1
|
Moser R, Pfeiffer S, Cala L, Klein E, Kiechle M, Behzadi ST, Fallenberg E, Combs SE, Weber W, Borm KJ. Detecting Metastatic Patterns of Oligometastatic Breast Cancer: A Comparative Analysis of 18F-FDG PET/CT and Conventional CT Imaging. J Nucl Med 2024:jnumed.123.266925. [PMID: 38637138 DOI: 10.2967/jnumed.123.266925] [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: 10/23/2023] [Revised: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
Metastasis-directed therapy has the potential to improve progression-free and overall survival in oligometastatic disease (OMD). For breast cancer, however, randomized trials have failed so far to confirm this finding. Because the concept of metastasis-directed therapy in OMD is highly dependent on the accuracy of the imaging modality, we aimed to assess the impact of 18F-FDG PET/CT on the definition of OMD in breast cancer patients. Methods: Eighty patients with a total of 150 18F-FDG PET/CT images (between October 2006 and January 2022) were enrolled in this retrospective study at the Technical University of Munich. The inclusion criteria were OMD, defined as 1-5 distant metastases, at the time of 18F-FDG PET/CT. For the current study, we systemically compared the metastatic pattern on 18F-FDG PET/CT with conventional CT. Results: At the time of 18F-FDG PET/CT, 21.3% of patients (n = 32) had a first-time diagnosis of metastatic disease, 40.7% (n = 61) had a previous history of OMD, and 38% (n = 57) had a previous history of polymetastatic disease. In 45.3% of cases, the imaging modality (18F-FDG PET/CT vs. conventional CT) had an impact on the assessment of whether OMD was present. An identical metastatic pattern was observed in only 32% of cases.18F-FDG PET/CT detected additional metastases in 33.3% of cases, mostly in the nonregional lymph node system. Conclusion: The use of 18F-FDG PET/CT had a substantial impact on the definition of OMD and detection of metastatic pattern in breast cancer. Our results emphasize the importance of establishing a standardized definition for imaging modalities in future trials and clinical practices related to metastasis-directed therapy in breast cancer patients.
Collapse
Affiliation(s)
- Rebecca Moser
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Sophie Pfeiffer
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Lisena Cala
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Sophie T Behzadi
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Eva Fallenberg
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
- Department of Radiation Sciences, Germany Institute of Innovative Radiotherapy, Helmholtz Zentrum München, Oberschleißheim, Germany; and
- German Consortium for Translational Cancer Research, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Kai J Borm
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany;
| |
Collapse
|
2
|
Smaczny S, Klein E, Jung S, Moeller K, Karnath HO. The line bisection bias as a deficit of proportional reasoning - evidence from number line estimation in neglect. Neuropsychologia 2024; 196:108848. [PMID: 38432323 DOI: 10.1016/j.neuropsychologia.2024.108848] [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: 09/13/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
This study aimed to investigate whether neurological patients presenting with a bias in line bisection show specific problems in bisecting a line into two equal parts or their line bisection bias rather reflects a special case of a deficit in proportional reasoning more generally. In the latter case, the bias should also be observed for segmentations into thirds or quarters. To address this question, six neglect patients with a line bisection bias were administered additional tasks involving horizontal lines (e.g., segmentation into thirds and quarters, number line estimation, etc.). Their performance was compared to five neglect patients without a line bisection bias, 10 patients with right hemispheric lesions without neglect, and 32 healthy controls. Most interestingly, results indicated that neglect patients with a line bisection bias also overestimated segments on the left of the line (e.g., one third, one quarter) when dissecting lines into parts smaller than halves. In contrast, such segmentation biases were more nuanced when the required line segmentation was framed as a number line estimation task with either fractions or whole numbers. Taken together, this suggests a generalization of line bisection bias towards a segmentation or proportional processing bias, which is congruent with attentional weighting accounts of line bisection/neglect. As such, patients with a line bisection bias do not seem to have specific problems bisecting a line, but seem to suffer from a more general deficit processing proportions.
Collapse
Affiliation(s)
- S Smaczny
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - E Klein
- University of Paris, LaPsyDÉ, CNRS UMR8240, La Sorbonne, Paris, France; Leibniz Institut Fuer Wissensmedien, Tuebingen, Germany
| | - S Jung
- Leibniz Institut Fuer Wissensmedien, Tuebingen, Germany; Department of Computer Science/Therapy Science, Trier University of Applied Science, Trier, Germany; Institute for Cognitive & Affective Neuroscience (ICAN), Trier University, Trier, Germany
| | - K Moeller
- Leibniz Institut Fuer Wissensmedien, Tuebingen, Germany; Centre for Mathematical Cognition, School of Science, Loughborough University, United Kingdom; LEAD Graduate School and Research Network, University of Tuebingen, Tuebingen, Germany
| | - H-O Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Department of Psychology, University of South Carolina, Columbia, SC, USA.
| |
Collapse
|
3
|
Schick K, Reiser S, Janssen L, Schacht L, Pittroff SID, Dörfler E, Klein E, Roenneberg C, Dinkel A, Fleischmann A, Berberat PO, Bauer J, Gartmeier M. Training in medical communication competence through video-based e-learning: How effective are video modeling and video reflection? Patient Educ Couns 2024; 121:108132. [PMID: 38184987 DOI: 10.1016/j.pec.2023.108132] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The present study investigated the efficacy of the didactic approaches of video modeling (VM, best-practice examples), video reflection (VR, problem-based approach), and the combination of both (VMR) in fostering medical communication competence in a video-based digital learning environment. METHODS N = 126 third-year medical students who participated in the pre-post study were assigned to either the intervention groups (VM, VR, and VMR) or the wait-list control group. The efficacy of the three approaches was assessed by means of a situational judgment test (SJT) of medical communication competence. To investigate the differences between the wait-list control and the intervention groups (H1), between the single-mode and combined conditions (H2), and between VM and VR (H3), we applied planned contrast analyses. RESULTS The planned contrasts showed that the VR condition significantly improved learning outcomes in comparison to the VM condition (H3). The decreased mean scores of the VM condition offset the increased mean scores of VR, and thus no significant differences could be found in H1 and H2. CONCLUSIONS Our study provides promising evidence that VR fosters medical communication competence more effectively than VM. PRACTICAL IMPLICATIONS Medical students' learning in video-based digital environments can be facilitated by the use of interactive VR.
Collapse
Affiliation(s)
- Kristina Schick
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany.
| | - Sabine Reiser
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Laura Janssen
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Laura Schacht
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Sylvia Irene Donata Pittroff
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Eva Dörfler
- Technical University of Munich, TUM Institute for LifeLong Learning, TUM ProLehre, Arcisstraße 21, 80333 München, Germany
| | - Evelyn Klein
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Obstetrics and Gynecology, Ismaninger Straße 22, 81675 München, Germany
| | - Casper Roenneberg
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675 München, Germany
| | - Andreas Dinkel
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Langerstr. 3, 81675 München, Germany
| | - Andreas Fleischmann
- Technical University of Munich, TUM Institute for LifeLong Learning, TUM ProLehre, Arcisstraße 21, 80333 München, Germany
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| | - Johannes Bauer
- University of Erfurt, Educational Research and Methodology, Nordhäuser Str. 63, 99089 Erfurt, Germany
| | - Martin Gartmeier
- Technical University of Munich, TUM School of Medicine & Health, Department Clinical Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675 München, Germany
| |
Collapse
|
4
|
Behzadi ST, Moser R, Kiesl S, Nano J, Peeken JC, Fischer JC, Fallenberg EM, Huber T, Haller B, Klein E, Kiechle M, Combs SE, Borm KJ. Tumor Contact With Internal Mammary Perforator Vessels as Risk Factor for Gross Internal Mammary Lymph Node Involvement in Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00339-0. [PMID: 38458496 DOI: 10.1016/j.ijrobp.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE The identification of internal mammary lymph node metastases and the assessment of associated risk factors are crucial for adjuvant regional lymph node irradiation in patients with breast cancer. The current study aims to investigate whether tumor contact with internal mammary perforator vessels is associated with gross internal mammary lymph node involvement. METHODS AND MATERIALS We included 297 patients with primary breast cancer and gross internal mammary (IMN+) and/or axillary metastases as well as 230 patients without lymph node metastases. Based on pretreatment dynamic contrast-enhanced magnetic resonance imaging, we assessed contact of the tumor with the internal mammary perforating vessels (IMPV). RESULTS A total of 59 patients had ipsilateral IMN+ (iIMN+), 10 patients had contralateral IMN+ (cIMN+), and 228 patients had ipsilateral axillary metastases without IMN; 230 patients had node-negative breast cancer. In patients with iIMN+, 100% of tumors had contact with ipsilateral IMPV, with 94.9% (n = 56) classified as major contact. In iIMN- patients, major IMPV contact was observed in only 25.3% (n = 116), and 36.2% (n = 166) had no IMPV contact at all. Receiver operating characteristic analysis revealed that "major IMPV contact" was more accurate in predicting iIMN+ (area under the curve, 0.85) compared with a multivariate model combining grade of differentiation, tumor site, size, and molecular subtype (area under the curve, 0.65). Strikingly, among patients with cIMN+, 100% of tumors had contact with a crossing contralateral IMPV, whereas in cIMN- patients, IMPVs to the contralateral side were observed in only 53.4% (iIMN+) and 24.8% (iIMN-), respectively. CONCLUSIONS Tumor contact with the IMPV is highly associated with risk of gross IMN involvement. Further studies are warranted to investigate whether this identified risk factor is also associated with microscopic IMN involvement and whether it can assist in the selection of patients with breast cancer for irradiation of the internal mammary lymph nodes.
