1
|
Codling D, Mueller C, Patel J, Stewart R, Arya R, Roberts L. Rates of venous thromboembolism associated with acute psychiatric admission: A retrospective cohort study. Exp Ther Med 2024; 27:188. [PMID: 38533433 PMCID: PMC10964734 DOI: 10.3892/etm.2024.12476] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/30/2024] [Indexed: 03/28/2024] Open
Abstract
The present study aimed to identify rates of venous thromboembolism (VTE) amongst patients treated in inpatient mental health units using linked primary care and mental health care records. Patients resident in the London Borough of Lambeth admitted to mental health units in Southeast London between January 2008 and March 2019 were included, as well as a control group of patients being treated in the community for mental illness. The primary outcome measure was a diagnosis of VTE being recorded in GP records during or within 3 months of an admission to a mental health unit. For 7,198 psychiatric inpatient admissions, 11 episodes of VTE (1.5/1,000 admissions) were identified, with no VTE cases identified in 4,561 patients being treated in the community for mental illness during an equivalent window. This finding indicates that VTE rates following psychiatric inpatient admission might be similar to those following unselected acute medical admission. Larger scale studies are required to confirm the estimated incidence of VTE in patients with mental health conditions and the contribution of acute psychiatry hospitalisation to VTE risk.
Collapse
Affiliation(s)
- David Codling
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, United Kingdom
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, United Kingdom
| | - Jignesh Patel
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, United Kingdom
| | - Roopen Arya
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital, London SE5 9RS, United Kingdom
| | - Lara Roberts
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital, London SE5 9RS, United Kingdom
| |
Collapse
|
2
|
Parmar M, Ma R, Attygalle S, Herath MD, Mueller C, Stubbs B, Stewart R, Perera G. Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02663-9. [PMID: 38622311 DOI: 10.1007/s00127-024-02663-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood. METHOD A cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year. RESULTS Loneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07-1.29), emergency presentation (HR 1.30, 1.21-1.40), days active per year (IRR 1.04, 1.03-1.05), and face-to-face contacts per year (IRR 1.28, 1.27-1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29-2.18) and mortality (HR 1.29, 1.01-1.65). CONCLUSION Patients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.
Collapse
Affiliation(s)
- Mayur Parmar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | - Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | | | - Maaheshi Deepika Herath
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
- Faculty of Life and Health Sciences, School of Medicine, Ulster University, Belfast, Northern Ireland
| | - Christoph Mueller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| |
Collapse
|
3
|
Biehn SE, Goncalves LM, Lehmann J, Marty JD, Mueller C, Ramirez SA, Tillier F, Sage CR. BioPrint meets the AI age: development of artificial intelligence-based ADMET models for the drug-discovery platform SAFIRE. Future Med Chem 2024; 16:587-599. [PMID: 38372202 DOI: 10.4155/fmc-2024-0007] [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] [Indexed: 02/20/2024] Open
Abstract
Background: To prioritize compounds with a higher likelihood of success, artificial intelligence models can be used to predict absorption, distribution, metabolism, excretion and toxicity (ADMET) properties of molecules quickly and efficiently. Methods: Models were trained with BioPrint database proprietary data along with public datasets to predict various ADMET end points for the SAFIRE platform. Results: SAFIRE models performed at or above 75% accuracy and 0.4 Matthew's correlation coefficient with validation sets. Training with both proprietary and public data improved model performance and expanded the chemical space on which the models were trained. The platform features scoring functionality to guide user decision-making. Conclusion: High-quality datasets along with chemical space considerations yielded ADMET models performing favorably with utility in the drug discovery process.
Collapse
Affiliation(s)
- Sarah E Biehn
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | | | - Juerg Lehmann
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | - Jessica D Marty
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | - Christoph Mueller
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | - Samuel A Ramirez
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | - Fabien Tillier
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| | - Carleton R Sage
- Eurofins DiscoveryAI, Eurofins Panlabs, Inc., Saint Charles, MO 63304, USA
| |
Collapse
|
4
|
Kawabata K, Krismer F, Heim B, Hussl A, Mueller C, Scherfler C, Gizewski ER, Seppi K, Poewe W. A Blinded Evaluation of Brain Morphometry for Differential Diagnosis of Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:381-390. [PMID: 38314609 PMCID: PMC10982602 DOI: 10.1002/mdc3.13987] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Advanced imaging techniques have been studied for differential diagnosis between PD, MSA, and PSP. OBJECTIVES This study aims to validate the utility of individual voxel-based morphometry techniques for atypical parkinsonism in a blinded fashion. METHODS Forty-eight healthy controls (HC) T1-WI were used to develop a referential dataset and fit a general linear model after segmentation into gray matter (GM) and white matter (WM) compartments. Segmented GM and WM with PD (n = 96), MSA (n = 18), and PSP (n = 20) were transformed into z-scores using the statistics of referential HC and individual voxel-based z-score maps were generated. An imaging diagnosis was assigned by two independent raters (trained and untrained) blinded to clinical information and final diagnosis. Furthermore, we developed an observer-independent index for ROI-based automated differentiation. RESULTS The diagnostic performance using voxel-based z-score maps by rater 1 and rater 2 for MSA yielded sensitivities: 0.89, 0.94 (95% CI: 0.74-1.00, 0.84-1.00), specificities: 0.94, 0.80 (0.90-0.98, 0.73-0.87); for PSP, sensitivities: 0.85, 0.90 (0.69-1.00, 0.77-1.00), specificities: 0.98, 0.94 (0.96-1.00, 0.90-0.98). Interrater agreement was good for MSA (Cohen's kappa: 0.61), and excellent for PSP (0.84). Receiver operating characteristic analysis using the ROI-based new index showed an area under the curve (AUC): 0.89 (0.77-1.00) for MSA, and 0.99 (0.98-1.00) for PSP. CONCLUSIONS These evaluations provide support for the utility of this imaging technique in the differential diagnosis of atypical parkinsonism demonstrating a remarkably high differentiation accuracy for PSP, suggesting potential use in clinical settings in the future.
Collapse
Affiliation(s)
- Kazuya Kawabata
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Department of NeurologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Florian Krismer
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Beatrice Heim
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Anna Hussl
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
| | | | - Christoph Scherfler
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Elke R. Gizewski
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
- Department of NeuroradiologyMedical University InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University InnsbruckInnsbruckAustria
- Neuroimaging Research Core FacilityMedical University InnsbruckInnsbruckAustria
| |
Collapse
|
5
|
Roll W, Bauer J, Dik A, Mueller C, Backhaus P, Räuber S, Zinnhardt B, Gallus M, Wimberley C, Körtvelyessy P, Schindler P, Stenzel W, Elger CE, Becker A, Lewerenz J, Wiendl H, Meuth SG, Schäfers M, Melzer N. [ 18F]DPA-714-PET-MRI reveals pronounced innate immunity in human anti-LGI1 and anti-CASPR2 limbic encephalitis. J Neurol 2024:10.1007/s00415-024-12302-7. [PMID: 38472399 DOI: 10.1007/s00415-024-12302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Wolfgang Roll
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Andre Dik
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christoph Mueller
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- Biomarkers and Translational Technologies (BTT), Pharma Research & Early Development (pRED), F.Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Marco Gallus
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurological Surgery, University of California San Francisco, San Francisco, USA
| | | | - Peter Körtvelyessy
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Schindler
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Werner Stenzel
- Department of Neuropathology, and Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Albert Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
6
|
Burgio MI, Veronese N, Sarà D, Saccaro C, Masnata R, Vassallo G, Catania A, Catanese G, Mueller C, Smith L, Dominguez LJ, Vernuccio L, Barbagallo M. Markers for the detection of Lewy body disease versus Alzheimer's disease in mild cognitive impairment: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:60. [PMID: 38451331 PMCID: PMC10920203 DOI: 10.1007/s40520-024-02704-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may evolve into dementia. Early recognition of possible evolution to Alzheimer's disease (AD) and dementia with Lewy Bodies (DLB) is of importance, but actual diagnostic criteria have some limitations. In this systematic review and meta-analysis, we aimed to find the most accurate markers that can discriminate patients with DLB versus AD, in MCI stage. METHODS We searched several databases up to 17 August 2023 including studies comparing markers that may distinguish DLB-MCI from AD-MCI. We reported data regarding sensitivity, specificity, and the area under the curves (AUCs) with their 95% confidence intervals (CIs). RESULTS Among 2219 articles initially screened, eight case-control studies and one cohort study were included for a total of 832 outpatients with MCI. The accuracy of cerebrospinal fluid (CSF) markers was the highest among the markers considered (AUC > 0.90 for the CSF markers), with the AUC of CSF Aβ42/Aβ40 of 0.94. The accuracy for clinical symptom scales was very good (AUC = 0.93), as evaluated in three studies. Although limited to one study, the accuracy of FDG-PET (cingulate island sign ratio) was very good (AUC = 0.95) in discriminating DLB from AD in MCI, while the accuracy of SPECT markers and EEG frequencies was variable. CONCLUSIONS Few studies have assessed the accuracy of biomarkers and clinical tools to distinguish DLB from AD at the MCI stage. While results are promising for CSF markers, FDG-PET and clinical symptoms scales, more studies, particularly with a prospective design, are needed to evaluate their accuracy and clinical usefulness. CLINICAL TRIAL REGISTRATION Prospero (CRD42023422600).
Collapse
Affiliation(s)
- Marianna Ilarj Burgio
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy.
| | - Davide Sarà
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Carlo Saccaro
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Roberta Masnata
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Giusy Vassallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Angela Catania
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Giuseppina Catanese
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Christoph Mueller
- South London and Maudsley National Health Service Foundation Trust, London, UK
- Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ligia Juliana Dominguez
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Laura Vernuccio
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| |
Collapse
|
7
|
Tsamakis K, Pantazidi M, Alevyzakis E, Tsiptsios D, Mueller C, Smyrnis N, Rizos EN. Early Onset of Tardive Dyskinesia in an Antipsychotic-Naive Patient Treated With Low-Dose Cariprazine. J Clin Psychopharmacol 2024; 44:189-191. [PMID: 38385774 DOI: 10.1097/jcp.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
|
8
|
Straburzynska-Migaj E, Senni M, Wachter R, Fonseca C, Witte KK, Mueller C, Lonn E, Butylin D, Noe A, Schwende H, Lawrence D, Suryawanshi B, Pascual-Figal D. Early Initiation of Sacubitril/Valsartan in Patients With Acute Heart Failure and Renal Dysfunction: An Analysis of the TRANSITION Study. J Card Fail 2024; 30:425-435. [PMID: 37678704 DOI: 10.1016/j.cardfail.2023.08.021] [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: 04/04/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Treatment of patients with heart failure with reduced ejection fraction (HFrEF) and renal dysfunction (RD) is challenging owing to the risk of further deterioration in renal function, especially after acute decompensated HF (ADHF). METHODS AND RESULTS We assessed the effect of RD (estimated glomerular filtration rate of ≥30 to <60 mL/min/1.73 m2) on initiation, up-titration, and tolerability of sacubitril/valsartan in hemodynamically stabilized patients with HFrEF admitted for ADHF (RD, n = 476; non-RD, n = 483). At week 10, the target dose of sacubitril/valsartan (97/103 mg twice daily) was achieved by 42% patients in RD subgroup vs 54% in non-RD patients (P < .001). Sacubitril/valsartan was associated with greater estimated glomerular filtration rate improvements in RD subgroup than non-RD (change from baseline least squares mean 4.1 mL/min/1.73 m2, 95% confidence interval 2.2-6.1, P < .001). Cardiac biomarkers improved significantly in both subgroups; however, compared with the RD subgroup, the improvement was greater in those without RD (N-terminal pro-brain natriuretic peptide, -28.6% vs -44.8%, high-sensitivity troponin T -20.3% vs -33.9%) (P < .001). Patients in the RD subgroup compared with those without RD experienced higher rates of hyperkalemia (16.3% vs 6.5%, P < .001), investigator-reported cardiac failure (9.7% vs 5.6%, P = .029), and renal impairment (6.4% vs 2.1%, P = .002). CONCLUSIONS Most patients with HFrEF and concomitant RD hospitalized for ADHF tolerated early initiation of sacubitril/valsartan and showed significant improvements in estimated glomerular filtration rate and cardiac biomarkers. CLINICAL TRIAL REGISTRATION NCT02661217.
Collapse
Affiliation(s)
- Ewa Straburzynska-Migaj
- Poznan University of Medical Sciences, Poznan, University Hospital in Poznan, Poznan, Poland.
| | - M Senni
- Cardiovascular Department and Cardiology Unit, ASST Papa Giovanni XXIII, University of Milano-Bicocca, Bergamo, Italy
| | - R Wachter
- Clinic and polyclinic for cardiology, Leipzig University Hospital, Leipzig, Germany
| | - C Fonseca
- Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - K K Witte
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - C Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Heart Center Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - E Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Canada
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | - D Pascual-Figal
- Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain & Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| |
Collapse
|
9
|
Merkouris E, Mavroudi T, Miliotas D, Tsiptsios D, Serdari A, Christidi F, Doskas TK, Mueller C, Tsamakis K. Probiotics' Effects in the Treatment of Anxiety and Depression: A Comprehensive Review of 2014-2023 Clinical Trials. Microorganisms 2024; 12:411. [PMID: 38399815 PMCID: PMC10893170 DOI: 10.3390/microorganisms12020411] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Changes in the gut microbiome can affect cognitive and psychological functions via the microbiota-gut-brain (MGB) axis. Probiotic supplements are thought to have largely positive effects on mental health when taken in sufficient amounts; however, despite extensive research having been conducted, there is a lack of consistent findings on the effects of probiotics on anxiety and depression and the associated microbiome alterations. The aim of our study is to systematically review the most recent literature of the last 10 years in order to clarify whether probiotics could actually improve depression and anxiety symptoms. Our results indicate that the majority of the most recent literature suggests a beneficial role of probiotics in the treatment of depression and anxiety, despite the existence of a substantial number of less positive findings. Given probiotics' potential to offer novel, personalized treatment options for mood disorders, further, better targeted research in psychiatric populations is needed to address concerns about the exact mechanisms of probiotics, dosing, timing of treatment, and possible differences in outcomes depending on the severity of anxiety and depression.
