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Nikolaev KO, Lake SR, Schmidt G, Demokritov SO, Demidov VE. Resonant generation of propagating second-harmonic spin waves in nano-waveguides. Nat Commun 2024; 15:1827. [PMID: 38418458 PMCID: PMC10902293 DOI: 10.1038/s41467-024-46108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
Generation of second-harmonic waves is one of the universal nonlinear phenomena that have found numerous technical applications in many modern technologies, in particular, in photonics. This phenomenon also has great potential in the field of magnonics, which considers the use of spin waves in magnetic nanostructures to implement wave-based signal processing and computing. However, due to the strong frequency dependence of the phase velocity of spin waves, resonant phase-matched generation of second-harmonic spin waves has not yet been achieved in practice. Here, we show experimentally that such a process can be realized using a combination of different modes of nano-sized spin-wave waveguides based on low-damping magnetic insulators. We demonstrate that our approach enables efficient spatially-extended energy transfer between interacting waves, which can be controlled by the intensity of the initial wave and the static magnetic field.
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Affiliation(s)
- K O Nikolaev
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany
| | - S R Lake
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
| | - G Schmidt
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
- Interdisziplinäres Zentrum für Materialwissenschaften, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
| | - S O Demokritov
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany.
| | - V E Demidov
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, 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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Zhang SC, Schmidt G, Paquette RL, Hakimian B, Ballas LK. Real World Utilization of Cranial or Craniospinal Radiation in Adult Acute Lymphoid Leukemia Patients: Data from the Center for International Blood and Marrow Transplant Research. Int J Radiat Oncol Biol Phys 2023; 117:e496-e497. [PMID: 37785563 DOI: 10.1016/j.ijrobp.2023.06.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Though CNS involvement at diagnosis in adult acute lymphoid leukemia (ALL) is relatively rare (3-7%), >50 % of patients will develop CNS relapse without CNS-directed therapy. Radiation therapy is commonly used as part of stem cell transplant (SCT) conditioning. Historically, a cranial boost was given to reduce risk of CNS relapse. While a CNS boost is not a universal part of prophylaxis, CNS directed RT is used in patients at highest risk for CNS relapse following transplantation, typically those with CNS disease at diagnosis or after induction. There is little data on real world utilization of CNS directed radiation as part of SCT for adult ALL patients. MATERIALS/METHODS The Center for International Blood and Marrow Transplant Research (CIBMTR) database was queried for adult ALL patients undergoing SCT between 2013 - 2019 who received TBI as part of their regimen where data was available on CNS directed RT. Patient demographics, pre-transplant response to induction, CNS status pre/post-transplant, and overall survival information were collected. Results were stratified by cranial irradiation (CNS-RT), craniospinal irradiation (CSI), or no cranial RT (nCRT). Radiation dose is not collected by the CIBMTR. The data presented here are preliminary and were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research. The analysis has not been reviewed or approved by the Advisory or Scientific Committees of the CIBMTR. RESULTS A total of 1240 patients were identified, of which 59 (5%) received CNS-RT, 2 (0.2%) received CSI, 989 (80%) received nCRT, and 190 (15%) had unknown CNS RT status. Median age was younger in patients receiving CNS-RT (26y, range 19-66y) or CSI (34y, 22-46y) compared to patients receiving nCRT (42y, 18-79y). Patients receiving CNS radiation had more advanced disease at time of transplant (17% requiring 3+ lines of induction before CR vs 50% vs 5%, respectively). 24% of CNS-RT patients and 50% of CSI patients had CNS disease at diagnosis compared to 7% of nCRT patients. 37% of CNS-RT patients and 100% of CSI patients had CNS disease prior to transplant compared to 11% of nCRT patients. Overall survival at 1-5 years was numerically higher with CNS-RT compared to no RT, though 95% confidence intervals overlapped at each follow up point. CONCLUSION Data from the CIBMTR on real world utilization of CNS-RT or CSI in adult ALL patients suggest inconsistent practice patterns with 11% of patients without any cranial RT having CNS disease prior to transplant and 57% of CNS-RT patients having no CNS disease prior to transplant. These data offer an interesting analysis of current CNS radiation practice patterns in the past 10 years for adult ALL patients, though interpretation is limited by the retrospective nature of the study and by significant limitations of available data.
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Affiliation(s)
- S C Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - G Schmidt
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - R L Paquette
- Blood and Marrow Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA
| | - B Hakimian
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - L K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Balalaikins M, Schmidt G, Aksjuta K, Hendrich L, Kairišs K, Sokolovskis K, Valainis U, Zolovs M, Nitcis M. The first comprehensive population size estimations for the highly endangered largest diving beetle Dytiscus latissimus in Europe. Sci Rep 2023; 13:9715. [PMID: 37322014 PMCID: PMC10272167 DOI: 10.1038/s41598-023-36242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Dytiscus latissimus (Coleoptera Dytiscidae) is an endangered diving beetle throughout its range. It is one of the two species of Dytiscidae listed in Annex II of the Habitats Directive, IUCN red list and in many national level legislations and therefore strictly protected. The conservation of endangered species first of all requires an assessment of their population size. Until now, a method has not been developed for estimating the size of D. latissimus populations. The article summarizes the results of two studies carried out independently in Germany and Latvia. Both studies were carried out in one water body used recapture method but with a different spatial placement of traps, which, according to our data, is an important factor in population estimation. We evaluated Jolly-Seber and Schnabel approaches of estimating aquatic beetle's populations and found that confidence intervals obtained by different methods in our research do not differ significantly, but combination of both models provide the most accurate estimates of population dynamics. As part of the study, we concluded that the populations of Dytiscus latissimus are relatively closed, so we accept that the Schnabel estimate shows more accurate data. By fixing the places of capture of each individual, it was found that females live mainly locally, and males actively move within the water body. This aspect indicates the advantage of the spatial placement of traps compared to the use of transects. The results of our study show a significantly higher number of both captured and recaptured males Such a sex ratio may indicate both a greater activity of males and differences in the sex ratio in the population. The study confirmed that environmental changes, such as the water level in a water body, can also significantly affect the result of a population assessment. In the frame of D. latissimus monitoring, to obtain an objective estimation of the species population size we recommend using four traps for each 100 m of water body shoreline with 4-8 censuses, dependently on the recapture rate.