Collapse
Affiliation(s)
- Sophie T Behzadi
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Rebecca Moser
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Sophia Kiesl
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Jana Nano
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Julius C Fischer
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Eva M Fallenberg
- Department of Radiology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Thomas Huber
- Department of Radiology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany; Deutsches Konsortium für translationale Krebsforschung (DKTK) - Partner Site Munich, Munich, Germany; Institute of Radiation Medicine, Helmholtz Zentrum München, Munich, Germany
| | - Kai J Borm
- Department of Radiation Oncology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany.
| |
Collapse
|
5
|
Lee L, Yi T, Fice M, Achar RK, Jones C, Klein E, Buac N, Lopez-Hisijos N, Colman MW, Gitelis S, Blank AT. Development and external validation of a machine learning model for prediction of survival in undifferentiated pleomorphic sarcoma. Musculoskelet Surg 2024; 108:77-86. [PMID: 37658174 DOI: 10.1007/s12306-023-00795-w] [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: 07/01/2022] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE Machine learning (ML) algorithms to predict cancer survival have recently been reported for a number of sarcoma subtypes, but none have investigated undifferentiated pleomorphic sarcoma (UPS). ML is a powerful tool that has the potential to better prognosticate UPS. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of histologically confirmed undifferentiated pleomorphic sarcoma (UPS) (n = 665). Patient, tumor, and treatment characteristics were recorded, and ML models were developed to predict 1-, 3-, and 5-year survival. The best performing ML model was externally validated using an institutional cohort of UPS patients (n = 151). RESULTS All ML models performed best at the 1-year time point and worst at the 5-year time point. On internal validation within the SEER cohort, the best models had c-statistics of 0.67-0.69 at the 5-year time point. The Multi-Layer Perceptron Neural Network (MLP) model was the best performing model and used for external validation. Similarly, the MLP model performed best at 1-year and worst at 5-year on external validation with c-statistics of 0.85 and 0.81, respectively. The MLP model was well calibrated on external validation. The MLP model has been made publicly available at https://rachar.shinyapps.io/ups_app/ . CONCLUSION Machine learning models perform well for survival prediction in UPS, though this sarcoma subtype may be more difficult to prognosticate than other subtypes. Future studies are needed to further validate the machine learning approach for UPS prognostication.
Collapse
Affiliation(s)
- L Lee
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA.
| | - T Yi
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - M Fice
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - R K Achar
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - C Jones
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - E Klein
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - N Buac
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - N Lopez-Hisijos
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - M W Colman
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - S Gitelis
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| | - A T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, USA
| |
Collapse
|
6
|
Riedel M, Kaefinger K, Stuehrenberg A, Ritter V, Amann N, Graf A, Recker F, Klein E, Kiechle M, Riedel F, Meyer B. ChatGPT's performance in German OB/GYN exams - paving the way for AI-enhanced medical education and clinical practice. Front Med (Lausanne) 2023; 10:1296615. [PMID: 38155661 PMCID: PMC10753765 DOI: 10.3389/fmed.2023.1296615] [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: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial learning and large language model tool developed by OpenAI in 2022. It utilizes deep learning algorithms to process natural language and generate responses, which renders it suitable for conversational interfaces. ChatGPT's potential to transform medical education and clinical practice is currently being explored, but its capabilities and limitations in this domain remain incompletely investigated. The present study aimed to assess ChatGPT's performance in medical knowledge competency for problem assessment in obstetrics and gynecology (OB/GYN). Methods Two datasets were established for analysis: questions (1) from OB/GYN course exams at a German university hospital and (2) from the German medical state licensing exams. In order to assess ChatGPT's performance, questions were entered into the chat interface, and responses were documented. A quantitative analysis compared ChatGPT's accuracy with that of medical students for different levels of difficulty and types of questions. Additionally, a qualitative analysis assessed the quality of ChatGPT's responses regarding ease of understanding, conciseness, accuracy, completeness, and relevance. Non-obvious insights generated by ChatGPT were evaluated, and a density index of insights was established in order to quantify the tool's ability to provide students with relevant and concise medical knowledge. Results ChatGPT demonstrated consistent and comparable performance across both datasets. It provided correct responses at a rate comparable with that of medical students, thereby indicating its ability to handle a diverse spectrum of questions ranging from general knowledge to complex clinical case presentations. The tool's accuracy was partly affected by question difficulty in the medical state exam dataset. Our qualitative assessment revealed that ChatGPT provided mostly accurate, complete, and relevant answers. ChatGPT additionally provided many non-obvious insights, especially in correctly answered questions, which indicates its potential for enhancing autonomous medical learning. Conclusion ChatGPT has promise as a supplementary tool in medical education and clinical practice. Its ability to provide accurate and insightful responses showcases its adaptability to complex clinical scenarios. As AI technologies continue to evolve, ChatGPT and similar tools may contribute to more efficient and personalized learning experiences and assistance for health care providers.
Collapse
Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Katharina Kaefinger
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Antonia Stuehrenberg
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Viktoria Ritter
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Niklas Amann
- Department of Gynecology and Obstetrics, Friedrich–Alexander-University Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Anna Graf
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Florian Recker
- Department of Gynecology and Obstetrics, Bonn University Hospital, Bonn, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Bastian Meyer
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TU), Munich, Germany
| |
Collapse
|
7
|
Koncina E, Nurmik M, Pozdeev VI, Gilson C, Tsenkova M, Begaj R, Stang S, Gaigneaux A, Weindorfer C, Rodriguez F, Schmoetten M, Klein E, Karta J, Atanasova VS, Grzyb K, Ullmann P, Halder R, Hengstschläger M, Graas J, Augendre V, Karapetyan YE, Kerger L, Zuegel N, Skupin A, Haan S, Meiser J, Dolznig H, Letellier E. IL1R1 + cancer-associated fibroblasts drive tumor development and immunosuppression in colorectal cancer. Nat Commun 2023; 14:4251. [PMID: 37460545 DOI: 10.1038/s41467-023-39953-w] [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] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
Fibroblasts have a considerable functional and molecular heterogeneity and can play various roles in the tumor microenvironment. Here we identify a pro-tumorigenic IL1R1+, IL-1-high-signaling subtype of fibroblasts, using multiple colorectal cancer (CRC) patient single cell sequencing datasets. This subtype of fibroblasts is linked to T cell and macrophage suppression and leads to increased cancer cell growth in 3D co-culture assays. Furthermore, both a fibroblast-specific IL1R1 knockout and IL-1 receptor antagonist Anakinra administration reduce tumor growth in vivo. This is accompanied by reduced intratumoral Th17 cell infiltration. Accordingly, CRC patients who present with IL1R1-expressing cancer-associated-fibroblasts (CAFs), also display elevated levels of immune exhaustion markers, as well as an increased Th17 score and an overall worse survival. Altogether, this study underlines the therapeutic value of targeting IL1R1-expressing CAFs in the context of CRC.
Collapse
Affiliation(s)
- E Koncina
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Nurmik
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - V I Pozdeev
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - C Gilson
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Tsenkova
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - R Begaj
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - S Stang
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - A Gaigneaux
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - C Weindorfer
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - F Rodriguez
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Schmoetten
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - E Klein
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - J Karta
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - V S Atanasova
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - K Grzyb
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - P Ullmann
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - R Halder
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - M Hengstschläger
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - J Graas
- Clinical and Epidemiological Investigation Center, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - V Augendre
- National Center of Pathology, Laboratoire National de Santé, Dudelange, Luxembourg
| | | | - L Kerger
- Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - N Zuegel
- Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - A Skupin
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - S Haan
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - J Meiser
- Cancer Metabolism Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - H Dolznig
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria.
| | - E Letellier
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg.
| |
Collapse
|
8
|
Smaczny S, Sperber C, Jung S, Moeller K, Karnath HO, Klein E. Disconnection in a left-hemispheric temporo-parietal network impairs multiplication fact retrieval. Neuroimage 2023; 268:119840. [PMID: 36621582 DOI: 10.1016/j.neuroimage.2022.119840] [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: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023] Open
Abstract
Arithmetic fact retrieval has been suggested to recruit a left-lateralized network comprising perisylvian language areas, parietal areas such as the angular gyrus (AG), and non-neocortical structures such as the hippocampus. However, the underlying white matter connectivity of these areas has not been evaluated systematically so far. Using simple multiplication problems, we evaluated how disconnections in parietal brain areas affected arithmetic fact retrieval following stroke. We derived disconnectivity measures by jointly considering data from n = 73 patients with acute unilateral lesions in either hemisphere and a white-matter tractography atlas (HCP-842) using the Lesion Quantification Toolbox (LQT). Whole-brain voxel-based analysis indicated a left-hemispheric cluster of white matter fibers connecting the AG and superior temporal areas to be associated with a fact retrieval deficit. Subsequent analyses of direct gray-to-gray matter disconnections revealed that disconnections of additional left-hemispheric areas (e.g., between the superior temporal gyrus and parietal areas) were significantly associated with the observed fact retrieval deficit. Results imply that disconnections of parietal areas (i.e., the AG) with language-related areas (i.e., superior and middle temporal gyri) seem specifically detrimental to arithmetic fact retrieval. This suggests that arithmetic fact retrieval recruits a widespread left-hemispheric network and emphasizes the relevance of white matter connectivity for number processing.