Collapse
Affiliation(s)
- Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Theodora Mavroudi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Daniil Miliotas
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
- 3rd Neurology Department, Aristotle University, 54124 Thessaloniki, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupoli, Greece; (E.M.); (T.M.); (D.M.); (D.T.); (F.C.)
| | | | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
- Institute of Medical and Biomedical Education, St George’s, University of London, London SW17 0RE, UK
| |
Collapse
|
10
|
Velayudhan L, Mueller C. Diagnostic challenges and disparities in young-onset dementia: insights from a Southeast London memory clinic study. Int Psychogeriatr 2024:1-3. [PMID: 38299381 DOI: 10.1017/s1041610224000073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Laurell AAS, Venkataraman AV, Schmidt T, Montagnese M, Mueller C, Stewart R, Lewis J, Mundell C, Isaacs JD, Krishnan MS, Barber R, Rittman T, Underwood BR. Estimating demand for potential disease-modifying therapies for Alzheimer's disease in the UK. Br J Psychiatry 2024:1-7. [PMID: 38235531 DOI: 10.1192/bjp.2023.166] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Phase three trials of the monoclonal antibodies lecanemab and donanemab, which target brain amyloid, have reported statistically significant differences in clinical end-points in early Alzheimer's disease. These drugs are already in use in some countries and are going through the regulatory approval process for use in the UK. Concerns have been raised about the ability of healthcare systems, including those in the UK, to deliver these treatments, considering the resources required for their administration and monitoring. AIMS To estimate the scale of real-world demand for monoclonal antibodies for Alzheimer's disease in the UK. METHOD We used anonymised patient record databases from two National Health Service trusts for the year 2019 to collect clinical, demographic, cognitive and neuroimaging data for these cohorts. Eligibility for treatment was assessed using the inclusion criteria from the clinical trials of donanemab and lecanemab, with consideration given to diagnosis, cognitive performance, cerebrovascular disease and willingness to receive treatment. RESULTS We examined the records of 82 386 people referred to services covering around 2.2 million people. After applying the trial criteria, we estimate that a maximum of 906 people per year would start treatment with monoclonal antibodies in the two services, equating to 30 200 people if extrapolated nationally. CONCLUSIONS Monoclonal antibody treatments for Alzheimer's disease are likely to present a significant challenge for healthcare services to deliver in terms of the neuroimaging and treatment delivery. The data provided here allows health services to understand the potential demand and plan accordingly.
Collapse
Affiliation(s)
- Axel A S Laurell
- Department of Psychiatry, University of Cambridge, UK; and Older People and Adult Community Directorate, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ashwin V Venkataraman
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Tatjana Schmidt
- Department of Clinical Neurosciences, University of Cambridge, UK
| | | | - Christoph Mueller
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan Lewis
- Informatics Department, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Clare Mundell
- Pharmacy Department, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jeremy D Isaacs
- Department of Neurology, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK; and Molecular and Clinical Sciences Research Institute, St George's, University of London, UK
| | - Mani S Krishnan
- Department of Old Age Psychiatry, Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, UK; and Older People and Adult Community Directorate, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
12
|
Read S, Hicks B, Budden E, Douglass J, Grahamslaw A, Herrero E, Joseph G, Kirkup C, Pusey M, Russell A, Sondh H, Sondh S, Storey B, Towson G, Baxter K, Birks Y, Brayne C, Colclough C, Dangoor M, Dixon J, Donaghy P, Gridley K, Harris PR, Hu B, King D, Knapp M, Miles E, Mueller C, Perach R, Robinson L, Rusted J, Thomas AJ, Wittenberg R, Banerjee S. Long-term impact of the COVID-19 pandemic on the quality of life of people with dementia and their family carers. Age Ageing 2024; 53:afad233. [PMID: 38275095 PMCID: PMC10811518 DOI: 10.1093/ageing/afad233] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Few studies have longitudinally mapped quality of life (QoL) trajectories of newly diagnosed people with dementia and their carers, particularly during coronavirus disease-2019 (COVID-19). METHODS In a UK cohort study, 261 newly diagnosed people with dementia and 206 family carers were assessed prior to the pandemic (July 2019-March 2020), followed up after the first lockdown (July-October 2020) and then again a year and 2 years later. Latent growth curve modelling examined the level and change of QoL over the four time-points using dementia-specific QoL measures (DEMQOL and C-DEMQOL). RESULTS Despite variations in individual change scores, our results suggest that generally people with dementia maintained their QoL during the pandemic and experienced some increase towards the end of the period. This contrasted with carers who reported a general deterioration in their QoL over the same period. 'Confidence in future' and 'Feeling supported' were the only carer QoL subscales to show some recovery post-pandemic. DISCUSSION It is positive that even during a period of global disruption, decline in QoL is not inevitable following the onset of dementia. However, it is of concern that carer QoL declined during this same period even after COVID-19 restrictions had been lifted. Carers play an invaluable role in the lives of people with dementia and wider society, and our findings suggest that, post-pandemic, they may require greater support to maintain their QoL.
Collapse
Affiliation(s)
- Sanna Read
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ben Hicks
- Brighton and Sussex Medical School, Centre for Dementia Studies, University of Sussex, Brighton, UK
| | - Emily Budden
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | | | - Elena Herrero
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregory Joseph
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Martha Pusey
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Alice Russell
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Sharon Sondh
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Bryony Storey
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Kate Baxter
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Margaret Dangoor
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Josie Dixon
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paul Donaghy
- Kings College London, Institute of Psychiatry, London, UK
| | - Kate Gridley
- Social Policy Research Unit, Faculty of Social Sciences, University of York, York, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Bo Hu
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eleanor Miles
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Rotem Perach
- School of Psychology, University of Sussex, Brighton, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | | - Alan J Thomas
- Institute for Ageing, Newcastle University, Newcastle, UK
| | - Raphael Wittenberg
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, UK
| |
Collapse
|
13
|
Hachenberger M, Yeniguen M, Suenner L, Hinchliffe D, Mueller C, Wietelmann A, Gerriets T, Tschernatsch M, Juenemann M, Gerner ST, Doeppner TR, Huttner HB, Braun T. Comparison of edoxaban and enoxaparin in a rat model of AlCl 3-induced thrombosis of the superior sagittal sinus. Naunyn Schmiedebergs Arch Pharmacol 2023; 396:3887-3892. [PMID: 37261475 PMCID: PMC10643418 DOI: 10.1007/s00210-023-02546-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
Cerebral sinus venous thrombosis (CSVT) is an uncommon disease that is usually treated with anticoagulation (heparin, low-molecular heparin, or vitamin K-antagonists). We compared treatment with edoxaban, an oral factor Xa-antagonist, that has not been approved in patients with CSVT, with enoxaparin, a well-established therapy, in a rat model of CSVT. Fifty male Wistar rats were randomized into 5 groups (10 animals each) and subjected to aluminum chloride (AlCl3)-induced thrombosis of the superior sagittal sinus (SSS) or sham procedure. Animals with thrombosis of the SSS were treated with edoxaban, enoxaparin, or placebo. Diagnostic workup included neurological examination, MRI imaging, MR-flow measurements of the SSS, and immunohistochemical staining. Neurological examination revealed no differences between treatment groups. Seven days after initial thrombosis, flow in the SSS was lower in the active treatment group as compared to sham-operated animals (p < 0.05). Flow in the SSS in the active treatment groups (edoxaban 1 h prior to thrombosis: 0.16 cm/s ± 0.06 cm/s; edoxaban 6 h after thrombosis: 0.13 cm/s ± 0.05 cm/s; enoxaparin: 0.13 cm/s ± 0.04 cm/s; placebo: 0.07 cm/s ± 0.02 cm/s) was higher as compared to placebo (p < 0.05), but there were no differences between the active treatment groups (p > 0.05). Immunohistochemical staining showed no differences in the actively treated animals. Edoxaban proved to be similar to enoxaparin in a model of experimental AlCl3-induced CSVT.
Collapse
Affiliation(s)
- M Hachenberger
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - M Yeniguen
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- NeuroCentrum Wetzlar, Sportparkstrasse 2, 35578, Wetzlar, Germany
| | - L Suenner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - D Hinchliffe
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
| | - C Mueller
- Department of Radiology, Kerckhoff-Klinik Bad Nauheim, 61231, Bad Nauheim, Germany
| | - A Wietelmann
- Scientific Service Group Magnetic Resonance Imaging, Max Planck Institute for Heart and Lung Research, 61231, Bad Nauheim, Germany
| | - T Gerriets
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- "Die Neurologen", Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - M Tschernatsch
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- "Die Neurologen", Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - M Juenemann
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - S T Gerner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - T R Doeppner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
- Department of Neurology, University of Goettingen Medical School, 37075, Goettingen, Germany
| | - H B Huttner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - T Braun
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany.
- Heart and Brain Research Group, 35385, Giessen, Germany.
| |
Collapse
|
14
|
Cai W, Ma W, Mueller C, Stewart R, Ji J, Shen WD. Association between late-life depression or depressive symptoms and stroke morbidity in elders: A systematic review and meta-analysis of cohort studies. Acta Psychiatr Scand 2023; 148:405-415. [PMID: 37728003 DOI: 10.1111/acps.13613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Whether late-life depression or depressive symptoms are a risk factor of future stroke in elders is important for prevention measures. A systematic review and meta-analysis were used to investigate the association between depression or depressive symptoms and risk of stroke in elders. METHODS Embase, MEDLINE, PsychINFO, and Web of Science were searched for studies published from inception to January 6, 2023. Prospective cohort studies reporting quantitative estimates of the association between depression or depressive symptoms and stroke morbidity in participants aged over 60 years were included. Reviews, meta-analyses, case reports, retrospective, cross-sectional, and theoretical studies were excluded. Study screening and data extraction were conducted by two researchers independently. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratios (HRs). Publication bias was evaluated via the symmetry of funnel plots and Egger tests. The Newcastle Ottawa Scale was used to assess the risk of bias. The quality of evidence of synthesis was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcome was any stroke, including non-fatal, fatal, ischemic and hemorrhagic sub-types. RESULTS Seventeen studies of 57,761 patients in total were included in the meta-analysis. A positive association was found between depressive disorder or symptoms and stroke risk (HR: 1.39; 95% CI: 1.22-1.58; p < 0.001). CONCLUSIONS Late-life depression or depressive symptoms are a significant risk factor for stroke in older people. Regular assessment and more effective management of associated comorbidities are recommended to reduce stroke risk.
Collapse
Affiliation(s)
- Wa Cai
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Ma
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jun Ji
- Department of Acupuncture Literature, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Wei-Dong Shen
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
15
|
Al-Batran SE, Mueller DW, Rafiyan MR, Kiselicki D, Atmaca A, Habibzada T, Mueller C, Brignone C, Triebel F, Loose M, Schaaf M, Sookthai D, Eickhoff R, Jaeger E, Goetze TO. A soluble LAG-3 protein (eftilagimod alpha) and an anti-PD-L1 antibody (avelumab) tested in a phase I trial: a new combination in immuno-oncology. ESMO Open 2023; 8:101623. [PMID: 37742484 PMCID: PMC10594027 DOI: 10.1016/j.esmoop.2023.101623] [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: 06/26/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Eftilagimod alpha (efti) is a major histocompatibility complex class II agonist activating antigen-presenting cells which leads to greater systemic type 1 T helper response and more cytotoxic CD8+ T-cell activation. This phase I trial evaluated the administration of efti, a soluble lymphocyte activation gene-3 (LAG-3) protein, combined with the anti-programmed death-ligand 1 (PD-L1) antibody avelumab in advanced solid tumors. PATIENTS AND METHODS Patients with heavily pretreated metastatic solid tumors received intravenous avelumab (800 mg) combined with subcutaneously administered efti (6 or 30 mg) for up to 12 cycles, followed by avelumab monotherapy. The primary endpoint was the assessment of the recommended phase II dose (RP2D) of efti in combination with avelumab. RESULTS Twelve patients with different tumor entities were enrolled (six patients in each cohort). During treatment, no dose-limiting toxicities occurred, and the severity of most adverse events was grade 1 or 2. In total, nine serious adverse events were documented, resulting in a fatal outcome in two cases, but none of them were assessed to be treatment related. Five patients (42%) achieved partial response. The median progression-free survival was 1.96 months and the median overall survival was not reached, with a 12-month survival rate of 75%. CONCLUSION Subcutaneously administered efti plus avelumab was well tolerated, and efti of 30 mg was determined to be RP2D. The activity is promising and warrants further investigation in future phase II trials.
Collapse
Affiliation(s)
- S-E Al-Batran
- UCT-University Cancer Center, Hospital Northwest, Frankfurt am Main; Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main.
| | - D W Mueller
- Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| | - M-R Rafiyan
- Department of Oncology and Hematology, Hospital Northwest, Frankfurt am Main
| | - D Kiselicki
- Department of Oncology and Hematology, Hospital Northwest, Frankfurt am Main
| | - A Atmaca
- Department of Oncology and Hematology, Hospital Northwest, Frankfurt am Main
| | - T Habibzada
- UCT-University Cancer Center, Hospital Northwest, Frankfurt am Main
| | | | | | | | - M Loose
- Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| | - M Schaaf
- Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| | - D Sookthai
- Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| | - R Eickhoff
- Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| | - E Jaeger
- Department of Oncology and Hematology, Hospital Northwest, Frankfurt am Main
| | - T O Goetze
- UCT-University Cancer Center, Hospital Northwest, Frankfurt am Main; Institute of Clinical Cancer Research IKF at Hospital Northwest, Frankfurt am Main
| |
Collapse
|
16
|
Bishara D, Riaz S, Sauer J, Mueller C, Gee S, Taylor D, Wilcha RJ, Edwards M, Beehuspoteea N, Mallia AMB, Brook J, Balasundaram B, Harwood D, Funnell N, Strydom A, Stewart R. A tool for safer prescribing in vulnerable adults: the continuing development of the Medichec app and website. BJPsych Bull 2023:1-7. [PMID: 37671832 DOI: 10.1192/bjb.2023.71] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
AIMS AND METHOD Adverse effects are a common concern when prescribing and reviewing medication, particularly in vulnerable adults such as older people and those with intellectual disability. This paper describes the development of an app giving information on side-effects, called Medichec, and provides a description of the processes involved in its development and how drugs were rated for each side-effect. Medications with central anticholinergic action, dizziness, drowsiness, hyponatraemia, QTc prolongation, bleeding and constipation were identified using the British National Formulary (BNF) and frequency of occurrence of these effects was determined using the BNF, product information and electronic searches, including PubMed. RESULTS Medications were rated using a traffic light system according to how commonly the adverse effect was known to occur or the severity of the effect. CLINICAL IMPLICATIONS Medichec can facilitate access to side-effects information for multiple medications, aid clinical decision-making, optimise treatment and improve patient safety in vulnerable adults.