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Affiliation(s)
- M Balalaikins
- DU Nature Studies and Environmental Education Centre, Vienības Str. 13, Daugavpils, 5401, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - G Schmidt
- Independent researcher, Heidelberg, Germany
| | - K Aksjuta
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - L Hendrich
- Department of Entomology, SNSB-Zoologische Staatssammlung München, München, Germany
| | - K Kairišs
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - K Sokolovskis
- Department of Biology, Lund University, Sölvegatan 37, 223 62, Lund, Sweden
| | - U Valainis
- DU Nature Studies and Environmental Education Centre, Vienības Str. 13, Daugavpils, 5401, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - M Zolovs
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia.
- Riga Stradins University, Statistics Unit, Balozu Str. 14, Rīga, 1048, LV, Latvia.
| | - M Nitcis
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
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Kapil A, Shumilov A, Wortmann P, Khelifa S, Chan J, Vandenberghe M, Barker C, Gustavson M, Carroll D, Sade H, Schmidt G. Abstract P6-04-16: ART: Automated Region segmentation of Tumor on HER2-stained breast cancer tissue. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-04-16] [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: 03/06/2023]
Abstract
Abstract
Background Computational pathology-based methods, eg, Quantitative Continuous Scoring (QCS) [Gustavson, SABCS 2020], are built to provide objective and quantitative methods to assess HER2 expression in breast cancer (BC). For accurate HER2 quantification, it is important to exclude non-invasive epithelium from analysis since HER2 overexpression could be more frequent in ductal carcinoma in situ (DCIS) and pleomorphic lobular carcinoma in situ (PLCIS) than in invasive BC [Lari, J Cancer 2011]. Generally, computational pathology-based approaches require experts to delineate the invasive BC regions of interest for analysis and exclude all benign/non-invasive epithelium. Developing a tool that delineates the invasive BC regions automatically without human intervention to avoid subjectivity of manual annotation by pathologists is ideal. We developed a novel, deep-learning–based system, called DualScaleNet, to perform Automated Region segmentation of Tumor (ART) by automatically identifying the invasive BC regions and excluding benign/non-invasive epithelium on HER2-stained digitized images. Identification and diagnosis of these regions, especially the in situ tumors are a challenge as they can mimic benign and invasive lesions causing wrong HER2 evaluation. Additional stains (eg, p63 for myoepithelial cells or laminin for basement membrane) are often required for diagnosis [Pinder, Mod Pathol 2010] but were not available for this study. Methods DualScaleNet works simultaneously on HER2-stained immunohistochemistry (IHC) image patches at 2 different resolutions. The target branch uses a higher resolution RGB image (0.5 μm/pixel) to learn accurate local details; the context branch uses a lower resolution image (4.0 μm/pixel) to incorporate more context in visual learning. The algorithm generates 4 output image layers representing probabilities of 4 classes: invasive tumor, ductal/lobular carcinoma in situ, benign epithelium, and other tissue. The final segmentation result is generated by assigning each image pixel the class with the largest probability value. The algorithm was trained using ground truth (GT) annotations generated by 5 pathologists using 6157 square field of views (FOVs), 200-500 μm in size. These FOVs were collected from 850 whole slide images (WSI), spanning 9 commercial BC sample cohorts stained with different HER2 assays and scanned by several versions of the Aperio AT2 scanner. The samples included a mixture of biopsies and resections and covered different BC histologies and HER2 staining intensities. To evaluate the reproducibility of tumor area detection by human pathologists, an interpathologist comparison in detection of invasive tumor regions was performed using 225 FOVs annotated by multiple pathologists. Results Analysis generated an average Dice/F1 Score of 81.6% among different pathologists for invasive cancer. On the same sample set (independent of the ART training set), the invasive cancer detection by the ART algorithm was on par with human pathologists, achieving a similar average Dice/F1 score of 80.7%. Conclusions Novel deep learning-based ART algorithm provides accurate segmentation of invasive cancer on HER2-stained IHC images. The performance was verified against the GT annotations provided by multiple pathologists. Since the algorithm is trained using annotations from multiple pathologists, it is not possible to generate higher accuracy with computational pathology than is achievable between independent pathologists. Importantly, the same WSI read by the ART will consistently output the exact same tumor region identification result thus removing the inherent human subjectivity and variability, while improving the turnaround time for analysis. This development serves as the necessary foundation upon which a computational pathology-based diagnostic can be built.
Citation Format: Ansh Kapil, Anatoliy Shumilov, Philipp Wortmann, Sihem Khelifa, Jessica Chan, Michel Vandenberghe, Craig Barker, Mark Gustavson, Danielle Carroll, Hadassah Sade, Günter Schmidt. ART: Automated Region segmentation of Tumor on HER2-stained breast cancer tissue [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-04-16.