Collapse
Affiliation(s)
- S Smaczny
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - C Sperber
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - S Jung
- Department of Computer Science/Therapy Science, Trier University of Applied Science, Trier, Germany; Leibniz Institut fuer Wissensmedien, Tuebingen, Germany
| | - K Moeller
- Leibniz Institut fuer Wissensmedien, Tuebingen, Germany; Centre for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany; Centre for Mathematical Cognition, School of Science, Loughborough University, United Kingdom
| | - H O Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany; Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - E Klein
- Leibniz Institut fuer Wissensmedien, Tuebingen, Germany; University of Paris, LaPsyDÉ, CNRS, Sorbonne Paris Cité, Paris, France.
| |
Collapse
|
9
|
Barragan C, Klein E, Alshehri H, Mafeld S, Shlomovitz E. Abstract No. 517 Percutaneous Transhepatic Choledochoscopy for Mirizzi Syndrome: A Minimally Invasive Option for a Complex Surgical Problem? J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.375] [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: 02/27/2023] Open
|
10
|
Batty EJ, Ibragimov U, Fadanelli M, Gross S, Cooper K, Klein E, Ballard AM, Young AM, Lockard AS, Oser CB, Cooper HLF. A qualitative analysis of rural syringe service program fidelity in Appalachian Kentucky: Staff and participant perspectives. J Rural Health 2023; 39:328-337. [PMID: 36117151 PMCID: PMC10484119 DOI: 10.1111/jrh.12715] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE As drug-related epidemics have expanded from cities to rural areas, syringe service programs (SSPs) and other harm reduction programs have been slow to follow. The recent implementation of SSPs in rural areas demands attention to program fidelity based on core components of SSP success. METHODS Semistructured interviews conducted with clients and staff at 5 SSPs in 5 counties within 2 Central Appalachian health districts. Interviews covered fidelity of SSP implementation to 6 core components: (1) meet needs for harm reduction supplies; (2) education and counseling for sexual, injection, and overdose risks; (3) cooperation between SSPs and local law enforcement; (4) provide other health and social services; (5) ensure low threshold access to services; and (6) promote dignity, the impact of poor fidelity on vulnerability to drug-related harms, and the risk environment's influence on program fidelity. We applied thematic methods to analyze the data. FINDINGS Rural SSPs were mostly faithful to the 6 core components. Deviations from core components can be attributed to certain characteristics of the local rural risk environment outlined in the risk environment model, including geographic remoteness, lack of resources and underdeveloped infrastructure, and stigma against people who inject drugs (PWID) CONCLUSIONS: As drug-related epidemics continue to expand outside cities, scaling up SSPs to serve rural PWID is essential. Future research should explore whether the risk environment features identified also influence SSP fidelity in other rural areas and develop and test strategies to strengthen core components in these vulnerable areas.
Collapse
Affiliation(s)
- E J Batty
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - U Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - M Fadanelli
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - S Gross
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - K Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - E Klein
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - A M Ballard
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA
| | - A M Young
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - A S Lockard
- Kentucky River District Health Department, Hazard, Kentucky, USA
| | - C B Oser
- Department of Sociology, University of Kentucky, Lexington, Kentucky, USA
| | - H L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
11
|
Klein E, Swanstrom L, Barragan C, Shmilovich H, Shlomovitz E. Abstract No. 99 Magnetic Compression Anastomosis for Untreatable Luminal Occlusions: Early Experience of a Novel Minimally Invasive Image-Guided Approach. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.147] [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: 02/27/2023] Open
|
12
|
Klein E, Swanstrom L, Barragan C, Shmilovich H, Shlomovitz E. Abstract No. 179 Percutaneous Placement of Lumen Apposing Metallic Stents for Patients with Afferent Loop Syndrome. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.235] [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: 02/26/2023] Open
|
13
|
Klein E, Beckert V, Schmidt G, Kiechle M, Paepke S. Use of Arista™ AH Absorbable Hemostat in breast surgery – analysis of seroma volumes and duration of drainage. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
14
|
Paepke S, Klein E, Andrulat A, Ankel C, Bauer L, Faridi A, Fink V, Gerber-Schäfer C, Gschwantler-Kaulich D, Heil J, Kümmel S, Ohlinger R, Thill M. Mesh-Pocket Supported Prepectoral Direct-to-Implant Breast Reconstruction: Preliminary Results of a Prospective Analysis. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
15
|
Munawwar B, Klein E, Schmidt G, Rief L, Heinemann F, Kiechle M, Paepke S. Comparison of Technetium (Tc)- and SPIO-guided Sentinel Lymph Node Biopsy (SLNB) in Patients with Neoadjuvant Chemotherapy in Early Breast Cancer – first retrospective data. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
16
|
Salvato I, Klein E, Forlani G, Poli A, Oudin A, Baus V, Golebiewska A, Accolla R, Niclou SP, Marchini A. OS08.5.A Adenovirus-mediated delivery of the MHC-II Transactivator CIITA gene induces tumor cell killing in immunocompetent glioblastoma organoids. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although immunotherapies represent an encouraging approach against cancer, to date none translated to the clinical benefit in Glioblastoma (GBM). One aspect contributing to this failure is the highly immunosuppressive GBM microenvironment. Our approach to overcome immunosuppression is to increase anti-tumor immune responses via adenovirus (AdV)-mediated delivery of the MHC-II Transactivator (CIITA) gene. CIITA-induced MHC-II expression is anticipated to convert GBM cells into surrogate antigen presenting cells able to prime T helper cells, therefore promoting CD4+ and CD8+ mediated immunity.
Material and Methods
We generated AdVs containing wild type CIITA (Ad-CIITA) using a replication-defective serotype5 adenoviral backbone. AdVs containing a mutated, non-functional version of CIITA (Ad-CIITA mutant) and an empty CMV promoter (Ad-null) were used as controls. AdV-mediated MHC-II expression was monitored at mRNA, protein and cell surface level. For the functional assessment of anti-tumor immune responses, we developed an advanced human GBM organoid model system consisting of tumor organoids co-cultured with either human peripheral blood mononuclear cells (PBMCs) or isolated CD3+ T cells. T cell mediated tumor cell killing was monitored over time via live cell imaging and flow cytometry.
Results
We successfully constructed and produced a CIITA-armed AdV that induces MHC-II expression in infected GBM cells, indicating the efficient expression of transcriptionally active CIITA for at least six days post infection. In immunocompetent human GBM organoids, Ad-CIITA infection of tumor cells led to prominent organoid disruption and tumor cell death, an effect that was not observed in the absence of PBMCs or CD3+ T cells. Tumor organoids infected with Ad-CIITA mutant remained intact, demonstrating the implication of cell surface MHC-II molecules in the observed phenotype.
Conclusion
Our results demonstrate that AdV-mediated delivery of CIITA is a promising strategy to increase T cell mediated immunity against glioblastoma.
Collapse
Affiliation(s)
- I Salvato
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - E Klein
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - G Forlani
- University of Insubria , Varese , Italy
| | - A Poli
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - A Oudin
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - V Baus
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - A Golebiewska
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - R Accolla
- University of Insubria , Varese , Italy
| | - S P Niclou
- Luxembourg Institute of Health , Luxembourg , Luxembourg
- University of Bergen , Bergen , Norway
| | - A Marchini
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| |
Collapse
|
17
|
Rezaeipour M, Klein E, Dording C, Niclou SP, Golebiewska A. P12.13.B Investigating the tumor - immune cell crosstalk in ex vivo glioblastoma models. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Immunotherapy is a promising therapeutic approach to fight cancer by activating the immune system. Multiple immune-based strategies are under development that aim at recruiting or re-activating cellular components of the immune system. While immunotherapies have recently revolutionized cancer therapy, they have shown so far little therapeutic success in glioblastoma patients. To enhance the efficacy of novel strategies, we need to better understand the immunogenic status of glioblastoma cells and their cross-talk with immune cells in different microenvironmental niches.
Material and Methods
We assessed expression of molecules related to antigen processing and presentation as well as immune checkpoints in patient tumor databases as well as in a series of glioblastoma patient-derived organoids, 3D stem-like cultures and adherent cell lines under varying microenvironmental conditions (varying oxygen levels, inflammation). We further established an allogenic co-culture protocol for glioblastoma organoids with immune cells isolated from HLA matched donor blood, allowing for the functional assessment of the crosstalk between tumor and immune cells.
Results
Analysis of a large cohort of patient tumors and patient-derived glioblastoma preclinical models shows inter-patient heterogeneity at the level of components of major histocompatibility complex (MHC)-MHC-II, immune checkpoints. Glioblastoma cells in general express MHC-I machinery, albeit at different levels. MHC-II and immune checkpoints are variably expressed across glioblastoma cells. Different tumor microenvironment conditions, including hypoxia and interferon-γ, impact the expression of immune-related molecules. Upon co-culture, HLA-matched donor-derived T cells integrate well into the core of glioblastoma tumor organoids and display reciprocal crosstalk with tumor cells.
Conclusion
Assessing antigen presentation and immune cell responses at the functional level are key to improve patient-specific responses to immunotherapies. Advanced glioblastoma organoids incorporating the immune compartment appear as clinically-relevant models for ex vivo efficacy studies.
