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Darwiche K, Randerath W, Hübner RH, Rathmayer M, Tiefgraber M, Borass V, Piening A, Hagmeyer L, Hetzel J, Eberhardt R, Gesierich W, Unnewehr M, Boeing S, Wilke M, Herth F, Bauer T. [Outpatient care in pulmonology - a scientific analysis and a position paper of the German Society of Respiratory Medicine (DGP)]. Pneumologie 2024. [PMID: 38508225 DOI: 10.1055/a-2279-7787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The ambulantization of patient care that were previously provided as inpatient service is one of the goals of the current reform in the German healthcare system. In pulmonology, this particularly applies to endoscopic procedures. However, the real costs of endoscopic services, which form the basis for the calculation of a future so called hybrid DRG or in the AOP catalog, are unclear. METHODS After selection of use cases including endoscopic procedures which can be performed on an outpatient basis by a committee of experts the appropriate DRGs were identified from the § 21-KHEntgG data for 2022 published by the Institute for the Hospital Remuneration System (InEK). The costs were calculated from the respective InEK cost matrix added by the calculated material costs. RESULTS The use cases suitable for outpatient treatment were systematic endobronchial ultrasound (EBUS) with transbronchial needle aspiration (calculated costs € 2,175.60 without or € 3,315.60 including PET/CT), navigation-assisted bronchoscopy for peripheral lesions (depending on the methodology € 2,870.23 to €4,120.23) and diagnostic (flexible) bronchoscopy (€ 1,121.02). CONCLUSION Outpatient treatment of endoscopic procedures that were previously performed inpatient is possible and necessary, and the costs calculated in this publication can form a reliable basis for appropriate reimbursement. Together with a structural quality that has been transformed to outpatient service and cross-sector cooperation, continued high-quality care for pneumological patients can be ensured.
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Affiliation(s)
- Kaid Darwiche
- Klinik für Pneumologie, Sektion für Interventionelle Pneumologie, Ruhrlandklinik - Universitätsmedizin Essen, Essen, Deutschland
| | - Winfried Randerath
- Institut für Pneumologie an der Universität zu Köln, Krankenhaus Bethanien, Solingen, Deutschland
| | - Ralf-Harto Hübner
- Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | | | | | - Volkmar Borass
- Patientenbeirat - Bereich Lunge, Westdeutsches Tumorzentrum, Essen, Deutschland
| | - Anne Piening
- Medizincontrolling, Lungenklinik Hemer, Hemer, Deutschland
| | - Lars Hagmeyer
- Institut für Pneumologie an der Universität zu Köln, Krankenhaus Bethanien, Solingen, Deutschland
| | - Juergen Hetzel
- Klinik für medizinische Onkologie und Pneumologie, Universitätsklinikum Tübingen, Deutschland
| | - Ralf Eberhardt
- Pneumologie & Internistische Intensivmedizin, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - Wolfgang Gesierich
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting, Deutschland
| | - Markus Unnewehr
- Innere Medizin V - Pneumologie, Infektiologie, Schlafmedizin, Allergologie, St. Barbara-Klinik Hamm, Hamm, Deutschland
| | - Sebastian Boeing
- Schwerpunktpraxis Lungen- und Bronchialheilkunde, Allergologie und Schlafmedizin, Neuss, Deutschland
| | | | - Felix Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik und Translational Lung Research Center Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Torsten Bauer
- Lungenklinik Heckeshorn, Klinik für Pneumologie; Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
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Keller S, Forstner J, Weis A, Biehler E, Trudzinski F, Michels J, Neetz B, Herth F, Schneider A, Ghiani A, Szecsenyi J, Wensing M, Poß-Doering R. [Interprofessional weaning boards and weaning consults for long-term ventilated patients: A qualitative study of perceived potential for patient care]. Pneumologie 2024; 78:180-190. [PMID: 37857322 DOI: 10.1055/a-2161-6014] [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] [Indexed: 10/21/2023]
Abstract
BACKGROUND The PRiVENT project aims to improve the care of invasively ventilated patients and to reduce the number of out-of-hospital long-term ventilated patients. PRiVENT offers intensive care units the opportunity to exchange information with experts from specialized weaning centers in interprofessional weaning boards and weaning consults and to exploit the full weaning potential of the patients. In the context of the accompanying process evaluation, the PRiVENT intervention components will be examined for sustainability, scalability and effectiveness, and the interprofessional collaboration between intensive care units and the responsible weaning centers will be investigated in order to identify potentials for the care of invasively managed patients. METHODS In a qualitative cross-sectional study, semistructured, problem-oriented interviews were conducted with care providers of participating ICUs. The data were digitally recorded, pseudonymized and verbatim transcribed. Data analysis was based on Brown and Clarke's Thematic Analysis and the Consolidated Framework for Implementation Research. MAXQDA 2020 software was used to organize the data. RESULTS Fourteen interviews were conducted with ICU care providers. The early transfer of patients to a weaning center and the integration of pulmonary expertise into routine care were identified as positively perceived potentials of the weaning boards and weaning consults. Especially in critically ill, multimorbid patients suffering from COVID-19, the expertise of the weaning centers was considered helpful. Due to heavy workloads, nurses were unable to participate in weaning boards and weaning consults. CONCLUSION Interprofessional collaboration between weaning centers and ICUs in weaning boards and weaning consults can improve the care of invasively ventilated patients. Strategies to promote the involvement of nurses should be discussed and developed.
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Affiliation(s)
- Sabrina Keller
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Johanna Forstner
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Diagnose- und Aufnahmezentrum, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - Aline Weis
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- hei_INNOVATION, Universität Heidelberg, Heidelberg, Deutschland
| | - Elena Biehler
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Franziska Trudzinski
- Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Julia Michels
- Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Benjamin Neetz
- Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Felix Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Armin Schneider
- Klinik für Anästhesie und Intensivmedizin, Waldburg-Zeil Kliniken GmbH und Co KG, Isny, Deutschland
| | - Alessandro Ghiani
- Pneumologie und Beatmungsmedizin, Lungenzentrum, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Stuttgart, Deutschland
| | - Joachim Szecsenyi
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michel Wensing
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Regina Poß-Doering
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Rott C, Limen E, Kriegsmann K, Herth F, Brock JM. Analysis of body composition with bioelectrical impedance analysis in patients with severe COPD and pulmonary emphysema. Respir Med 2024; 223:107559. [PMID: 38350511 DOI: 10.1016/j.rmed.2024.107559] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/13/2024] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often suffer from cachexia and malnutrition. Less is known about body composition and nutritional behaviour in patients with advanced COPD and pulmonary emphysema. METHODS We performed a single-center prospective analysis of patients with COPD GOLD III/IV. Metabolic parameters, dietary and exercise behavior, lung function, exercise capacity and body composition by bioelectrical impedance analysis (BIA) were analyzed. Patients with severe emphysema (emphysema index [EI] >20%) were compared to patients with mild emphysema (EI ≤ 20%). RESULTS A total of 121 patients (45.5% female, mean age 64.8 ± 8.1 years, mean FEV1 31.0 ± 8.6%, mean RV 234.7 ± 50.6%) were analyzed, of whom 14.1% were underweight. Only 5% of the patients substituted protein and only about 1/3 performed regular exercise training. BIA showed an unfavourable body composition: body fat ↑, ECM/BCM-index ↑, phase angle ↓ (5.0 ± 0.9°), cell percentage ↓, FFMI (fat-free mass index) ↓. The 94 patients with severe emphysema (mean EI 36.6 ± 8.5%) had lower body-mass-index (22.8 ± 4.3 vs. 31.1 ± 5.8 kg/m2, p < 0.001), FFMI, body weight and body fat, but did not differ significantly in the quality of body composition (e.g. phase angle). Their lipid and glucose metabolism were even better than in mild emphysema patients. CONCLUSION The finding of significantly lower BMI but similar body composition and better metabolic status in severe emphysema patients needs further investigation. However, it should not distract from the necessity to implement dietary and exercise recommendations for advanced COPD patients.
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Affiliation(s)
- Christina Rott
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Eldridge Limen
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | | | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
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Zader JA, Jörres RA, Mayer I, Alter P, Bals R, Watz H, Mertsch P, Rabe KF, Herth F, Trudzinski FC, Welte T, Kauczor HU, Behr J, Walter J, Vogelmeier CF, Kahnert K. Effects of triple therapy on disease burden in patients of GOLD groups C and D: results from the observational COPD cohort COSYCONET. BMC Pulm Med 2024; 24:103. [PMID: 38424530 PMCID: PMC10905841 DOI: 10.1186/s12890-024-02902-4] [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: 10/06/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Randomized controlled trials described beneficial effects of inhaled triple therapy (LABA/LAMA/ICS) in patients with chronic obstructive pulmonary disease (COPD) and high risk of exacerbations. We studied whether such effects were also detectable under continuous treatment in a retrospective observational setting. METHODS Data from baseline and 18-month follow-up of the COPD cohort COSYCONET were used, including patients categorized as GOLD groups C/D at both visits (n = 258). Therapy groups were defined as triple therapy at both visits (triple always, TA) versus its complement (triple not always, TNA). Comparisons were performed via multiple regression analysis, propensity score matching and inverse probability weighting to adjust for differences between groups. For this purpose, variables were divided into predictors of therapy and outcomes. RESULTS In total, 258 patients were eligible (TA: n = 162, TNA: n = 96). Without adjustments, TA patients showed significant (p < 0.05) impairments regarding lung function, quality of life and symptom burden. After adjustments, most differences in outcomes were no more significant. Total direct health care costs were reduced but still elevated, with inpatient costs much reduced, while costs of total and respiratory medication only slightly changed. CONCLUSION Without statistical adjustment, patients with triple therapy showed multiple impairments as well as elevated treatment costs. After adjusting for differences between treatment groups, differences were reduced. These findings are compatible with beneficial effects of triple therapy under continuous, long-term treatment, but also demonstrate the limitations encountered in the comparison of controlled intervention studies with observational studies in patients with severe COPD using different types of devices and compounds.
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Affiliation(s)
- Jennifer A Zader
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Imke Mayer
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- PreMeDICaL, Inria Montpellier, IDESP, Montpellier, France
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Marburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
- Helmholtz Centre for Infection Research (HZI), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Saarland University Campus, 66123, Saarbrücken, Germany
| | - Henrik Watz
- Member of the German Center for Lung Research, Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Pontus Mertsch
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany
| | - Klaus F Rabe
- Member of the German Center for Lung Research, Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Woehrendamm 80, 22927, Grosshansdorf, Germany
- Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, 24098, Kiel, Germany
| | - Felix Herth
- Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126, Heidelberg, Germany
- Member of the German Center for Lung Research, Translational Lung Research Centre Heidelberg (TLRC), Heidelberg, Germany
| | - Franziska C Trudzinski
- Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126, Heidelberg, Germany
- Member of the German Center for Lung Research, Translational Lung Research Centre Heidelberg (TLRC), Heidelberg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany
| | - Julia Walter
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr.1, 80336, Munich, Germany.
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Muley T, Schneider MA, Meister M, Thomas M, Heußel CP, Kriegsmann M, Holdenrieder S, Wehnl B, Rolny V, Mang A, Gerber R, Herth F. CYFRA 21-1, CA 125 and CEA provide additional prognostic value in NSCLC patients with stable disease at first CT scan. Tumour Biol 2024; 46:S163-S175. [PMID: 37840516 DOI: 10.3233/tub-220042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Serum tumor markers (STM) may complement imaging and provide additional clinical information for patients with non-small cell lung cancer (NSCLC). OBJECTIVE To determine whether STMs can predict outcomes in patients with stable disease (SD) after initial treatment. METHODS This single-center, prospective, observational trial enrolled 395 patients with stage III/IV treatment-naïve NSCLC; of which 263 patients were included in this analysis. Computed Tomography (CT) scans were performed and STMs measured before and after initial treatment (two cycles of chemotherapy and/or an immune checkpoint inhibitor or tyrosine kinase inhibitor); analyses were based on CT and STM measurements obtained at first CT performed after cycle 2 only PFS and OS were analyzed by Kaplan-Meier curves and Cox-proportional hazard models. RESULTS When patients with SD (n = 100) were split into high- and low-risk groups based on CYFRA 21-1, CEA and CA 125 measurements using an optimized cut-off, a 4-fold increase risk of progression or death was estimated for high- vs low-risk SD patients (PFS, HR 4.17; OS, 3.99; both p < 0.0001). Outcomes were similar between patients with high-risk SD or progressive disease (n = 35) (OS, HR 1.17) and between patients with low-risk SD or partial response (n = 128) (PFS, HR 0.98; OS, 1.14). CONCLUSIONS STMs can provide further guidance in patients with indeterminate CT responses by separating them into high- and low-risk groups for future PFS and OS events.
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Affiliation(s)
- Thomas Muley
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mark A Schneider
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Meister
- Translational Research Unit, Thoraxklinik, University Hospital, Heidelberg, Germany
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Oncology, Thoraxklinik, University Hospital, Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, Institute of Pathology, University Hospital, Heidelberg, Germany
| | - Stefan Holdenrieder
- Department of Laboratory Medicine, Deutsches Herzzentrum München, Munich, Germany
| | | | | | - Anika Mang
- Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Felix Herth
- Translational Lung Research Center, German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pulmonology and Critical Care, Thoraxklinik, University Hospital, Heidelberg, Germany
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Brock JM, Kontogianni K, Sciurba FC, Criner GJ, Herth F. Utility of rehabilitation prior to bronchoscopic lung volume reduction: post hoc analysis of the VENT trial. ERJ Open Res 2024; 10:00735-2023. [PMID: 38259808 PMCID: PMC10801745 DOI: 10.1183/23120541.00735-2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 01/24/2024] Open
Abstract
Background and objective Rehabilitation programmes are a valuable treatment modality for patients with COPD to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation prior to bronchoscopic lung volume reduction (BLVR) is unclear. Methods We performed a post hoc analysis of the Valve for Emphysema Palliation Trial (VENT) trial, the first multicentre randomised trial comparing the safety and efficacy of BLVR. Patients completed a pulmonary rehabilitation programme prior to BLVR over 6-10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (6-min walk distance (6MWD)) were assessed before and after rehabilitation and we tried to identify predictors for pulmonary rehabilitation benefit. Results Lung function and exercise capacity of 403 patients (mean±sd age 63.3±7.4 years, 37.5% female, mean±sd forced expiratory volume in 1 s 30.1±7.6 L) were analysed. Exercise capacity significantly improved from 331.6±98.8 m to 345.6±95.3 m (p<0.001) in 6-min walk testing (6MWT), with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnoea after 6MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6MWD <250 m) benefited more from pulmonary rehabilitation. The indication and prerequisites for BLVR were still present in all patients after pulmonary rehabilitation. Conclusion The national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.