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Affiliation(s)
- Ansh Kapil
- 1AstraZeneca Computational Pathology GmbH
| | - Anatoliy Shumilov
- 2AstraZeneca Computational Pathology GmbH, Early Oncology, Munich, Germany, München, Bayern, Germany
| | - Philipp Wortmann
- 3AstraZeneca Computational Pathology GmbH, Early Oncology, Munich, Germany
| | - Sihem Khelifa
- 4AstraZeneca Computational Pathology GmbH, Early Oncology, Munich, Germany
| | - Jessica Chan
- 5AstraZeneca Computational Pathology GmbH, Early Oncology, Munich, Germany, Germany
| | - Michel Vandenberghe
- 6AstraZeneca Precision Medicine & Biosamples, Oncology R&D, Cambridge, United Kingdom
| | | | - Mark Gustavson
- 8AstraZeneca Precision Medicine & Biosamples, Oncology R&D, Cambridge, United Kingdom
| | - Danielle Carroll
- 9AstraZeneca Translational Medicine, Early Oncology, Cambridge, United Kingdom
| | | | - Günter Schmidt
- 11AstraZeneca Computational Pathology GmbH, Munich, Bayern, Germany
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Failmezger H, Hessel H, Kapil A, Schmidt G, Harder N. Spatial heterogeneity of cancer associated protein expression in immunohistochemically stained images as an improved prognostic biomarker. Front Oncol 2022; 12:964716. [PMID: 36601480 PMCID: PMC9806230 DOI: 10.3389/fonc.2022.964716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
The identification of new tumor biomarkers for patient stratification before therapy, for monitoring of disease progression, and for characterization of tumor biology plays a crucial role in cancer research. The status of these biomarkers is mostly scored manually by a pathologist and such scores typically, do not consider the spatial heterogeneity of the protein's expression in the tissue. Using advanced image analysis methods, marker expression can be determined quantitatively with high accuracy and reproducibility on a per-cell level. To aggregate such per-cell marker expressions on a patient level, the expression values for single cells are usually averaged for the whole tissue. However, averaging neglects the spatial heterogeneity of the marker expression in the tissue. We present two novel approaches for quantitative scoring of spatial marker expression heterogeneity. The first approach is based on a co-occurrence analysis of the marker expression in neighboring cells. The second approach accounts for the local variability of the protein's expression by tiling the tissue with a regular grid and assigning local spatial heterogeneity phenotypes per tile. We apply our novel scores to quantify the spatial expression of four different membrane markers, i.e., HER2, CMET, CD44, and EGFR in immunohistochemically (IHC) stained tissue sections of colorectal cancer patients. We evaluate the prognostic relevance of our spatial scores in this cohort and show that the spatial heterogeneity scores clearly outperform the marker expression average as a prognostic factor (CMET: p-value=0.01 vs. p-value=0.3).
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Wortmann P, Tan TH, Haneder S, Storti AE, Kapil A, Chesebrough J, Sutton D, Sulikowski M, Lewis A, Koch S, Sweet S, Song Z, Chain D, Kim YJ, Luheshi N, Kinneer K, Cooper ZA, Rebelatto M, Schmidt G, Sade H, Barrett JC. Abstract 452: Development and implementation of image analysis-based Quantitative Continuous Score (QCS) for B7-H4 IHC to understand AZD8205 pharmacodynamics. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Antibody-Drug-Conjugates (ADCs) are biopharmaceutical drugs designed for targeted tumor therapy, meant to improve therapeutic index by restricting drug delivery to tumor cells that express the target antigen. ADCs bind to the target molecule on the cell membrane, which triggers internalization, linker cleavage, and ultimately drug release inside the target cell. Prospective patient selection can be done by quantifying the level of target expression in the tumor using immuno-histochemistry (IHC). However, this process typically involves pathologists and is time consuming, expensive, and prone to human bias. We have developed a supervised deep learning algorithm that segments IHC images of invasive tumor epithelium into individual epithelial cells and their membrane, cytoplasm and nucleus with high accuracy. On unseen test data its performance for epithelial cell detection and segmentation is comparable to the inter-pathologist consensus. With our algorithm, we can describe the target molecule distribution of individual cells in a fully quantitative fashion after using standard IHC methods: we call our approach Quantitative Continuous Score (QCS). We applied QCS to interrogate the mechanism of action of AZD8205, a B7-H4 directed ADC incorporating a novel topoisomerase I linker-warhead. Pharmacodynamic effects were evaluated in vivo, using a human tumor xenograft mouse model and the cell line HT29-huB7-H4 Clone 26, engineered to express human B7-H4. After tumors grew in volume to approximately 250 to 300 mm3, animals were randomized and each mouse received an IV injection of either AZD8205 (1.25, 3.5, or 7 mg/kg) or control articles. Tumors were collected at designated timepoints, fixed in 10% neutral buffered formalin and subsequently embedded into paraffin blocks. IHC and QCS were then used to examine human IgG, γH2AX foci, cleaved caspase-3, and epithelial cell density in tumor samples over time. Using our novel approach we could quantitatively measure the level of AZD8205 bound to tumor cells, with the highest level of ADC on the cell membrane detected at 24-48 hrs. Increased dose levels accelerated the binding kinetics of the drug and led to to a 4- and 3-fold excess of γH2AX and CC-3 respectively, as well as more cells being killed, with up to 2/3 of all epithelial cells dead at the highest dose studied. In summary, we here set the basis for future mechanistic investigation of model systems using computational pathology to improve our understanding of ADC effects. Computational pathology has the potential to determine molecule abundance quantitatively, increase throughput and avoid human bias. Our data implies QCS has the potential to identify patients who may respond to AZD8205, which we will interrogate further and integrate into future clinical studies.
Citation Format: Philipp Wortmann, Tze Heng Tan, Susanne Haneder, Andrea Ennio Storti, Ansh Kapil, Jon Chesebrough, Daniel Sutton, Michal Sulikowski, Arthur Lewis, Sofia Koch, Steve Sweet, Zifeng Song, David Chain, Yeoun Jin Kim, Nadia Luheshi, Krista Kinneer, Zachary A. Cooper, Marlon Rebelatto, Günter Schmidt, Hadassah Sade, J. Carl Barrett. Development and implementation of image analysis-based Quantitative Continuous Score (QCS) for B7-H4 IHC to understand AZD8205 pharmacodynamics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 452.
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Bengel PRF, Kessel B, Schloegl S, Bauer A, Junttila J, Lubinski A, Malik M, Merkely B, Schmidt G, Svendsen JH, Vos MA, Willems R, Sticherling C, Friede T, Zabel M. QRS duration as an independent risk factor for appropriate shocks and mortality in patients with prophylactic implantable cardioverter-defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Community’s 7th Framework Programme FP7/2007-2013
Background
The implantable cardioverter defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death (SCD) in high-risk heart failure patients. However, improvements in risk stratification are necessary to increase the efficiency of ICD use. We performed an analysis of the retrospective EU-CERT-ICD registry with respect to QRS duration and effects of cardiac resynchronisation therapy (CRT) on outcomes.