Collapse
Affiliation(s)
- Delia Bishara
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sahar Riaz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Justin Sauer
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siobhan Gee
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Taylor
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robyn-Jenia Wilcha
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Millie Edwards
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nirja Beehuspoteea
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Anne Marie Bonnici Mallia
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Brook
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Harwood
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicola Funnell
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Strydom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Mental Health of Older Adults and Dementia Department, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
17
|
Buehring B, Mueller C, Parvaee R, Andreica I, Kiefer D, Kiltz U, Tsiami S, Pourhassan M, Westhoff T, Wirth R, Baraliakos X, Babel N, Braun J. [Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center]. Z Rheumatol 2023; 82:563-572. [PMID: 36877305 DOI: 10.1007/s00393-023-01332-7] [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] [Accepted: 01/12/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is a clinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria. OBJECTIVE To investigate the prevalence and severity of SP in patients with RMD. METHODS A total of 141 consecutive patients over 65 years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in a cross-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP 1 and 2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as a parameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in a standardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student's T-test and the χ2-test were used for statistics. RESULTS Of the patients included 73% were female, the mean age was 73 years and 80% had an inflammatory RMD. According to EWGSOP 2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP. DISCUSSION This study showed a relatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in a standardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.
Collapse
Affiliation(s)
- B Buehring
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland.
- Klinik für Rheumatologie, Immunologie und Osteologie, Bergisches Rheuma - Zentrum, Klinisches Osteologisches Schwerpunktzentrum DVO, Europäisches Expertenzentrum Systemische Sklerose, Krankenhaus St. Josef, Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Bergstr. 6-12, 42105, Wuppertal, Deutschland.
| | - C Mueller
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - R Parvaee
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - I Andreica
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - D Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - S Tsiami
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - M Pourhassan
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - T Westhoff
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - R Wirth
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - N Babel
- Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| |
Collapse
|
18
|
Ronaldson A, Stewart R, Mueller C, Das-Munshi J, Newbury JB, Mudway IS, Broadbent M, Fisher HL, Beevers S, Dajnak D, Hotopf M, Hatch SL, Bakolis I. Associations between air pollution and mental health service use in dementia: a retrospective cohort study. BMJ Ment Health 2023; 26:e300762. [PMID: 37550086 PMCID: PMC10577765 DOI: 10.1136/bmjment-2023-300762] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Little is known about the role of air pollution in how people with dementia use mental health services. OBJECTIVE We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia. METHODS In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models. FINDINGS In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function. CONCLUSIONS Residential air pollution exposure is associated with increased CMHT usage among people with dementia. CLINICAL IMPLICATIONS Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
Collapse
Affiliation(s)
- Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joanne B Newbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
| |
Collapse
|
19
|
Glebov OO, Mueller C, Stewart R, Aarsland D, Perera G. Antidepressant drug prescription and incidence of COVID-19 in mental health outpatients: a retrospective cohort study. BMC Med 2023; 21:209. [PMID: 37340474 PMCID: PMC10283271 DOI: 10.1186/s12916-023-02877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Currently, the main pharmaceutical intervention for COVID-19 is vaccination. While antidepressant (AD) drugs have shown some efficacy in treatment of symptomatic COVID-19, their preventative potential remains largely unexplored. Analysis of association between prescription of ADs and COVID-19 incidence in the population would be beneficial for assessing the utility of ADs in COVID-19 prevention. METHODS Retrospective study of association between AD prescription and COVID-19 diagnosis was performed in a cohort of community-dwelling adult mental health outpatients during the 1st wave of COVID-19 pandemic in the UK. Clinical record interactive search (CRIS) was performed for mentions of ADs within 3 months preceding admission to inpatient care of the South London and Maudsley (SLaM) NHS Foundation Trust. Incidence of positive COVID-19 tests upon admission and during inpatient treatment was the primary outcome measure. RESULTS AD mention was associated with approximately 40% lower incidence of positive COVID-19 test results when adjusted for socioeconomic parameters and physical health. This association was also observed for prescription of ADs of the selective serotonin reuptake inhibitor (SSRI) class. CONCLUSIONS This preliminary study suggests that ADs, and SSRIs in particular, may be of benefit for preventing COVID-19 infection spread in the community. The key limitations of the study are its retrospective nature and the focus on a mental health patient cohort. A more definitive assessment of AD and SSRI preventative potential warrants prospective studies in the wider demographic.
Collapse
Affiliation(s)
- Oleg O Glebov
- Institute of Neuroregeneration and Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Shandong, China.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley National Health Service Foundation Trust, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
20
|
Gallus M, Roll W, Dik A, Barca C, Zinnhardt B, Hicking G, Mueller C, Naik VN, Anstötz M, Krämer J, Rolfes L, Wachsmuth L, Pitsch J, van Loo KM, Räuber S, Okada H, Wimberley C, Strippel C, Golombeck KS, Johnen A, Kovac S, Groß CC, Backhaus P, Seifert R, Lewerenz J, Surges R, Elger CE, Wiendl H, Ruck T, Becker AJ, Faber C, Jacobs AH, Bauer J, Meuth SG, Schäfers M, Melzer N. Translational imaging of TSPO reveals pronounced innate inflammation in human and murine CD8 T cell-mediated limbic encephalitis. Sci Adv 2023; 9:eabq7595. [PMID: 37294768 PMCID: PMC10256169 DOI: 10.1126/sciadv.abq7595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2023] [Indexed: 06/11/2023]
Abstract
Autoimmune limbic encephalitis (ALE) presents with new-onset mesial temporal lobe seizures, progressive memory disturbance, and other behavioral and cognitive changes. CD8 T cells are considered to play a key role in those cases where autoantibodies (ABs) target intracellular antigens or no ABs were found. Assessment of such patients presents a clinical challenge, and novel noninvasive imaging biomarkers are urgently needed. Here, we demonstrate that visualization of the translocator protein (TSPO) with [18F]DPA-714-PET-MRI reveals pronounced microglia activation and reactive gliosis in the hippocampus and amygdala of patients suspected with CD8 T cell ALE, which correlates with FLAIR-MRI and EEG alterations. Back-translation into a preclinical mouse model of neuronal antigen-specific CD8 T cell-mediated ALE allowed us to corroborate our preliminary clinical findings. These translational data underline the potential of [18F]DPA-714-PET-MRI as a clinical molecular imaging method for the direct assessment of innate immunity in CD8 T cell-mediated ALE.
Collapse
Affiliation(s)
- Marco Gallus
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurosurgery, University of Münster, Münster, Germany
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Wolfgang Roll
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Andre Dik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Cristina Barca
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- Biomarkers and Translational Technologies (BTT), Pharma Research and Early Development (pRED), F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Gordon Hicking
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christoph Mueller
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Venu Narayanan Naik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Max Anstötz
- Institute of Anatomy II, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Julia Krämer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Leoni Rolfes
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Julika Pitsch
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Karen M. J. van Loo
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany
| | - Saskia Räuber
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Hideho Okada
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Christine Strippel
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Kristin S. Golombeck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Johnen
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Catharina C. Groß
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Rainer Surges
- Department of Epileptology, University of Bonn, Bonn, Germany
| | | | - Heinz Wiendl
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Tobias Ruck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Albert J. Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sven G. Meuth
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
21
|
Mueller C, Stewart R. Beyond confusion: Embedding psychiatry in delirium research and clinical practice. Acta Psychiatr Scand 2023; 147:395-397. [PMID: 37102379 DOI: 10.1111/acps.13552] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
22
|
Friedrich M, Perera G, Leutgeb L, Haardt D, Frey R, Stewart R, Mueller C. Predictors of hospital readmission for patients diagnosed with delirium: An electronic health record data analysis. Acta Psychiatr Scand 2023; 147:506-515. [PMID: 36441117 PMCID: PMC10463092 DOI: 10.1111/acps.13523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/13/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Delirium is an acute and fluctuating change in attention and cognition that increases the risk of functional decline, institutionalisation and death in hospitalised patients. After delirium, patients have a significantly higher risk of readmission to hospital. Our aim was to investigate factors associated with hospital readmission in people with delirium. METHODS We carried out an observational retrospective cohort study using linked mental health care and hospitalisation records from South London. Logistic regression models were used to predict the odds of 30-day readmission and Cox proportional hazard models to calculate readmission risks when not restricting follow-up time. RESULTS Of 2814 patients (mean age 78.9 years SD ±11.8) discharged from hospital after an episode of delirium, 823 (29.3%) were readmitted within 30 days. Depressed mood (odds ratio (OR) 1.34 (95% confidence interval (CI) 1.08-1.66)), moderate-to-severe physical health problems (OR 1.67 (95% CI 1.18-2.2.36)) and a history of serious circulatory disease (OR 1.29 (95% CI 1.07-1.55)) were associated with higher odds of hospital readmission, whereas a diagnosis of delirium superimposed on dementia (OR 0.67 (95% CI 0.53-0.84)) and problematic alcohol/substance (OR 0.54 (95% CI 0.33-0.89)) use were associated with lower odds. Cox proportionate hazard models showed similar results. CONCLUSION Almost one-third of patients with delirium were readmitted within a short period of time, a more detailed understanding of the underlying risk factors could help prevent readmissions. Our findings indicate that the aetiology (as alcohol-related delirium), the recognition that delirium occurred in the context of dementia, as well as potentially modifiable factors, as depressed mood affect readmission risk, and should be assessed in clinical settings.
Collapse
Affiliation(s)
- Michaela‐Elena Friedrich
- Department of Child and Adolescent PsychiatryKlinik HietzingViennaAustria
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Lisa Leutgeb
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - David Haardt
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - Richard Frey
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
23
|
Franz M, Aburahma K, Yablonski P, Carlens J, Saipbaev A, Mueller C, Sommer W, Kuehn C, Haverich A, Warnecke G, Avsar M, Schwerk N, Salman J, Bobylev D, Ius F. Nine-Year Experience with Treatment of Early Detectable Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.117] [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: 04/05/2023] Open
|
24
|
Majem M, Forster M, Krebs M, Peguero J, Clay T, Felip E, Iams W, Roxburgh P, de Spéville BD, Bajaj P, Mueller C, Triebel F. 11MO Final data from a phase II study (TACTI-002) of eftilagimod alpha (soluble LAG-3) and pembrolizumab in 2nd-line metastatic NSCLC pts resistant to PD-1/PD-L1 inhibitors. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00265-4] [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: 04/03/2023]
|
25
|
Co M, Mueller C, Mayston R, Das-Munshi J, Prina M. Ethnicity and survival after a dementia diagnosis: a retrospective cohort study using electronic health record data. Alzheimers Res Ther 2023; 15:67. [PMID: 36991518 PMCID: PMC10052806 DOI: 10.1186/s13195-022-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Individuals from minority ethnic groups in the UK are thought to be at higher risk of developing dementia while facing additional barriers to receiving timely care. However, few studies in the UK have examined if there are ethnic disparities in survival once individuals receive a dementia diagnosis. METHODS We conducted a retrospective cohort study using electronic health record data of individuals diagnosed with dementia from a large secondary mental healthcare provider in London. Patients from Black African, Black Caribbean, South Asian, White British, and White Irish ethnic backgrounds were followed up for a 10-year period between 01 January 2008 and 31 December 2017. Data were linked to death certificate data from the Office of National Statistics to determine survival from dementia diagnosis. Standardised mortality ratios were calculated to estimate excess deaths in each ethnicity group as compared to the gender- and age-standardised population of England and Wales. We used Cox regression models to compare survival after dementia diagnosis across each ethnicity group. RESULTS Mortality was elevated at least twofold across all ethnicity groups with dementia compared to the general population in England and Wales. Risk of death was lower in Black Caribbean, Black African, White Irish, and South Asian groups as compared to the White British population, even after adjusting for age, gender, neighbourhood-level deprivation, indicators of mental and physical comorbidities. Risk of death remained lower after additionally accounting for those who emigrated out of the cohort. CONCLUSIONS While mortality in dementia is elevated across all ethnic groups as compared to the general population, reasons for longer survival in minority ethnic groups in the UK as compared to the White British group are unclear and merit further exploration. Implications of longer survival, including carer burden and costs, should be considered in policy and planning to ensure adequate support for families and carers of individuals with dementia.