Collapse
Affiliation(s)
- M Rezaeipour
- Luxembourg Institute of Health , Luxembourg , Luxembourg
- University of Luxembourg , Luxembourg , Luxembourg
| | - E Klein
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - C Dording
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - S P Niclou
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - A Golebiewska
- Luxembourg Institute of Health , Luxembourg , Luxembourg
| |
Collapse
|
18
|
Moreno-Sanchez PM, Oudin A, Yabo YA, Klein E, Baus V, Poli A, Michelucci A, Niclou SP, Golebiewska A. OS10.5.A Modeling immunocompetent tumor microenvironment in glioblastoma patient-derived orthotopic xenografts. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To date, glioblastoma (GBM) remains a fatal disease, with a median overall survival of roughly over a year. There is a crucial need of new treatment options, yet most clinical trials have failed partly due to the lack of predictive preclinical model systems. Currently, most patient-derived preclinical models suffer from the reduction or absence of immune system components, which represents a bottleneck for adequate immunotherapy testing. Humanized mice offer new opportunities here, since they rebuild an adaptive human immune system in a NSG mouse. Derivation of glioblastoma patient-derived orthotopic xenografts (PDOXs) in humanized mice appears thus as a promising tool for testing new treatment strategies targeting the tumor microenvironment (TME).
Material and Methods
We derived PDOXs through intracranial implantation of GBM primary organoids in different immunocompromised mouse strains (Nude, NOD/SCID, NSG). To introduce back the adaptive human immune system, GBM PDOXs were further derived in human CD34+ hematopoietic stem cell-engrafted NSG (HU-CD34+) mice. We applied single-cell RNA-sequencing, multicolor flow cytometry, immunohistochemical analyses and functional studies to examine the heterogeneous TME in a cohort of GBM PDOX models. We further interrogated the contribution and crosstalk between the human and mouse components constituting the brain TME in HU-CD34+ PDOXs.
Results
We show that glioma PDOXs can be derived in mice of different background including Nude, NOD-SCID, NSG and HU-CD34+ mice. Mouse-derived TME created in PDOX models contains tumor-associated macrophages (TAMs) known as major immuno-suppressive components of human GBM tumors. We further show that PDOXs derived in HU-CD34+ NSG mice present human CD45+ immune cells in the bone marrow and blood. Interestingly, we detect an influx of human immune cells in tumors developed in the mouse brain, which interact with the brain-derived immunosuppressive TME of mouse origin.
Conclusion
We here provide a thorough characterization of the heterogeneous brain TME created in GBM PDOX models. We show that human GBM can instruct mouse-derived brain cells towards immune-suppressive TME. The missing adaptive immune component can be introduced by derivation of GBM PDOXs in humanized mice. Such immunocompetent in vivo models will be important for testing novel therapies targeting different immune components in GBM.
Collapse
Affiliation(s)
- P M Moreno-Sanchez
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg , Belvaux , Luxembourg
| | - A Oudin
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
| | - Y A Yabo
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg , Belvaux , Luxembourg
| | - E Klein
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
| | - V Baus
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
| | - A Poli
- Neuro-Immunology Group, Department of Cancer Research, Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - A Michelucci
- Neuro-Immunology Group, Department of Cancer Research, Luxembourg Institute of Health , Luxembourg , Luxembourg
| | - S P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
| | - A Golebiewska
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research , Luxembourg , Luxembourg
| |
Collapse
|
19
|
Riedel M, Amann N, Recker F, Hennigs A, Heublein S, Meyer B, Karge A, Eisenkolb G, Lammert J, Graf A, Klein E, Weiss M, Riedel F. The COVID-19 pandemic and its impact on medical teaching in obstetrics and gynecology—A nationwide expert survey among teaching coordinators at German university hospitals. PLoS One 2022; 17:e0269562. [PMID: 35930549 PMCID: PMC9355177 DOI: 10.1371/journal.pone.0269562] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose The COVID-19 pandemic has imposed severe challenges on medical education at German university hospitals. In this first German nationwide expert survey, we addressed the responsible university teaching coordinators in obstetrics and gynecology departments and investigated their experiences during the pandemic as well as their opinions on future developments, especially with regard to the broader implementation of e-learning in the standard curriculum. Methods The questionnaire included 42 items and was disseminated among teaching coordinators at all 41 departments of obstetrics and gynecology at German university hospitals via an email that included a weblink to the online survey provider. Responses were collected between 19 April and 7 June 2021. Results In total, 30 responses were collected from 41 departments across Germany and their respective teaching coordinators in obstetrics and gynecology. The general opinion of the medical teaching provided during the pandemic was positive, whereas the teaching quality in practical skills was considered inferior and not equivalent to the standard face-to-face curriculum. Lectures and seminars had to be substituted by remote-learning alternatives, while clinical clerkships were reduced in length and provided less patient contact. Students in their final year experienced only a few differences in the clinical and teaching routine. Teaching coordinators in obstetrics and gynecology stated that they intend to incorporate more e-learning into the curriculum in the future. Conclusion The medical educators’ views presented here may help to complement the already-thoroughly investigated experiences of students under the restrictions of the COVID-19 pandemic. Medical educators in obstetrics and gynecology at German university hospitals have successfully established online and hybrid teaching alternatives to their standard face-to-face courses. Building on recent experiences, digitalization could help to improve future medical education.
Collapse
Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
- * E-mail:
| | - Niklas Amann
- Department of Gynecology and Obstetrics, Friedrich–Alexander-University Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Florian Recker
- Department of Gynecology and Obstetrics, Bonn University Hospital, Bonn, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Bastian Meyer
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anne Karge
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Gabriel Eisenkolb
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Jacqueline Lammert
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anna Graf
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Martin Weiss
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
- NMI Natural and Medical Sciences Institute, University of Tübingen, Reutlingen, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
20
|
Mauhin W, Belmatoug N, Berger M, Besset Q, Boitiaux J, Brassier A, Douillard C, Gousseff M, Lavigne C, Martis N, Mellot C, Nguyen A, Subran B, Klein E, Strauss C, Guillot E, Lidove O. Accès compassionnel à l’enzymothérapie chez les patients adultes avec déficit en sphingomyélinase acide (Niemann-Pick B) en France : expérience multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Lakkaraja M, Hosszu K, Mcavoy D, Mauguen A, Purdon T, Auchincloss T, Klein E, Khakoo Y, Santomasso B, Senechal B, Riviere I, Sadelain M, Curran K, Park J, Brentjens R, Boelens J. Immunotherapy: DISCOVERY PROTEOMICS FOR ANALYTES TO PREDICT CYTOKINE RELEASE SYNDROME ON DAY OF INFUSION OF CHIMERIC ANTIGEN RECEPTOR (CAR) T CELLS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
22
|
Riedel M, Eisenkolb G, Amann N, Karge A, Meyer B, Tensil M, Recker F, Dobberkau AM, Riedel F, Kuschel B, Klein E. Experiences with alternative online lectures in medical education in obstetrics and gynecology during the COVID-19 pandemic—possible efficient and student-orientated models for the future? Arch Gynecol Obstet 2021; 305:1041-1053. [PMID: 34961899 PMCID: PMC8712207 DOI: 10.1007/s00404-021-06356-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
Purpose The onset of the COVID-19 pandemic posed an eminent challenge for medical teachers worldwide. Face-to-face lectures and seminars were no longer possible, and alternatives had to be found. E-learning concepts quickly emerged as the only practicable solutions and also offered the opportunity to evaluate whether traditional face-to-face lectures could be translated into an online format, independent of the COVID-19 pandemic. Methods We offered an e-learning program consisting of lecture notes, screencasts with audio narration, and online webinars that covered topics normally taught in traditional lectures and seminars. To evaluate the learning behavior and quality of our e-learning program, we drafted a questionnaire that students completed at the end of the 2020 summer semester that had been designed to enable a comparative analysis of the different e-learning modules. Results Voluntary participation in the online courses was high. Survey analysis revealed high satisfaction with and a distinctive preference for the format, even under regular, COVID-19-independent conditions. In general, a positive appraisal of e-learning—especially as a substitute for regular lectures—was found. Students also reported higher studying efficiency. Exam results were equal to those of previous semesters. Conclusion Both acceptance of and satisfaction with our e-learning modules were high, and students displayed increased demand for this kind of e-learning format. We, therefore, conclude that e-learning offerings could serve as reasonable, efficient, student-orientated substitutes for certain medical courses, especially lectures. These curricular adaptations would correlate with the high digitalization seen in students’ everyday lives. This correlation may also hold true independent of the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Gabriel Eisenkolb
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Niklas Amann
- Department of Gynecology and Obstetrics, Ludwig Maximilians University (LMU), Munich, Germany
| | - Anne Karge
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Bastian Meyer
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | | | - Florian Recker
- Department of Gynecology and Obstetrics, Bonn University Hospital, Bonn, Germany
| | - Anna Maria Dobberkau
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Bettina Kuschel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University, Munich, Germany
| |
Collapse
|
23
|
Greipl S, Klein E, Lindstedt A, Kiili K, Moeller K, Karnath HO, Bahnmueller J, Bloechle J, Ninaus M. When the brain comes into play: Neurofunctional correlates of emotions and reward in game-based learning. Computers in Human Behavior 2021. [DOI: 10.1016/j.chb.2021.106946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
24
|
Schrodi S, Braun M, Andrulat A, Harbeck N, Mahner S, Kiechle M, Klein E, Schnelzer A, Schindlbeck C, Bauerfeind I, Schubert-Fritschle G, Nekljudova V, Mayr D, Weichert W, Denkert C, Loibl S, Engel J. Outcome of breast cancer patients with low hormone receptor positivity: analysis of a 15-year population-based cohort. Ann Oncol 2021; 32:1410-1424. [PMID: 34419555 DOI: 10.1016/j.annonc.2021.08.1988] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 02/17/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guideline recommendations for the treatment of breast cancer with low hormone receptor (HR) expression (1%-9%) are ambiguous and several studies showed more similarities with HR-negative tumors than with HR strongly positive tumors (≥10%). We used a population-based 15-year cohort to compare patient characteristics and outcome of HR low positive tumors with HR-negative and HR strongly positive tumors, respectively. PATIENTS AND METHODS A total of 38 560 women diagnosed with early invasive breast cancer between 2004 and 2018 within the scope of the Munich Cancer Registry with 4.9 million inhabitants were included. Descriptive analyses of prognostic factors, treatment, and outcome analyses using the Kaplan-Meier method; cumulative incidence in consideration of competing risks; and multivariate analyses (Cox regression and Fine-Gray model) were conducted. Endpoints were time to local recurrence (TTLR), time to lymph node recurrence (TTLNR), time to metastasis (TTM), overall survival (OS), and relative survival (RS). RESULTS A total of 861 patients (2%) had HR low positive, 4862 (13%) HR-negative, and 32 837 (85%) HR strongly positive tumors. Within the HER2-negative cohort (n = 33 366), survival of HR low positive tumors was significantly worse than that of HR strongly positive tumors [OS hazard ratio 0.66 (95% confidence interval 0.55-0.78)], whereas between HR low positive and HR-negative tumors no significant survival difference could be detected [OS hazard ratio 0.93 (95% confidence interval 0.78-1.11)]. TTLR, TTLNR, and TTM showed similar results. By contrast, within the HER2-positive cohort (n = 5194), no statistically significant differences between the three HR groups could be detected in multivariate analyses. CONCLUSION Current definitions for HR positivity and its clinical relevance should be reconsidered. Patients with HR low positive/HER2-negative tumors could be regarded and treated similar to patients with triple-negative tumors.