Methods/Results
A total of 5033 patients (81% males) from 14 European centres had an ICD implanted for primary prophylaxis. Mean age at the time of ICD implantation was 64±11 years and ischemic cardiomyopathy was the underlying pathology in 65% of patients. CRT was used in 43% of the patients. The median follow-up was 2.7 years (IQR 1.4-4.6 years). Predefined primary endpoints were all-cause mortality, first appropriate and first inappropriate shocks. The effect of covariates on the cumulative primary endpoints were assessed through hazard ratios in the Fine and Gray subdistributional hazard models (accounting for the competing risks) stratified by centres.
Because of resynchronization by the device, the analysis considered a different influence of QRS on outcomes in the CRT-D and the ICD groups. We observed an increase in the cumulative incidence of the first appropriate shock with increasing QRS values for patients implanted with only an ICD (HR 1.12 per 10ms increase, p<0.001). In patients with CRT-D, increasing QRS values related to a (statistically non-significant) decrease in the cumulative incidence of the first appropriate shocks (HR 0.96 per 10ms, p=0.299).
Since a wide QRS is an indication for CRT-D therapy, high QRS values cluster among those patients with implanted CRT-D, while among patients with QRS under 130ms standard ICD implantations are more frequent. This can explain the observed increase in the cumulative incidence of the first appropriate shocks for increasing QRS values up to 130ms in the ICD-group and its decrease for increasing QRS values over 130ms in the CRT-D group.
Regarding all-cause mortality, hazard ratios for age, LVEF, NYHA, ICM, AF, diabetes and sex category agreed with the results obtained in previously published meta-analyses.
Increased QRS values are associated with higher mortality in the ICD group (HR 1.09 per 10ms increase, p<0.001), but not in the CRT-D group (HR 0.99 per 10ms increase, p=0.695).
Conclusion
In our study, we confirmed QRS duration as an independent risk factor for appropriate ICD shocks and all-cause mortality in patients with ICD for primary prophylaxis. However, this was only observed in patients with single- or dual-chamber ICD, while there was no correlation in CRT-D patients. The findings suggest that CRT-D exerts a protective effect regarding the occurrence of first appropriate shock and all-cause mortality for patients with QRS values higher than 130 ms and indication for resynchronization.
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Affiliation(s)
- PRF Bengel
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
| | - B Kessel
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S Schloegl
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
| | - A Bauer
- Medical University of Innsbruck, Dept. of Cardiology, Innsbruck, Austria
| | - J Junttila
- Medical Research Center Oulu, Oulu, Finland
| | - A Lubinski
- Medical University of Lodz, Dept. of Cardiology, Lodz, Poland
| | - M Malik
- Imperial College London, National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - G Schmidt
- Technical University of Munich, Med. Klinik und Poliklinik I, Klinikum rechts der Isar, Munich, Germany
| | - JH Svendsen
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - MA Vos
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands (The)
| | - R Willems
- University Hospitals Leuven, Leuven, Belgium
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Friede
- University Medical Center of Gottingen (UMG), Department of Medical Statistics, Goettingen, Germany
| | - M Zabel
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
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Gavriel CG, Dimitriou N, Brieu N, Nearchou IP, Arandjelović O, Schmidt G, Harrison DJ, Caie PD. Assessment of Immunological Features in Muscle-Invasive Bladder Cancer Prognosis Using Ensemble Learning. Cancers (Basel) 2021; 13:cancers13071624. [PMID: 33915698 PMCID: PMC8036815 DOI: 10.3390/cancers13071624] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/03/2023] Open
Abstract
The clinical staging and prognosis of muscle-invasive bladder cancer (MIBC) routinely includes the assessment of patient tissue samples by a pathologist. Recent studies corroborate the importance of image analysis in identifying and quantifying immunological markers from tissue samples that can provide further insight into patient prognosis. In this paper, we apply multiplex immunofluorescence to MIBC tissue sections to capture whole-slide images and quantify potential prognostic markers related to lymphocytes, macrophages, tumour buds, and PD-L1. We propose a machine-learning-based approach for the prediction of 5 year prognosis with different combinations of image, clinical, and spatial features. An ensemble model comprising several functionally different models successfully stratifies MIBC patients into two risk groups with high statistical significance (p value < 1×10-5). Critical to improving MIBC survival rates, our method correctly classifies 71.4% of the patients who succumb to MIBC, which is significantly more than the 28.6% of the current clinical gold standard, the TNM staging system.
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Affiliation(s)
- Christos G. Gavriel
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (I.P.N.); (D.J.H.); (P.D.C.)
- Correspondence:
| | - Neofytos Dimitriou
- School of Computer Science, University of St Andrews, St Andrews KY16 9SX, UK; (N.D.); (O.A.)
| | - Nicolas Brieu
- Definiens GmbH, 80636 Munich, Germany; (N.B.); (G.S.)
| | - Ines P. Nearchou
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (I.P.N.); (D.J.H.); (P.D.C.)
| | - Ognjen Arandjelović
- School of Computer Science, University of St Andrews, St Andrews KY16 9SX, UK; (N.D.); (O.A.)
| | | | - David J. Harrison
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (I.P.N.); (D.J.H.); (P.D.C.)
- NHS Lothian, University Hospitals Division, Edinburgh EH16 4SA, UK
| | - Peter D. Caie
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (I.P.N.); (D.J.H.); (P.D.C.)
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12
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Schmidt G, Gerlinger C, Endrikat J, Gabriel L, Müller C, Baus S, Volk T, Findeklee S, Solomayer EF, Hamza A, Ströder R. Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction. Arch Gynecol Obstet 2021; 304:197-202. [PMID: 33728537 PMCID: PMC8164585 DOI: 10.1007/s00404-021-06016-8] [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: 10/12/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction. Methods Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation. Results The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good). Conclusion Undergraduate student’s medical education can be enhanced by teaching breast US skills.