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Affiliation(s)
- Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Konstantina Kontogianni
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Frank C Sciurba
- Pulmonary Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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Brock JM, Böhmker F, Schuster PU, Eberhardt R, Gompelmann D, Kontogianni K, Dittrich S, Benjamin N, Herth F. Endobronchial lung volume reduction with valves reduces exacerbations in severe emphysema patients. Respir Med 2023; 218:107399. [PMID: 37673413 DOI: 10.1016/j.rmed.2023.107399] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Exacerbations drive the progression of chronic obstructive pulmonary disease (COPD). Endoscopic lung volume reduction (ELVR) with valves is an established treatment option for patients with severe emphysema. Post-interventional exacerbations are observed in 8-17% of cases. Whether the exacerbation rate changes in the medium term after ELVR, is not known. METHODS This is a single-center retrospective analysis of severe emphysema patients with endobronchial valve implantation. The number of exacerbations before and after ELVR was compared, including lung function parameters, exercise capacity and degree of lung volume reduction. The primary endpoint of the study was the number of exacerbations one year after ELVR compared to one year before ELVR. RESULTS 129 patients (mean age 64.1 ± 7.7 years, 57% female, mean FEV1 0.8 ± 0.2 l, mean RV 243.4 ± 54.9 %) with ELVR in the years 2016-2019 and complete exacerbation history were analyzed. Patients experienced a mean of 2.5 ± 2.2 moderate and severe exacerbations in the year before ELVR. The number of exacerbations decreased significantly to 1.8 ± 2.2 exacerbations in the first year after ELVR (p = 0.009). The decrease in exacerbation rate was associated with the development of complete lobar atelectasis (r = 0.228. p = 0.009). Accordingly, in 41 patients with complete lobar atelectasis, the decrease in exacerbation rate was higher from 2.8 ± 2.0 to 1.4 ± 1.8 exacerbations (p < 0.001). CONCLUSIONS ELVR with valves appears promising to reduce the exacerbation rate in COPD patients, especially when the full treatment benefit of complete lobar atelectasis is achieved.
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Affiliation(s)
- Judith Maria Brock
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Felix Böhmker
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | | | - Ralf Eberhardt
- Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Konstantina Kontogianni
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Susanne Dittrich
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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Seker-Cin H, Tay TKY, Kazdal D, Kluck K, Ball M, Neumann O, Winter H, Herth F, Heußel CP, Savai R, Schirmacher P, Thomas M, Budczies J, Allgäuer M, Christopoulos P, Stenzinger A, Volckmar AL. Analysis of rare fusions in NSCLC: Genomic architecture and clinical implications. Lung Cancer 2023; 184:107317. [PMID: 37586177 DOI: 10.1016/j.lungcan.2023.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Molecular diagnosis for targeted therapies has been improved significantly in non-small-cell lung cancer (NSCLC) patients in recent years. Here we report on the prevalence of rare fusions in NSCLC and dissect their genomic architecture and potential clinical implications. MATERIALS AND METHODS Overall, n = 5554 NSCLC patients underwent next-generation sequencing (NGS) for combined detection of oncogenic mutations and fusions either at primary diagnosis (n = 5246) or after therapy resistance (n = 308). Panels of different sizes were employed with closed amplicon-based, or open assays, i.e. anchored multiplex PCR (AMP) and hybrid capture-based, for detection of translocations, including "rare" fusions, defined as those beyond ALK, ROS1, RET and <0.5 % frequency in NSCLC. RESULTS Rare fusions involving EGFR, MET, HER2, BRAF and other potentially actionable oncogenes were detected in 0.5% (n = 26) of therapy-naive and 2% (n = 6) TKI-treated tumors. Detection was increased using open assays and/or larger panels, especially those covering >25 genes, by approximately 1-2% (p = 0.001 for both). Patient characteristics (age, gender, smoking, TP53 co-mutations (56%), or mean tumor mutational burden (TMB) (4.8 mut/Mb)) showed no association with presence of rare fusions. Non-functional alterations, i.e. out-of-frame or lacking kinase domains, comprised one-third of detected rare fusions and were significantly associated with simultaneous presence of classical oncogenic drivers, e.g. EGFR or KRAS mutations (p < 0.001), or use of larger panels (frequency of non-functional among the detected rare fusions 57% for 25+ gene- vs. 12% for smaller panels, p < 0.001). As many rare fusions were identified before availability of targeted therapy, mean survival for therapy-naïve patients was 23.8 months, comparable with wild-type tumors. CONCLUSION Approximately 1-2% of advanced NSCLC harbor rare fusions, which are potentially actionable and may support diagnosis. Routine adoption of broad NGS assays capable to identify exact fusion points and potentially retained protein domains can increase the yield of therapeutically relevant molecular information in advanced NSCLC.
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Affiliation(s)
- Huriye Seker-Cin
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Timothy Kwang Yong Tay
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anatomical Pathology, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Daniel Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany
| | - Klaus Kluck
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Ball
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Olaf Neumann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Oncology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Pulmonology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Claus-Peter Heußel
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Rajkumar Savai
- Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany; Institute for Lung Health (ILH), Justus Liebig University, 35392 Giessen, Germany
| | - Peter Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Center for Personalized Medicine Heidelberg (ZPM), Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Oncology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Center for Personalized Medicine Heidelberg (ZPM), Heidelberg, Germany
| | - Michael Allgäuer
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Petros Christopoulos
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Oncology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany.
| | - Anna-Lena Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.
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9
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Lederer C, Mayer K, Somogyi V, Kriegsmann K, Kriegsmann M, Buschulte K, Polke M, Findeisen P, Herth F, Kreuter M. Krebs von den Lungen-6 as a Potential Predictive Biomarker in Fibrosing Interstitial Lung Diseases. Respiration 2023; 102:591-600. [PMID: 37586349 DOI: 10.1159/000531945] [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: 02/07/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND As fibrosing interstitial lung diseases (fILDs) are associated with high mortality, monitoring of disease activity under treatment is highly relevant. Krebs von den Lungen-6 (KL-6) is associated with the presence and severity of different fILDs, mainly in Asian patient populations. OBJECTIVES Our aim was to evaluate KL-6 as a predictive biomarker in fILDs in Caucasian patients. METHODS Consecutive patients with fILDs were recruited prospectively and serum concentrations of KL-6 were measured at baseline (BL), after 6 and 12 months (6 Months, 12 Months). Clinical characteristics including pulmonary function tests were assessed at 6-monthly visits and correlated with KL-6 BL levels as well as with KL-6 level changes. RESULTS A total of 47 fILD patients were included (mean age: 65 years, 68% male). KL-6 levels at BL were significantly higher in fILD patients than in healthy controls (n = 44, mean age: 45, 23% male) (ILD: 1,757 ± 1960 U/mL vs. control: 265 ± 107 U/mL, p < 0.0001). However, no differences were noted between ILD subgroups. KL-6 decreased significantly under therapy (6M∆BL-KL6: -486 ± 1,505 mean U/mL, p = 0.032; 12M∆BL-KL6: -547 ± 1,782 mean U/mL, p = 0.041) and KL-6 level changes were negatively correlated with changes in pulmonary function parameters (forced vital capacity [FVC]: r = -0.562, p < 0.0001; DLCOSB: r = -0.405, p = 0.013). While neither absolute KL-6 levels at BL nor KL-6 level changes were associated with ILD progression (FVC decline ≥10%, DLCOSB decline ≥15% or death), patients with a stable FVC showed significantly decreasing KL-6 levels (p = 0.022). CONCLUSIONS A decline of KL-6 under therapy correlated with a clinically relevant stabilization of lung function. Thus, KL-6 might serve as a predictive biomarker, which however must be determined by larger prospective cohorts.
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Affiliation(s)
- Christoph Lederer
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany,
| | - Katharina Mayer
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
| | - Vivien Somogyi
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
- Mainz Center for Pulmonary Medicine, Department of Pneumology, Mainz University Medical Center and Department of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidleberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, University Hospital Heidelberg, Germany and Pathology Wiesbaden, Wiesbaden, Germany
| | - Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Felix Herth
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik Heidelberg, University Hospital Heidelberg and German Center for Lung Research (DZL), Heidelberg, Germany
- Mainz Center for Pulmonary Medicine, Department of Pneumology, Mainz University Medical Center and Department of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
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10
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Requena G, Czira A, Banks V, Wood R, Tritton T, Castillo CM, Yeap J, Wild R, Compton C, Rothnie KJ, Herth F, Quint JK, Ismaila AS. Comparison of Rescue Medication Prescriptions in Patients with Chronic Obstructive Pulmonary Disease Receiving Umeclidinium/Vilanterol versus Tiotropium Bromide/Olodaterol in Routine Clinical Practice in England. Int J Chron Obstruct Pulmon Dis 2023; 18:1431-1444. [PMID: 37465818 PMCID: PMC10351530 DOI: 10.2147/copd.s411437] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Routinely collected healthcare data on the comparative effectiveness of the long-acting muscarinic antagonist/long-acting β2-agonist combination umeclidinium/vilanterol (UMEC/VI) versus tiotropium bromide/olodaterol (TIO/OLO) for chronic obstructive pulmonary disease (COPD) is limited. This study compared rescue medication prescriptions in patients with COPD in England receiving UMEC/VI versus TIO/OLO. Patients and Methods This retrospective cohort study used primary care data from the Clinical Practice Research Datalink Aurum database linked with secondary care administrative data from Hospital Episode Statistics. Patients with a COPD diagnosis at age ≥35 years were included (indexed) following initiation of single-inhaler UMEC/VI or TIO/OLO between July 1, 2015, and September 30, 2019. Outcomes included the number of rescue medication prescriptions at 12-months (primary), and at 6-, 18- and 24-months (secondary), adherence at 6-, 12-, 18- and 24-months post-index, defined as proportion of days covered ≥80% (secondary), and time-to-initiation of triple therapy (exploratory). Inverse probability of treatment weighting (IPTW) was used to balance potential confounding baseline characteristics. Superiority of UMEC/VI versus TIO/OLO for the primary outcome of rescue medication prescriptions was assessed using an intention-to-treat analysis with a p-value < 0.05. Results In total, 8603 patients were eligible (UMEC/VI: n = 6536; TIO/OLO: n = 2067). Following IPTW, covariates were well balanced across groups. Patients initiating UMEC/VI had statistically significantly fewer (mean [standard deviation]; p-value) rescue medication prescriptions versus TIO/OLO in both the unweighted (4.84 [4.78] vs 5.68 [5.00]; p < 0.001) and weighted comparison (4.91 [4.81] vs 5.48 [5.02]; p = 0.0032) at 12 months; consistent results were seen at all timepoints. Adherence was numerically higher for TIO/OLO versus UMEC/VI at all timepoints. Time-to-triple therapy was similar between treatment groups. Conclusion UMEC/VI was superior to TIO/OLO in reducing rescue medication prescriptions at 12 months after treatment initiation in a primary care cohort in England, potentially suggesting improvements in symptom control with UMEC/VI compared with TIO/OLO.
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Affiliation(s)
- Gema Requena
- GSK, R&D Global Medical, Brentford, Middlesex, UK
| | | | - Victoria Banks
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Robert Wood
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Theo Tritton
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | - Jie Yeap
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Rosie Wild
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | | | - Felix Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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11
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Ost DE, Feller-Kopman DJ, Gonzalez AV, Grosu HB, Herth F, Mazzone P, Park JES, Porcel JM, Shojaee S, Tsiligianni I, Vachani A, Bernstein J, Branson R, Flume PA, Akdis CA, Kolb M, Portela EB, Smyth A. Reporting Standards for Diagnostic Testing: Guidance for Authors From Editors of Respiratory, Sleep, and Critical Care Journals. J Bronchology Interv Pulmonol 2023; 30:207-222. [PMID: 37070780 DOI: 10.1097/lbr.0000000000000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/24/2023] [Indexed: 04/19/2023]
Abstract
Diagnostic testing is fundamental to medicine. However, studies of diagnostic testing in respiratory medicine vary significantly in terms of their methodology, definitions, and reporting of results. This has led to often conflicting or ambiguous results. To address this issue, a group of 20 respiratory journal editors worked to develop reporting standards for studies of diagnostic testing based on a rigorous methodology to guide authors, peer reviewers, and researchers when conducting studies of diagnostic testing in respiratory medicine. Four key areas are covered, including defining the reference standard of truth, measures of dichotomous test performance when used for dichotomous outcomes, measures of multichotomous test performance for dichotomous outcomes, and what constitutes a useful definition of diagnostic yield. The importance of using contingency tables for reporting results is addressed with examples from the literature. A practical checklist is provided as well for reporting studies of diagnostic testing.
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Affiliation(s)
| | | | | | | | | | | | - John E S Park
- Oxford University Hospitals NHS, Oxford, United Kingdom
| | | | | | | | - Anil Vachani
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Patrick A Flume
- Medical University of South Carolina, Charleston, South Carolina
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma, University of Zurich, Zurich, Switzerland
| | | | | | - Alan Smyth
- University of Nottingham and NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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12
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Brock JM, Schuster PU, Böhmker F, Eberhardt R, Gompelmann D, Kontogianni K, Trudzinski F, Benjamin N, Herth F. Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung Volume Reduction. Int J Chron Obstruct Pulmon Dis 2023; 18:933-943. [PMID: 37229440 PMCID: PMC10204716 DOI: 10.2147/copd.s408674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit. Patients and Methods We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified. Results We identified 73 patients with 1-12 revision bronchoscopies and 1-5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before. Conclusion Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Felix Böhmker
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniela Gompelmann
- Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Franziska Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nicola Benjamin
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
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13
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Schwartz U, Llamazares Prada M, Pohl ST, Richter M, Tamas R, Schuler M, Keller C, Mijosek V, Muley T, Schneider MA, Quast K, Hey J, Heußel CP, Warth A, Winter H, Serçin Ö, Karmouty-Quintana H, Jyothula SS, Patel MK, Herth F, Koch I, Petrosino G, Titimeaua A, Mardin BR, Weichenhan D, Jurkowski TP, Imbusch CD, Brors B, Benes V, Jung B, Wyatt D, Stahl HF, Plass C, Jurkowska RZ. High-resolution transcriptomic and epigenetic profiling identifies novel regulators of COPD. EMBO J 2023:e111272. [PMID: 37143403 DOI: 10.15252/embj.2022111272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are still waiting for curative treatments. Considering its environmental cause, we hypothesized that COPD will be associated with altered epigenetic signaling in lung cells. We generated genome-wide DNA methylation maps at single CpG resolution of primary human lung fibroblasts (HLFs) across COPD stages. We show that the epigenetic landscape is changed early in COPD, with DNA methylation changes occurring predominantly in regulatory regions. RNA sequencing of matched fibroblasts demonstrated dysregulation of genes involved in proliferation, DNA repair, and extracellular matrix organization. Data integration identified 110 candidate regulators of disease phenotypes that were linked to fibroblast repair processes using phenotypic screens. Our study provides high-resolution multi-omic maps of HLFs across COPD stages. We reveal novel transcriptomic and epigenetic signatures associated with COPD onset and progression and identify new candidate regulators involved in the pathogenesis of chronic lung diseases. The presence of various epigenetic factors among the candidates demonstrates that epigenetic regulation in COPD is an exciting research field that holds promise for novel therapeutic avenues for patients.