Collapse
Affiliation(s)
- S Schrodi
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany.
| | - M Braun
- Department of Gynecology and Obstetrics, Breast Centre, Red Cross Hospital, Munich, Germany
| | - A Andrulat
- Department of Gynecology and Obstetrics, Breast Centre, Red Cross Hospital, Munich, Germany
| | - N Harbeck
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - M Kiechle
- Department of Gynecology and Obstetrics, Breast Centre, University Hospital, Technical University Munich (TUM), Munich, Germany
| | - E Klein
- Department of Gynecology and Obstetrics, Breast Centre, University Hospital, Technical University Munich (TUM), Munich, Germany
| | - A Schnelzer
- Department of Obstetrics and Gynecology, Breast Centre, RoMed Kliniken, Rosenheim, Germany
| | - C Schindlbeck
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany; Department of Gynecology and Obstetrics, Breast Centre, Klinikum Traunstein, Traunstein, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Breast Centre, Klinikum Landshut, Landshut, Germany
| | - G Schubert-Fritschle
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany
| | - V Nekljudova
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | - D Mayr
- Department of Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - W Weichert
- Institute of Pathology, Technical University Munich (TUM), Munich, Germany
| | - C Denkert
- Department of Pathology, University Hospital Marburg (UKGM), Philipps-University Marburg, Marburg, Germany
| | - S Loibl
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | - J Engel
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany
| |
Collapse
|
25
|
Lin A, van Diemen P, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Cadet S, Danad I, Driessen R, Slomka P, Berman D, Dey D, Knaapen P. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Ischemia And Impaired Myocardial Blood Flow. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Han D, Lin A, Kuronuma K, Tzolos E, Kwan A, Klein E, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow B, Cury R, Feuchtner G, Hadamitzky M, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines T, Al-Mallah M, de Araújo Gonçalves P, danad I, Gransar H, Lu Y, lee J, Baskaran L, Al'Aref S, Budoff M, Samady H, Virmani R, Narula J, Chang H, Min J, Lin F, Shaw L, Slomka P, Dey D, Berman D. Plaque Location And Vessel Geometry On Coronary Computed Tomography Angiography Predict Future Culprit Lesions Associated With Acute Coronary Syndrome: Results From The ICONIC Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Grill S, Klein E. Incorporating Genomic and Genetic Testing into the Treatment of Metastatic Luminal Breast Cancer. Breast Care (Basel) 2021; 16:101-107. [PMID: 34012365 PMCID: PMC8114047 DOI: 10.1159/000513800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment of patients with luminal metastatic breast cancer (MBC) has become even more complex over the last few years as molecular profiling has begun to alter disease management. It is well accepted that MBC is not curable but is treatable. Today we are able to prolong progression-free survival and partly overall survival with targeted and more individual treatment strategies adjusted according to the molecular subtype. SUMMARY Genetic and genomic testing has become therapeutically relevant in luminal MBC and is therefore an integral component within the treatment spectrum. By now, germline testing of BRCA1 and BRCA2 and somatic testing for PIK3CA mutations are inevitable elements in disease management and the current state of the art in luminal MBC patients. Furthermore, testing of ESR1 resistance mutation, ERBB2 mutation, microsatellite instability, and neurotrophic tyrosine receptor kinase (NTRK) gene fusion (mainly in secretory breast cancer) has recently gained increasing attention. However, based on the expanding role of personalized medicine, clinicians are now faced with substantial new challenges and possibly unsuspected possibilities. The following review summarizes current developments in genetic and genomic testing in luminal MBC. KEY MESSAGES In luminal MBC genomics have become an integral component within the spectrum of oncological treatment establishing novel therapeutic facilities. Further developments in treatment personalization adjusted according to the molecular subtype should become increasingly important in order to enhance the progress of de-escalation of chemotherapy in luminal MBC. However, based on the expanding role of personalized medicine, clinicians are now faced with substantial new challenges and possibly unsuspected possibilities.
Collapse
Affiliation(s)
- Sabine Grill
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | | |
Collapse
|
28
|
Pereira LP, Wetzel C, Pavani FM, Olschowsky A, Moraes BM, Klein E. Entrevista narrativa com pessoas em situação de rua com transtornos mentais: relato de experiência. Esc Anna Nery 2021. [DOI: 10.1590/2177-9465-ean-2020-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo relatar a experiência do uso da entrevista narrativa com pessoas em situação de rua com transtornos mentais. Método relato de experiência realizada em uma capital do Sul do Brasil. A coleta de dados ocorreu de julho a outubro de 2019. Resultados a aplicação da entrevista narrativa desenvolveu-se em duas etapas: aproximação com o campo e seleção dos participantes; e construção da narrativa. A primeira envolveu uma inserção em um Consultório na Rua e possibilitou a identificação e o desenvolvimento de vínculo com os usuários. A segunda ocorreu com o desenvolvimento da entrevista narrativa e envolveu os seguintes passos: contato e negociação, história principal e fase de questionamentos. Conclusão a entrevista narrativa se apresenta como ferramenta metodológica com potencial para a construção de itinerários terapêuticos de pessoas em situação de rua com transtornos mentais, contextualizando suas opções na busca pelo seu cuidado na perspectiva de suas histórias de vida. Implicação para a prática a entrevista narrativa possibilita fazer-se ouvir em histórias frequentemente negligenciadas. Por ter como foco central a construção de sentidos por parte de quem vivencia determinada realidade, permitiu a reconstrução desses, possibilitando novos olhares e insights em relação à própria experiência de quem relatava.
Collapse
Affiliation(s)
| | | | | | | | | | - Evelyn Klein
- Universidade Federal do Rio Grande do Sul, Brasil
| |
Collapse
|
29
|
Kurtzman K, Oxnard G, Klein E, Seiden M, Hubbell E, Venn O, Jamshidi A, Zhang N, Beausang J, Gross S, Fung E, Yecies J, Shaknovich R, Fields A, Sekeres M, Richards D, Yu P, Aravanis A, Hartman AR, Liu M. PR01.08 Simultaneous Multi-Cancer Detection and Tissue of Origin Prediction Via Targeted Bisulfite Sequencing of Plasma Cell-Free DNA. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
30
|
Lakoh S, Klein E, Adekamnbi O. Antibiotic resistance and use among adult inpatients in a large urban tertiary hospital in Sierra Leone. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
31
|
Hinson JS, Rothman RE, Carroll K, Mostafa HH, Ghobadi K, Smith A, Martinez D, Shaw-Saliba K, Klein E, Levin S. Targeted rapid testing for SARS-CoV-2 in the emergency department is associated with large reductions in uninfected patient exposure time. J Hosp Infect 2020; 107:35-39. [PMID: 33038435 PMCID: PMC7538869 DOI: 10.1016/j.jhin.2020.09.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/05/2022]
Abstract
Opportunity exists to decrease healthcare-related exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), preserve infection control resources, and increase care capacity by reducing the time to diagnosis of coronavirus disease 2019 (COVID-19). A retrospective cohort analysis was undertaken to measure the effect of targeted rapid molecular testing for SARS-CoV-2 on these outcomes. In comparison with standard platform testing, rapid testing was associated with a 65.6% reduction (12.6 h) in the median time to removal from the isolation cohort for patients with negative diagnostic results. This translated to an increase in COVID-19 treatment capacity of 3028 bed-hours and 7500 fewer patient interactions that required the use of personal protective equipment per week.