Collapse
Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neurosciences, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rosie Mayston
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, UK
| | - Jayati Das-Munshi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neurosciences, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| |
Collapse
|
26
|
Sheehan R, Mansour H, Broadbent M, Hassiotis A, Mueller C, Stewart R, Strydom A, Sommerlad A. Recording of intellectual disability in general hospitals in England 2006-2019: Cohort study using linked datasets. PLoS Med 2023; 20:e1004117. [PMID: 36940198 PMCID: PMC10069786 DOI: 10.1371/journal.pmed.1004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/03/2023] [Accepted: 02/20/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Accurate recognition and recording of intellectual disability in those who are admitted to general hospitals is necessary for making reasonable adjustments, ensuring equitable access, and monitoring quality of care. In this study, we determined the rate of recording of intellectual disability in those with the condition who were admitted to hospital and factors associated with the condition being unrecorded. METHODS AND FINDINGS Retrospective cohort study using 2 linked datasets of routinely collected clinical data in England. We identified adults with diagnosed intellectual disability in a large secondary mental healthcare database and used general hospital records to investigate recording of intellectual disability when people were admitted to general hospitals between 2006 and 2019. Trends over time and factors associated with intellectual disability being unrecorded were investigated. We obtained data on 2,477 adults with intellectual disability who were admitted to a general hospital in England at least once during the study period (total number of admissions = 27,314; median number of admissions = 5). People with intellectual disability were accurately recorded as having the condition during 2.9% (95% CI 2.7% to 3.1%) of their admissions. Broadening the criteria to include a nonspecific code of learning difficulty increased recording to 27.7% (95% CI 27.2% to 28.3%) of all admissions. In analyses adjusted for age, sex, ethnicity, and socioeconomic deprivation, having a mild intellectual disability and being married were associated with increased odds of the intellectual disability being unrecorded in hospital records. We had no measure of quality of hospital care received and could not relate this to the presence or absence of a record of intellectual disability in the patient record. CONCLUSIONS Recognition and recording of intellectual disability in adults admitted to English general hospitals needs to be improved. Staff awareness training, screening at the point of admission, and data sharing between health and social care services could improve care for people with intellectual disability.
Collapse
Affiliation(s)
- Rory Sheehan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Hassan Mansour
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew Broadbent
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andre Strydom
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, United Kingdom
| |
Collapse
|
27
|
Aburahma K, Franz M, Julia C, Heise E, Saipbaev A, Mueller C, Kühn C, Haverich A, Warnecke G, Avsar M, Schwerk N, Salman J, Bobylev D, Ius F. Nine-Year Experience with Treatment of Early Donor Specific Anti-HLA Antibodies in Pediatric Lung Transplant Recipients. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761791] [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: 03/22/2023]
Affiliation(s)
- K. Aburahma
- Hannover Medical School, Hannover, Deutschland
| | - M. Franz
- Hannover Medical School, Hannover, Deutschland
| | - C. Julia
- Hannover Medical School, Hannover, Deutschland
| | - E. Heise
- Hannover Medical School, Hannover, Deutschland
| | - A. Saipbaev
- Hannover Medical School, Hannover, Deutschland
| | - C. Mueller
- Hannover Medical School, Hannover, Deutschland
| | - C. Kühn
- Hannover Medical School, Hannover, Deutschland
| | - A. Haverich
- Hannover Medical School, Hannover, Deutschland
| | - G. Warnecke
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - M. Avsar
- Hannover Medical School, Hannover, Deutschland
| | - N. Schwerk
- Hannover Medical School, Hannover, Deutschland
| | - J. Salman
- Hannover Medical School, Hannover, Deutschland
| | - D. Bobylev
- Hannover Medical School, Hannover, Deutschland
| | - F. Ius
- Hannover Medical School, Hannover, Deutschland
| |
Collapse
|
28
|
Kossmann DF, Huang M, Weihmann R, Xiao X, Gätgens F, Weber TM, Brass HUC, Bitzenhofer NL, Ibrahim S, Bangert K, Rehling L, Mueller C, Tiso T, Blank LM, Drepper T, Jaeger KE, Grundler FMW, Pietruszka J, Schleker ASS, Loeschcke A. Production of tailored hydroxylated prodiginine showing combinatorial activity with rhamnolipids against plant-parasitic nematodes. Front Microbiol 2023; 14:1151882. [PMID: 37200918 PMCID: PMC10187637 DOI: 10.3389/fmicb.2023.1151882] [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: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/20/2023] Open
Abstract
Bacterial secondary metabolites exhibit diverse remarkable bioactivities and are thus the subject of study for different applications. Recently, the individual effectiveness of tripyrrolic prodiginines and rhamnolipids against the plant-parasitic nematode Heterodera schachtii, which causes tremendous losses in crop plants, was described. Notably, rhamnolipid production in engineered Pseudomonas putida strains has already reached industrial implementation. However, the non-natural hydroxyl-decorated prodiginines, which are of particular interest in this study due to a previously described particularly good plant compatibility and low toxicity, are not as readily accessible. In the present study, a new effective hybrid synthetic route was established. This included the engineering of a novel P. putida strain to provide enhanced levels of a bipyrrole precursor and an optimization of mutasynthesis, i.e., the conversion of chemically synthesized and supplemented monopyrroles to tripyrrolic compounds. Subsequent semisynthesis provided the hydroxylated prodiginine. The prodiginines caused reduced infectiousness of H. schachtii for Arabidopsis thaliana plants resulting from impaired motility and stylet thrusting, providing the first insights on the mode of action in this context. Furthermore, the combined application with rhamnolipids was assessed for the first time and found to be more effective against nematode parasitism than the individual compounds. To obtain, for instance, 50% nematode control, it was sufficient to apply 7.8 μM hydroxylated prodiginine together with 0.7 μg/ml (~ 1.1 μM) di-rhamnolipids, which corresponded to ca. ¼ of the individual EC50 values. In summary, a hybrid synthetic route toward a hydroxylated prodiginine was established and its effects and combinatorial activity with rhamnolipids on plant-parasitic nematode H. schachtii are presented, demonstrating potential application as antinematodal agents. Graphical Abstract.
Collapse
Affiliation(s)
- D. F. Kossmann
- Institute of Bio- and Geosciences (IBG-1): Biotechnology, Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Bioorganic Chemistry, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - M. Huang
- INRES, Molecular Phytomedicine, University of Bonn, Bonn, Germany
| | - R. Weihmann
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - X. Xiao
- INRES, Molecular Phytomedicine, University of Bonn, Bonn, Germany
| | - F. Gätgens
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - T. M. Weber
- Institute of Bioorganic Chemistry, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - H. U. C. Brass
- Institute of Bioorganic Chemistry, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - N. L. Bitzenhofer
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - S. Ibrahim
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - K. Bangert
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - L. Rehling
- INRES, Molecular Phytomedicine, University of Bonn, Bonn, Germany
| | - C. Mueller
- iAMB—Institute of Applied Microbiology, ABBt—Aachen Biology and Biotechnology, RWTH Aachen University, Aachen, Germany
| | - T. Tiso
- iAMB—Institute of Applied Microbiology, ABBt—Aachen Biology and Biotechnology, RWTH Aachen University, Aachen, Germany
| | - L. M. Blank
- iAMB—Institute of Applied Microbiology, ABBt—Aachen Biology and Biotechnology, RWTH Aachen University, Aachen, Germany
| | - T. Drepper
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | - K.-E. Jaeger
- Institute of Bio- and Geosciences (IBG-1): Biotechnology, Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
| | | | - J. Pietruszka
- Institute of Bio- and Geosciences (IBG-1): Biotechnology, Forschungszentrum Jülich GmbH, Jülich, Germany
- Institute of Bioorganic Chemistry, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
- *Correspondence: J. Pietruszka,
| | - A. S. S. Schleker
- INRES, Molecular Phytomedicine, University of Bonn, Bonn, Germany
- A. S. S. Schleker,
| | - A. Loeschcke
- Institute of Molecular Enzyme Technology, Forschungszentrum Jülich, Heinrich Heine University Düsseldorf, Jülich, Germany
- A. Loeschcke,
| |
Collapse
|
29
|
von Werdt D, Gungor B, Barreto de Albuquerque J, Gruber T, Zysset D, Kwong Chung CKC, Corrêa-Ferreira A, Berchtold R, Page N, Schenk M, Kehrl JH, Merkler D, Imhof BA, Stein JV, Abe J, Turchinovich G, Finke D, Hayday AC, Corazza N, Mueller C. Regulator of G-protein signaling 1 critically supports CD8 + T RM cell-mediated intestinal immunity. Front Immunol 2023; 14:1085895. [PMID: 37153600 PMCID: PMC10158727 DOI: 10.3389/fimmu.2023.1085895] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/13/2023] [Indexed: 05/09/2023] Open
Abstract
Members of the Regulator of G-protein signaling (Rgs) family regulate the extent and timing of G protein signaling by increasing the GTPase activity of Gα protein subunits. The Rgs family member Rgs1 is one of the most up-regulated genes in tissue-resident memory (TRM) T cells when compared to their circulating T cell counterparts. Functionally, Rgs1 preferentially deactivates Gαq, and Gαi protein subunits and can therefore also attenuate chemokine receptor-mediated immune cell trafficking. The impact of Rgs1 expression on tissue-resident T cell generation, their maintenance, and the immunosurveillance of barrier tissues, however, is only incompletely understood. Here we report that Rgs1 expression is readily induced in naïve OT-I T cells in vivo following intestinal infection with Listeria monocytogenes-OVA. In bone marrow chimeras, Rgs1 -/- and Rgs1 +/+ T cells were generally present in comparable frequencies in distinct T cell subsets of the intestinal mucosa, mesenteric lymph nodes, and spleen. After intestinal infection with Listeria monocytogenes-OVA, however, OT-I Rgs1 +/+ T cells outnumbered the co-transferred OT-I Rgs1- /- T cells in the small intestinal mucosa already early after infection. The underrepresentation of the OT-I Rgs1 -/- T cells persisted to become even more pronounced during the memory phase (d30 post-infection). Remarkably, upon intestinal reinfection, mice with intestinal OT-I Rgs1 +/+ TRM cells were able to prevent the systemic dissemination of the pathogen more efficiently than those with OT-I Rgs1 -/- TRM cells. While the underlying mechanisms are not fully elucidated yet, these data thus identify Rgs1 as a critical regulator for the generation and maintenance of tissue-resident CD8+ T cells as a prerequisite for efficient local immunosurveillance in barrier tissues in case of reinfections with potential pathogens.
Collapse
Affiliation(s)
- Diego von Werdt
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Bilgi Gungor
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Thomas Gruber
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Daniel Zysset
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cheong K. C. Kwong Chung
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
- Department of Gastrointestinal Health, Immunology, Nestlé Research, Lausanne, Switzerland
| | - Antonia Corrêa-Ferreira
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Regina Berchtold
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Nicolas Page
- Department of Pathology, Division of Clinical Pathology, University & University Hospitals of Geneva, Geneva, Switzerland
| | - Mirjam Schenk
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
| | - John H. Kehrl
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Doron Merkler
- Department of Pathology, Division of Clinical Pathology, University & University Hospitals of Geneva, Geneva, Switzerland
| | - Beat A. Imhof
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
- Department of Pathology and Immunology, Centre Medical Universitaire, University of Geneva, Geneva, Switzerland
| | - Jens V. Stein
- Department of Oncology, Microbiology and Immunology, University of Fribourg, Fribourg, Switzerland
| | - Jun Abe
- Department of Oncology, Microbiology and Immunology, University of Fribourg, Fribourg, Switzerland
| | - Gleb Turchinovich
- Department of Biomedicine, and University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniela Finke
- Department of Biomedicine, and University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Adrian C. Hayday
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | - Nadia Corazza
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
- *Correspondence: Christoph Mueller, ; Nadia Corazza,
| | - Christoph Mueller
- Division of Experimental Pathology, Institute of Pathology, University of Bern, Bern, Switzerland
- Department of Biomedicine, and University Children’s Hospital Basel, University of Basel, Basel, Switzerland
- *Correspondence: Christoph Mueller, ; Nadia Corazza,
| |
Collapse
|
30
|
Rogowska M, Thornton M, Creese B, Velayudhan L, Aarsland D, Ballard C, Tsamakis K, Stewart R, Mueller C. Implications of Adverse Outcomes Associated with Antipsychotics in Older Patients with Dementia: A 2011-2022 Update. Drugs Aging 2023; 40:21-32. [PMID: 36513918 PMCID: PMC9747539 DOI: 10.1007/s40266-022-00992-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Accepted: 11/10/2022] [Indexed: 12/15/2022]
Abstract
Neuropsychiatric symptoms affect most patients with dementia over the course of the disease. They include a wide variety of symptoms from apathy and depression to psychosis, irritability, impulsivity and agitation. These symptoms are associated with significant distress to the patient and caregivers, as well as more rapid progression of dementia, institutionalisation and higher mortality. The first-line management of the neuropsychiatric symptoms of dementia should be non-pharmacological. If medications are required, antipsychotics are commonly chosen. Second-generation antipsychotics such as risperidone, olanzapine, quetiapine and aripiprazole are prescribed more often than first-generation antipsychotics, such as haloperidol. The aim of this review is to provide an update on findings on adverse outcomes and clinical implications of antipsychotic use in dementia. These medications may increase mortality and can be associated with adverse events including pneumonia, cerebrovascular events, parkinsonian symptoms or higher rates of venous thromboembolism. Risks related to antipsychotic use in dementia are moderated by a number of modifiable and non-modifiable factors such as co-prescribing of other medications, medical and psychiatric co-morbidities, and demographics such as age and sex, making individualised treatment decisions challenging. Antipsychotics have further been associated with an increased risk of reliance on long-term care and institutionalisation, and they might not be cost-effective for healthcare systems. Many of these risks can potentially be mitigated by close physical health monitoring of antipsychotic treatment, as well as early withdrawal of pharmacotherapy when clinically possible.
Collapse
Affiliation(s)
- Marianna Rogowska
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK.
| | - Mary Thornton
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
| | - Byron Creese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Exeter Medical School, Exeter, UK
| | - Latha Velayudhan
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dag Aarsland
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
- Stavanger University Hospital, Stavanger, Norway
| | - Clive Ballard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Stavanger University Hospital, Stavanger, Norway
| | - Konstantinos Tsamakis
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
- Second Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital 'ATTIKON', Athens, Greece
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
31
|
Chen S, Wang Y, Mueller C. Code-Based Algorithms for Identifying Dementia in Electronic Health Records: Bridging the Gap Between Theory and Practice. J Alzheimers Dis 2023; 95:941-943. [PMID: 37718822 DOI: 10.3233/jad-230887] [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] [Indexed: 09/19/2023]
Abstract
Code-based algorithms are crucial tools in the detection of dementia using electronic health record data, with broad applications in medical research and healthcare. Vassilaki et al.'s study explores the efficacy of code-based algorithms in dementia detection using electronic health record data, achieving approximately 70% sensitivity and positive predictive value. Despite the promising results, the algorithms fail to detect around 30% of dementia cases, highlighting challenges in distinguishing cognitive decline factors. The study emphasizes the need for algorithmic improvements and further exploration across diverse healthcare systems and populations, serving as a critical step toward bridging gaps in dementia care and understanding.