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Affiliation(s)
- Uwe Schwartz
- BioMed X Institute, Heidelberg, Germany
- NGS Analysis Center Biology and Pre-Clinical Medicine, University of Regensburg, Regensburg, Germany
| | - Maria Llamazares Prada
- BioMed X Institute, Heidelberg, Germany
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stephanie T Pohl
- BioMed X Institute, Heidelberg, Germany
- Division of Biomedicine, School of Biosciences, Cardiff University, Cardiff, UK
| | | | | | - Michael Schuler
- Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Corinna Keller
- Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Thomas Muley
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Translational Research Unit, Heidelberg Lung Biobank, Thoraxklinik,, University Hospital Heidelberg, Heidelberg, Germany
| | - Marc A Schneider
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Translational Research Unit, Heidelberg Lung Biobank, Thoraxklinik,, University Hospital Heidelberg, Heidelberg, Germany
| | - Karsten Quast
- Global Computational Biology and Digital Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Joschka Hey
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Claus P Heußel
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Arne Warth
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Translational Research Unit, Heidelberg Lung Biobank, Thoraxklinik,, University Hospital Heidelberg, Heidelberg, Germany
- Pathological Institute, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Translational Research Unit, Heidelberg Lung Biobank, Thoraxklinik,, University Hospital Heidelberg, Heidelberg, Germany
- Department of Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Harry Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Soma Sk Jyothula
- Center for Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manish K Patel
- Center for Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Felix Herth
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Translational Research Unit, Heidelberg Lung Biobank, Thoraxklinik,, University Hospital Heidelberg, Heidelberg, Germany
- Department of Pneumology and Critical Care Medicine and Translational Research Unit, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
| | - Ina Koch
- Asklepios Biobank for Lung Diseases, Department of Thoracic Surgery, Asklepios Fachkliniken München-Gauting, German Center for Lung Research (DZL), Munich, Germany
| | | | - Alexandru Titimeaua
- Division of Biomedicine, School of Biosciences, Cardiff University, Cardiff, UK
| | | | - Dieter Weichenhan
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Charles D Imbusch
- Division of Applied Bioinformatics, German Cancer Research Center, Heidelberg, Germany
| | - Benedikt Brors
- Division of Applied Bioinformatics, German Cancer Research Center, Heidelberg, Germany
| | - Vladimir Benes
- Genome Biology Unit, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Birgit Jung
- Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - David Wyatt
- Biotherapeutics Discovery, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Heiko F Stahl
- Immunology and Respiratory Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Christoph Plass
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Renata Z Jurkowska
- BioMed X Institute, Heidelberg, Germany
- Division of Biomedicine, School of Biosciences, Cardiff University, Cardiff, UK
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14
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Goldschmid H, Kluck K, Ball M, Kirchner M, Allgäuer M, Winter H, Herth F, Heußel CP, Pullamsetti SS, Savai R, Yong TTK, Schirmacher P, Peters S, Thomas M, Christopoulos P, Budczies J, Stenzinger A, Kazdal D. Spatial profiling of the microenvironment reveals low intratumoral heterogeneity and STK11-associated immune evasion in therapy-naïve lung adenocarcinomas. Lung Cancer 2023; 180:107212. [PMID: 37141769 DOI: 10.1016/j.lungcan.2023.107212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Intratumoral heterogeneity was found to be a significant factor causing resistance to lung cancer therapies, including immune checkpoint blockade. Lesser is known about spatial heterogeneity of the tumor microenvironment (TME) and its association with genetic properties of the tumor, which is of particular interest in the therapy-naïve setting. MATERIALS AND METHODS We performed multi-region sampling (2-4 samples per tumor; total of 55 samples) from a cohort of 19 untreated stage IA-IIIB lung adenocarcinomas (n = 11 KRAS mutant, n = 1 ERBB2 mutant, n = 7 KRAS wildtype). For each sample the expression of 770 immunooncology-related genes was analyzed using the nCounter platform, while the mutational status was determined by hybrid capture-based next-generation sequencing (NGS) using a large panel covering more than 500 genes. RESULTS Global unsupervised analyses revealed clustering of the samples into two groups corresponding to a 'hot' or 'cold' immunologic tumor contexture based on the abundance of immune cell infiltrates. All analyzed specific immune cell signatures (ICsig) showed a significantly higher intertumoral than intratumoral heterogeneity (p < 0.02), as most of the analyzed cases (14/19) showed a very homogenous spatial immune cell profile. PD-L1 exhibited a significantly higher intertumoral than intratumoral heterogeneity (p = 1.03e-13). We found a specific association with 'cold' TME for STK11 (11/14, p < 0.07), but not KRAS, TP53, LRP1B, MTOR, U2AF1 co-mutations, and validated this finding using The Cancer Genome Atlas (TCGA) data. CONCLUSION Early-stage lung adenocarcinomas show considerable intertumoral, but limited intratumoral heterogeneity, which is clinically highly relevant as assessment before neoadjuvant treatment is based on small biopsies. STK11 mutations are specifically associated with a 'cold' TME, which could affect the efficacy of perioperative immunotherapy.
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Affiliation(s)
- Hannah Goldschmid
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kluck
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Ball
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany
| | - Martina Kirchner
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Allgäuer
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Pulmonology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Claus-Peter Heußel
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Soni Savai Pullamsetti
- Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Rajkumar Savai
- Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany; Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Timothy Tay Kwang Yong
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Department of Anatomical Pathology, Department of Molecular Pathology at Singapore General Hospital, Singapore
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Center for Personalized Medicine Heidelberg (ZPM), Heidelberg, Germany
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Thomas
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Oncology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Petros Christopoulos
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; Department of Thoracic Oncology, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Budczies
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Daniel Kazdal
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Germany.
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Höger P, Veith M, Greulich T, Limen E, Brock J, Schlamp K, Buschulte K, Presotto MA, Schäfer JC, Herth F, Trudzinski FC. Characterization of three new SERPINA1 variants PiQ0Heidelberg II, PiQ0Heidelberg III and PiQ0Heidelberg IV in patients with severe alpha-1 antitrypsin deficiency. Respir Med Case Rep 2023; 43:101838. [PMID: 37021142 PMCID: PMC10068255 DOI: 10.1016/j.rmcr.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
Background The clinical and molecular characteristics of three patients with previously unreported SERPINA1 mutations associated with severe alpha-1 antitrypsin deficiency (AATD) are described. The pathophysiology of the chronic obstructive pulmonary disease (COPD) present in these patients was characterized through clinical, biochemical, and genetic examinations. Case presentations Case 1: A 73-year-old male with bilateral centri-to panlobular emphysema and multiple increasing ventrobasal bullae and incomplete fissures, COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade III B), progressive dyspnea on exertion (DOE), AAT level of 0.1-0.2 g/L. Genetic testing revealed a unique SERPINA1 mutation: Pi*Z/c.1072C > T. This allele was designated PiQ0Heidelberg II. Case 2: A 47-year-old male with severely heterogenous centri-to panlobular emphysema concentrated in the lower lobes, COPD GOLD IV D with progressive DOE, AAT <0.1 g/L. He also had a unique Pi*Z/c.10del mutation in SERPINA1. This allele was named PiQ0Heidelberg III. Case 3: A 58-year-old female with basally accentuated panlobular emphysema, GOLD II B COPD, progressive DOE. AAT 0.1 g/L. Genetic analysis revealed Pi*Z/c.-5+1G > A and c.-472G > A mutations in SERPINA1. This variant allele was named PiQ0Heidelberg IV. Conclusions Each of these patients had a unique and previously unreported SERPINA1 mutation. In two cases, AATD and a history of smoking led to severe lung disease. In the third case, timely diagnosis, and institution of AAT replacement stabilized lung function. Wider screening of COPD patients for AATD could lead to faster diagnosis and earlier treatment of AATD patients with AATD which could slow or prevent progression of their disease.
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16
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Andre F, Seitz S, Fortner P, Allmendinger T, Sommer A, Brado M, Sokiranski R, Fink J, Kauczor HU, Heussel CP, Herth F, Frey N, Görich J, Buss SJ. Simultaneous assessment of heart and lungs with gated high-pitch ultra-low dose chest CT using artificial intelligence-based calcium scoring. Eur J Radiol Open 2023; 10:100481. [PMID: 36852255 PMCID: PMC9958356 DOI: 10.1016/j.ejro.2023.100481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose The combined testing for coronary artery and pulmonary diseases is of clinical interest as risk factors are shared. In this study, a novel ECG-gated tin-filtered ultra-low dose chest CT protocol (GCCT) for integrated heart and lung acquisition and the applicability of artificial intelligence (AI)-based coronary artery calcium scoring were assessed. Methods In a clinical registry of 10481 patients undergoing heart and lung CT, GCCT was applied in 44 patients on a dual-source CT. Coronary calcium scans (CCS) with 120 kVp, 100 kVp, and tin-filtered 100 kVp (Sn100) of controls, matched with regard to age, sex, and body-mass index, were retrieved from the registry (ntotal=176, 66.5 (59.4-74.0) years, 52 men). Automatic tube current modulation was used in all scans. In 20 patients undergoing GCCT and Sn100 CCS, Agatston scores were measured both semi-automatically by experts and by AI, and classified into six groups (0, <10, <100, <400, <1000, ≥1000). Results Effective dose decreased significantly from 120 kVp CCS (0.50 (0.41-0.61) mSv) to 100 kVp CCS (0.34 (0.26-0.37) mSv) to Sn100 CCS (0.14 (0.11-0.17) mSv). GCCT showed higher values (0.28 (0.21-0.32) mSv) than Sn100 CCS but lower than 120 kVp and 100 kVp CCS (all p < 0.05) despite greater scan length. Agatston scores correlated strongly between GCCT and Sn100 CCS in semi-automatic and AI-based measurements (both ρ = 0.98, p < 0.001) resulting in high agreement in Agatston score classification (κ = 0.97, 95% CI 0.92-1.00; κ = 0.89, 95% CI 0.79-0.99). Regarding chest findings, further diagnostic steps were recommended in 28 patients. Conclusions GCCT allows for reliable coronary artery disease and lung cancer screening with ultra-low radiation exposure. GCCT-derived Agatston score shows excellent agreement with standard CCS, resulting in equivalent risk stratification.
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Affiliation(s)
- Florian Andre
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
- MVZ-DRZ Heidelberg, Heidelberg, Germany
- Correspondence to: University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
| | | | | | | | | | | | | | | | - Hans-Ulrich Kauczor
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg
| | - Claus P. Heussel
- University of Heidelberg, Thoraxklinik, Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- University of Heidelberg, Thoraxklinik, Department of Pneumology and Critical Care Medicine, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Norbert Frey
- University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany
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17
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Saccomanno J, Hübner RH, Witzenrath M, Doellinger F, Dittrich AS, Kontogianni K, Herth F, Brock JM. Bronchoscopic Measurement of Collateral Ventilation: State of the Art. Respiration 2023; 102:296-307. [PMID: 36731440 DOI: 10.1159/000528419] [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: 08/25/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Endoscopic lung volume reduction procedure with valves is a well-studied treatment option for advanced lung emphysema to target lung hyperinflation in carefully selected patients with COPD. Before valve implantation, collateral ventilation (CV) of the target lobe needs to be assessed to obtain an optimal treatment effect. The analysis of CV according to current standards occurs via an in vivo assessment with the Chartis®system (PulmonX Inc., Redwood City, CA, USA) and a computed tomography (CT) scan of the thorax with interlobar fissure analysis. The focus of this review is to provide detailed information about the Chartis®procedure and interpretation of Chartis® phenotypes. As a main tool in the assessment of CV and being a safe procedure, the Chartis® assessment should be performed by default to confirm interlobar fissure analysis in most emphysema patients. Based on the obtained results, lung volume reduction therapy options should be discussed in an interdisciplinary emphysema conference.
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Affiliation(s)
- Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Doellinger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Susanne Dittrich
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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18
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Denkinger CM, Janssen M, Schäkel U, Gall J, Leo A, Stelmach P, Weber SF, Krisam J, Baumann L, Stermann J, Merle U, Weigand MA, Nusshag C, Bullinger L, Schrezenmeier JF, Bornhäuser M, Alakel N, Witzke O, Wolf T, Vehreschild MJGT, Schmiedel S, Addo MM, Herth F, Kreuter M, Tepasse PR, Hertenstein B, Hänel M, Morgner A, Kiehl M, Hopfer O, Wattad MA, Schimanski CC, Celik C, Pohle T, Ruhe M, Kern WV, Schmitt A, Lorenz HM, Souto-Carneiro M, Gaeddert M, Halama N, Meuer S, Kräusslich HG, Müller B, Schnitzler P, Parthé S, Bartenschlager R, Gronkowski M, Klemmer J, Schmitt M, Dreger P, Kriegsmann K, Schlenk RF, Müller-Tidow C. Anti-SARS-CoV-2 antibody-containing plasma improves outcome in patients with hematologic or solid cancer and severe COVID-19: a randomized clinical trial. Nat Cancer 2023; 4:96-107. [PMID: 36581734 PMCID: PMC9886549 DOI: 10.1038/s43018-022-00503-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/29/2022] [Indexed: 04/26/2023]
Abstract
Patients with cancer are at high risk of severe coronavirus disease 2019 (COVID-19), with high morbidity and mortality. Furthermore, impaired humoral response renders severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines less effective and treatment options are scarce. Randomized trials using convalescent plasma are missing for high-risk patients. Here, we performed a randomized, open-label, multicenter trial ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001632-10/DE ) in hospitalized patients with severe COVID-19 (n = 134) within four risk groups ((1) cancer (n = 56); (2) immunosuppression (n = 16); (3) laboratory-based risk factors (n = 36); and (4) advanced age (n = 26)) randomized to standard of care (control arm) or standard of care plus convalescent/vaccinated anti-SARS-CoV-2 plasma (plasma arm). No serious adverse events were observed related to the plasma treatment. Clinical improvement as the primary outcome was assessed using a seven-point ordinal scale. Secondary outcomes were time to discharge and overall survival. For the four groups combined, those receiving plasma did not improve clinically compared with those in the control arm (hazard ratio (HR) = 1.29; P = 0.205). However, patients with cancer experienced a shortened median time to improvement (HR = 2.50; P = 0.003) and superior survival with plasma treatment versus the control arm (HR = 0.28; P = 0.042). Neutralizing antibody activity increased in the plasma cohort but not in the control cohort of patients with cancer (P = 0.001). Taken together, convalescent/vaccinated plasma may improve COVID-19 outcomes in patients with cancer who are unable to intrinsically generate an adequate immune response.
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Affiliation(s)
- Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.