Collapse
Affiliation(s)
- J S Hinson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - R E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Carroll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H H Mostafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Ghobadi
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - A Smith
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Martinez
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Levin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
32
|
Thill M, Klein E, Faridi A, Meiré A, Gerber-Schäfer C, Baumann C, Blohmer J, Mau C, Tofall S, Nolte E, Strittmatter H, Ohlinger R, Paepke S. Patient Reported Outcome and cosmetic evaluation following implant-based breast-reconstruction with a titanized polypropylene mesh: A prospective clinical study in 269 patients. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Ettl J, Anders SI, Hapfelmeier A, Paepke S, Noske A, Weichert W, Klein E, Kiechle M. First prospective outcome data for the second-generation multigene test Endopredict in ER-positive/HER2-negative breast cancer. Arch Gynecol Obstet 2020; 302:1461-1467. [PMID: 32902674 PMCID: PMC7584549 DOI: 10.1007/s00404-020-05771-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 01/30/2023]
Abstract
Purpose Prospectively collected outcome data of patients (pts) whose adjuvant systemic therapy recommendation was based on the clinico-molecular test EndoPredict® (EP) are presented. Methods Pts with ER-positive, HER2-negative early breast cancer with 0–3 positive lymph nodes were enrolled. The EP was carried out on all tumor samples. Pts were evaluated for treatment compliance, local recurrence, distant metastases and overall survival. Censored time-to-event outcomes were analysed by Cox proportional hazards models. Additional estimates of the event-free-survival were calculated by the Kaplan–Meier method. Hypothesis testing was conducted on two-sided exploratory 5% significance levels. Results 373 consecutive pts were enrolled. EP classified 238 pts (63.8%) as low risk and 135 pts (36.2%) as high risk. Median follow-up was 41.6 months. Risk for disease recurrence or death in EPclin high-risk patients was twofold higher in comparison with EPclin low-risk patients (hazard ratio (HR) 2.05 (95% CI 0.85–4.96; p = 0.110). Patients with EPclin high risk were at significant higher risk of distant metastases than patients with EPclin low risk (HR 5.18; 95% CI 1.04–25.74; p = 0.0443). EPclin high-risk patients who actually underwent adjuvant CTX had a 3-year-DFS of 96.3% (95% CI 92.2–100) in contrast to EPclin high-risk patients without CTX (3-year-DFS: 91.5% (95% CI 82.7–100%); HR 0.32; 95% CI 0.10–1.05; p = 0.061). Conclusion These first prospective outcome results show that EP, in clinical routine, is a valid clinico-molecular test, to predict DFS and to guide decision of adjuvant CTX use in ER-positive, HER2-negative early breast cancer pts with 0–3 positive lymph nodes. Adjuvant CTX seems to be beneficial for EPclin high-risk patients.
Collapse
Affiliation(s)
- Johannes Ettl
- Department of Obstetrics and Gynecology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
| | - Sophie-Isabelle Anders
- Department of Obstetrics and Gynecology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Stefan Paepke
- Department of Obstetrics and Gynecology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Aurelia Noske
- Institute of Pathology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| |
Collapse
|
34
|
Bojko M, Barrett R, Morales-Perez M, Buzzi G, Smith A, Klein E, Usha L, Swoboda A, O'Connor P, Joyce C, Lomasney L, Sheean P, Gomez-Perez S. Adherence to American Cancer Society (ACS) Guidelines in Women with Metastatic Breast Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Schneeweiss A, Ettl J, Lüftner D, Beckmann MW, Belleville E, Fasching PA, Fehm TN, Geberth M, Häberle L, Hadji P, Hartkopf AD, Hielscher C, Huober J, Ruckhäberle E, Janni W, Kolberg HC, Kurbacher CM, Klein E, Lux MP, Müller V, Nabieva N, Overkamp F, Tesch H, Laakmann E, Taran FA, Seitz J, Thomssen C, Untch M, Wimberger P, Wuerstlein R, Volz B, Wallwiener D, Wallwiener M, Brucker SY. Initial experience with CDK4/6 inhibitor-based therapies compared to antihormone monotherapies in routine clinical use in patients with hormone receptor positive, HER2 negative breast cancer - Data from the PRAEGNANT research network for the first 2 years of drug availability in Germany. Breast 2020; 54:88-95. [PMID: 32956934 PMCID: PMC7509062 DOI: 10.1016/j.breast.2020.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/29/2019] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 02/04/2023] Open
Abstract
Purpose Treatment with CDK4/6 inhibitors and endocrine therapy (CDK4/6i + ET) is a standard for patients with advanced hormone receptor–positive, HER2-negative (HR + HER2–) breast cancer (BC). However, real-world data on the implementation of therapy usage, efficacy, and toxicity have not yet been reported. Methods The PRAEGNANT registry was used to identify advanced HR + HER2– BC patients (n = 1136). The use of chemotherapy, ET, everolimus + ET, and CDK4/6i + ET was analyzed for first-line, second-line, and third-line therapy. Progression-free survival (PFS) and overall survival (OS) were also compared between patients treated with CDK4/6i + ET and ET monotherapy. Also toxicity was assessed. Results CDK4/6i + ET use increased from 38.5% to 62.7% in the first 2 years after CDK4/6i treatment became available (November 2016). Chemotherapy and ET monotherapy use decreased from 2015 to 2018 from 42.2% to 27.2% and from 53% to 9.5%, respectively. In this early analysis no statistically significant differences were found comparing CDK4/6i + ET and ET monotherapy patients with regard to PFS and OS. Leukopenia was was seen in 11.3% of patients under CDK4/6i + ET and 0.5% under ET monotherapy. Conclusions In clinical practice, CDK4/6i + ET has been rapidly implemented. A group of patients with a more unfavorable prognosis was possibly treated in the real-world setting than in the reported randomized clinical trials. The available data suggest that longer follow-up times and a larger sample size are required in order to identify differences in survival outcomes. Studies should be supported that investigate whether chemotherapy can be avoided or delayed in this patient population by using CDK4/6i + ET. CDK4/6i + ET use increased from 39% to 63% after becoming available. Chemotherapy and ET monotherapy use decreased from 42% to 27% and 53%–10%. There was no difference between CDK4/6i + ET and ET monotherapy regarding PFS and OS.
Collapse
Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncolo0gy and Tumour Immunology, Berlin, Germany
| | - Matthias W Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | | | - Lothar Häberle
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Biostatistics Unit, Erlangen University Hospital, Department of Gynecology and Obstetrics, Erlangen, Germany
| | - Peyman Hadji
- Frankfurt Center of Bone Health Frankfurt, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | | | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Christian M Kurbacher
- Gynecology I (Gynecologic Oncology), Gynäkologisches Zentrum Bonn Friedensplatz, Bonn, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael P Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt, Germany
| | - Elena Laakmann
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Pauline Wimberger
- National Center for Tumor Diseases (NCT), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University Hospital, Technical University of Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center, and CCC Munich, Munich University Hospital, Germany
| | - Bernhard Volz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
36
|
Schmidt G, Mathes S, Klein E, Kiechle M, Paepke D. Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy. J Evid Based Integr Med 2020; 25:2515690X20949444. [PMID: 32808558 PMCID: PMC7436788 DOI: 10.1177/2515690x20949444] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose. Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013. Methods. In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire. Results. 78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients. Conclusion. Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
Collapse
Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Sofia Mathes
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| |
Collapse
|
37
|
Klein E, Otaki Y, Gransar H, Han D, Tzolos E, Tamarappoo B, Hayes S, Friedman J, Thomson L, Slomka P, Dey D, Cheng V, Berman D. Reproducibility Of Various Approaches To Measuring Aortic Sinus Size. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
38
|
Michel L, Marmé F, Hamberger D, Bodenbeck L, Klein E, Smetanay K, Schneeweiss A. Effektivität von Kühlung und Kompression der Hände zur Prävention einer Chemotherapie-induzierten Polyneuropathie bei Patientinnen mit primärem Mammakarzinom. Erste Ergebnisse der prospektiven, randomisierten POLAR Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714590] [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] Open
Affiliation(s)
- L Michel
- Nationales Centrum für Tumorerkrankungen (NCT)
- Universitätsfrauenklinik
| | - F Marmé
- Universitätsfrauenklinik (UMM)
| | - D Hamberger
- Nationales Centrum für Tumorerkrankungen (NCT)
| | - L Bodenbeck
- Nationales Centrum für Tumorerkrankungen (NCT)
- Universitätsfrauenklinik
| | - E Klein
- Nationales Centrum für Tumorerkrankungen (NCT)
| | - K Smetanay
- Nationales Centrum für Tumorerkrankungen (NCT)
- Universitätsfrauenklinik
| | | |
Collapse
|
39
|
Otaki Y, Han D, Klein E, Gransar H, Tamarappoo B, Hayes S, Friedman J, Thomson L, Slomka P, Dey D, Berman D. Visual Assessment Of Coronary Plaque Characteristics Improves The Utility Of FFRct. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
40
|
Grünewald M, Klein E, Hapfelmeier A, Wuensch A, Berberat PO, Gartmeier M. Improving physicians' surgical ward round competence through simulation-based training. Patient Educ Couns 2020; 103:971-977. [PMID: 31810763 DOI: 10.1016/j.pec.2019.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Ward rounds are an essential part of physicians' daily routine. Existing studies suggest that their practical implementation is inconsistent. Therefore, developing interventions to train ward round competence and assessing if they are effective educational tools are crucial goals for research. METHODS We analysed a simulation-based tutorial dedicated to fourth-year medical students, including casework and ward round simulation. We investigated the effectiveness of this intervention regarding ward round competence through a randomized controlled trial. Performance was assessed with the modified/validated surgical ward round assessment tool by two blinded and trained raters. Supplementary, motivation during the ward round tutorial was assessed for all students at different time points. RESULTS Analysis of the ratings show that, in contrast to the control group (pre: 66.1 vs. post: 64.8 points, p = 0.72), the ward round competence of the intervention group (pre: 62.6 vs. post: 69.6 points, p = 0.0169) improved significantly after participating in the ward round tutorial. CONCLUSION The results show that our simulation-based training is an effective way to improve competence of medical students in conducting surgical ward rounds. PRACTICE IMPLICATIONS Participation in ward round trainings is a valuable tool to prepare students for their future professional practise.