Collapse
Affiliation(s)
- Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Yuqi Wang
- Department of Computer Science, University College London, London, UK
| | - Christoph Mueller
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
32
|
Klevebro F, Han S, Ash S, Mueller C, Cools-Lartigue J, Maynard N, Ferri L, Low D. Open left thoracoabdominal esophagectomy a viable option in the era of minimally invasive esophagectomy. Dis Esophagus 2022; 36:6576314. [PMID: 35511475 DOI: 10.1093/dote/doac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/27/2022] [Indexed: 01/11/2023]
Abstract
Minimally invasive surgical technique has become standard at many institutions in esophageal cancer surgery. In some situations, however other surgical approaches are required. Left thoracoabdominal esophagectomy (LTE) facilitates complete resection of esophageal cancer particularly for bulky distal esophageal tumors, but there are concerns that this approach is associated with significant morbidity. Prospectively entered esophagectomy databases from three high-volume centers were reviewed for patients undergoing LTE or MIE 2009-2019. Patient demographics, tumor characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 915 patients were included in the study, LTE was applied in 684 (74.8%) patients, and MIE in 231 (25.2%) patients. LTE patients had more locally advanced tumor stage and received more neoadjuvant treatment. Patients treated with MIE had more comorbidities. The results showed no difference in overall postoperative complications (LTE = 61.7%, MIE = 65.7%, P = 0.289), severe complications (Clavien-Dindo ≥IIIa (LTE = 25.9%, MIE 26.8%, P = 0.806)), pneumonia (LTE = 29.0%, MIE = 24.7%, P = 0.211), anastomotic leak (LTE = 7.8%, MIE = 11.3%, P = 0.101), or in-hospital mortality (LTE = 2.6%, MIE = 3.5%, P = 0.511). Median number of resected lymph nodes was 24 for LTE and 25 for MIE (P = 0.491). LTE was used for more advanced tumors in patients that were more likely to have received neoadjuvant treatment compared with MIE, however postoperative morbidity, mortality, and oncologic outcomes were equivalent to that of MIE in this cohort. In conclusion open resection with left thoracoabdominal approach is a valid option in selected patients when performed at high-volume esophagectomy centers.
Collapse
Affiliation(s)
- F Klevebro
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle WA, USA.,Department of Surgery, CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - S Han
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle WA, USA
| | - S Ash
- Department of Medicine, Oxford University Hospitals NHS, Ludwig Institute for Cancer Research, Nuffield, University of Oxford Trust, Oxford, UK
| | - C Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Mc Gill University Health Center, Montreal, Canada
| | - J Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Mc Gill University Health Center, Montreal, Canada
| | - N Maynard
- Department of Medicine, Oxford University Hospitals NHS, Ludwig Institute for Cancer Research, Nuffield, University of Oxford Trust, Oxford, UK
| | - L Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Mc Gill University Health Center, Montreal, Canada
| | - D Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle WA, USA
| |
Collapse
|
33
|
Mueller C, Elben S, Day GS, Alves P, Hebert J, Tang-Wai DF, Holtmann O, Iorio R, Perani D, Titulaer MJ, Hansen N, Bartsch T, Johnen A, Illes Z, Borm L, Willison AG, Wiendl H, Meuth SG, Kovac S, Bölte J, Melzer N. Review and meta-analysis of neuropsychological findings in autoimmune limbic encephalitis with autoantibodies against LGI1, CASPR2, and GAD65 and their response to immunotherapy. Clin Neurol Neurosurg 2022; 224:107559. [PMID: 36549220 DOI: 10.1016/j.clineuro.2022.107559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/20/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES It is assumed that autoimmune limbic encephalitis (ALE) demonstrates distinct neuropsychological manifestations with differential responses to immunotherapy according to which associated autoantibody (AAB), if any, is identified. Towards investigating whether this is the case, this study aims to summarize respective findings from the primary literature on ALE with AABs binding to cell surface neural antigens and ALE with AABs against intracellular neural antigens. METHODS We chose ALE with AABs against leucine-rich, glioma inactivated protein 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) as the most frequent cell surface membrane antigens, and ALE with AABs to Embryonic Lethal, Abnormal Vision, Like 1 (ELAVL) proteins (anti-Hu) and glutamic acid decarboxylase 65 (GAD65) as the most frequent intracellular neural antigens. The PubMed and Scopus databases were searched on March 1st, 2021 for neuropsychological test and -screening data from patients with ALE of these AAB-types. Findings were reviewed according to AAB-type and immunotherapy status and are presented in a review section and are further statistically evaluated and presented in a meta-analysis section in this publication. RESULTS Of the 1304 initial hits, 32 studies on ALE with AABs against LGI1, CASPR2, and GAD65 reporting cognitive screening data could be included in a review. In ALE with AABs against LGI1, CASPR2 and GAD65, memory deficits are the most frequently reported deficits. However, deficits in attention and executive functions including working memory, fluency, and psychological function have also been reported. This review shows that ALE patients with AABs against both LGI1 and CASPR2 show higher percentages of neuropsychological deficits compared to ALE patients with AABs against GAD65 before and after initiation of immunotherapy. However, the methodologies used in these studies were heterogenous, and longitudinal studies were not comparable. Moreover, 21 studies including ALE patients with AABs against LGI1 and GAD65 were also suitable for meta-analysis. No suitable study on ALE with AABs against ELAVL proteins could be identified. Meta-Analyses could be executed for cognitive screening data and only partially, due to the small number of studies. However, in statistical analysis no consistent effect of AAB or immunotherapy on performance in cognitive screening tests could be found. CONCLUSION Currently, there is no definite evidence supporting the notion that different AAB-types of ALE exhibit distinct neuropsychological manifestations and respond differently to immunotherapy. Overall, we could not identify evidence for any effect of immunotherapy on cognition in ALE. More systematic, in-depth and longitudinal neuropsychological assessments of patients with different AAB-types of ALE are required in the future to investigate these aspects.
Collapse
Affiliation(s)
- Christoph Mueller
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Saskia Elben
- Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Gregory S Day
- Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, United States.
| | - Pedro Alves
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria, CHULN, Lisboa, Portugal; Laboratório de Estudos de Linguagem, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Julien Hebert
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada.
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada; Memory Clinic, Toronto Western Hospital (University Health Network), Toronto, Canada.
| | - Olga Holtmann
- Institute of Medical Psychology and Systems Neuroscience, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Daniela Perani
- Division of Neuroscience, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milano, MI, Italy.
| | - Maarten J Titulaer
- Department of Neurology, Neuropsychology and Immunology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University of Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany.
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Rosalind-Franklin-Straße 10, 24105 Kiel, Germany.
| | - Andreas Johnen
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Zslot Illes
- Department of Neurology with Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense, Denmark.
| | - Leah Borm
- Institute of Psychology, Westfälische Wilhelms-University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Alice G Willison
- Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Jens Bölte
- Institute of Psychology, Westfälische Wilhelms-University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, Westfälische Wilhelms-University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| |
Collapse
|
34
|
Chen S, Price AC, Cardinal RN, Moylett S, Kershenbaum AD, Fitzgerald J, Mueller C, Stewart R, O’Brien JT. Association between antidementia medication use and mortality in people diagnosed with dementia with Lewy bodies in the UK: A retrospective cohort study. PLoS Med 2022; 19:e1004124. [PMID: 36472984 PMCID: PMC9725132 DOI: 10.1371/journal.pmed.1004124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLBs) is a common cause of dementia but has higher mortality than Alzheimer's disease (AD). The reasons for this are unclear, but antidementia drugs (including acetylcholinesterase inhibitors [AChEIs] and memantine) symptomatically benefit people with DLB and might improve outcomes. We investigated whether AChEIs and/or memantine were associated with reduced hospital admissions and mortality. METHODS AND FINDINGS We performed a retrospective cohort study of those diagnosed with DLB between 1 January 2005 and 31 December 2019, using data from electronic clinical records of secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million), as well as linked records from national Hospital Episode Statistics (HES) data. Eligible patients were those who started AChEIs or memantine within 3 months of their diagnosis (cases) and those who never used AChEIs or memantine (controls). Outcomes included admission, length of stay, and mortality. Cox proportional hazard and linear regression models were used. Of 592 patients with DLB, 219 never took AChEIs or memantine, 100 took AChEIs only, and 273 took both AChEIs and memantine. The cohorts were followed up for an average of 896 days, 981 days, and 1,004 days, respectively. There were no significant differences in the cohorts' baseline characteristics, except for socioeconomic status that was lower in patients who never took AChEIs or memantine (χ2 = 23.34, P = 0.003). After controlling for confounding by sociodemographic factors (age, sex, marital status, ethnicity, socioeconomic status), antipsychotic use, antidepressant use, cognitive status, physical comorbidity, anticholinergic burden, and global health performance, compared with patients who never took AChEIs or memantine, patients taking AChEIs only or taking both had a significantly lower risk of death (adjusted hazard ratio (HR) = 0.67, 95% CI = 0.48 to 0.93, p = 0.02; adjusted HR = 0.64, 95% CI = 0.50 to 0.83, P = 0.001, respectively). Those taking AChEIs or both AChEIs and memantine had significantly shorter periods of unplanned hospital admission for physical disorders (adjusted coefficient -13.48, 95% CI = [-26.87, -0.09], P = 0.049; adjusted coefficient -14.21, 95% CI = [-24.58, -3.85], P = 0.007, respectively), but no difference in length of stay for planned admissions for physical disorders, or for admissions for mental health disorders. No significant additional associations of memantine on admission, length of stay, and mortality were found (all P > 0.05). The main limitation was that this was a naturalistic study and possible confounds cannot be fully controlled, and there may be selection bias resulting from nonrandom prescription behaviour in clinical practice. However, we mimicked the intention-to-treat design of clinical trials, and the majority of baseline characters were balanced between cohorts. In addition, our series of sensitivity analyses confirmed the consistency of our results. CONCLUSION In this study, we observed that use of AChEIs with or without memantine in DLB was associated with shorter duration of hospital admissions and decreased risk of mortality. Although our study was naturalistic, it supports further the use of AChEIs in DLB.
Collapse
Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Annabel C. Price
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Sinéad Moylett
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Laboratory of Neuroimmunology, KU Leuven, Leuven, Belgium
| | - Anne D. Kershenbaum
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - James Fitzgerald
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Christoph Mueller
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
35
|
Mbazira A, Bishara D, Perera G, Rawlins E, Webb S, Archer M, Balasundaram B, Shetty H, Tsamakis K, Taylor D, Sauer J, Stewart R, Mueller C. Sedation‐associated medications at dementia diagnosis, their receptor activity, and associations with adverse outcomes in a large clinical cohort. Alzheimers Dement 2022. [DOI: 10.1002/alz.065479] [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: 12/24/2022]
Affiliation(s)
- Agnes Mbazira
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | - Delia Bishara
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
- King’s College London LONDON United Kingdom
| | | | - Elizabeth Rawlins
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | - Silas Webb
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | - Matthew Archer
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | | | - Hitesh Shetty
- South London and the Maudsley NHS Foundation Trust London United Kingdom
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital ‘ATTIKON’, School of Medicine Athens Greece
| | - David Taylor
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | - Justin Sauer
- South London and Maudsley NHS Foundation Trust LONDON United Kingdom
| | - Robert Stewart
- King’s College London London United Kingdom
- South London and Maudsley NHS Foundation Trust London United Kingdom
| | - Christoph Mueller
- King’s College London London United Kingdom
- South London and Maudsley NHS Foundation Trust London United Kingdom
| |
Collapse
|
36
|
Mavrodaris A, Mueller C, Perera G, Brayne C, Stewart R. Infections in people with dementia and mortality: A population‐based cohort study. Alzheimers Dement 2022. [DOI: 10.1002/alz.065397] [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: 12/24/2022]
Affiliation(s)
| | | | | | - Carol Brayne
- University of Cambridge Cambridge United Kingdom
| | - Robert Stewart
- King’s College London London United Kingdom
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation London United Kingdom
| |
Collapse
|
37
|
Tsamakis K, Tsiptsios D, Stubbs B, Ma R, Romano E, Mueller C, Ahmad A, Triantafyllis AS, Tsitsas G, Dragioti E. Summarising data and factors associated with COVID-19 related conspiracy theories in the first year of the pandemic: a systematic review and narrative synthesis. BMC Psychol 2022; 10:244. [PMID: 36320071 PMCID: PMC9623972 DOI: 10.1186/s40359-022-00959-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Conspiracy theories can have particularly harmful effects by negatively shaping health-related behaviours. A significant number of COVID-19 specific conspiracy theories emerged in the immediate aftermath of the pandemic outbreak. The aim of this study was to systematically review the literature on conspiracy theories related to COVID-19 during the first year of the pandemic (2020), to identify their prevalence, their determinants and their public health consequences. A comprehensive literature search was carried out in PubMed and PsycINFO to detect all studies examining any conspiracy theory related to COVID-19 between January 1st 2020, and January 10th 2021. Forty-three studies were included with a total of 61,809 participants. Between 0.4 and 82.7% of participants agreed with at least one conspiracy belief. Certain sociodemographic factors (young age, female gender, being non-white, lower socioeconomic status), psychological aspects (pessimism, blaming others, anger) and other qualities (political conservatism, religiosity, mistrust in science and using social media as source of information) were associated with increased acceptance of conspiracy theories. Conspiracy beliefs led to harmful health-related behaviours and posed a serious public health threat. Large-scale collaborations between governments and healthcare organizations are needed to curb the spread of conspiracy theories and their adverse consequences.