- Partner site Heidelberg University Hospital, German Center for Infection Research, Heidelberg, Germany.
| | - Maike Janssen
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Schäkel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Gall
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Albrecht Leo
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Patrick Stelmach
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan F Weber
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Baumann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jacek Stermann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Florian Schrezenmeier
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre for Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Schmiedel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Partner site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development, Hamburg, Germany
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center, Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | | | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Anke Morgner
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Michael Kiehl
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Olaf Hopfer
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Mohammad-Amen Wattad
- Department of Hematology, Oncology, Palliative Care and Stem Cell Transplantation, Klinikum Hochsauerland, Meschede, Germany
| | - Carl C Schimanski
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Cihan Celik
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Thorsten Pohle
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Matthias Ruhe
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Winfried V Kern
- Department of Medicine II, Division of Infectious Diseases and Travel Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mary Gaeddert
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Niels Halama
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Translational Immunotherapy (D240), German Cancer Research Center, Heidelberg, Germany
- Helmholtz Institute for Translational Oncology, Mainz, Germany
| | - Stefan Meuer
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sylvia Parthé
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina Gronkowski
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Klemmer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.
- National Center for Tumor Diseases, Heidelberg, Germany.
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Czira A, Requena G, Banks V, Wood R, Tritton T, Castillo CM, Yeap J, Wild R, Compton C, Rothnie KJ, Herth F, Quint JK, Ismaila AS. Comparative Effectiveness of Umeclidinium/Vilanterol versus Inhaled Corticosteroid/Long-Acting β 2-Agonist in Patients with Chronic Obstructive Pulmonary Disease in a Primary Care Setting in England. Int J Chron Obstruct Pulmon Dis 2023; 18:643-659. [PMID: 37155496 PMCID: PMC10122847 DOI: 10.2147/copd.s405498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
Purpose To compare adherence to once-daily umeclidinium/vilanterol (UMEC/VI), a long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA), and twice-daily inhaled corticosteroids (ICS)/LABA single-inhaler dual therapy in patients with chronic obstructive pulmonary disease (COPD) in a primary care cohort in England. Patients and Methods Active comparator, new-user, retrospective cohort study using CPRD-Aurum primary care data and linked Hospital Episode Statistics secondary care administrative data. Patients without exacerbations in the previous year were indexed on first/earliest prescription date of once-daily UMEC/VI or twice-daily ICS/LABA as initial maintenance therapy between July 2014-September 2019. Primary outcome: medication adherence at 12 months post-index, defined as proportion of days covered (PDC) ≥80%. PDC represented proportion of time over the treatment duration that the patient was theoretically in possession of the medication. Secondary outcomes: adherence at 6, 18, and 24 months post-index, time-to-triple therapy, time-to-first on-treatment COPD exacerbation, COPD-related and all-cause healthcare resource utilization (HCRU), and direct health-care costs. A propensity score was generated and inverse probability of treatment weighting (IPTW) was used to balance potential confounders. Superiority was defined as >0% difference between treatment groups. Results In total, 6815 eligible patients were included (UMEC/VI:1623; ICS/LABA:5192). At 12 months post-index, weighted odds of a patient being adherent were significantly greater with UMEC/VI versus ICS/LABA (odds ratio [95% CI]: 1.71 [1.09, 2.66]; p=0.0185), demonstrating superiority of UMEC/VI. Patients taking UMEC/VI were statistically significantly more adherent than those taking ICS/LABA at 6, 18, and 24 months post-index (p<0.05). Differences in time-to-triple therapy, time-to-moderate COPD exacerbations, HCRU, and direct medical costs were not statistically significant between treatments after IPTW was applied. Conclusion At 12 months post-treatment initiation, once-daily UMEC/VI was superior to twice-daily ICS/LABA in medication adherence among patients with COPD without exacerbations in the previous year, newly initiating dual maintenance therapy in England. The finding was consistent at 6, 18, and 24 months.
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Affiliation(s)
- Alexandrosz Czira
- R&D Global Medical, GSK, Brentford, Middlesex, UK
- Correspondence: Alexandrosz Czira, Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, UK, Tel +44 7788 351610, Email
| | - Gema Requena
- R&D Global Medical, GSK, Brentford, Middlesex, UK
| | - Victoria Banks
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Robert Wood
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Theo Tritton
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | - Jie Yeap
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Rosie Wild
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | | | - Felix Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Boecker D, Zhang Z, Breves R, Herth F, Kramer A, Bulitta C. Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid (HOCl) for prevention or therapeutic support of infections. GMS Hyg Infect Control 2023; 18:Doc07. [PMID: 37034111 PMCID: PMC10073986 DOI: 10.3205/dgkh000433] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on in vivo use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl's biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of in vivo applications in the context of the body's own physiological defense mechanisms.
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Affiliation(s)
- Dirk Boecker
- TOTO Consulting LLC, San Jose CA, USA
- *To whom correspondence should be addressed: Dirk Boecker, TOTO Consulting LLC, San Jose CA, USA, E-mail:
| | - Zhentian Zhang
- Institute for Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Felix Herth
- Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Axel Kramer
- Institut of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Clemens Bulitta
- Institut für Medizintechnik, Ostbayerische Technische Hochschule (OTH) Amberg-Weiden, Amberg-Weiden, Germany
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21
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Kahnert K, Jörres RA, Kauczor HU, Alter P, Trudzinski FC, Herth F, Jobst B, Weinheimer O, Nauck S, Mertsch P, Kauffmann-Guerrero D, Behr J, Bals R, Watz H, Rabe KF, Welte T, Vogelmeier CF, Biederer J. Standardized airway wall thickness Pi10 from routine CT scans of COPD patients as imaging biomarker for disease severity, lung function decline, and mortality. Ther Adv Respir Dis 2023; 17:17534666221148663. [PMID: 36718763 PMCID: PMC9896094 DOI: 10.1177/17534666221148663] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/01/2023] Open
Abstract
BACKGROUND Chest computed tomography (CT) is increasingly used for phenotyping and monitoring of patients with COPD. The aim of this work was to evaluate the association of Pi10 as a measure of standardized airway wall thickness on CT with exacerbations, mortality, and response to triple therapy. METHODS Patients of GOLD grades 1-4 of the COSYCONET cohort with prospective CT scans were included. Pi10 was automatically computed and analyzed for its relationship to COPD severity, comorbidities, lung function, respiratory therapy, and mortality over a 6-year period, using univariate and multivariate comparisons. RESULTS We included n = 433 patients (61%male). Pi10 was dependent on both GOLD grades 1-4 (p = 0.009) and GOLD groups A-D (p = 0.008); it was particularly elevated in group D, and ROC analysis yielded a cut-off of 0.26 cm. Higher Pi10 was associated to lower FEV1 % predicted and higher RV/TLC, moreover the annual changes of lung function parameters (p < 0.05), as well as to an airway-dominated phenotype and a history of myocardial infarction (p = 0.001). These associations were confirmed in multivariate analyses. Pi10 was lower in patients receiving triple therapy, in particular in patients of GOLD groups C and D. Pi10 was also a significant predictor for mortality (p = 0.006), even after including multiple other predictors. CONCLUSION In summary, Pi10 was found to be predictive for the course of the disease in COPD, in particular mortality. The fact that Pi10 was lower in patients with severe COPD receiving triple therapy might hint toward additional effects of this functional therapy on airway remodeling. REGISTRATION ClinicalTrials.gov, Identifier: NCT01245933.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 5, Munich 80336, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Franziska C Trudzinski
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre.,Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik-Heidelberg gGmbH, Translational Lung Research Centre.,Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Bertram Jobst
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Sebastian Nauck
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Pontus Mertsch
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany.,Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Klaus F Rabe
- Lung Clinic Grosshansdorf, Airway Research Center (ARCN), Grosshansdorf, German.,Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.,University of Latvia, Faculty of Medicine, Raina bulvaris 19, Riga, LV-1586 Latvia
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22
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Kahnert K, Fischer C, Alter P, Trudzinski F, Welte T, Behr J, Herth F, Kauczor HU, Bals R, Watz H, Rabe K, Söhler S, Kokot I, Vogelmeier C, Jörres R. [What have we learned from the German COPD cohort COSYCONET and where do we go from here?]. Pneumologie 2022; 77:81-93. [PMID: 36526266 PMCID: PMC9931494 DOI: 10.1055/a-1966-0848] [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: 12/23/2022]
Abstract
COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given.
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Affiliation(s)
- Kathrin Kahnert
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland,Korrespondenzadresse PD Dr. med. Kathrin Kahnert Klinikum der Universität München LMU, Medizinische Klinik VZiemssenstr. 180336 MünchenDeutschland
| | - Carolina Fischer
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Peter Alter
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Franziska Trudzinski
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Tobias Welte
- 9177Klinik für Pneumologie, Medizinische Hochschule Hannover, Member of the German Center of Lung Research (DZL), Hannover, Deutschland
| | - Jürgen Behr
- 27192Medizinische Klinik und Poliklinik V, Klinikum der Universitat München LMU, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), München, Deutschland
| | - Felix Herth
- 14996Thoraxklinik-Heidelberg gGmbH, Translational Lung
Research Centre Heidelberg (TLRC), Member of the German Center for Lung
Research, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- 27178Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Deutschland
| | - Robert Bals
- 39072Innere Medizin V – Pulmonologie, Allergologie, Beatmungs-und Umweltmedizin, Universitätsklinikum des Saarlandes, Associated member of the Germen Center of Lung Research (DZL), Homburg, Deutschland,9377Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, Saarbrücken, Deutschland
| | - Henrik Watz
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland
| | - Klaus Rabe
- 9213Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Deutschland,98594Medizinische Fakultät, Christian-Albrechts Universität zu Kiel, Kiel, Deutschland
| | - Sandra Söhler
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Inge Kokot
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Claus Vogelmeier
- 9377Klinik für Pneumologie, Philipps-Universitat Marburg, Member of the German Center for Lung Research (DZL), Marburg, Deutschland
| | - Rudolf Jörres
- 27192Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
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23
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Denkinger CM, Janssen M, Schäkel U, Gall J, Leo A, Stelmach P, Weber SF, Krisam J, Baumann L, Stermann J, Merle U, Weigand M, Bullinger L, Schrezenmeier JF, Bornhäuser M, Alakel N, Witzke O, Wolf T, Vehreschild M, Schmiedel S, Addo M, Herth F, Kreuter M, Tepasse PR, Hertenstein B, Hänel M, Morgner A, Kiehl M, Hopfer O, Wattad MA, Schimanski C, Celik C, Pohle T, Ruhe M, Kern W, Schmitt A, Schmitt M, Lorenz HM, Souto-Carneiro M, Halama N, Meurer S, Kräusslich HG, Müller B, Bartenschlager R, Gronkowski M, Klemmer J, Kriegsmann K, Schlenk R, Müller-Tidow C. 1142. Plasma with high titers of anti-SARS-Cov2 antibodies improves outcome of COVID-19 in patients with hematological malignancy and cancer in a randomized controlled trial. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.980] [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: 12/23/2022] Open
Abstract
Abstract
Background
Patients with hematological malignancy or other cancers as well as immunosuppression bear a high risk for severe COVID-19. Monoclonal antibodies (mAb) are efficient at early stages of the disease but may lose potency with new variants. Trials on plasma from convalescent donors in unselected patients have not shown clinical benefit. No randomized trials focussing on patients with underlying disease have been published.
Methods
We conducted an open-label, multicenter, randomized controlled trial to evaluate efficacy of plasma (CVP - convalescent or after vaccination) in patients with COVID-19 at high risk for adverse outcome in Germany. We assessed the effect of high-titer CVP (2 units from different donors, 238-337 ml each, on subsequent days). Patients with hematological or other malignancy (group 1), immunosuppression (group 2), age >50 and ≤75 years and lymphopenia and/or high D-dimers (group 3) or age >75 years (group 4) who were hospitalized with confirmed SARS-CoV-2 infection and with an oxygen saturation ≤94% were included. Primary outcome measure was time to clinical improvement on a seven-point ordinal scale, secondary outcome was mortality (Janssen et al. Trials 2020 Oct 6;21(1):828).
Results
Overall, 133 patients were randomized, 68 received CVP with an additional 10 patients as a crossover on day 10. Median age (range) was 68 years (39-95) in the CVP group and 70 (38-90) in controls. For the entire cohort, no significant difference was seen in time to improvement (median days: CVP 12.5 vs. control 18; HR 1.24 (95% confidence interval (CI) 0.83-1.85), p=0.29). Subgroup analysis (group 1+2) revealed shortened time to improvement (median days CVP 13 vs. control 32; HR 2.03 (95%CI 1.17-3.6), p=0.01) and mortality was reduced (mortality CVP n=6 (18%) vs. control n=10 (29%). No significant differences in time to improvement were observed in group 3 or 4 (HR 0.72 (95%CI 0.41-1.28), p=0.26). No relevant adverse events were observed.
Conclusion
CVP improves time to clinical improvement and mortality for COVID-19 patients with underlying hematological disease/cancer or other reasons of impaired immune response. Even with new variants, high-titer CVP may offer a widely available and inexpensive therapy option in high-risk groups.
Funding
BMBF FKZ 01KI20152; EudraCT 2020-001632-10.
Disclosures
Uta Merle, MD, Gilead: Sponsored congress travel and accommodation Markus Weigand, MD, Bbraun: Speakers fee/ad boards fee|Biotest: Speakers fee/ad boards fee|Eumedica: Speakers fee/ad boards fee|Gilead: Speakers fee/ad boards fee|MSD: Speakers fee/ad boards fee|Pfizer: Speakers fee/ad boards fee|Shionogi: Speakers fee/ad boards fee|SOBI: Speakers fee/ad boards fee Martin Bornhäuser, MD, Alexion: Honoraria|Jazz Pharmaceuticals: Honoraria|MSD: Honoraria|Novartis: Honoraria Nael Alakel, MD, Amgen: personal fee, travel grant|Gilead: personal fee, travel grant|MSD Sharp and Dohme GmbH: personal fee, travel grant|Pfizer: personal fee, travel grant Timo Wolf, MD, Gilead Sciences: Lecture fee, travel grant|Janssen Pharmaceuticals: Lecture fee, travel grant|Merck Sharp Dome: Lecture fee, travel grant Maria Vehreschild, Prof. Dr., 3M: speaker fee|Astellas: Advisor/Consultant|Astellas: speaker fee|biologische heilmittel heel gmbh: Grant/Research Support|BioNtech: Grant/Research Support|EUMEDICA: Advisor/Consultant|Farmak International Holding: Advisor/Consultant|Ferring: Advisor/Consultant|Ferring: Speaker fee|Gilead Sciences: Advisor/Consultant|Immunic AG: Advisor/Consultant|MaaT: Advisor/Consultant|Merck: Advisor/Consultant|Merck: speaker fee|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: speaker fees|Pfizer: speaker fee|Roche Molecular Systems: Grant/Research Support|Roche Molecular Systems: speaker fees|SocraRTec R&D GmbH: Advisor/Consultant|Takeda California: Grant/Research Support Hanns-Martin Lorenz, MD, Abbvie: Advisor/Consultant|Abbvie: Honoraria|Actelion: Advisor/Consultant|Actelion: Honoraria|Alexion: Advisor/Consultant|Alexion: Honoraria|Amgen: Advisor/Consultant|Amgen: Grant/Research Support|Astra Zeneca: Advisor/Consultant|Astra Zeneca: Honoraria|Baxter: Advisor/Consultant|Baxter: Advisor/Consultant|Baxter: Honoraria|Baxter: Honoraria|Bayer Vital: Advisor/Consultant|Bayer Vital: Honoraria|Biogen: Advisor/Consultant|Biogen: Honoraria|BMS: Advisor/Consultant|BMS: Honoraria|Boehringer Ingelheim: Advisor/Consultant|Boehringer Ingelheim: Honoraria|Celgene: Advisor/Consultant|Celgene: Honoraria|Fresenius: Advisor/Consultant|Fresenius: Honoraria|Genzyme: Advisor/Consultant|Genzyme: Honoraria|Gilead/Galapagos: Advisor/Consultant|Gilead/Galapagos: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Hexal: Advisor/Consultant|Hexal: Honoraria|Janssen-Cilag: Advisor/Consultant|Janssen-Cilag: Honoraria|Lilly: Advisor/Consultant|Lilly: Honoraria|Medac: Advisor/Consultant|Medac: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Mundipharm: Advisor/Consultant|Mundipharm: Honoraria|Mylan: Advisor/Consultant|Mylan: Honoraria|Novartis: Advisor/Consultant|Novartis: Honoraria|octapharm: Advisor/Consultant|octapharm: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Roche/Chugai: Advisor/Consultant|Roche/Chugai: Honoraria|Sandoz: Advisor/Consultant|Sandoz: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Honoraria|Shire: Advisor/Consultant|Shire: Honoraria|SOBI: Advisor/Consultant|SOBI: Honoraria|Thermo Fisher: Advisor/Consultant|Thermo Fisher: Honoraria|UCB: Advisor/Consultant|UCB: Honoraria.