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Affiliation(s)
- G Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany.
| | - C Gerlinger
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - J Endrikat
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - L Gabriel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - C Müller
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - S Baus
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - T Volk
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- MVZ Fertility Center Hamburg, 20095, Hamburg, Germany
| | - E F Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - A Hamza
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- Department of Gynecology, Obstetrics, Kantonsspital Baden AG, 5404, Baden, Switzerland
| | - R Ströder
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
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Haragan A, Nekolla K, Kapil A, Brieu N, Widmaier M, Budco A, Kanchev I, Testori M, Chan J, Schneider K, Hidalgo Sastre A, Baehner M, Schmidt G, Field J, Davies M, Gosney J. FP07.02 Deep Learning Based Analysis of Multiplex IHC Accurately Interprets PD-L1 and Provides Prognostic Information in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.102] [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: 11/25/2022]
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Müller C, Schmidt G, Juhasz-Böss S, Solomayer EF, Juhasz-Böss I. Neoadjuvant behandelte Brustkrebspatientinnen: Einflussfaktoren auf die pathologische Komplettremission. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Müller
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - G Schmidt
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - S Juhasz-Böss
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - EF Solomayer
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - I Juhasz-Böss
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
- Universitätsklinikum Freiburg, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
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15
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Paepke S, Kiechle M, Karsten M, Blohmer J, Schmidt G, Stassek J, Kühn T, Thill M. SPIO-guided Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer – first monoinstitutional data and perspectives. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pekolj J, Clariá Sánchez R, Salceda J, Maurette RJ, Schelotto PB, Pierini L, Cánepa E, Moro M, Stork G, Resio N, Neffa J, Mc Cormack L, Quiñonez E, Raffin G, Obeide L, Fernández D, Pfaffen G, Salas C, Linzey M, Schmidt G, Ruiz S, Alvarez F, Buffaliza J, Maroni R, Campi O, Bertona C, de Santibañes M, Mazza O, Belotto de Oliveira M, Diniz AL, Enne de Oliveira M, Machado MA, Kalil AN, Pinto RD, Rezende AP, Ramos EJB, Talvane T Oliveira A, Torres OJM, Jarufe Cassis N, Buckel E, Quevedo Torres R, Chapochnick J, Sanhueza Garcia M, Muñoz C, Castro G, Losada H, Vergara Suárez F, Guevara O, Dávila D, Palacios O, Jimenez A, Poggi L, Torres V, Fonseca GM, Kruger JAP, Coelho FF, Russo L, Herman P. Laparoscopic Liver Resection: A South American Experience with 2887 Cases. World J Surg 2020; 44:3868-3874. [PMID: 32591841 DOI: 10.1007/s00268-020-05646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Affiliation(s)
- J Pekolj
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Clariá Sánchez
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Salceda
- Hospital Ramón Santamarina, Tandil, Argentina
| | | | | | - L Pierini
- Clínica Nefrología, Clínica Uruguay, Hospital Iturraspe, Santa Fe, Argentina
| | - E Cánepa
- Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - M Moro
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - G Stork
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - N Resio
- Unidad HPB Sur, General Roca, Argentina
| | - J Neffa
- Hospital Italiano de Mendoza, Mendoza, Argentina
| | | | - E Quiñonez
- Hospital El Cruce, Buenos Aires, Argentina
| | - G Raffin
- Hospital Argerich, Buenos Aires, Argentina
| | - L Obeide
- Hospital Universitario Privado, Córdoba, Argentina
| | - D Fernández
- Clínica Pueyrredón, Mar del Plata, Argentina
| | - G Pfaffen
- Sanatorio Güemes, Buenos Aires, Argentina
| | - C Salas
- Sanatorio 9 de Julio, Santiago del Estero, Argentina, Hospital Centro de Salud, San Miguel de Tucumán, Argentina
| | - M Linzey
- Hospital Angel C. Padilla, San Miguel de Tucumán, Argentina
| | - G Schmidt
- Hospital Escuela Gral, Corrientes, Argentina
| | - S Ruiz
- Clínica Colón, Mar del Plata, Argentina
| | - F Alvarez
- Clínica Reina Fabiola, Hospital Italiano, Córdoba, Argentina
| | | | - R Maroni
- Hospital Papa Francisco, Salta, Argentina
| | - O Campi
- Clínica Regional General Pico, Santa Rosa, Argentina
| | - C Bertona
- Hospital Español, Mendoza, Argentina
| | - M de Santibañes
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - O Mazza
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - A L Diniz
- A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - A N Kalil
- Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde, Porto Alegre, Brazil
| | - R D Pinto
- Hospital Santa Catarina de Blumenau, Blumenau, Brazil
| | | | - E J B Ramos
- Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - O J M Torres
- Hospital Universitario HUUFMA, Hospital São Domingos, UDI Hospital, Fortaleza, Brazil
| | | | - E Buckel
- Clínica Las Condes, Santiago, Chile
| | | | | | | | - C Muñoz
- Hospital de Talca, Talca, Chile
| | | | - H Losada
- Hospital de Temuco, Temuco, Chile
| | - F Vergara Suárez
- Clínica Vida - Fundación Colombiana de Cancerología, Medellin, Colombia
| | - O Guevara
- Instituto Nacional de Cancerologia, Bogotá, Colombia
| | | | | | - A Jimenez
- Hospital Clínicas, Asunción, Paraguay
| | - L Poggi
- Clínica Anglo Americana, Lima, Peru
| | - V Torres
- Hospital Guillermo Almenara ESSALUD, Lima, Peru
| | - G M Fonseca
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - J A P Kruger
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - F F Coelho
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - L Russo
- Hospital Maciel, Casmu, Montevideo, Uruguay
| | - P Herman
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil.