Collapse
Affiliation(s)
- Konstantinos Tsamakis
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK ,grid.5216.00000 0001 2155 0800Second Department of Psychiatry, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece ,grid.264200.20000 0000 8546 682XInstitute of Medical and Biomedical Education, St George’s University of London, London, UK
| | - Dimitrios Tsiptsios
- grid.12284.3d0000 0001 2170 8022Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Brendon Stubbs
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Ruimin Ma
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Eugenia Romano
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Christoph Mueller
- grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Ayesha Ahmad
- grid.264200.20000 0000 8546 682XInstitute of Medical and Biomedical Education, St George’s University of London, London, UK
| | - Andreas S. Triantafyllis
- grid.414012.20000 0004 0622 6596Department of Cardiology, Asklepeion General Hospital Athens, Athens, Greece
| | - George Tsitsas
- grid.15823.3d0000 0004 0622 2843Counselling Centre, Harokopio University, Athens, Greece
| | - Elena Dragioti
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| |
Collapse
|
38
|
Simkin L, Yung P, Greig F, Perera G, Tsamakis K, Rizos E, Stewart R, Velayudhan L, Mueller C. The impact of the first UK COVID-19 lockdown on presentations with psychosis to mental health services for older adults: An electronic health records study in South London. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5834. [PMID: 36333839 PMCID: PMC9828419 DOI: 10.1002/gps.5834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/17/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Social distancing restrictions in the COVID-19 pandemic may have had adverse effects on older adults' mental health. Whereby the impact on mood is well-described, less is known about psychotic symptoms. The aim of this study was to compare characteristics associated with psychotic symptoms during the first UK lockdown and a pre-pandemic comparison period. METHODS In this retrospective observational study we analysed anonymised records from patients referred to mental health services for older adults in South London in the 16-week period of the UK lockdown starting in March 2020, and in the comparable pre-pandemic period in 2019. We used logistic regression models to compare the associations of different patient characteristics with increased odds of presenting with any psychotic symptom (defined as hallucinations and/or delusion), hallucinations, or delusions, during lockdown and the corresponding pre-pandemic period. RESULTS 1991 referrals were identified. There were fewer referrals during lockdown but a higher proportion of presentations with any psychotic symptom (48.7% vs. 42.8%, p = 0.018), particularly hallucinations (41.0% vs. 27.8%, p < 0.001). Patients of non-White ethnicity (adjusted odds ratio (OR): 1.83; 95% confidence interval (CI): 1.13-2.99) and patients with dementia (adjusted OR: 3.09; 95% CI: 1.91-4.99) were more likely to be referred with psychotic symptoms during lockdown. While a weaker association between dementia and psychotic symptoms was found in the pre-COVID period (adjusted OR: 1.55; 95% CI: 1.19-2.03), interaction terms indicated higher odds of patients of non-White ethnicity or dementia to present with psychosis during the lockdown period. CONCLUSIONS During lockdown, referrals to mental health services for adults decreased, but contained a higher proportion with psychotic symptoms. The stronger association with psychotic symptoms in non-White ethnic groups and patients with dementia during lockdown suggests that barriers in accessing care might have increased during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Lauren Simkin
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Paul Yung
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Flora Greig
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Gayan Perera
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Second Department of PsychiatryNational and Kapodistrian University of Athens‘Attikon’ University General HospitalAthensGreece
| | - Emmanouil Rizos
- Second Department of PsychiatryNational and Kapodistrian University of Athens‘Attikon’ University General HospitalAthensGreece
| | - Robert Stewart
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Latha Velayudhan
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
39
|
Boeddinghaus J, Meier M, Nestelberger T, Koechlin L, Lopez-Ayala P, Rubini Gimenez M, Miro O, Martin-Sanchez J, Kawecki D, Keller D, Nickel C, Bingisser R, Christ M, Mueller C. Clinical risk scores versus simple integrated clinical judgment in patients with suspected acute coronary syndromes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The clinical utility of clinical risk scores in patients presenting with suspected acute coronary syndromes to the emergency department (ED) is uncertain.
Purpose
We aimed to directly compare the performance of three established clinical risk scores to simple integrated clinical judgment (ICJ) of the treating ED physician.
Methods
Thirty day major adverse cardiac events (MACE) including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (AMI, including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the emergency department (ED) with acute chest discomfort in an international multicenter study (12 centres in 5 European countries). ICJ for the likelihood that an ACS is the cause of acute chest discomfort was quantified by the treating ED physician using a visual analogue scale at 90 minutes after patient's presentation to the ED. At this time, the ED physician had obtained the patient history, physical examination including vital signs, the 12-lead electrocardiogram at presentation, and the first local (hs)-cTn measurement. We directly compared the prognostic performance of the HEART-score, the GRACE-score, and the T-MACS decision aid to simple integrated clinical judgment (ICJ) of the treating ED physician. We also assessed the safety for rule-out of MACE at 30-days.
Results
Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy as quantified by the area under the receiver-operating characteristics curve was 0.85 (95% CI, 0.84–0.87) for the HEART-score, 0.85 (95% CI, 0.84–0.87) for the GRACE-score, 0.79 (95% CI, 0.77–0.80) for the TIMI decision aid, and 0.87 (95% CI, 0.85–0.88) for ICJ (Figure). The HEART-score identified 1893/4551 (41.6%) patients as low-risk with an NPV of 96.0% (95% CI, 95.0–96.8), the GRACE score identified 1542/4551 (33.9%) patients as low-risk with an NPV of 97.0% (95% CI, 96.0–97.7), the TIMI score identified 2157/4551 (47.4%) patients as low-risk with an NPV of 93.1% (95% CI, 91.9–94.1), and simple ICJ identified 1743/4551 (38.3%) patients as low-risk with an NPV of 95.6% (95% CI, 94.5–96.5).
Conclusion
The simple ICJ of the treating physician performed well for the prediction of 30-day MACE and might be an alternative to the well-validated HEART-score, GRACE-score, and T-MACS decision aid.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The study was supported by research grants from the the Swiss Heart Foundation and the University of Basel.
Collapse
Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - M Meier
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - P Lopez-Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | | | - O Miro
- Hospital Clinic de Barcelona, Emergency Department , Barcelona , Spain
| | - J Martin-Sanchez
- Hospital Clinic San Carlos, Emergency Department , Madrid , Spain
| | - D Kawecki
- Silesian Center for Heart Diseases (SCHD), Cardiology , Zabrze , Poland
| | - D Keller
- University Hospital Zurich, Emergency Department , Zurich , Switzerland
| | - C Nickel
- University Hospital Basel, Emergency , Basel , Switzerland
| | - R Bingisser
- University Hospital Basel, Emergency , Basel , Switzerland
| | - M Christ
- Lucerne Cantonal Hospital, Emergency , Lucerne , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| |
Collapse
|
40
|
Zimmermann T, Koechlin L, Walter J, Kimenai D, Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Puelacher C, Gualandro D, Strebel I, Diebold M, Twerenbold R, Hammarsten O, Meex S, Mueller C. Differences in circulating cardiac troponin I and T in acute and chronic cardiac disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1341] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical practice and guidelines assume that cardiac troponin I (cTnI) and cTnT are interchangeable, reflecting identical pathophysiological processes. However, it is unknown if cTnI and cTnT really are equivalent measures in different pathophysiological settings.
Purpose
To highlight potential differences in the release of cTnI and cTnT.
Methods
Large pooled cohort analysis including extensively characterized individuals, stratified into three groups: no cardiac disease (normal aging), chronic cardiac disease, and acute cardiac disease. Circulating cTnI and cTnT concentrations were measured blinded to clinical data using high-sensitivity assays (hs-cTnI-Architect, hs-cTnT-Elecsys) and their ratio calculated. Findings were validated using a second hs-cTnI assay (hs-cTnI-Clarity).
Results
Among 8719 individuals, 29% female, 10% had no known cardiac disease, 71% chronic cardiac disease, and 20% acute cardiac disease. Baseline characteristics including renal function were comparable between individuals with chronic and acute cardiac disease. Normal aging (without cardiac disease) was associated with a disproportional increase in cTnT versus cTnI (low cTnI/cTnT ratio, median 0.50, IQR 0.38–0.68). Although older, patients with chronic cardiac disease had a slightly higher cTnI/cTnT ratio (median 0.53, IQR 0.37–0.79, p<0.05). In contrast, in patients with acute cardiac disease, cTnI concentrations were disproportionally elevated compared to cTnT concentrations, resulting in a cTnI/cTnT ratio of 1.96 (IQR 0.93–4.73, p<0.001). Internal validation using a second hs-cTnI assay confirmed these findings.
Conclusion
These findings suggest relevant differences in the release of cTnI and cTnT with a greater release of cTnT versus cTnI in normal aging and a disproportional increase in cTnI versus cTnT in acute cardiac disease.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation
Collapse
Affiliation(s)
| | - L Koechlin
- University Hospital Basel , Basel , Switzerland
| | - J Walter
- University Hospital Basel , Basel , Switzerland
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | | | | | | | - C Puelacher
- University Hospital Basel , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel , Basel , Switzerland
| | - I Strebel
- University Hospital Basel , Basel , Switzerland
| | - M Diebold
- University Hospital Basel , Basel , Switzerland
| | - R Twerenbold
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - O Hammarsten
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - S Meex
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
| |
Collapse
|
41
|
Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri K, Mork C, Wussler D, Bolliger D, Osswald S, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Primary acute heart failure (AHF) is an established and common cause of hospitalization. AHF may also develop secondarily, e.g. postoperatively (pAHF). Little is known about pAHF.
Purpose
To assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.
Methods
We prospectively included 9,164 consecutive patients at high cardiovascular risk undergoing 11,262 non-cardiac surgeries. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, was determined. Logistic regression models identified the risk factors for pAHF. Cox regression analysis compared mortality and AHF readmission within 1 year in patients with and without pAHF. External validation was performed using a prospective cohort multicenter study of 1250 patients.
Results
The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2–2.8%). pAHF most often occurred on postoperative day 2 (median day 4). About half of pAHF (51%) occurred in patients without known HF (de novo pAHF), and 49% in patients with chronic HF. Preserved left ventricular ejection fraction (LVEF) was the dominant phenotype among de novo pAHF (72%), while reduced LVEF was dominant among pAHF in chronic HF (43%). Age, coronary artery disease, peripheral artery disease, diabetes, urgent/emergent surgery, chronic HF, atrial fibrillation, chronic obstructive pulmonary disease, anemia, and chronic myocardial injury were independent predictors of pAHF. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p<0.001) and AHF readmission (15% vs. 2%, p<0.001) within 1 year than patients without pAHF. pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3–2.2]; P<0.001) and AHF readmission (aHR 2.7 [95% CI 1.7–4.2]; P<0.001) within 1 year. Findings were confirmed in an external validation cohort of 1250 patients, e.g. incidence of pAHF 2.4% (95% CI, 1.6–3.3%).
Conclusions
pAHF frequent developed following non-cardiac surgery, being de novo in about half of cases, and associated with an unacceptable high mortality. Strategies focusing on early detection and treatment of pAHF seem warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
Collapse
Affiliation(s)
| | - C Puelacher
- University Hospital Basel , Basel , Switzerland
| | - M S Chew
- Linköping University , Linköping , Sweden
| | | | - G Lurati Buse
- University Hospital Düsseldorf , Düsseldorf , Germany
| | - N Glarner
- University Hospital Basel , Basel , Switzerland
| | - D Mueller
- University Hospital Basel , Basel , Switzerland
| | - F A M Cardozo
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - K Burri
- University Hospital Basel , Basel , Switzerland
| | - C Mork
- University Hospital Basel , Basel , Switzerland
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel , Basel , Switzerland
| | - S Osswald
- University Hospital Basel , Basel , Switzerland
| | - B Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Cardiology , São Paulo , Brazil
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
| |
Collapse
|
42
|
Puelacher C, Gualandro D, Glarner N, Lurati Buse G, Lampart A, Bolliger D, Steiner L, Gerhard H, Clerc O, Kindler C, Cardozo FA, Caramelli B, Osswald S, Mueller C. Risk stratification of perioperative myocardial infarction/injury following noncardiac surgery in high risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2533] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Perioperative myocardial infarction/injury (PMI) screening is increasingly recommended by current guidelines. PMI is often caused by type 2 myocardial infarction, and risk stratification tools for these patients are lacking.
Purpose
To derive and internally validate a risk prognostication model for PMI of likely type 2 infarction (lT2MI)
Methods
We included consecutive high-risk patients undergoing noncardiac surgery into this prospective multicenter study. Patients received a systematic routine PMI screening with pre- and postoperative measurement of cardiac troponin (cTn). PMI was prospectively defined as an absolute increase of cTn above the preoperative value. PMI etiology was centrally adjudicated and hierarchically classified by 2 independent physicians based on all clinical information obtained during index hospitalization and selected those with lT2MI for further analyses. To identify risk factors and allow risk stratification in lT2MI, we prespecified that only perioperative variables should be included into the model. We constructed a logistic binary regression model for major adverse cardiac events (MACE) within 120 days, including variables available at time of clinical evaluation: additional symptoms or ECG-criteria required according to the Universal Definition of Myocardial Infarction, absolute increase in cTn (categorized according to level of absolute increase 1–<2 times the 99th percentile, ≥2 to <4 times, and ≥4 times), urgency of procedure, perioperative bleeding (drop in haemoglobin >30g/L or deemed relevant for PMI by adjudicator), and ESC/ESA surgery risk (low, medium, high risk of cardiac events). Variables were omitted from the final model if the p-value was >0.05. Variable levels with similar odds ratios were grouped for simplification of the prognostic model. We constructed a calibration plot and calculated the area under the receiver-operating characteristics curve (AUC) and Brier Score. For internal validation we calculated the predicted probabilities and classified patients into low-risk (predicted event rate <10%), intermediate range (10–20%), and high-risk (>20%), and compared the predicted with the observed event rate.
Results
PMI occurred in 1016/7754 patients (13.1%) of which 750/1016 (73.8%) were adjudicated as lT2MI. MACE within 120 days occurred in 118/750 (15.7%) patients. The initial and final logistic prognostic model for 120-day MACE or death is shown in the table. Internal validation found a good fit of predicted and observed event rate following bootstrapping of 1000 iterations (Figure 1), a good AUC of 0.71 and a Brier score of 0.12.