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Affiliation(s)
- Claudia M Denkinger
- Division for Infectious Diseases and Tropical Medicine, University Hospital Heidelberg , Heidelberg, Baden-Wurttemberg , Germany
| | - Maike Janssen
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Ulrike Schäkel
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Julia Gall
- NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Albrecht Leo
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg , Heidelberg, Heidelberg, Baden-Wurttemberg , Germany
| | - Patrick Stelmach
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Stefan F Weber
- Division of Infectious Diseases and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Johannes Krisam
- Institute for Medical Biometry and Informatics, Ruprecht-Karls University Heidelberg , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Lukas Baumann
- Institute for Medical Biometry and Informatics, Ruprecht-Karls University Heidelberg , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Jacek Stermann
- Institute for Medical Biometry and Informatics, Ruprecht-Karls University Heidelberg , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Uta Merle
- Department of Internal Medicine IV, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Markus Weigand
- Department of Anaesthesiology, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic , Berlin, Germany, Berlin, Berlin , Germany
| | - Jens-Florian Schrezenmeier
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic , Berlin, Germany, Berlin, Berlin , Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital and Faculty of Medicine Carl Gustav Carus of TU Dresden , Dresden, Germany, Dresden, Sachsen , Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital and Faculty of Medicine Carl Gustav Carus of TU Dresden , Dresden, Germany, Dresden, Sachsen , Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitymedicine Essen, University Duisburg-Essen , Germany, Essen, Nordrhein-Westfalen , Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt , Frankfurt am Main, Germany, Frankfurt, Hessen , Germany
| | - Maria Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt , Frankfurt am Main, Germany, Frankfurt, Hessen , Germany
| | - Stefan Schmiedel
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany, Hamburg, Hamburg , Germany
| | - Marylyn Addo
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf , Hamburg, Germany, Hamburg, Hamburg , Germany
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research(DZL) , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology , Münster, Germany, Münster, Nordrhein-Westfalen , Germany
| | - Bernd Hertenstein
- Medical Department I , Klinikum Bremen-Mitte, Bremen, Germany, Bremen, Bremen , Germany
| | - Mathias Hänel
- Department of Internal Medicine III , Klinikum Chemnitz gGmbH, Chemnitz, Germany, Chemnitz, Sachsen , Germany
| | - Anke Morgner
- Department of Internal Medicine III , Klinikum Chemnitz gGmbH, Chemnitz, Germany, Chemnitz, Sachsen , Germany
| | - Michael Kiehl
- Department I of Internal Medicine, Frankfurt (Oder) General Hospital , Frankfurt/Oder, Germany, Frankfurt a.d. Oder, Brandenburg , Germany
| | - Olaf Hopfer
- Department I of Internal Medicine, Frankfurt (Oder) General Hospital , Frankfurt/Oder, Germany, Frankfurt a.d. Oder, Brandenburg , Germany
| | - Mohammad-Amen Wattad
- Department of Hematology , Oncology, Palliative Care and Stem Cell Transplantation, Klinikum Hochsauerland GmbH, Meschede, Germany, Meschede, Nordrhein-Westfalen , Germany
| | - Carl Schimanski
- Department of Internal Medicine II , Klinikum Darmstadt GmbH, Darmstadt, Germany, Darmstadt, Hessen , Germany
| | - Cihan Celik
- Department of Internal Medicine II , Klinikum Darmstadt GmbH, Darmstadt, Germany, Darmstadt, Hessen , Germany
| | - Thorsten Pohle
- Department of Internal Medicine I , Klinikum Herford, Germany, Herford, Nordrhein-Westfalen , Germany
| | - Matthias Ruhe
- Department of Internal Medicine I , Klinikum Herford, Germany, Herford, Nordrhein-Westfalen , Germany
| | - Winfried Kern
- Department of Medicine II, Division of Infectious Diseases and Travel Medicine, University Medical Centre Freiburg , Freiburg, Germany, Freiburg, Baden-Wurttemberg , Germany
| | - Anita Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Michael Schmitt
- University of Heidelberg , Heidelberg, Baden-Wurttemberg , Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Margarida Souto-Carneiro
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Niels Halama
- Department of Medical Oncology and Internal Medicine V, National Center for Tumor Diseases (NCT), University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Stefan Meurer
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg , Heidelberg, Heidelberg, Baden-Wurttemberg , Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Martina Gronkowski
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Jennifer Klemmer
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Katharina Kriegsmann
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Richard Schlenk
- NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital , Heidelberg, Germany, Heidelberg, Baden-Wurttemberg , Germany
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24
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Salome P, Walz D, Sforazzini F, Kudak A, Dostal M, Regnery S, Schlamp K, Thomas M, Herth F, Jäkel O, Heußel C, Hoerner-Rieber J, Debus J, Knoll M, Abdollahi A. Multi-Omics Classifier of Tumor Recurrence vs. Radiation-Induced Lung Fibrosis in NSCLC Patients Treated with SBRT. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1542] [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: 11/30/2022]
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25
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Nagel C, Olschewski H, Sorichter S, Uezgoer G, Diehm C, Huppert P, Iber T, Herth F, Harutyunova S, Marra AM, Benjamin N, Salkić A, Grünig E, Egenlauf B. Impairment of Inspiratory Muscle Function after COVID-19. Respiration 2022; 101:981-989. [DOI: 10.1159/000527361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Persistent symptoms after acute coronavirus-disease-2019 (COVID-19) are common, and there is no significant correlation with the severity of the acute disease. In long-COVID (persistent symptoms >4 weeks after acute COVID-19), respiratory symptoms are frequent, but lung function testing shows only mild changes that do not explain the symptoms. Although COVID-19 may lead to an impairment of the peripheral nervous system and skeletal muscles, respiratory muscle function has not been examined in this setting. <b><i>Methods:</i></b> In this study, we assessed the severity of dyspnea (NYHA-function class) in long-COVID patients and analyzed its association with body mass index (BMI), FEV1, forced vital capacity, other parameters of body plethysmography, diffusing capacity for carbon monoxide (DLCO), arterial blood gases, and inspiratory muscle function, assessed by airway occlusion pressure (P0.1) and maximal inspiratory pressure (PImax) in two respiratory clinics in Germany between Oct 2020 and Aug 2021. <b><i>Results:</i></b> A total of 116 patients were included in the study. The mean age was 50.2 ± 14.5 years; BMI, 26.7 ± 5.87 kg/m<sup>2</sup>; NYHA class I, 19%; II, 27%; III, 41%; and IV, 14%. While lung function values and computed tomography or conventional X-ray of the chest were in the normal range, inspiratory muscle function was markedly impaired. P01 was elevated to 154 ± 83%predicted and PImax was reduced to 41 ± 25%predicted. PImax reduction was strongly associated with the severity of dyspnea but independent of BMI, time after acute COVID-19 and most of the other parameters. <b><i>Conclusions:</i></b> This study shows that in long-COVID patients, respiratory symptoms may be mainly caused by reduced inspiratory muscle strength. Assessment of PImax and P0.1 might better explain dyspnea than classical lung function tests and DLCO. A prospective study is needed to confirm these results.
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Frey DL, Bridson C, Dittrich S, Graeber SY, Stahl M, Wege S, Herth F, Sommerburg O, Schultz C, Dalpke A, Mall MA, Boutin S. Changes in Microbiome Dominance Are Associated With Declining Lung Function and Fluctuating Inflammation in People With Cystic Fibrosis. Front Microbiol 2022; 13:885822. [PMID: 35633718 PMCID: PMC9136159 DOI: 10.3389/fmicb.2022.885822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Airway inflammation and microbiome dysbiosis are hallmarks of cystic fibrosis (CF) lung disease. However, longitudinal studies are needed to decipher which factors contribute to the long-term evolution of these key features of CF. We therefore evaluated the relationship between fluctuation in microbiome and inflammatory parameters in a longitudinal study including a short- (1-year) and a long-term (3+ years) period. We collected 118 sputum samples from 26 CF adult patients and analyzed them by 16S rRNA gene sequencing. We measured the levels of inflammatory cytokines, neutrophil elastase, and anti-proteinases; lung function (FEV1% predicted); and BMI. The longitudinal evolution was analyzed based on (i) the rates of changes; (ii) the intra-patient stability of the variables; and (iii) the dependency of the rates of changes on the baseline values. We observed that the diversity of the microbiome was highly variable over a 1-year period, while the inflammatory markers showed a slower evolution, with significant changes only observed in the 3+ year cohort. Further, the degree of fluctuation of the biomass and the dominance of the microbiome were associated with changes in inflammatory markers, especially IL-1β and IL-8. This longitudinal study demonstrates for the first time that the long-term establishment and periodical variation of the abundance of a dominant pathogen is associated with a more severe increase in inflammation. This result indicates that a single time point or 1-year study might fail to reveal the correlation between microbial evolution and clinical degradation in cystic fibrosis.
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Affiliation(s)
- Dario L. Frey
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Calum Bridson
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany
| | - Susanne Dittrich
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Y. Graeber
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany
- Division of Pediatric Pulmonology and Allergology and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
| | - Mirjam Stahl
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany
- Division of Pediatric Pulmonology and Allergology and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
| | - Sabine Wege
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Division of Pediatric Pulmonology and Allergology and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Carsten Schultz
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, OR, United States
| | - Alexander Dalpke
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany
- Institute of Medical Microbiology and Virology, Technische Universität Dresden, Dresden, Germany
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
| | - Sébastien Boutin
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany
- *Correspondence: Sébastien Boutin,
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de Castilhos J, Zamir E, Hippchen T, Rohrbach R, Schmidt S, Hengler S, Schumacher H, Neubauer M, Kunz S, Müller-Esch T, Hiergeist A, Gessner A, Khalid D, Gaiser R, Cullin N, Papagiannarou SM, Beuthien-Baumann B, Krämer A, Bartenschlager R, Jäger D, Müller M, Herth F, Duerschmied D, Schneider J, Schmid RM, Eberhardt JF, Khodamoradi Y, Vehreschild MJGT, Teufel A, Ebert MP, Hau P, Salzberger B, Schnitzler P, Poeck H, Elinav E, Merle U, Stein-Thoeringer CK. Correction to: Severe Dysbiosis and Specific Haemophilus and Neisseria Signatures as Hallmarks of the Oropharyngeal Microbiome in Critically Ill Coronavirus Disease 2019 (COVID-19) Patients. Clin Infect Dis 2022; 75:185. [PMID: 35536665 PMCID: PMC9383973 DOI: 10.1093/cid/ciac254] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Juliana de Castilhos
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany.,Vale do Rio dos Sinos University (UNISINOS), Sao Leopoldo, Brazil
| | - Eli Zamir
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Gastroenterology and Infectious Diseases, University Clinic Heidelberg, Heidelberg, Germany
| | - Roman Rohrbach
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Sabine Schmidt
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Silvana Hengler
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Hanna Schumacher
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Melanie Neubauer
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabrina Kunz
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany
| | - Tonia Müller-Esch
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Clinical Microbiology and Hygiene, University Clinic Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, University Clinic Regensburg, Regensburg, Germany
| | - Dina Khalid
- Department of Virology, University Clinic Heidelberg, Heidelberg, Germany
| | - Rogier Gaiser
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Nyssa Cullin
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Stamatia M Papagiannarou
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | | | - Alwin Krämer
- German Cancer Research Center (DKFZ), Research Division Molecular Hematology/Oncology, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Research Division Virus-associated Carcinogenesis, Heidelberg
| | - Dirk Jäger
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Michael Müller
- Thoraxklinik and Translational Lung Research Center, Heidelberg University, Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik and Translational Lung Research Center, Heidelberg University, Heidelberg, Germany
| | - Daniel Duerschmied
- Department of Internal Medicine III, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johann F Eberhardt
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Andreas Teufel
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, and Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, and Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Clinic Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infectious Disease, University Clinic Regensburg, Regensburg, Germany
| | - Paul Schnitzler
- Department of Virology, University Clinic Heidelberg, Heidelberg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany.,National Center for Tumor Diseases (NCT) WERA
| | - Eran Elinav
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany.,Weizmann Institute of Science, Rehovot, Israel
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, University Clinic Heidelberg, Heidelberg, Germany
| | - Christoph K Stein-Thoeringer
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
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28
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Herrmann A, Herrmann M, Passlick B, Herth F, Herrmann J. Cycling‐induced recurrent spontaneous pneumomediastinum and pneumopericardium in a young female patient. Clin Case Rep 2022; 10:e05587. [PMID: 35340655 PMCID: PMC8934540 DOI: 10.1002/ccr3.5587] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/18/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Abstract
We present an exceptional case of recurrent cycling‐induced spontaneous pneumomediastinum and pneumopericardium in a female patient without any trauma. Radiological and endoscopic examinations were carried out to exclude other differential diagnoses. Decision for in‐hospital observation and conservative treatment was made. No symptoms were reported 12 months after return to sports activity.
