. LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol 2015; 88:20150036. [PMID: 25873481 PMCID: PMC4628529 DOI: 10.1259/bjr.20150036] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 04/13/2015] [Indexed: 12/16/2022] Open
Abstract
Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage non-small-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.
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Affiliation(s)
- S Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
| | | | - E Shash
- EORTC Headquarters, Brussels, Belgium
| | - M Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - C Le Pechoux
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - C Faivre-Finn
- Institute of Cancer Sciences, Radiotherapy Related Research, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - D De Ruysscher
- KU Leuven–University of Leuven, University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - H Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - J Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - C Fink
- Department of Radiology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - U Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
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49
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Kösters A, Rieder F, Wiesinger HP, Dorn U, Hofstaedter T, Fink C, Müller E, Seynnes OR. Alpine Skiing With total knee ArthroPlasty (ASWAP): effect on tendon properties. Scand J Med Sci Sports 2015; 25 Suppl 2:67-73. [PMID: 26083704 DOI: 10.1111/sms.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program. Tendon stiffness, Young's modulus, and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P < 0.001) larger in the operated (OP) than in the non-operated (NOP) leg at baseline, without any difference in other tendon properties. After training, stiffness increased in the IG by 5.8% and 15.8%, respectively, in the OP and NOP legs. Likewise, mean CSA increased in the IG by 2.9% in the OP and 3.8% in the NOP leg, whereas no significant changes were found for the Young's modulus. None of the tendon parameters changed in the CG. Results indicate that patellar tendon structure and/or loading pattern are altered following TKA, but this tissue seems to retain its adaptation capacity. Further, alpine skiing appears to offer a suitable rehabilitation strategy for TKA patients.
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Affiliation(s)
- A Kösters
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - F Rieder
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - H-P Wiesinger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - U Dorn
- Orthopaedic University Clinic, PMU Salzburg, Salzburg, Austria
| | - T Hofstaedter
- Orthopaedic University Clinic, PMU Salzburg, Salzburg, Austria
| | - C Fink
- Sportsclinic Austria, Innsbruck, Austria
| | - E Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - O R Seynnes
- Norwegian School of Sport Sciences, Oslo, Norway
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50
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Kösters A, Pötzelsberger B, Dela F, Dorn U, Hofstaedter T, Fink C, Müller E. Alpine Skiing With total knee ArthroPlasty (ASWAP): study design and intervention. Scand J Med Sci Sports 2015; 25 Suppl 2:3-9. [DOI: 10.1111/sms.12459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Affiliation(s)
- A. Kösters
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
| | - B. Pötzelsberger
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
| | - F. Dela
- Xlab; Department of Biomedical Sciences; Center for Healthy Aging; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - U. Dorn
- Orthopaedic University Clinic; PMU Salzburg; Salzburg Austria
| | - T. Hofstaedter
- Orthopaedic University Clinic; PMU Salzburg; Salzburg Austria
| | - C. Fink
- Sportsclinic Austria; Innsbruck Austria
| | - E. Müller
- Department of Sport Science and Kinesiology; University of Salzburg; Salzburg Austria
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