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Meier A, Nekolla K, Hewitt LC, Earle S, Yoshikawa T, Oshima T, Miyagi Y, Huss R, Schmidt G, Grabsch HI. Hypothesis-free deep survival learning applied to the tumour microenvironment in gastric cancer. J Pathol Clin Res 2020; 6:273-282. [PMID: 32592447 PMCID: PMC7578283 DOI: 10.1002/cjp2.170] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
The biological complexity reflected in histology images requires advanced approaches for unbiased prognostication. Machine learning and particularly deep learning methods are increasingly applied in the field of digital pathology. In this study, we propose new ways to predict risk for cancer‐specific death from digital images of immunohistochemically (IHC) stained tissue microarrays (TMAs). Specifically, we evaluated a cohort of 248 gastric cancer patients using convolutional neural networks (CNNs) in an end‐to‐end weakly supervised scheme independent of subjective pathologist input. To account for the time‐to‐event characteristic of the outcome data, we developed new survival models to guide the network training. In addition to the standard H&E staining, we investigated the prognostic value of a panel of immune cell markers (CD8, CD20, CD68) and a proliferation marker (Ki67). Our CNN‐derived risk scores provided additional prognostic value when compared to the gold standard prognostic tool TNM stage. The CNN‐derived risk scores were also shown to be superior when systematically compared to cell density measurements or a CNN score derived from binary 5‐year survival classification, which ignores time‐to‐event. To better understand the underlying biological mechanisms, we qualitatively investigated risk heat maps for each marker which visualised the network output. We identified patterns of biological interest that were related to low risk of cancer‐specific death such as the presence of B‐cell predominated clusters and Ki67 positive sub‐regions and showed that the corresponding risk scores had prognostic value in multivariate Cox regression analyses (Ki67&CD20 risks: hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.15–1.89, p = 0.002; CD20&CD68 risks: HR = 1.33, 95% CI = 1.07–1.67, p = 0.009). Our study demonstrates the potential additional value that deep learning in combination with a panel of IHC markers can bring to the field of precision oncology.
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Affiliation(s)
- Armin Meier
- Image Data Sciences, Definiens GmbH, Munich, Germany
| | | | - Lindsay C Hewitt
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sophie Earle
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's , University of Leeds, Leeds, UK
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Ralf Huss
- Institute of Pathology and Molecular Diagnostic, University Hospital Augsburg, Augsburg, Germany
| | | | - Heike I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's , University of Leeds, Leeds, UK
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Tuthill M, Cappuccini F, Bryant RJ, Poulton I, Pollock E, Carter L, Verrill C, Meier A, Schmidt G, Catto JWF, Evans T, Gillessen S, Protheroe A, Hamdy F, Hill AV, Redchenko I. Phase I/II open label nonrandomized safety and efficacy study of the viral vectored ChAdOx1-MVA 5T4 immunotherapy in combination with PD-1 checkpoint blockade in intermediate-risk localized or locally advanced prostate cancer and advanced metastatic prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3170 Background: Antigen-specific immunotherapy (Sipuleucel-T) is licenced for the treatment for castrate resistant prostate cancer, but has modest clinical efficacy and is complex to administer to patients. New therapeutic antigen-specific approaches are required to generate and sustain therapeutic immune responses against tumour specific antigens in men with early and advanced prostate cancer. We have previously reported immunogenicity and efficacy data of a novel viral vectored vaccines-based immunotherapy based on two replication-deficient viruses, chimpanzee adenovirus (ChAdOx1) and MVA, targeting an oncofetal self-antigen 5T4, administered as a single agent and in combination with anti-PD-1 in mouse tumour models. We tested this immunotherapy alone in a first-in-human trial, VANCE (NCT02390063), in intermediate risk prostate cancer patients. Based on encouraging safety and exceptional T cell immunogenicity of the VANCE study, the phase I/II trial, ADVANCE (NCT03815942) is being undertaken to test the immunotherapy safety and efficacy in combination with PD-1 blockade in intermediate risk disease and metastatic prostate cancer. Methods: Study design: ADVANCE, an open label non-randomised phase I/II study, will recruit 12 patients with intermediate-risk prostate cancer patients (Gleason score ≤ 7, local tumour stage ≤T3c, PSA≤ 20 ng/ml) scheduled to undergo radical prostatectomy (Cohort 1) and 24 mCRPC patients with disease progression on anti-androgen therapy with either enzalutamide or abiraterone (Cohort 2). Cohort 1 will receive one cycle of ChAdOx1-MVA 5T4 immunotherapy and a single nivolumab infusion. Cohort 2 will receive 2 cycles of ChAdOx1-MVA 5T4 vaccination and three nivolumab infusions. Primary endpoint: Cohort 1 - PSA change from baseline to surgery, Cohort 2 – composite response rate measured as either ≥50% reduction of circulating tumour DNA or ≥50% serum PSA decrease from baseline at 24-week assessment and the maximal response rate. Secondary and exploratory endpoints include 5T4-specific immune response in the periphery, progression-free and overall survival and reduction of circulating tumour cells. 23 of planned 24 patients have been enrolled in Cohort 2. Enrolment to the Cohort 1 is ongoing. The data analysis is expected to be completed by Q4 2020 for Cohort 2. Clinical trial information: NCT03815942 .
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Affiliation(s)
- Mark Tuthill
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | | | - Richard John Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Ian Poulton
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Emily Pollock
- Department of Immunobiology, Guy's Hospital, London, United Kingdom
| | - Lucy Carter
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | | | | | - James WF Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Tom Evans
- Vaccitech ltd, Oxford, United Kingdom
| | | | | | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Adrian V.S. Hill
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Irina Redchenko
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
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DiGuardo M, Krull A, Dietz A, Soiney K, Chicos A, Wayne J, Skaer C, Wadewitz M, Bowler C, Schmidt G, Stubbs J, Jacob E. The Mayo Clinic Cellular Therapy Fellowship: Training the Next Generation of Cellular Therapy Leaders. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Lobmaier SM, Müller A, Zelgert C, Shen C, Su PC, Schmidt G, Haller B, Berg G, Fabre B, Weyrich J, Wu HT, Frasch MG, Antonelli MC. Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. Arch Gynecol Obstet 2019; 301:405-414. [PMID: 31781889 DOI: 10.1007/s00404-019-05390-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/14/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. METHODS Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth. RESULTS 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001]. CONCLUSION Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. TRIAL REGISTRATION Clinical trial registration: NCT03389178.