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Affiliation(s)
- Anna Herrmann
- Department for Nutrition Institute for Sports and Sports Science University of Freiburg Freiburg im Breisgau Germany
| | - Matthias Herrmann
- Faculty of Medicine University Hospital of Freiburg Freiburg im Breisgau Germany
| | - Bernward Passlick
- Department of Thoracic Surgery Medical Center‐University of Freiburg Freiburg im Breisgau Germany
| | - Felix Herth
- Department of Pulmonary and Respiratory Critical Care Medicine ThoraxklinikHeidelberg University Hospital Heidelberg Germany
- Translational Lung Research Center Heidelberg University of Heidelberg Heidelberg Germany
| | - Johannes Herrmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
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29
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Moslemi A, Kontogianni K, Brock J, Wood S, Herth F, Kirby M. Differentiating COPD and Asthma using Quantitative CT Imaging and Machine Learning. Eur Respir J 2022; 60:13993003.03078-2021. [PMID: 35210316 DOI: 10.1183/13993003.03078-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
There are similarities and differences between chronic obstructive pulmonary disease (COPD) and asthma patients in terms of computed tomography (CT) disease-related features. Our objective was to determine the optimal subset of CT imaging features for differentiating COPD and asthma using machine learning.COPD and asthma patients were recruited from Heidelberg University Hospital. CT was acquired and 93 features were extracted (VIDA Diagnostics): percentage of low-attenuating-areas below -950HU (LAA950), LAA950 hole count, estimated airway-wall-thickness for a 10 mm internal perimeter airway (Pi10), total-airway-count (TAC), as well as inner/outer perimeter/areas and wall thickness for each of five segmental airways, and the average of those five airways. Hybrid feature selection was used to select the optimum number of features, and support vector machine was used to classify COPD and asthma.Ninety-five participants were included (n=48 COPD; n=47 asthma); there were no differences between COPD and asthma for age (p=0.25) or FEV1 (p=0.31). In a model including all CT features, the accuracy and F1-score was 80% and 81%, respectively. The top features were: LAA950, LAA950 hole count, average outer and inner airway perimeter, outer and inner airway area RB1, and TAC. In the model with only airway features, the accuracy and F1-score were 66% and 68%, respectively. The top features were: inner area RB1, wall thickness RB1, outer area LB1, TAC LB10, average outer/inner perimeter, Pi10, and TAC.In conclusions, COPD and asthma can be differentiated using machine learning with moderate-high accuracy by a subset of only 7 CT features.
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Affiliation(s)
- Amir Moslemi
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-first authors
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany.,Co-first authors
| | - Judith Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany
| | | | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany .,Co-senior authors
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-senior authors
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30
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Schellenberg MD, Imach S, Iberl G, Kirchner M, Herth F, Trudzinski F. Clinical characterization and possible pathophysiological causes of the Deventilation Syndrome in COPD. Sci Rep 2022; 12:1099. [PMID: 35058534 PMCID: PMC8776740 DOI: 10.1038/s41598-022-05118-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
In daily routine, many COPD patients report early onset augmented dyspnea following use of NIV (Deventilation Syndrome, DVS) as a negative side-effect. The aim of this study is the clinical characterization and concrete definition of DVS. This monocenter prospective observational study collected demographic, physiologic and symptomatic data from 67 in-patients with severe COPD Gold III–IV and chronic hypercapnic failure before, during and after use of an established NIV. During their inpatient follow-up, we examined patients during the first hour after termination of nocturnal NIV. DVS was defined by the authors as an increase of ≥ 2 points on the Borg scale during the first 30 min in patients who reported repeated dyspnea after the use of NIV. We monitored cardiovascular and respiratory data and measured diaphragm excursion. Subjective dyspnea was documented by use of the Borg scale and questionnaires. In addition, respirator and demographic data were collected. DVS occurred in 58% of our COPD patient collective, showing predominant emphysema phenotype. Patients with DVS were more severely ill than non-DVS concerning bronchial obstruction (FEV1 0.6 vs. 0.8 l, p < 0.05) and hypercapnia during spontaneous breathing (pre NIV pCO2: 54.5 vs. 49.3 mmHg, p < 0.02). DVS patients showed significantly higher respiratory rates (RR) (20.1 vs. 18.1/min p < 0.05) after termination of NIV. This trial characterizes and defines early onset augmented dyspnea after the use of NIV, referred to as DVS. It is hereby brought to attention as a frequent side effect of long-term home ventilation and possible pathophysiologic mechanisms are elucidated.
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31
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Ball M, Christopoulos P, Kirchner M, Allgaeuer M, Brandt R, Winter H, Heussel CP, Herth F, Froehling S, Savai R, Kriegsmann M, Schirmacher P, Peters S, Thomas M, Stenzinger A, Kazdal D. Histological and Molecular Plasticity of ALK-positive Non-Small-Cell Lung Cancer under Targeted Therapy - a Case Report. Cold Spring Harb Mol Case Stud 2022; 8:mcs.a006156. [PMID: 35058282 PMCID: PMC9059782 DOI: 10.1101/mcs.a006156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
With medical progress in cancer therapy, tyrosine kinase inhibitors (TKIs) became a standard of care for many cancer types. But the broad range of possible targeted therapies was accompanied by a plethora of potential resistance mechanisms, of which many have still to be identified. Here, we present the case of a patient with an EML4–ALK translocated non-small-cell lung cancer treated with four different TKIs. Her tumor developed not only a well-known ALK–TKI resistance mutation but also underwent a histological transformation from adenocarcinoma to squamous cell carcinoma. To confirm a shared monoclonal origin of the phenotypically different tumors, a phylogenetic reconstruction was conducted: This revealed a cluster of mutations including NFE2L2, KMT2D, and MLH1, which are possible triggering events for the transformation.
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32
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Presotto MA, Veith M, Trinkmann F, Schlamp K, Polke M, Eberhardt R, Herth F, Trudzinski FC. Clinical characterization of a novel alpha1-antitrypsin null variant: PiQ0 Heidelberg. Respir Med Case Rep 2022; 35:101570. [PMID: 35028284 PMCID: PMC8741486 DOI: 10.1016/j.rmcr.2021.101570] [Citation(s) in RCA: 3] [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: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/30/2021] [Indexed: 10/24/2022] Open
Abstract
The clinical characterization of a null variant of SERPINA1 - PiQ0Heidelberg - resulting in alpha1-antitrypsin (AAT) deficiency is described. This rare mutation (c.-5+5 G > A) has been previously identified but not clinically described. The 77 year-old female patient had GOLD-3, Group B COPD, severe destructive panlobular emphysema and newly observed respiratory failure on exertion at the time the genetic analysis was performed. Serum AAT level was 0.1 g/L (reference 0.9-2.0 g/L). Isoelectric focusing showed only the Z-protein indicating that this was a null mutation. The patient has started AAT replacement. Early screening and identification of AAT deficiency would allow for earlier intervention.
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Affiliation(s)
- Maria A Presotto
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martina Veith
- University Medical Centre Giessen and Marburg, Philipps-University, Dept of Medicine, Pulmonary and Critical Care Medicine, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Kai Schlamp
- Department of Radiology, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Markus Polke
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
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Billeter AT, Zumkeller M, Brock J, Herth F, Zech U, Zeier M, Rupp C, Wagenlechner P, Mehrabi A, Müller-Stich BP. Obesity surgery in patients with end-stage organ failure: Is it worth it? Surg Obes Relat Dis 2021; 18:495-503. [PMID: 34920966 DOI: 10.1016/j.soard.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known about the long-term outcomes of patients with end-stage organ failure (ESOF) undergoing obesity surgery. OBJECTIVE To investigate the perioperative and mid-term outcomes of patients with ESOF undergoing obesity surgery. SETTING University hospital, Germany. METHODS A total of 1 094 patients undergoing obesity surgery from 2006 to 2019 were screened. Inclusion criteria were ejection fraction <30%, continuous oxygen/noninvasive ventilation therapy, liver cirrhosis, or kidney failure stage 4/5. ESOF patients were compared with matched standard (MS) patients without advanced organ failure and matched for age, gender, body mass index (BMI), operation type, diabetes, arterial hypertension, and sleep apnea. RESULTS Twenty-seven ESOF patients (56% female, age 50.3 ± 8.6, BMI 53.8 ± 8.7 kg/m2) were identified. Eighty-five percent had a sleeve gastrectomy. Mid-term total weight loss was 26.6% ± 9.0% in the ESOF patients versus 17.8% ± 11.1% in MS patients (P = .181). Long-term improvement of type 2 diabetes was comparable (ESOF: HbA1C 8.79 ± 2.06% to 6.25±1.17%, P = .047; MS: HbA1C 7.94 ± 2.02% to 7.2 ± 1.28%; P = .343). Depression scores (Patient Health Questionnaire 9) among ESOF patients improved from 13.0 ± 6.3 to 6.1 ± 5.8 (P = .004) but without significant change in MS patients (9.4 ± 7.3 to 4.3 ± 5.7; P = .082). Lung function improved in all patients although only 15% were off oxygen therapy. Treatment goals were achieved in >50% of the other groups. Major complications occurred in 11% (ESOF) versus 4% (MS) of patients (P = .299) with one death in the ESOF group (4%). CONCLUSION Both groups had similar outcomes regarding weight loss and co-morbidity improvement. Depression only improved significantly in the ESOF group. Patients with ESOF should not be precluded from obesity surgery. Further investigation is needed to define optimized selection criteria.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Michael Zumkeller
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Judith Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Zech
- Department of Endocrinology and Metabolism, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Rupp
- Department of Gastroenterology, Infectious Diseases and Intoxication, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Wagenlechner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
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de Castilhos J, Zamir E, Hippchen T, Rohrbach R, Schmidt S, Hengler S, Schumacher H, Neubauer M, Kunz S, Müller-Esch T, Hiergeist A, Gessner A, Khalid D, Gaiser R, Cullin N, Papagiannarou SM, Beuthien-Baumann B, Krämer A, Bartenschlager R, Jäger D, Müller M, Herth F, Duerschmied D, Schneider J, Schmid RM, Eberhardt JF, Khodamoradi Y, Vehreschild MJGT, Teufel A, Ebert MP, Hau P, Salzberger B, Schnitzler P, Poeck H, Elinav E, Merle U, Stein-Thoeringer CK. Severe Dysbiosis and Specific Haemophilus and Neisseria Signatures as Hallmarks of the Oropharyngeal Microbiome in Critically Ill Coronavirus Disease 2019 (COVID-19) Patients. Clin Infect Dis 2021; 75:e1063-e1071. [PMID: 34694375 PMCID: PMC8586732 DOI: 10.1093/cid/ciab902] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND At the entry site of respiratory virus infections, the oropharyngeal microbiome has been proposed as a major hub integrating viral and host immune signals. Early studies suggested that infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are associated with changes of the upper and lower airway microbiome, and that specific microbial signatures may predict coronavirus disease 2019 (COVID-19) illness. However, the results are not conclusive, as critical illness can drastically alter a patient's microbiome through multiple confounders. METHODS To study oropharyngeal microbiome profiles in SARS-CoV-2 infection, clinical confounders, and prediction models in COVID-19, we performed a multicenter, cross-sectional clinical study analyzing oropharyngeal microbial metagenomes in healthy adults, patients with non-SARS-CoV-2 infections, or with mild, moderate, and severe COVID-19 (n = 322 participants). RESULTS In contrast to mild infections, patients admitted to a hospital with moderate or severe COVID-19 showed dysbiotic microbial configurations, which were significantly pronounced in patients treated with broad-spectrum antibiotics, receiving invasive mechanical ventilation, or when sampling was performed during prolonged hospitalization. In contrast, specimens collected early after admission allowed us to segregate microbiome features predictive of hospital COVID-19 mortality utilizing machine learning models. Taxonomic signatures were found to perform better than models utilizing clinical variables with Neisseria and Haemophilus species abundances as most important features. CONCLUSIONS In addition to the infection per se, several factors shape the oropharyngeal microbiome of severely affected COVID-19 patients and deserve consideration in the interpretation of the role of the microbiome in severe COVID-19. Nevertheless, we were able to extract microbial features that can help to predict clinical outcomes.