Collapse
Affiliation(s)
- Marc Grünewald
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Evelyn Klein
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 Munich, Germany.
| | - Alexander Hapfelmeier
- Technical University of Munich, Institute of Medical Informatics, Statistics and Epidemiology, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Alexander Wuensch
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Clinic of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5a, 79104 Freiburg, Germany.
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Martin Gartmeier
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| |
Collapse
|
41
|
Abstract
Nous disons du temps qu’il s’écoule ou qu’il passe. Mais s’écoule-t-il ou passe-t-il de lui-même ? Ou bien ne s’agit-il que d’une impression qui provient entièrement de nous ? Pour répondre à ces questions, il faudrait pouvoir identifier et caractériser le « moteur du temps », c’est-à-dire le mécanisme caché au sein du monde par lequel le futur devient d’abord présent, puis passé : quelle est cette force secrète qui fait que dès qu’un instant présent se présente, un autre instant présent apparaît, qui demande au précédent de bien vouloir aller se faire voir ailleurs et prend aussitôt sa place, avant qu’un autre instant présent l’envoie lui-même se promener dans le passé, prenne sa place dans le présent, et ainsi de suite ? Ce moteur du temps est-il physique, objectif ou intrinsèquement lié aux sujets conscients que nous sommes ? D’où vient en somme que le temps passe ? Certains auteurs avancent que le temps serait à lui-même son propre moteur. D’autres disent qu’il doit sa motricité implacable à la dynamique de l’univers en expansion. D’autres enfin pensent que le moteur du temps, ce n’est ni le temps lui-même ni la dynamique de l’univers, mais tout simplement nous, nous autres les humains, bipèdes supérieurs, qui sommes des observateurs dotés de conscience. Cette idée selon laquelle le temps n’existe pas en tant que tel en dehors du sujet a été brillamment défendue par de nombreux philosophes – par Kant notamment –, mais elle doit se confronter à une donnée factuelle, qui constitue pour elle une difficulté notable : nous savons désormais que des objets plus anciens que toute forme de vie sur Terre ont bel et bien existé dans le passé de l’univers; que des événements innombrables se sont enchaîné, dont aucune conscience humaine n’a pu être le témoin; que l’humanité, espèce en définitive toute récente, n’a pas été contemporaine de tout ce que l’univers a connu ou traversé. Mais alors, si le passage du temps dépend de la conscience, n’existe que par elle ou que pour elle, comment le temps a-t-il pu s’écouler avant son apparition ? Cantonner le temps dans le sujet ou vouloir que le temps n’ait de réalité que subjective, n’est-ce pas s’interdire d’expliquer l’apparition du sujet dans le temps ?
Collapse
|
42
|
MacNeil JD, Martz VK, Korsrud GO, Salisbury CDC, Oka H, Epstein RL, Barnes CJ, Alfredsson G, Barry C, Bergner B, Chan W, Diserens JM, IInicki LP, Klein E, Koscinski B, Vasco G, Phillippo T, Mawhinny H, Mϋller E, Petz M, Oka H, Patel R, Telling GM, Webb M, Henry C, Farrington WH. Chlortetracycline, Oxytetracycline, and Tetracycline in Edible Animal Tissues, Liquid Chromatographic Method: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.2.405] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Thirteen laboratories analyzed samples of edible animal tissues for tetracycline residues. The method included extraction of analytes into buffer, elution from a C18 solid-phase extraction (SPE) cartridge, and reversed-phase liquid chromatographic (LC) analysis, including use of a confirmation column. An additional laboratory, using an alternative LC assay based on a different sample cleanup, also analyzed the samples. Results showed the 2 methods are comparable. The LC method for determination of cholortetracycline, oxytetracycline, and tetracycline in edible animal tissues has been adopted by AOAC INTERNATIONAL. Results from 13 laboratories indicate that the method under study provides generally better results at the higher concentrations tested than at concentrations near the detection limit and that there is less problem with interferences in muscle tissue than in kidney. The method can achieve reliable results for analytes and matrixes studied at concentrations from 0.1 to 0.6 ppm and above, depending on the analyte-matrix combination, with generally better performance to be expected with muscle than with kidney. The poorer performance for fortified samples, particularly kidney, was attributed to additional homogenization steps required to prepare these samples. Recovery of analytes from different
Collapse
Affiliation(s)
- James D MacNeil
- Agriculture and Agri-Food Canada, Health of Animals Laboratory, Saskatoon, SK, S7N 2R3, Canada
| | - Valerie K Martz
- Agriculture and Agri-Food Canada, Health of Animals Laboratory, Saskatoon, SK, S7N 2R3, Canada
| | - Gary O Korsrud
- Agriculture and Agri-Food Canada, Health of Animals Laboratory, Saskatoon, SK, S7N 2R3, Canada
| | - Craig D C Salisbury
- Agriculture and Agri-Food Canada, Health of Animals Laboratory, Saskatoon, SK, S7N 2R3, Canada
| | - Hisao Oka
- Aichi Prefectural Institute of Public Health, Laboratory of Food and Drug Chemistry, 7-6 Nagare, Tsujmachi, Kita-Ku Nagoya 462, Japan
| | - Robert L Epstein
- U.S. Department of Agriculture, Agricultural Marketing Service, Science Division, PO Box 96456, Washington, DC 20090
| | - Charlie J Barnes
- U.S. Food and Drug Administration, Office of Science, HFV-501, Bldg 328A, BARC-East, Beltsville, MD 20705
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Drozdoff L, Klein E, Kalder M, Brambs C, Kiechle M, Paepke D. Potential Interactions of Biologically Based Complementary Medicine in Gynecological Oncology. Integr Cancer Ther 2019; 18:1534735419846392. [PMID: 31046491 PMCID: PMC6501502 DOI: 10.1177/1534735419846392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the potential risks of interactions between biologically based complementary and alternative medication (BB-CAM) and conventional drugs during systemic therapy in breast and gynecological cancer patients by analyzing the actual CAM-drug combinations from individual patients' records. METHODS From September 2014 to December 2014 and from February 2017 to May 2017, all patients (n = 717) undergoing systemic therapy at the Gynecologic Oncology Day Care Unit in the Gynecology and Obstetrics Department of the Technical University of Munich, Germany, were asked to participate in a questionnaire about all their medications. To assess the potential risk of CAM-drug interactions (CDIs), we initially utilized the Lexicomp drug interaction database. This assessment was then expanded with a systematic search of other digital databases, such as the National Center for Complementary and Integrative Health, Memorial Sloan Kettering Cancer Center, PubMed, and MEDLINE as well as the Cochrane Library. RESULTS Among 448 respondents, 74.1% reported using BB-CAM simultaneously with their systemic therapy. The assessment showed 1 patient with a potentially clinically relevant CDI, where the interaction was based on a self-medicated combination of Echinacea and cyclophosphamide. Furthermore, 81 patients (18.1%) were thought to have interactions because of a combination of BB-CAMs and cytochrome P450 3A4-metabolized anticancer drugs. CONCLUSIONS Our data demonstrated high overall use of BB-CAMs by cancer patients undergoing systemic therapy. The analyses showed only 1 clinically relevant CDI.
Collapse
Affiliation(s)
- Loisa Drozdoff
- 1 Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Evelyn Klein
- 1 Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | | | | | - Marion Kiechle
- 1 Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Daniela Paepke
- 1 Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| |
Collapse
|
44
|
Noske A, Anders SI, Ettl J, Hapfelmeier A, Steiger K, Specht K, Weichert W, Kiechle M, Klein E. Risk stratification in luminal-type breast cancer: Comparison of Ki-67 with EndoPredict test results. Breast 2019; 49:101-107. [PMID: 31786414 PMCID: PMC7375593 DOI: 10.1016/j.breast.2019.11.004] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Adjuvant chemotherapy decision in patients with hormone receptor positive, HER2 negative breast cancer (BC) is challenging. Ki-67 is widely used for adjuvant therapy decision in BC. The multigene assay EndoPredict (EP) has shown to provide valid and additional information about the risk of recurrence compared to traditional pathological factors. In this study, we compared Ki-67 with EP assay generated risk groups. METHODS We analyzed the results from prospective EP testing (n = 373) and tumor proliferation assessed by Ki-67 staining in luminal breast cancer. We statistically investigated the association of both parameters and probed for equivalence in risk stratification. RESULTS Evaluation of Ki-67 was feasible in 307 (82%) BC specimens with known EP test results. The EPscore (now called 12-gene molecular score) delineated 140 low and 167 high scores. After combining the EPscore with pathological tumor stage and nodal status, we received 203 EPclin low-risk and 104 EPclin high-risk classifications. EPscore and EPclin were significantly associated with Ki-67 indices and tumor grade (p < 0.001). Overall, we observed a moderate correlation between Ki-67 and the EPscore (r = 0.63) as well as the EPclin score (r = 0.59). CONCLUSION Ki-67 values above 25% partly overlap with EP test results and therefore indicate a high-risk profile. In these cases, the additional prognostic information from EP testing might be rather low. However, low and intermediate Ki-67 values (less than 25%) alone were not reliable in predicting a low risk EP profile, indicating that EP testing is useful in this subgroup.