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Affiliation(s)
- Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - A Müller
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - C Zelgert
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Shen
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - P C Su
- Department of Mathematics, Duke University, Durham, NC, 27705, USA
| | - G Schmidt
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Buenos Aires, Argentina
| | - G Berg
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Facultad de Farmacia Y Bioquímica, Buenos Aires, Argentina
| | - B Fabre
- Facultad de Farmacia Y Bioquímica. Instituto de Fisiopatología Y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J Weyrich
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - H T Wu
- Department of Mathematics, Duke University, Durham, NC, 27705, USA.,Department of Statistical Science, Duke University, Durham, NC, 27705, USA.,Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - M G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - M C Antonelli
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Instituto de Biología Celular Y Neurociencia "Prof. E. De Robertis", Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Groher M, Zimmermann J, Musa H, Ackermann A, Surace M, Rodriguez-Canales J, Rebelatto M, Steele K, Kapil A, Brieu N, Rognoni L, Segerer F, Spitzmüller A, Tan TH, Schäpe A, Schmidt G. Insights into the tumour immune microenvironment using tissue phenomics to drive cancer immunotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Nekolla K, Brieu N, Gavriel C, Widmaier M, Budco A, Medrikova D, Kanchev I, Testori M, Chan J, Dundee P, Anderson P, Lawrentschuk N, Wong LM, Phan P, Gibbs P, Harrison D, Baehner M, Caie P, Tran B, Schmidt G. Prognostic immunoprofiling of muscle invasive bladder cancer (MIBC) patients in a multicentre setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nef HM, Wiebe J, Schmidt G, Möllmann H, Boeder NF, Dörr O, Bauer T, Blachutzik F, Liebetrau C, Elsässer A, Foin N, Hamm CW. Everolimus- vs. novolimus-eluting bioresorbable scaffolds in patients with acute coronary syndrome. Herz 2019; 45:95-104. [PMID: 31209520 DOI: 10.1007/s00059-019-4822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable scaffolds (Absorb). METHODS In this retrospective study, patients with ACS (including unstable angina pectoris, ST-segment elevation myocardial infarction, or non-ST-segment elevation myocardial infarction) treated with either the Absorb or the DESolve BRS were evaluated in a 1:1 matched-pair analysis. Major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization, were evaluated as a major endpoint. The occurrence of scaffold thrombosis was also assessed. RESULTS A total of 102 patients were eligible for this analysis. The rate of MACE at 12 months was comparable between the Absorb and the DESolve group (8.3% vs. 6.8%, p = 0.738). The occurrence of target lesion revascularization (6.2% vs. 4.7%; p = 0.700) and scaffold thrombosis (4.1% vs. 2.1%; p = 0.580) was comparable as well. All instances of scaffold thrombosis occurred within 30 days of the index procedure. CONCLUSION In this study, similar 12-month event rates were observed for both BRS types after implantation for the treatment of ACS.
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Affiliation(s)
- H M Nef
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.
| | - J Wiebe
- Deutsches Herzzentrum Muenchen, Munich, Germany
| | - G Schmidt
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - H Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - N F Boeder
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - O Dörr
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - T Bauer
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - F Blachutzik
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | - C Liebetrau
- Kerckhoff Heart Center, Bad Nauheim, Germany
| | - A Elsässer
- Department of Cardiology, University of Oldenburg, Oldenburg, Germany
| | - N Foin
- Duke-NUS Medical School, National Heart Centre Singapore, Singapore, Singapore
| | - C W Hamm
- Medizinische Klinik I, Department of Cardiology and Angiology, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.,Kerckhoff Heart Center, Bad Nauheim, Germany
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24
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Harder N, Schönmeyer R, Nekolla K, Meier A, Brieu N, Vanegas C, Madonna G, Capone M, Botti G, Ascierto PA, Schmidt G. Automatic discovery of image-based signatures for ipilimumab response prediction in malignant melanoma. Sci Rep 2019; 9:7449. [PMID: 31092853 PMCID: PMC6520405 DOI: 10.1038/s41598-019-43525-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/24/2019] [Indexed: 01/07/2023] Open
Abstract
In the context of precision medicine with immunotherapies there is an increasing need for companion diagnostic tests to identify potential therapy responders and avoid treatment coming along with severe adverse events for non-responders. Here, we present a retrospective case study to discover image-based signatures for developing a potential companion diagnostic test for ipilimumab (IPI) in malignant melanoma. Signature discovery is based on digital pathology and fully automatic quantitative image analysis using virtual multiplexing as well as machine learning and deep learning on whole-slide images. We systematically correlated the patient outcome data with potentially relevant local image features using a Tissue Phenomics approach with a sound cross validation procedure for reliable performance evaluation. Besides uni-variate models we also studied combinations of signatures in several multi-variate models. The most robust and best performing model was a decision tree model based on relative densities of CD8+ tumor infiltrating lymphocytes in the intra-tumoral infiltration region. Our results are well in agreement with observations described in previously published studies regarding the predictive value of the immune contexture, and thus, provide predictive potential for future development of a companion diagnostic test.
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Affiliation(s)
| | | | | | | | | | | | - Gabriele Madonna
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Mariaelena Capone
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gerardo Botti
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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Brieu N, Gavriel CG, Nearchou IP, Harrison DJ, Schmidt G, Caie PD. Automated tumour budding quantification by machine learning augments TNM staging in muscle-invasive bladder cancer prognosis. Sci Rep 2019; 9:5174. [PMID: 30914794 PMCID: PMC6435679 DOI: 10.1038/s41598-019-41595-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/11/2019] [Indexed: 12/12/2022] Open
Abstract
Tumour budding has been described as an independent prognostic feature in several tumour types. We report for the first time the relationship between tumour budding and survival evaluated in patients with muscle invasive bladder cancer. A machine learning-based methodology was applied to accurately quantify tumour buds across immunofluorescence labelled whole slide images from 100 muscle invasive bladder cancer patients. Furthermore, tumour budding was found to be correlated to TNM (p = 0.00089) and pT (p = 0.0078) staging. A novel classification and regression tree model was constructed to stratify all stage II, III, and IV patients into three new staging criteria based on disease specific survival. For the stratification of non-metastatic patients into high or low risk of disease specific death, our decision tree model reported that tumour budding was the most significant feature (HR = 2.59, p = 0.0091), and no clinical feature was utilised to categorise these patients. Our findings demonstrate that tumour budding, quantified using automated image analysis provides prognostic value for muscle invasive bladder cancer patients and a better model fit than TNM staging.
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Affiliation(s)
- Nicolas Brieu
- Definiens AG, Bernhard-Wicki-Straße 5, 80636, München, Germany
| | - Christos G Gavriel
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF, UK
| | - Ines P Nearchou
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF, UK
| | - David J Harrison
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF, UK
| | - Günter Schmidt
- Definiens AG, Bernhard-Wicki-Straße 5, 80636, München, Germany
| | - Peter D Caie
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF, UK.