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Affiliation(s)
- Juliana de Castilhos
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany,Vale do Rio dos Sinos University (UNISINOS), Sao Leopoldo, Brazil
| | - Eli Zamir
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Gastroenterology and Infectious Diseases, University Clinic Heidelberg, Heidelberg, Germany
| | - Roman Rohrbach
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Sabine Schmidt
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Silvana Hengler
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Hanna Schumacher
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Melanie Neubauer
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabrina Kunz
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany
| | - Tonia Müller-Esch
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Clinical Microbiology and Hygiene, University Clinic Regensburg, Regensburg, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, University Clinic Regensburg, Regensburg, Germany
| | - Dina Khalid
- Department of Virology, University Clinic Heidelberg, Heidelberg, Germany
| | - Rogier Gaiser
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Nyssa Cullin
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | - Stamatia M Papagiannarou
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany
| | | | - Alwin Krämer
- German Cancer Research Center (DKFZ), Research Division Molecular Hematology/Oncology, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Heidelberg, Germany,German Cancer Research Center (DKFZ), Research Division Virus-associated Carcinogenesis, Heidelberg
| | - Dirk Jäger
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Michael Müller
- Thoraxklinik and Translational Lung Research Center, Heidelberg University, Heidelberg, Germany
| | - Felix Herth
- Thoraxklinik and Translational Lung Research Center, Heidelberg University, Heidelberg, Germany
| | - Daniel Duerschmied
- Department of Internal Medicine III, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johann F Eberhardt
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Andreas Teufel
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, and Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, Section of Hepatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, and Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit and Department of Neurology, University Clinic Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infectious Disease, University Clinic Regensburg, Regensburg, Germany
| | - Paul Schnitzler
- Department of Virology, University Clinic Heidelberg, Heidelberg, Germany
| | - Hendrik Poeck
- Department of Internal Medicine III, University Clinic Regensburg, Regensburg, Germany,National Center for Tumor Diseases (NCT) WERA
| | - Eran Elinav
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany,Weizmann Institute of Science, Rehovot, Israel
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, University Clinic Heidelberg, Heidelberg, Germany
| | - Christoph K Stein-Thoeringer
- German Cancer Research Center (DKFZ), Research Division Microbiome and Cancer, Heidelberg, Germany,National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany,Corresponding author: Christoph K. Stein-Thoeringer, MD, Microbiome and Cancer Research Division, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany,
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35
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Triphan SMF, Weinheimer O, Gutberlet M, Heußel CP, Vogel‐Claussen J, Herth F, Vogelmeier CF, Jörres RA, Kauczor H, Wielpütz MO, Biederer J, Jobst BJ. Echo
Time‐Dependent
Observed Lung
T
1
in Patients With Chronic Obstructive Pulmonary Disease in Correlation With Quantitative Imaging and Clinical Indices. J Magn Reson Imaging 2021. [DOI: 10.1002/jmri.27235] [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: 11/09/2022] Open
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36
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Mathioudakis AG, Tsilochristou O, Adcock IM, Bikov A, Bjermer L, Clini E, Flood B, Herth F, Horvath I, Kalayci O, Papadopoulos NG, Ryan D, Sanchez Garcia S, Correia-de-Sousa J, Tonia T, Pinnock H, Agache I, Janson C. ERS/EAACI statement on adherence to international adult asthma guidelines. Eur Respir Rev 2021; 30:30/161/210132. [PMID: 34526316 DOI: 10.1183/16000617.0132-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022] Open
Abstract
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK .,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,These authors were Task Force Co-chairs and are equal authors
| | - Olympia Tsilochristou
- Dept of Allergy, Guy's and St Thomas' Foundation Trust, London, UK.,Peter Gorer Dept of Immunobiology, King's College London, London, UK.,These authors were Task Force Co-chairs and are equal authors
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London and the NIHR Imperial Biomedical Research Centre, London, UK
| | - Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Enrico Clini
- Dept of Medical Specialities, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy
| | - Breda Flood
- European Federation of Allergy and Airways Diseases Patients Association (EFA), Dublin, Ireland
| | - Felix Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ildiko Horvath
- National Koranyi Institute for Pulmonology, Budapest, Hungary.,Institute of Public Health, Semmelweis University, Budapest, Hungary
| | - Omer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,Allergy Dept, Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Dermot Ryan
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Guimarães, Portugal
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hillary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ioana Agache
- Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.,These authors were Task Force Co-chairs and are equal authors
| | - Christer Janson
- Dept of Medical Science, Respiratory, Allergy and Sleep Research, Uppsala University and University Hospital, Uppsala, Sweden.,These authors were Task Force Co-chairs and are equal authors
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37
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Kahnert K, Trudzinski FC, Bickert C, Munker D, Milger K, Irlbeck M, Tomasi R, Schneider C, Michel S, Herth F, Behr J, Jörres R, Kneidinger N. Oxygenated hemoglobin predicts outcome in patients with chronic lung allograft dysfunction. Transplantation 2021. [DOI: 10.1183/13993003.congress-2021.oa2915] [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: 11/05/2022]
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38
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Kahnert K, Lutter JI, Welte T, Alter P, Behr J, Herth F, Kauczor HU, Söhler S, Pfeifer M, Watz H, Vogelmeier CF, Bals R, Jörres RA, Trudzinski FC. Impact of the COVID-19 pandemic on the behaviour and health status of patients with COPD: results from the German COPD cohort COSYCONET. ERJ Open Res 2021; 7:00242-2021. [PMID: 34430659 PMCID: PMC8287574 DOI: 10.1183/23120541.00242-2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Infection control measures for coronavirus disease 2019 (COVID-19) might have affected management and clinical state of patients with COPD. We analysed to which extent this common notion is fact-based. Methods: Patients of the COSYCONET cohort were contacted with three recurring surveys (COVID1, 2 and 3 at 0, 3 and 6 months, respectively). The questionnaires comprised behaviour, clinical and functional state, and medical treatment. The responses to the questionnaires were compared amongst themselves and with pre-COVID information from the last visit of COSYCONET. Results: Overall, 594 patients were contacted and 375 patients (58% males, forced expiratory volume in 1 s (FEV1) 61±22% predicted) provided valid data in COVID1 and COVID2. Five patients reported infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most patients – except for patients with higher education – reported compliance with recommended protective measures, whereby compliance to hygiene, contact and access to physicians slightly improved between COVID1 and COVID2. Also, patients obtained more information from physicians than from public media. In the majority of cases, the personal physician could not be substituted by remote consultation. Over time, symptoms slightly increased and self-assessed physical capacity decreased. Results of COVID3 were similar. Women and patients with more exacerbations and dyspnoea avoided medical consultations, whereas Global Initiative for Chronic Obstructive Lung Disease (GOLD) D patients were more amenable to tele-consultation. Conclusion: In well-characterised COPD patients, we observed on average slight deteriorations of clinical state during the period of COVID-19 restrictions, with high and partially increasing adherence to protective measures. The data suggest that in particular, women and GOLD D patients should be actively contacted by physicians to identify deteriorations. During the period of #COVID19 restrictions, slight deteriorations of clinical state with increasing adherence to protective measures were observed. In particular, women and GOLD D patients are at risk of deterioration.https://bit.ly/2S7fhEo
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Affiliation(s)
- Kathrin Kahnert
- Dept of Medicine V, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, CPC-M, DZL, Munich, Germany
| | - Tobias Welte
- Dept of Pneumology, Hannover Medical School, Hannover, Germany
| | - Peter Alter
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Jürgen Behr
- Dept of Medicine V, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Felix Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), DZL, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, DZL, Heidelberg, Germany
| | - Sandra Söhler
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Michael Pfeifer
- Dept of Respiratory Medicine, Donaustauf Hospital, Regensburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), DZL, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU, LMU University Hospital, CPC-M, DZL, Munich, Germany
| | - Franziska C Trudzinski
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), DZL, Heidelberg, Germany
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39
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Herrmann Y, Starck T, Brindl N, Kitchen PJ, Rädeker L, Sebastian J, Köppel L, Tobian F, Souares A, Mihaljevic AL, Merle U, Hippchen T, Herth F, Knorr B, Welker A, Denkinger CM. Description and analysis of representative COVID-19 cases-A retrospective cohort study. PLoS One 2021; 16:e0255513. [PMID: 34329364 PMCID: PMC8323911 DOI: 10.1371/journal.pone.0255513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Most data on COVID-19 was collected in hospitalized cases. Much less is known about the spectrum of disease in entire populations. In this study, we examine a representative cohort of primarily symptomatic cases in an administrative district in Southern Germany. METHODS We contacted all confirmed SARS-CoV-2 cases in the administrative district. Consenting participants answered a retrospective survey either via a telephone, electronically or via mail. Clinical and sociodemographic features were compared between hospitalized and non-hospitalized patients. Additionally, we assessed potential risk factors for hospitalization and time to hospitalization in a series of regression models. RESULTS We included 897 participants in our study, 69% out of 1,305 total cases in the district with a mean age of 47 years (range 2-97), 51% of which were female and 47% had a pre-existing illness. The percentage of asymptomatic, mild, moderate (leading to hospital admission) and critical illness (requiring mechanical ventilation) was 54 patients (6%), 713 (79%), 97 (11%) and 16 (2%), respectively. Seventeen patients (2%) died. The most prevalent symptoms were fatigue (65%), cough (62%) and dysgeusia (60%). The risk factors for hospitalization included older age (OR 1.05 per year increase; 95% CI 1.04-1.07) preexisting lung conditions (OR 3.09; 95% CI 1.62-5.88). Female sex was a protective factor (OR 0.51; 95% CI 0.33-0.77). CONCLUSION This representative analysis of primarily symptomatic COVID-19 cases confirms age, male sex and preexisting lung conditions but not cardiovascular disease as risk factors for severe illness. Almost 80% of infection take a mild course, whereas 13% of patients suffer moderate to severe illness. TRIAL REGISTRATION German Clinical Trials Register, DRKS00022926. URL: https://www.drks.de/drks_web/setLocale_EN.do.
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Affiliation(s)
- Yannis Herrmann
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
- * E-mail: (CMD); (YH)
| | - Tim Starck
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Niall Brindl
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Philip J. Kitchen
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Lukas Rädeker
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Jakob Sebastian
- Faculty of Medicine, Ruprecht Karl University of Heidelberg, Heidelberg, Germany
| | - Lisa Köppel
- Division of Tropical Medicine, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Tobian
- Division of Tropical Medicine, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | - Theresa Hippchen
- Department of Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Chest Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | - Britta Knorr
- Department of Public Health, Landratsamt Rhein-Neckar, Heidelberg, Germany
| | - Andreas Welker
- Department of Public Health, Landratsamt Rhein-Neckar, Heidelberg, Germany
| | - Claudia M. Denkinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail: (CMD); (YH)
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40
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Triphan SMF, Weinheimer O, Gutberlet M, Heußel CP, Vogel-Claussen J, Herth F, Vogelmeier CF, Jörres RA, Kauczor HU, Wielpütz MO, Biederer J, Jobst BJ. Echo Time-Dependent Observed Lung T 1 in Patients With Chronic Obstructive Pulmonary Disease in Correlation With Quantitative Imaging and Clinical Indices. J Magn Reson Imaging 2021; 54:1562-1571. [PMID: 34050576 DOI: 10.1002/jmri.27746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a clinical need for imaging-derived biomarkers for the management of chronic obstructive pulmonary disease (COPD). Observed pulmonary T1 (T1 (TE)) depends on the echo-time (TE) and reflects regional pulmonary function. PURPOSE To investigate the potential diagnostic value of T1 (TE) for the assessment of lung disease in COPD patients by determining correlations with clinical parameters and quantitative CT. STUDY TYPE Prospective non-randomized diagnostic study. POPULATION Thirty COPD patients (67.7 ± 6.6 years). Data from a previous study (15 healthy volunteers [26.2 ± 3.9 years) were used as reference. FIELD STRENGTH/SEQUENCE Study participants were examined at 1.5 T using dynamic contrast-enhanced three-dimensional gradient echo keyhole perfusion sequence and a multi-echo inversion recovery two-dimensional UTE (ultra-short TE) sequence for T1 (TE) mapping at TE1-5 = 70 μsec, 500 μsec, 1200 μsec, 1650 μsec, and 2300 μsec. ASSESSMENT Perfusion images were scored by three radiologists. T1 (TE) was automatically quantified. Computed tomography (CT) images were quantified in software (qCT). Clinical parameters including pulmonary function testing were also acquired. STATISTICAL TESTS Spearman rank correlation coefficients (ρ) were calculated between T1 (TE) and perfusion scores, clinical parameters and qCT. A P-value <0.05 was considered statistically significant. RESULTS Median values were T1 (TE1-5 ) = 644 ± 78 msec, 835 ± 92 msec, 835 ± 87 msec, 831 ± 131 msec, 893 ± 220 msec, all significantly shorter than previously reported in healthy subjects. A significant increase of T1 was observed from TE1 to TE2 , with no changes from TE2 to TE3 (P = 0.48), TE3 to TE4 (P = 0.94) or TE4 to TE5 (P = 0.02) which demonstrates an increase at shorter TEs than in healthy subjects. Moderate to strong Spearman's correlations between T1 and parameters including the predicted diffusing capacity for carbon monoxide (DLCO, ρ < 0.70), mean lung density (MLD, ρ < 0.72) and the perfusion score (ρ > -0.69) were found. Overall, correlations were strongest at TE2 , weaker at TE1 and rarely significant at TE4 -TE5 . DATA CONCLUSION In COPD patients, the increase of T1 (TE) with TE occurred at shorter TEs than previously found in healthy subjects. Together with the lack of correlation between T1 and clinical parameters of disease at longer TEs, this suggests that T1 (TE) quantification in COPD patients requires shorter TEs. The TE-dependence of correlations implies that T1 (TE) mapping might be developed further to provide diagnostic information beyond T1 at a single TE. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Simon M F Triphan
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Member of the German Center for Lung Research, Hannover, Germany
| | - Claus P Heußel
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Member of the German Center for Lung Research, Hannover, Germany
| | - Felix Herth
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.,Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Bertram J Jobst
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Lung Research Center, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
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Kazdal D, Rempel E, Oliveira C, Allgäuer M, Harms A, Singer K, Kohlwes E, Ormanns S, Fink L, Kriegsmann J, Leichsenring M, Kriegsmann K, Stögbauer F, Tavernar L, Leichsenring J, Volckmar AL, Longuespée R, Winter H, Eichhorn M, Heußel CP, Herth F, Christopoulos P, Reck M, Muley T, Weichert W, Budczies J, Thomas M, Peters S, Warth A, Schirmacher P, Stenzinger A, Kriegsmann M. Conventional and semi-automatic histopathological analysis of tumor cell content for multigene sequencing of lung adenocarcinoma. Transl Lung Cancer Res 2021; 10:1666-1678. [PMID: 34012783 PMCID: PMC8107748 DOI: 10.21037/tlcr-20-1168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/11/2022]
Abstract
Background Targeted genetic profiling of tissue samples is paramount to detect druggable genetic aberrations in patients with non-squamous non-small cell lung cancer (NSCLC). Accurate upfront estimation of tumor cell content (TCC) is a crucial pre-analytical step for reliable testing and to avoid false-negative results. As of now, TCC is usually estimated on hematoxylin-eosin (H&E) stained tissue sections by a pathologist, a methodology that may be prone to substantial intra- and interobserver variability. Here we the investigate suitability of digital pathology for TCC estimation in a clinical setting by evaluating the concordance between semi-automatic and conventional TCC quantification. Methods TCC was analyzed in 120 H&E and thyroid transcription factor 1 (TTF-1) stained high-resolution images by 19 participants with different levels of pathological expertise as well as by applying two semi-automatic digital pathology image analysis tools (HALO and QuPath). Results Agreement of TCC estimations [intra-class correlation coefficients (ICC)] between the two software tools (H&E: 0.87; TTF-1: 0.93) was higher compared to that between conventional observers (0.48; 0.47). Digital TCC estimations were in good agreement with the average of human TCC estimations (0.78; 0.96). Conventional TCC estimators tended to overestimate TCC, especially in H&E stainings, in tumors with solid patterns and in tumors with an actual TCC close to 50%. Conclusions Our results determine factors that influence TCC estimation. Computer-assisted analysis can improve the accuracy of TCC estimates prior to molecular diagnostic workflows. In addition, we provide a free web application to support self-training and quality improvement initiatives at other institutions.
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Affiliation(s)
- Daniel Kazdal
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Eugen Rempel
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Cristiano Oliveira
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Allgäuer
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Harms
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kerstin Singer
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Elke Kohlwes
- Institute of Pathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Steffen Ormanns
- Institute of Pathology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Ludger Fink
- Institute of Pathology, Cytopathology, and Molecular Pathology, UEGP MVZ, Giessen/Wetzlar/Limburg, Germany
| | - Jörg Kriegsmann
- MVZ for Histology, Cytology and Molecular Diagnostics, Trier, Germany
| | | | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Stögbauer
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Luca Tavernar
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Leichsenring
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Rémi Longuespée
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Eichhorn
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Heußel
- Department of Thoracic Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany.,Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Herth
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Pulmonology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Petros Christopoulos
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Reck
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Thomas Muley
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Jan Budczies
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Institute of Pathology, Cytopathology, and Molecular Pathology, UEGP MVZ, Giessen/Wetzlar/Limburg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Center for Personalized Medicine Heidelberg (ZPM), Heidelberg, Germany.,National Network Genomic Medicine Heidelberg (nNGM), Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
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Clementsen PF, Bodtger U, Konge L, Christiansen IS, Nessar R, Salih GN, Kolekar S, Meyer CN, Colella S, Jenssen C, Herth F, Hocke M, Dietrich CF. Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide. Endosc Ultrasound 2021; 10:325-334. [PMID: 33666182 PMCID: PMC8544013 DOI: 10.4103/eus-d-20-00139] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.