Collapse
Affiliation(s)
- Aurelia Noske
- Institute of Pathology, Technical University of Munich, School of Medicine, Germany.
| | - Sophie-Isabelle Anders
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, School of Medicine, Germany
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, School of Medicine, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, School of Medicine, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
45
|
Loevinsohn G, Cichowitz C, Klein E, Irvin N. 9 Race Matters: Racial and Ethnic Disparities in the Application of Hospital Observation. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Schuster A, Neirinckx V, Klein E, Nazarov PV, Oudin A, Muller A, Azuaje F, Herold-Mende C, Klink B, Niclou SP. P11.26 Genome-wide shRNA screen identifies candidate genes driving glioblastoma invasion. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
A major hallmark of glioblastoma (GBM) is its highly invasive capacity, contributing to its aggressive behaviour. Since invasive cells cannot be easily removed by surgery or irradiation, they are left behind and eventually result in lethal recurrence. Therefore, a better understanding of the invasion process and of the key molecular players underlying the invasive capacities of GBM may lead to the identification of new therapeutic targets for GBM patients.
MATERIAL AND METHODS
To identify candidate genes responsible for invasion, a genome-wide shRNA screen was performed in patient-derived GBM sphere cultures. The phenotype of the most promising candidate was validated in in vitro invasion assays, ex vivo brain slice cultures and in vivo orthotopic xenografts in mice. Gene knockdown in invasive GBM cell lines was compared with overexpression in non-invasive cells. RNA sequencing of knockdown cells, along with the generation of deletion constructs were applied to uncover the mechanisms regulating invasion.
RESULTS
Through a whole genome shRNA screen, a zinc-finger containing protein was identified as an invasion essential candidate gene. Knockdown of this gene confirmed a strong decrease in invasion capacity in two highly invasive GBM cell lines. In contrast, gene overexpression switched non-invasive GBM cells to an invasive phenotype. Deletion of either one or both zinc-finger motifs led to decreased invasion indicating that the two zinc-finger motifs are essential for regulating invasion. Mutation of the nuclear localisation signal resulted in retention of the protein in the cytoplasm and loss of the invasion phenotype demonstrating that the protein activity is required in the nucleus. Gene expression analyses revealed that invasion-related genes are significantly regulated by the candidate gene once it is localized in the nucleus.
CONCLUSION
We identified a zinc-finger containing protein as a novel driver of GBM invasion, presumably through a transcription factor activity resulting in the induction of an invasive transcriptional program. This protein and its downstream pathway may represent a novel promising target to overcome invasive capacities in GBM.
Collapse
Affiliation(s)
- A Schuster
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - V Neirinckx
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - E Klein
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - P V Nazarov
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - A Oudin
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - A Muller
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - F Azuaje
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - B Klink
- Laboratoire National de Santé, Dudelange, Luxembourg
| | - S P Niclou
- Luxembourg Institute of Health, Luxembourg, Luxembourg
| |
Collapse
|
47
|
Hau A, Houben L, Klein E, Oudin A, Stieber D, Flies B, Kaoma T, Azuaje F, Fritah S, Bjerkvig R, Hertel F, Mittelbronn M, Golebiewska A, Niclou SP. OS12.2 Targeting epigenetic pathways in the treatment of recurrent high-grade glioma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
High grade glioma (HGG) patients develop resistance to standard treatment leading to disease progression and limited life expectancy. Advances in the molecular characterisation of treatment-naïve HGGs based on next-generation sequencing and DNA methylation analyses have led to a better delineation of HGG subtypes and the identification of distinct genomic abnormalities. Furthermore, using large patient cohorts of longitudinal tumor samples, comprehensive genomic profiling studies emerged to investigate therapy-associated evolution of gliomas. All together, those studies point out the need for personalised treatment strategies, where applied drugs will be adapted to the unique patient-specific genetic abnormalities.
MATERIAL AND METHODS
We collected fresh samples of more than 800 brain tumors containing almost 300 glioma specimen with approximately 100 longitudinal samples of initial and recurrent tumors from 43 matched patients. By now, we have successfully established 34 patient-derived orthotopic xenografts (PDOXs) in mice. We performed comprehensive molecular profiling using array comparative genomic hybridisation, DNA methylation analysis and targeted DNA sequencing on patient specimen and their derivatives such as 3D tumor organoids and PDOXs. The custom-design sequencing panel comprises 234 genes that reflect both established genetic identifiers for individual glioma subtype classification and novel genes encoding mainly epigenetic effector genes. Based on patient-derived material we carried out drug response screening on 3D tumor organoids using a compound library matching the majority of genes that were assessed by targeted sequencing.
RESULTS
We succeeded in generating a live biobank of HGG patient-derived xenografts and 3D organoids that neatly recapitulates the mutational spectrum including structural DNA variation and methylation-based subtypes of gliomas. A highlight is the generation of 19 PDOXs of paired initial and relapse HGGs from a total of 9 glioma patients. A detailed analysis of the paired longitudinal samples indicated that PDOX models closely recapitulate the evolutionary trajectory of the parental tumors. Targeted sequencing of longitudinal HGG PDOXs suggests that relapse tumors accumulate somatic mutations in epigenetic effectors compared with the Initial. Differential drug responses between initial and relapse tumors were observed after screening of in vitro 3D tumor organoids.
CONCLUSION
Response assessment of naïve initial gliomas and recurrences provides crucial information on the differential sensitivity between initial and relapsed HGGs and offers novel personalised therapeutic options in the relapse setting. Furthermore, in depth correlation of the profiled somatic molecular landscape with drug response will enable pharmacogenomic predictions of potential inhibitors in the clinical setting.
Collapse
Affiliation(s)
- A Hau
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - L Houben
- National Center of Genetics, Laboratoire national de santé, Dudelange, Luxembourg
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - E Klein
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - A Oudin
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - D Stieber
- National Center of Genetics, Laboratoire national de santé, Dudelange, Luxembourg
| | - B Flies
- National Center of Genetics, Laboratoire national de santé, Dudelange, Luxembourg
| | - T Kaoma
- Bioinformatics platform, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - F Azuaje
- Bioinformatics platform, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - S Fritah
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - R Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - F Hertel
- Neurosurgery Department, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - M Mittelbronn
- National Center of Pathology, Laboratoire national de santé, Dudelange, Luxembourg
| | - A Golebiewska
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - S P Niclou
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| |
Collapse
|
48
|
Paepke S, Kiechle M, Ankel C, Weyrich J, Klein E, Schneider A, Johannigmann-Malek N, Dietrich AS, Ohlinger R, Thill M. Surgical Studies of Reconstructive Breast Surgery - An Overview of the Topics at the 2019 Annual Meeting of the Working Group for Reconstructive Surgery in Oncology-Gynecology. Geburtshilfe Frauenheilkd 2019; 79:584-590. [PMID: 31217627 PMCID: PMC6570614 DOI: 10.1055/a-0873-8110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
This yearʼs annual AWOgyn meeting focused on studies of reconstructive breast surgery. As the majority of breast reconstructions are implant-based, most studies also focused on implant-based reconstruction. Since 2011, the guidelines have recommended using interposed mesh materials as support. The basic idea behind every type of material is to provide coverage and stabilization for the implant by constructing an “internal bra” which will create the appropriate implant shape and maintain the position, stability and flexibility of the implant. The Working Group for Reconstructive Surgery in Oncology-Gynecology (AWOgyn) has undertaken to analyze different materials with regard to indications, success rates and side effects as documented in registers, clinical assessments and study protocols. This has increased application safety and is expected to improve it even further in future. Prospective studies are being carried out to investigate issues such as the optimal material, optimal implant site and best cosmetic results. The first results for porcine and human acellular matrices and for partially resorbable titanium-coated synthetic polypropylene meshes are now available. In 2019, the AWOgyn working group will be launching further studies to evaluate a perforated acellular dermal matrix (Fortiva
®
), a titanium-coated implant pocket (TiLOOP
®
Bra Pocket) and a fully resorbable synthetic mesh (TIGR
®
mesh).
Collapse
Affiliation(s)
- Stefan Paepke
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Marion Kiechle
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | | | - Joy Weyrich
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Evelyn Klein
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Anna Schneider
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | | | - Anna-Sophia Dietrich
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Ralf Ohlinger
- Gynaecology and Obstetrics, Universitatsmedizin Greifswald, Greifswald, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, Agaplesion Markus Krankenhaus Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
49
|
Boulad F, Scaradavou A, Avecilla S, Tonon J, Kernan N, Prockop S, Klein E, Boelens J. Excellent outcomes of combined umbilical cord blood and bone marrow grafts for allogeneic transplantation of pediatric patients from HLA-matched siblings. a single institution experience. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
50
|
Gibson B, Sanguinetti J, Mullins T, Salazar S, Buchman L, Cutter C, Klein E, Aragon D, Heinrich M, Badran B, Yu A, Clark V. Excitability changes induced in the motor cortex by transcranial ultrasound stimulation. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|