Conclusion
The derived risk prognostication model for PMI of lT2MI can aid in the stratification of patients and support clinical decision making following noncardiac surgery.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
Collapse
Affiliation(s)
- C Puelacher
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - N Glarner
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - G Lurati Buse
- University Hospital Dusseldorf, Anaesthesiology , Dusseldorf , Germany
| | - A Lampart
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - D Bolliger
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - L Steiner
- University Hospital Basel, Department of Anaesthesiology , Basel , Switzerland
| | - H Gerhard
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - O Clerc
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - C Kindler
- Cantonal Hospital Aarau, Department of Anaesthesiology , Aarau , Switzerland
| | - F A Cardozo
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - B Caramelli
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - S Osswald
- University Hospital Basel, Cardiology , Basel , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiology , Basel , Switzerland
| |
Collapse
|
43
|
Wussler D, Belkin M, Walter J, Kozhuharov N, Goudev A, Flores D, Maeder M, Shrestha S, Gualandro D, De Oliveira M, Rickli H, Breidthardt T, Muenzel T, Erne P, Mueller C. Detrimental effects of intense vasodilation in women with acute heart failure: novel insights from a prospective randomized controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ according to sex. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes. However, sex-specific differences in heart failure pathophysiology and the effect of the strategy in women with AHF remained unclear.
Purpose
To characterize sex-specific differences in heart failure pathophysiology and to evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF.
Methods
In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100 mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. The subgroup analysis according to sex was predefined.
Results
Among 781 patients who completed the trial, 288 (36.9%) were women. Women were significantly older, had a higher systolic blood pressure at presentation and a more common history of diastolic dysfunction (all ps<0.05), whereas men had a significantly higher body surface area, a more common history of ischemic heart disease and a significant lower left ventricular ejection fraction (all ps<0.05). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 35 female patients (23.6%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.3%; adjusted hazard ratio, 1.62 [95% CI, 1.05–2.50]; P=0.03).
Conclusion
Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Basel
Collapse
Affiliation(s)
- D Wussler
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - M Belkin
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - J Walter
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - N Kozhuharov
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - A Goudev
- Medical University of Sofia, Department of Cardiology , Sofia , Bulgaria
| | - D Flores
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - M Maeder
- Cantonal Hospital St. Gallen, Department of Cardiology , St. Gallen , Switzerland
| | - S Shrestha
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| | - M De Oliveira
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - H Rickli
- Cantonal Hospital St. Gallen, Department of Cardiology , St. Gallen , Switzerland
| | - T Breidthardt
- University Hospital Basel, Department of Internal Medicine , Basel , Switzerland
| | - T Muenzel
- University Medical Center of the Johannes Gutenberg University , Mainz , Germany
| | - P Erne
- Department of Cardiology, Luzerner Kantonsspital , Luzern , Switzerland
| | - C Mueller
- University Hospital Basel, Department of Cardiology , Basel , Switzerland
| |
Collapse
|
44
|
Schulte C, Mueller C, Escobar JD, Tong T, Lackner K, Schulze A, Blankenberg S, Salomaa V, Wild P, Zeller T. VEGF beta is a candidate biomarker for cardiovascular risk stratification. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1362] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The blood-based transcriptome changes in relation to body weight but longitudinal data on specific transcripts are rare. Monocytes play a crucial role in the development of atherosclerosis and coronary artery disease. Monitoring monocytic gene expression patterns could aid to identify biomarkers for improved cardiovascular risk stratification. BMI and diabetes mellitus (T2DM) are associated with coronary artery disease (CAD). There are mRNAs associated with the development of atherosclerosis and CAD, which can be detected in circulating cells. The exact pathways and direct targets have not been explored.
Objective
To apply transcriptome screening and validation analysis to identify novel biomarker candidates associated with longitudinal changes of BMI as cardiovascular risk factors and test association with clinical endpoints.
Methods
Transcriptome-wide monocytic gene expression changes were screened in relation to changes in BMI over a time period of 5 years in 1,092 participants of the Gutenberg Health Study with available transcriptomics data at baseline investigation and at 5-years follow-up. Functional enrichment of BMI-related genes (FDR <0.01) was tested based on pathway databases and selected gene sets. Serum VEGFB levels were quantified and validated in serum from n=1,895 individuals from an independent cohort study (FinRisk). In-vitro, THP1 cells were stimulated with recombinant VEGFB.
Results
143 transcripts showed a significant association with change in BMI over 5 years. Decreased VEGFB mRNA levels strongly associated with increased BMI (p=2.8x10–9). Lower levels of VEGFB mRNA were associated with increased mortality (HRperSD=0.757, 95% CI: 0.647–0.885, p=0.0005) following adjustment for age and sex and incident diabetes (p=0.01). Circulating VEGFB levels inversely correlated with VEGFB mRNA (r=−0.2, p=0.0024) and positively correlated with an increase in BMI (beta=0.226, p=8.4x10–6), type 2 diabetes mellitus risk (HRperSD=1.279, 95% CI: 1.148–1.425, p=7.8x10–6) and all-cause mortality (HRperSD=1.184, 95% CI: 1.045–1.342, p=0.008). Further exploration in n=1,895 individuals from FinRisk revealed an association of increased VEGFB levels with increased risk for heart failure (HRperSD=1.373, 95% CI: 1.210–1.560, p=1.0x10–6) and coronary artery disease (HR=1.018, 95% CI: 1.003–1.034, p=0.019), even after adjustment for BMI. In THP-1 culture, stimulation with VEGFB resulted in downregulation of VEGFB mRNA levels.
Conclusion
Decreased monocytic gene expression of VEGFB is related to increased BMI, increased risk of T2DM and all-cause mortality. Vice versa,circulating VEGFB levels associates positively with BMI, diabetes, mortality as well as heart failure and coronary heart disease. We hypothesize that monocytes regulate VEGFB expression by a negative feed-back mechanism based. Circulating VEGFB is a potential novel biomarker candidate for weight-related diabetes risk and cardiovascular risk evaluation.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK
Collapse
Affiliation(s)
- C Schulte
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - C Mueller
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J D Escobar
- The University Medical Center Hamburg-Eppendorf, University Center of Cardiovascular Science, University Heart and vascular Center , Hamburg , Germany
| | - T Tong
- The University Medical Center Hamburg-Eppendorf, University Center of Cardiovascular Science, University Heart and vascular Center , Hamburg , Germany
| | - K Lackner
- Johannes Gutenberg University Mainz (JGU), University Medical Center , Mainz , Germany
| | - A Schulze
- Johannes Gutenberg University Mainz (JGU), University Medical Center , Mainz , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - V Salomaa
- National Institute for Health and Welfare (THL), Department of Public Health Solutions , Helsinki , Finland
| | - P Wild
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - T Zeller
- The University Medical Center Hamburg-Eppendorf, University Center of Cardiovascular Science, University Heart and vascular Center , Hamburg , Germany
| |
Collapse
|
45
|
Doudesis D, Lee KK, Bularga A, Ferry AV, Tuck C, Anand A, Boeddinghaus J, Mueller C, Greenslade JH, Pickering JW, Than MP, Cullen L, Mills NL. Machine learning to optimise use of cardiac troponin in the diagnosis of acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1349] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend fixed cardiac troponin thresholds for the assessment of patients with suspected acute coronary syndrome, however, performance varies in important patient groups as concentrations are influenced by age, sex and comorbidities. This limitation can be addressed using machine learning algorithms.
Methods
Machine learning algorithms were developed that integrate cardiac troponin concentrations at presentation or on serial testing with age, sex and clinical features in 10,038 consecutive emergency patients with suspected acute coronary syndrome. The primary outcome was an adjudicated diagnosis of type 1, type 4b or type 4c myocardial infarction. The best performing algorithm was selected for the CoDE-ACS (Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome) decision-support tool, and performance was externally validated in 3,035 patients pooled from three prospective studies.
Findings
CoDE-ACS had excellent discrimination and calibration using cardiac troponin at presentation (area under curve [AUC] 0.959, 95% confidence interval 0.948–0.971, Brier score 0.040), in the pooled external validation cohort. At presentation, the rule-out score identified 62.1% (1,885/3,035) of all patients as low-probability of myocardial infarction with a 99.5% (99.1–99.7%) negative predictive value and 97.0% (96.3–97.6%) sensitivity. The rule-in score identified 8.3% (252/3,035) of patients as high-probability with an 83.7% (82.4–85.0%) positive predictive value and 98.5% (98.0–98.9%) specificity. Performance of the rule-out and rule-in scores was consistent across patient subgroups (Figure 1 and Figure 2). CoDE-ACS incorporating a second cardiac troponin measurement also had excellent discrimination and calibration (AUC 0.971 [0.962–0.980], Brier score 0.039) and refined the individualised probabilities in the 29.5% (898/3,035) of patients neither ruled-out or ruled-in at presentation to guide further investigation.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Conclusions
We developed and externally validated the CoDE-ACS decision-support tool using machine learning to aid in the diagnosis of myocardial infarction. CoDE-ACS had excellent diagnostic performance to rule-out and rule-in myocardial infarction at presentation, performed consistently across patient subgroups, and provided individualised probabilities to guide further care in those who require serial troponin measurements.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health ResearchBritish Heart Foundation
Collapse
Affiliation(s)
- D Doudesis
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - K K Lee
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A V Ferry
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| | - J Boeddinghaus
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - C Mueller
- University of Basel, Cardiovascular Research Institute Basel and Department of Cardiology , Basel , Switzerland
| | - J H Greenslade
- University of Queensland, School of Medicine , Brisbane , Australia
| | - J W Pickering
- University of Otago, Christchurch Heart Institute , Christchurch , New Zealand
| | - M P Than
- Christchurch Hospital , Christchurch , New Zealand
| | - L Cullen
- University of Queensland, School of Medicine , Brisbane , Australia
| | - N L Mills
- University of Edinburgh, Centre for Cardiovascular Sciences , Edinburgh , United Kingdom
| |
Collapse
|
46
|
Koechlin L, Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Miro O, Wussler D, Zimmermann T, Strebel I, Christ M, Wildi K, Rubini Gimenez M, Martin-Sanchez J, Keller D, Twerenbold R, Mueller C. Performance of high-sensitivity cardiac troponin T versus I for the early diagnosis of myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1339] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical practice guidelines assume that both cardiac troponin (cTn) T and cTnI concentrations reflect identical pathophysiological processes and are equally effective in the detection of myocardial injury. However, there are differences between cTnT and cTnI that have been reported.
Purpose
The aim of this study was to directly compare the diagnostic performance of high-sensitivity cardiac troponin (hs-cTn) T versus hs-cTnI for the early diagnosis of acute myocardial infarction (MI).
Methods
In a prospective multicentre study, diagnostic and prognostic accuracies of hs-cTnT and I were analyzed in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient according to the fourth universal definition of MI. Adjudication of the final diagnoses was performed twice: once using serial measurements of hs-cTnT and once using hs-cTnI. Furthermore, the clinical performance of hs-cTnT/I when embedded in the European Society of Cardiology (ESC) 0/1h-algorithm was assessed.
Results
Among 5087 consecutive patients (median [Interquartile range, IQR] age 61 [49.0, 74.0] years, 33.2% female), 951 (18.7%) and 901 patients (17.7%) had an adjudicated final diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) when using serial measurements of hs-cTnT and hs-cTnI for adjudication, respectively. Diagnostic accuracy was very high for both hs-cTnT and hs-cTnI and comparable when using hs-cTnT for adjudication (hs-cTnT: area under the curve [AUC] 0.93 [95% CI 0.92–0.94] versus hs-cTnI AUC 0.93 [95% CI 0.92–0.94]; p=0.891). However, when using serial measurements of hs-cTnI for adjudication, diagnostic accuracy was significantly higher for hs-cTnI (AUC 0.93 [95% CI 0.92–0.94] versus AUC 0.94 [95% CI 0.94–0.95], p<0.001; Figure 1). This was confirmed in subgroup analyses including early presenter (≤3h), patients with renal failure, known coronary artery disease and elderly (≥70 years). However, both assays performed excellent with very high safety for rule-out and high accuracy for rule-in MI when embedded in the ESC 0/1h-algorithm. Prognostic accuracies for 730-day all-cause mortality and cardiovascular death were significantly higher for hs-cTnT compared to hs-cTnI (Figure 2).
Conclusions
While there seem to be differences between hs-cTnT and hs-cTnI in their diagnostic and prognostic performance, clinical relevance needs to be further evaluated since both assays performed excellent when embedded in their respective early triage algorithms.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Foundation, Swiss Heart Foundation
Collapse
Affiliation(s)
- L Koechlin
- University Hospital Basel , Basel , Switzerland
| | | | | | | | - O Miro
- Hospital Clinic de Barcelona , Barcelona , Spain
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | | | - I Strebel
- University Hospital Basel , Basel , Switzerland
| | - M Christ
- Kantonsspital Lucerne, Emergency Department , Lucerne , Switzerland
| | - K Wildi
- University Hospital Basel , Basel , Switzerland
| | - M Rubini Gimenez
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - J Martin-Sanchez
- Hospital Clinico San Carlos, Servicio de Urgencias , Madrid , Spain
| | - D Keller
- University Hospital Zurich, Emergency Department , Zurich , Switzerland
| | - R Twerenbold
- University Medical Center Hamburg Eppendorf, University Center of Cardiovascular Science & Department of Cardiology , Hamburg , Germany
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
| |
Collapse
|
47
|
Boeddinghaus J, Nestelberger T, Koechlin L, Lopez-Ayala P, Wildi K, Rubini Gimenez M, Miro O, Martin-Sanchez J, Keller D, Christ M, Twerenbold R, Mueller C. Association of accompanying dyspnea with diagnoses and outcome of patients presenting with suspected acute coronary syndromes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The presence of accompanying dyspnea is routinely assessed and common in chest pain patients with suspected acute coronary syndromes (ACS), but its impact on differential diagnoses, diagnostic work-up and outcome is incompletely understood.