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Affiliation(s)
- Paul Frost Clementsen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Respiratory Medicine, Næstved Hospital, Næstved; Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida Skovgaard Christiansen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rafi Nessar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Shailesh Kolekar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Christian Niels Meyer
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sara Colella
- Pulmonology Unit, "C.G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg Heidelberg, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Mountzios G, Samantas E, Senghas K, Zervas E, Krisam J, Samitas K, Bozorgmehr F, Kuon J, Agelaki S, Baka S, Athanasiadis I, Gaissmaier L, Elshiaty M, Daniello L, Christopoulou A, Pentheroudakis G, Lianos E, Linardou H, Kriegsmann K, Kosmidis P, El Shafie R, Kriegsmann M, Psyrri A, Andreadis C, Fountzilas E, Heussel C, Herth F, Winter H, Emmanouilidis C, Oikonomopoulos G, Meister M, Muley T, Bischoff H, Saridaki Z, Razis E, Perdikouri E, Stenzinger A, Boukovinas I, Reck M, Syrigos K, Thomas M, Christopoulos P. P75.04 Advanced Lung Cancer Inflammation Index (ALI), Neutrophil-to-Lymphocyte Ratio (NLR), and PD-(L)1 Inhibitor Efficacy in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1038] [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: 10/21/2022]
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Zylla MM, Merle U, Vey JA, Korosoglou G, Hofmann E, Müller M, Herth F, Schmidt W, Blessing E, Göggelmann C, Weidner N, Fiedler MO, Weigand MA, Kälble F, Morath C, Leiner J, Kieser M, Katus HA, Thomas D. Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19. J Clin Med 2021; 10:jcm10010133. [PMID: 33401735 PMCID: PMC7796041 DOI: 10.3390/jcm10010133] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 11/26/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiac manifestation of COVID-19 has been reported during the COVID pandemic. The role of cardiac arrhythmias in COVID-19 is insufficiently understood. This study assesses the incidence of cardiac arrhythmias and their prognostic implications in hospitalized COVID-19-patients. METHODS A total of 166 patients from eight centers who were hospitalized for COVID-19 from 03/2020-06/2020 were included. Medical records were systematically analyzed for baseline characteristics, biomarkers, cardiac arrhythmias and clinical outcome parameters related to the index hospitalization. Predisposing risk factors for arrhythmias were identified. Furthermore, the influence of arrhythmia on the course of disease and related outcomes was assessed using univariate and multiple regression analyses. RESULTS Arrhythmias were detected in 20.5% of patients. Atrial fibrillation was the most common arrhythmia. Age and cardiovascular disease were predictors for new-onset arrhythmia. Arrhythmia was associated with a pronounced increase in cardiac biomarkers, prolonged hospitalization, and admission to intensive- or intermediate-care-units, mechanical ventilation and in-hospital mortality. In multiple regression analyses, incident arrhythmia was strongly associated with duration of hospitalization and mechanical ventilation. Cardiovascular disease was associated with increased mortality. CONCLUSIONS Arrhythmia was the most common cardiac event in association with hospitalization for COVID-19. Older age and cardiovascular disease predisposed for arrhythmia during hospitalization. Whereas in-hospital mortality is affected by underlying cardiovascular conditions, arrhythmia during hospitalization for COVID-19 is independently associated with prolonged hospitalization and mechanical ventilation. Thus, incident arrhythmia may indicate a patient subgroup at risk for a severe course of disease.
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Affiliation(s)
- Maura M. Zylla
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-35183
| | - Uta Merle
- Department of Gastroenterology, Hepatology and Infectious Disease, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;
| | - Johannes A. Vey
- Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.A.V.); (M.K.)
| | - Grigorios Korosoglou
- GRN Klinikum Weinheim, Klinik für Kardiologie, Angiologie und Pneumologie, Röntgenstraße 1, 69469 Weinheim, Germany;
| | - Eva Hofmann
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
| | - Michael Müller
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
- German Center for Lung Research (DZL)Translational Lung Resarch Center (TLRCH), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Felix Herth
- Department of Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany; (M.M.); (F.H.)
- German Center for Lung Research (DZL)Translational Lung Resarch Center (TLRCH), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Werner Schmidt
- Department of Anaesthesiology, Intensive Care, Pain Therapy, Thoraxklinik, Heidelberg University Hospital, Röntgenstr. 1, 69126 Heidelberg, Germany;
| | - Erwin Blessing
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Innere Medizin, Guttmannstraße 1, 76307 Karlsbad, Germany;
| | - Christoph Göggelmann
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany;
| | - Mascha O. Fiedler
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (M.O.F.); (M.A.W.)
| | - Markus A. Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; (M.O.F.); (M.A.W.)
| | - Florian Kälble
- Nierenzentrum Heidelberg, Department of Nephrology, Heidelberg University Hospital, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany; (F.K.); (C.M.)
| | - Christian Morath
- Nierenzentrum Heidelberg, Department of Nephrology, Heidelberg University Hospital, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany; (F.K.); (C.M.)
| | - Johannes Leiner
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (J.A.V.); (M.K.)
| | - Hugo A. Katus
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (E.H.); (C.G.); (J.L.); (H.A.K.); (D.T.)
- German Center for Cardiovascular Research (DZHK), Partner site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Heidelberg Center for Heart Rhythm Disorders (HCR), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Haidl P, Jany B, Geiseler J, Andreas S, Arzt M, Dreher M, Frey M, Hauck RW, Herth F, Hämäläinen N, Jehser T, Kenn K, Lamprecht B, Magnet F, Oldenburg O, Schenk P, Schucher B, Studnicka M, Voshaar T, Windisch W, Woehrle H, Worth H. [Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]. Pneumologie 2020; 74:813-841. [PMID: 33291162 DOI: 10.1055/a-1252-1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.
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Affiliation(s)
- P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - B Jany
- Klinikum Würzburg Mitte (KWM), Klinik für Innere Medizin, Pneumologie und Beatmungsmedizin, Standort MissioKlinik, Würzburg
| | - J Geiseler
- Klinikum Vest, Medizinische Klinik IV: Pneumologie, Beatmungs- und Schlafmedizin, Marl
| | - S Andreas
- Lungenfachklinik Immenhausen, Universitätsmedizin Göttingen, Immenhausen
| | - M Arzt
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - M Dreher
- Universitätsklinikum Aachen, Klinik für Pneumologie und Internistische Intensivmedizin, Aachen
| | - M Frey
- Klinik Barmelweid, Rombach, Schweiz
| | - R W Hauck
- Klinikum Altötting, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Altötting
| | - F Herth
- Thoraxklinik, Abteilung für Pneumologie und Beatmungsmedizin, Universität Heidelberg, Heidelberg
| | | | - T Jehser
- Gemeinschaftskrankenhaus Havelhöhe, Palliativstation, Berlin
| | - K Kenn
- Philips Universität Marburg, Lehrstuhl für pneumologische Rehabilitation, Marburg
| | - B Lamprecht
- Kepler Universitätsklinikum, Med Campus III, Linz, Österreich
| | - F Magnet
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Fakultät für Gesundheit - Department für Humanmedizin, Köln
| | - O Oldenburg
- Clemenshospital, Klinik für Kardiologie, Münster
| | - P Schenk
- Landesklinikum Hochegg, Abteilung für Pulmologie, Grimmenstein, Österreich
| | - B Schucher
- LungenClinic Grosshansdorf, Großhansdorf
| | - M Studnicka
- Landeskrankenhaus Salzburg, Universitätsklinikum der PMU, Universitätsklinik für Pneumologie, Salzburg, Österreich
| | - T Voshaar
- Krankenhaus Bethanien Lungenzentrum, Medizinische Klinik III, Moers
| | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Fakultät für Gesundheit - Department für Humanmedizin, Köln
| | | | - H Worth
- Facharztzentrum Fürth, Fürth
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Herth F, Hohlfeld JM, Haas J, de la Hoz A, Jin X, Kreitner KF, Vogelmeier C, Vogel-Claussen J, Watz H. The effect of tiotropium/olodaterol versus fluticasone propionate/salmeterol on left ventricular filling and lung hyperinflation in patients with COPD. BMJ Open Respir Res 2020; 7:7/1/e000741. [PMID: 33268341 PMCID: PMC7713210 DOI: 10.1136/bmjresp-2020-000741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022] Open
Abstract
This exploratory, randomised, double-blind, double-dummy, multicentre, cross-over study explored the effect of 6 weeks of treatment with tiotropium/olodaterol (T/O) versus fluticasone propionate/salmeterol (F/S) on left ventricular filling in patients with chronic obstructive pulmonary disease with functional residual capacity (FRC) >120% predicted and postbronchodilator improvement of FRC ≥7.5%. Overall, 76 patients were randomised across nine sites. Treatment with T/O or F/S increased left ventricular end-diastolic volume index from baseline (adjusted mean change: T/O: 2.317 mL/m2, F/S: 2.855 mL/m2), with no statistically significant difference between treatments. However, T/O resulted in a significantly greater reduction in lung hyperinflation versus F/S (FRC plethysmography absolute change from baseline: F/S: –0.329 L, T/O: –0.581 L).
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Affiliation(s)
- Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik-Heidelberg GmbH, Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Jens M Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | - Alberto de la Hoz
- TA CardioMetabolism Respiratory Medicine, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Xidong Jin
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut, USA
| | | | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Marburg, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf GmbH, Airway Research Centre North (ARCN), Grosshansdorf, Germany
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Brock JM, Billeter A, Müller-Stich BP, Herth F. Obesity and the Lung: What We Know Today. Respiration 2020; 99:856-866. [PMID: 33242862 DOI: 10.1159/000509735] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity is becoming more and more prevalent especially in Western industrial nations. The understanding of adipose tissue as an endocrine organ as well as the detection of adipocytokines - hormones that are secreted from the adipose tissue - gave reason to examine the interactions between adipose tissue and target organs. These efforts have been intensified especially in the context of bariatric surgery as promising weight loss therapy. Interactions between the lung and adipose tissue have rarely been investigated and are not well understood. There are obvious mechanical effects of obesity on lung function explaining the associations between obesity and lung diseases, in particular obesity hypoventilation syndrome, obstructive sleep apnea syndrome, asthma, and chronic obstructive pulmonary disease. The rise in the prevalence of obesity affects the epidemiology of pulmonary diseases as well. The aim of this review is to summarize the current knowledge on interactions, associations, and consequences of obesity and weight loss on lung function and lung diseases. Based on these data, areas for future research are identified.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany,
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
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Drick N, Milger K, Seeliger B, Fuge J, Korn S, Buhl R, Schuhmann M, Herth F, Kendziora B, Behr J, Kneidinger N, Bergmann KC, Taube C, Welte T, Suhling H. Switch from IL-5 to IL-5-Receptor α Antibody Treatment in Severe Eosinophilic Asthma. J Asthma Allergy 2020; 13:605-614. [PMID: 33204117 PMCID: PMC7667509 DOI: 10.2147/jaa.s270298] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Anti-IL-5 antibodies represent an established therapy for severe eosinophilic asthma (SEA), but some patients show inadequate response. The objective of this study was to assess the effects of a switch to anti-IL-5Rα therapy in patients with inadequate response to anti-IL-5 therapy. Methods In this retrospective multi-centre, real-life study, we analysed all SEA patients switched from anti-IL-5 to anti-IL-5Rα therapy due to inadequate response or intolerability. Pulmonary function tests, blood gas analyses, asthma control tests (ACT) and oral corticosteroid (OCS) usage were analysed and compared at three timepoints: baseline (BL, before anti-IL-5 therapy), timepoint 1 (T1, under anti-IL-5 therapy) and timepoint 2 (T2, under anti-IL-5Rα therapy). Results Of 665 patients treated with anti-IL-5 antibodies, 70 were switched to anti-IL-5Rα and 60 were included in the analysis. Median treatment duration was 8 months [IQR 5; 15] for anti-IL-5 and 5 months [IQR 4; 6] for anti-IL-5Rα therapy. FEV1 was 61% of predicted at BL [IQR 41; 74], 61% [IQR 43; 79] at T1 and 68% [IQR 49; 87] at T2 (pT1-T2=0.011). ACT score was 10 [IQR 8; 13], 16 [IQR 10; 19] and 19 [IQR 14; 22], respectively (both p<0.001). The number of patients requiring OCS was reduced from 41 (BL) to 32 (T1) and 19 (T2) (both p<0.001). Ten patients discontinued anti-IL-5Rα therapy due to insufficient efficacy (n=7) and adverse events (n=3). Conclusion Switching from anti-IL-5 to anti-IL-5Rα therapy in patients with inadequate response was associated with significantly improved FEV1, asthma control and OCS reduction.
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Affiliation(s)
- Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Stephanie Korn
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Maren Schuhmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Kendziora
- Allergy-Centre-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juergen Behr
- Department of Internal Medicine V, Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilians University of Munich (LMU), Munich, Germany
| | | | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Essen, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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Yoneda KY, Herth F, Spangler T, Raina S, Panescu D. Long-term Survival Results following Endobronchial RF Ablation in a Healthy-Porcine Model. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5252-5258. [PMID: 33019169 DOI: 10.1109/embc44109.2020.9176238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents results from long-term survival study where healthy swine were ablated with a novel technology designed for treating early-stage non-small cell lung cancer using an endobronchial flexible catheter.Methods - The radiofrequency ablation (RFA) system has been presented previously and consisted of an ablation catheter, radiofrequency generator, irrigation pump for infusion of hypertonic saline (HS) and a laptop. The catheter carried an occlusion balloon, a 5 mm long RF electrode, with irrigation holes, and a 1 mm long electrode for bipolar impedance measurements. The outer diameter (OD) was 1.4 mm for compatibility with current bronchoscopes, navigation systems and radial EBUS. Nine swine were treated in this study with survival times of 1, 4 and 12 weeks (N=3 at each time point). In all animals, the treatment sites consisted of one location in the upper right lung (RUL) and another one in the lower right lung (RLL). CTs were taken pre-op, immediately post-op and at every 2 weeks post treatment. Ablation times ranged from 6 to 8 min and average applied power was 68 W (range 63 - 72 W).Results - At 1-week survival, large zones of necrotic tissue were observed in all respective 6 ablations. Ablation volumes had an average diameter of 3.2 cm at RUL locations and 3.8 cm in RLLs (likely due to longer RLL ablation durations). As time progressed, the necrotic tissue was gradually replaced with fibrotic tissue. At 4-week survival, the replacement was almost complete in all respective 3 animals. As a result, ablation volumes decreased to an average diameter of 1.3 cm at RUL locations and 2.3 cm in RLLs (likely due to longer RLL ablation durations). At 12-week survival, as the replacement process continued, histopathology revealed zones of residual necrotic tissue that were further reduced in size. Ablation zones had been resorbed and contracted by fibrous scar tissue. The average volume of the treatment effect decreased to 1.1 cm (RUL) and to 1.6 cm (RLL) in equivalent diameter. There were no complications in any of the nine animals.Conclusion - In healthy swine lungs, RFA with a 1.4-mm OD, radial-EBUS-sheath-compatible, endobronchial catheter was effective and safe. This system and therapeutic approach may be considered for further evaluation in minimally invasive treatment of tumorous lung nodules.
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