Purpose
To determine the association of accompanying dyspnea with diagnoses, diagnostic work-up, and outcome of patients presenting with suspected ACS to the emergency department (ED).
Methods
We prospectively enrolled unselected patients presenting to the ED with chest pain as the main symptom suggestive of ACS in an international multicenter study. Final diagnoses were adjudicated by two independent cardiologists using all information including cardiac imaging. Patients were stratified by the presence or absence of self-reported dyspnea. The primary diagnostic endpoint was the differential diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The primary prognostic endpoint was all-cause mortality at two years.
Results
Among 6045 patients, 2892/6045 (48%) had accompanying dyspnea. Final diagnoses in patients with versus without dyspnea were different (overall p<0.001), but prevalence of ACS was comparable (MI 22.4% vs. 21.9%, p=0.602, unstable angina 8.7% vs. 7.9%, p=0.291). In contrast, patients with dyspnea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, p<0.001). Diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn)T/I concentrations at presentation for the diagnosis of MI was high and not affected by the presence of dyspnea (area under the curve 0.89–0.91 in both groups). The ESC 0/1h-algorithms performed excellent in both groups with negative predictive values >99.4%. The presence of dyspnea was associated with all-cause death at two years (hazard ratio [HR] 2.487 [95% CI, 2.001–3.091, p<0.001) and remained an independent predictor after adjustment for covariates at baseline (HR 1.813 [95% CI, 1.453–2.261, p=0.001]). Overall mortality rates were higher in patients with dyspnea at two years (9.0% vs. 3.7%, p<0.001).
Conclusion
Accompanying dyspnea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease such as heart failure. While the safety of the diagnostic work-up was not affected, accompanying dyspnea was associated with and an independent predictor for two-year all-cause mortality.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss Heart Foundation, University of Basel.
Collapse
Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - P Lopez-Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - K Wildi
- The Prince Charles Hospital, Critical Care Research Group , Brisbane , Australia
| | | | - O Miro
- Hospital Clinic de Barcelona, Emergency Department , Barcelona , Spain
| | - J Martin-Sanchez
- Hospital Clinic San Carlos, Emergency Department , Madrid , Spain
| | - D Keller
- University Hospital Zurich, Emergency Department , Zurich , Switzerland
| | - M Christ
- Lucerne Cantonal Hospital, Emergency , Lucerne , Switzerland
| | - R Twerenbold
- University Heart & Vascular Center Hamburg, Cardiology , Hamburg , Germany
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| |
Collapse
|
48
|
Lopez Ayala P, Boeddinghaus J, Nestelberger T, Strebel I, Koechlin L, Rubini Gimenez M, Wildi K, Twerenbold R, Mueller C. Combining qualitative and quantitative ECG criteria with the ESC 0/1h-hs-cTn-algorithm in the early diagnosis of non-ST-elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1352] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The electrocardiogram (ECG) is one of the three main diagnostic tools for the assessment of patients with suspected non-ST-elevation myocardial infarction (NSTEMI). However, it is unknown how established qualitative or novel quantitative ECG criteria can best be combined with high-sensitivity cardiac troponin (hs-cTn)-based diagnostic algorithms, such as the ESC 0/1h-algorithm, for the early diagnosis of NSTEMI.
Methods
ST-segment depression, T-wave inversion, and a novel modified ST-segment deviation score (1), defined as the sum of ST-segment elevation in aVR plus absolute, unsigned ST-segment depressions in the remaining leads, were assessed blinded to all clinical data among unselected patients presenting with acute chest discomfort to the emergency department in an international multicentre prospective diagnostic study. Final diagnoses were centrally adjudicated by two independent cardiologists based on complete cardiac work-up, cardiac imaging and serial hs-cTn. Direct rule-in thresholds for the modified ST-segment deviation score, achieving a positive predictive value (PPV) of >70% justifying early monitorization and management, were derived, validated and compared to ST-segment depression and T-wave inversion and applied 1) alone and 2) in combination with the ESC 0/1h-hs-cTnT/I-algorithms.
Results
Among 3299 eligible patients, NSTEMI was present in 581 (17.6%) patients. ST-segment depression identified 243/3299 patients (7.4%) with a specificity of 96.5% (95% CI 95.7–97.1) and a PPV of 60.5% (95% CI 54.2–66.4) for the rule-in of NSTEMI, while T-wave inversion had a low PPV (38.0%; 95% CI 33.1–43.1). A modified ST-segment deviation score ≥6mm triaged 108/3299 patients (3.3%) towards direct rule-in upon ED arrival, resulting in a PPV of 71.3% (95% CI 62.1–79.0) and a specificity of 98.9% (95% CI 98.4–99.2), Figure 1. Bootstrap internal validation confirmed the robustness of these findings. Most patients ruled-in by ST-segment depression or a modified ST-segment deviation score ≥6mm would have been also ruled-in by the ESC 0/1h-hs-cTnT/I-algorithm, albeit 1–2h later. Combining ST-segment depression or a modified ST-segment deviation score ≥6mm with the ESC 0/1h-hs-cTnT-algorithm (Figure 2) accelerated the rule-in in those identified already by the ECG-criteria, and resulted in a modest number of reclassifications from rule-out or observe to rule-in. These results were confirmed in a secondary analysis assessing the combination of these ECG signatures with two ESC 0/1h-hs-cTnI-algorithms (Architect and Centaur).
Conclusion
Combining either ST-segment depression or a modified ST-segment deviation Score ≥6mm with the ESC 0/1h-hs-cTnT/I-algorithms accelerated and improved the early diagnosis of NSTEMI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Heart Foundation (SHF) and Swiss National Science Foundation (SNSF)
Collapse
Affiliation(s)
- P Lopez Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | | | - K Wildi
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| | - R Twerenbold
- University Heart & Vascular Center Hamburg, Cardiology , Hamburg , Germany
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB) , Basel , Switzerland
| |
Collapse
|
49
|
Belkin M, Wussler D, Kozhuharov N, Michou E, Sabti Z, Walter J, Goudev A, Flores D, Shresta S, Menosi Gualandro D, Pfister O, Breidthardt T, Mueller C. Prognostic value of a disease-specific health-related quality score in acute heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite the striking therapeutic progress made in the treatment of heart failure (HF), rehospitalization rate and mortality remain a major and often unpredictable problem. Previous studies have shown the prognostic value of Kansas City Cardiomyopathy Questionnaire (KCCQ), a score assessing disease-specific health-related quality of life in stable chronic HF patients. Recently, a large study including 4898 patients with acute HF (AHF) enrolled in China reported the incremental predictive ability of KCCQ for a composite outcome of death and rehospitalization. However, these findings were not yet confirmed. In order to address this unmet need, the aim of this study was to examine the prognostic value of KCCQ in another AHF cohort.
Purpose
To validate the prognostic value of the KCCQ in AHF.
Methods
Goal-directed AfterLoad Reduction in Acute Congestive Cardiac Decompensation Study (GALACTIC) was a prospective, multicenter (n=10), randomized, interventional controlled trial enrolling adult patients presenting with AHF. KCCQ was assessed shortly after admission. We focused on the prognostic value of the short version KCCQ-12, explored the association with the composite of all-cause mortality and AHF rehospitalization within 30- and 180-day follow-up and compared it to the original score. Patients were grouped into quartiles according their KCCQ: high-risk (0–<25), moderate- to high-risk (25–<50), low- to moderate-risk (50–<75) and low-risk group (75–100). Cumulative incidence of assessed endpoints was displayed in Kaplan-Meier curves. Covariate adjustments were made using Cox regression. Prognostic accuracy over N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated by time-dependent area under the curve.
Results
Among 781 patients, 419 (median age 78, 35% female, 32% new onset of HF) had a complete set of variables to calculate KCCQ. Follow-up was available in all patients up to 180 days. 29 (7%) and 122 (29%) patients died or were rehospitalized for AHF within 30- and 180-days, respectively. Median KCCQ-12 was 37.5 with 25% of patients attaining the high- and 8% the low-risk group. After adjustment, each 10-point decrease in the KCCQ was associated with a 10% increase in 180-day risk regardless of new onset or acute decompensated chronic HF, age, sex, comorbidities, systolic blood pressure, creatinine, NT-proBNP and sodium levels. The prognostic ability for a 30-day risk was not significant. Using the same adjustments, a 10-point decrease in the original KCCQ was significant for a 20% and a 11% increase in risk for the short- and long-term composite outcome. The prognostic accuracy of KCCQ was comparable to NT-proBNP.
Conclusions
Health status, measured by the KCCQ-12 among patients with AHF, is significantly associated with a long-term composite outcome of all-cause mortality and AHF rehospitalization. The original KCCQ overall score is an independent predictor for both, the 30- and 180-day composite outcome.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, the Swiss National Science Foundation
Collapse
Affiliation(s)
- M Belkin
- University Hospital Basel , Basel , Switzerland
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | | | - E Michou
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - Z Sabti
- University Hospital Basel , Basel , Switzerland
| | - J Walter
- University Hospital Basel , Basel , Switzerland
| | - A Goudev
- University Hospital Tsaritsa Yoanna , Sofia , Bulgaria
| | - D Flores
- University Hospital Basel , Basel , Switzerland
| | - S Shresta
- University Hospital Basel , Basel , Switzerland
| | | | - O Pfister
- University Hospital Basel , Basel , Switzerland
| | | | - C Mueller
- University Hospital Basel , Basel , Switzerland
| |
Collapse
|
50
|
Papachristou A, Puelacher C, Glarner N, Strebel I, Steiger J, Diebold M, Lurati Buse G, Bolliger D, Steiner LA, Gurke L, Wolff T, Mujagic E, Gualandro DM, Mueller C, Breidthardt T. Renal failure: a non-cardiac source of high sensitivity cardiac troponin T. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2611] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Circulating high sensitivity cardiac troponin T (hs-cTnT) levels are frequently elevated in patients with end-stage renal disease (ESRD). The underlying pathophysiology is largely unknown. Currently, accumulation of hs-cTnT due to impaired renal clearance, as well as increased production caused by chronic cardiomyocyte injury is being discussed.
Purpose
The aim of this study was to assess the relative contribution of impaired renal clearance as a non-cardiac source of elevated hs-cTnT concentrations, using renal transplantation as an in vivo model of rapidly improved renal function and on a short-term basis rather unchanged cardiac pathology.
Methods
This single-centre study was a secondary analysis within a prospective active surveillance study program for perioperative myocardial infarction/injury (PMI). 42 consecutive high-risk patients undergoing renal transplantation without evidence of PMI were included. Serial creatinine and hs-cTnT (Elecsys, Roche) measurements were performed pre-transplant (baseline) and post-transplant on day (d) 1, between d2 and d5, and between d14 and d180. The effect of time and creatinine on hs-cTnT was estimated with a log-level non-linear mixed-effects model, where time and creatinine were treated as the fixed effects and subject as the random effect. Natural cubic splines were used to account for nonlinearity in the fixed effects.
Results
Baseline median serum creatinine concentration was 616 umol/L [interquartile range (IQR) 477–825], and significantly fell to 425 umol/L (IQR 313–619) on d1, 285 umol/L (IQR 194–509) on day2–5, and 116 umol/L (IQR 100–166) on d14–180 (p<0.001, p<0.001, and p=0.043, respectively; Figure 1A).
Pre-transplant hs-cTnT concentrations were above the 99th percentile (14ng/L) in all patients, median hs-cTnT concentration was 50 ng/L (IQR 35–70). In parallel to the fall in serum creatinine from baseline to d1, hs-cTnT concentrations significantly fell to 28 ng/L (IQR 15–40) on d1 (p<0.001), and then remained constant on d2–5 (27 ng/L (IQR 18–35)), and on d14–180 (24 ng/L (IQR 19–28); Figure 1B).
The mixed-effect model showed a significant decrease of hs-cTnT between baseline and d1 (p<0.001), whereas no significant change between d1 and d2 (p=0.82) occurred (Figure 2).
Conclusion
In contrast to the continuously falling serum creatinine levels, hs-cTnT concentrations reduced by about 50% only within the first 24 hours with a functional graft and then remained elevated above the 99th percentile. This suggests, that ESRD is a non-cardiac source of elevated circulating hs-cTnT concentrations, which contributes about 50%, while the other 50% seem related to chronic cardiomyocyte injury. Further studies assessing the long-term effect of renal transplantation on hs-cTnT levels and cardiac function are needed.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
Collapse
Affiliation(s)
- A Papachristou
- University Hospital Basel, Cradiovascular Research Institute Basel and Department of Cardiology, Division of Internal Medicine , Basel , Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Reasearch Institute Basel and Department of Cardiology , Basel , Switzerland
| | - N Glarner
- University Hospital Basel, Cardiovascular Reasearch Institute Basel and Department of Cardiology , Basel , Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Reasearch Institute Basel and Department of Cardiology , Basel , Switzerland
| | - J Steiger
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology , Basel , Switzerland
| | - M Diebold
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology , Basel , Switzerland
| | - G Lurati Buse
- University Hospital Duesseldorf, Department of Anaesthesiology , Duesseldorf , Germany
| | - D Bolliger
- University Hospital Basel, Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine, and Pain Therapy , Basel , Switzerland
| | - L A Steiner
- University Hospital Basel, Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine, and Pain Therapy , Basel , Switzerland
| | - L Gurke
- University Hospital Basel, Department of Vascular Surgery and Renal Transplantation , Basel , Switzerland
| | - T Wolff
- University Hospital Basel, Department of Vascular Surgery and Renal Transplantation , Basel , Switzerland
| | - E Mujagic
- University Hospital Basel, Department of Vascular Surgery and Renal Transplantation , Basel , Switzerland
| | - D M Gualandro
- University Hospital Basel, Cardiovascular Reasearch Institute Basel and Department of Cardiology , Basel , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Reasearch Institute Basel and Department of Cardiology , Basel , Switzerland
| | - T Breidthardt
- University Hospital Basel, Cradiovascular Research Institute Basel and Department of Cardiology, Division of Internal Medicine , Basel , Switzerland
| |
Collapse
|