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Kapil A, Meier A, Zuraw A, Steele KE, Rebelatto MC, Schmidt G, Brieu N. Deep Semi Supervised Generative Learning for Automated Tumor Proportion Scoring on NSCLC Tissue Needle Biopsies. Sci Rep 2018; 8:17343. [PMID: 30478349 PMCID: PMC6255873 DOI: 10.1038/s41598-018-35501-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/06/2018] [Indexed: 12/22/2022] Open
Abstract
The level of PD-L1 expression in immunohistochemistry (IHC) assays is a key biomarker for the identification of Non-Small-Cell-Lung-Cancer (NSCLC) patients that may respond to anti PD-1/PD-L1 treatments. The quantification of PD-L1 expression currently includes the visual estimation by a pathologist of the percentage (tumor proportional scoring or TPS) of tumor cells showing PD-L1 staining. Known challenges like differences in positivity estimation around clinically relevant cut-offs and sub-optimal quality of samples makes visual scoring tedious and subjective, yielding a scoring variability between pathologists. In this work, we propose a novel deep learning solution that enables the first automated and objective scoring of PD-L1 expression in late stage NSCLC needle biopsies. To account for the low amount of tissue available in biopsy images and to restrict the amount of manual annotations necessary for training, we explore the use of semi-supervised approaches against standard fully supervised methods. We consolidate the manual annotations used for training as well the visual TPS scores used for quantitative evaluation with multiple pathologists. Concordance measures computed on a set of slides unseen during training provide evidence that our automatic scoring method matches visual scoring on the considered dataset while ensuring repeatability and objectivity.
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Kasoha M, Radosa J, Solomayer EF, Juhasz-Böss I, Bohle RM, Schmidt G. Identifikation von Prognosefaktoren beim triple-negativen Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- M Kasoha
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktiosmedizin, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - J Radosa
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktiosmedizin, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - EF Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktiosmedizin, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - I Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktiosmedizin, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - RM Bohle
- Instituts für Allgemeine und Spezielle Pathologie, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
| | - G Schmidt
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktiosmedizin, Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar
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Müller C, Juhasz-Böss S, Schmidt G, Gabriel L, Hayo C, Radosa J, Solomayer EF, Breitbach GP, Juhasz-Böss I. Einflussfaktoren auf den Beginn einer neoadjuvanten Chemotherapie bei Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1675446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- C Müller
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - S Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - G Schmidt
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - L Gabriel
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - C Hayo
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - J Radosa
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - EF Solomayer
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - GP Breitbach
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
| | - I Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtsmedizin und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg
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Schmidt G, Kasoha M, Solomayer EF. Identifikation von Prognosefaktoren beim triple-negativen Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- G Schmidt
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
| | - M Kasoha
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
| | - EF Solomayer
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
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Huwer SI, Jung L, Solomayer EF, Breitbach GP, Schmidt G. Postradiogenes Angiosarkom der Mamma – Case Report. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- SI Huwer
- Uniklinik Homburg/Saar, Homburg, Deutschland
| | - L Jung
- Uniklinik Homburg/Saar, Homburg, Deutschland
| | | | | | - G Schmidt
- Uniklinik Homburg/Saar, Homburg, Deutschland
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31
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Kasoha M, Takacs Z, Bohle RM, Schmidt G, Linxweiler M, Schick B, Juhasz-Böss I, Solomayer EF. Protein expression of SEC62 in triple-negative breast cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Kasoha
- University of Saarland, Department of Obstetrics, Gynecology and Reproductive Medicine, Homburg, Deutschland
| | - Z Takacs
- University of Saarland, Department of Obstetrics, Gynecology and Reproductive Medicine, Homburg, Deutschland
| | - RM Bohle
- University of Saarland, Institute for General and Special Pathology, Homburg, Deutschland
| | - G Schmidt
- University of Saarland, Department of Obstetrics, Gynecology and Reproductive Medicine, Homburg, Deutschland
| | - M Linxweiler
- University of Saarland, Department of Otorhinolaryngology, Homburg, Deutschland
| | - B Schick
- University of Saarland, Department of Otorhinolaryngology, Homburg, Deutschland
| | - I Juhasz-Böss
- University of Saarland, Department of Obstetrics, Gynecology and Reproductive Medicine, Homburg, Deutschland
| | - EF Solomayer
- University of Saarland, Department of Obstetrics, Gynecology and Reproductive Medicine, Homburg, Deutschland
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Iordache II, Schmidt G, Leingartner A, Sima R, Benndorf D, Jung L, Juhasz-Böss I, Solomayer EF. Dermatofibrosarcoma protuberans der Mamma – ein Fallbericht. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- II Iordache
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - G Schmidt
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - A Leingartner
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - R Sima
- Medizinische Fakultät der Universität Bukarest, Sf. Ioan Krankenhaus, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Bukarest, Rumänien
| | - D Benndorf
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - L Jung
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - I Juhasz-Böss
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
| | - EF Solomayer
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Deutschland
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Schmidt G, Solomayer EF. Zusammenhang zwischen Mammografie, Mammasonografie und endgültigem pathologischen Befund bei Patientinnen mit Mammakarzinom nach abgeschlossener neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- G Schmidt
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
| | - EF Solomayer
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
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Schmidt G, Solomayer EF. Bestimmung des Einflusses des BMI und weiterer sekundärer Faktoren auf die Prognose und auf die Ansprechrate einer neoadjuvanten Chemotherapie bei triple negativem Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- G Schmidt
- Uniklinik Homburg/Saar, Gynäkologie, Homburg, Deutschland
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Meier A, Nekolla K, Earle S, Hewitt L, Aoyama T, Yoshikawa T, Schmidt G, Huss R, Grabsch H. End-to-end learning to predict survival in patients with gastric cancer using convolutional neural networks. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schmidt G, Solomayer EF. Vergleich Redondrainage vs. Slitdrainage bei Mammakarzinom-Operationen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- G Schmidt
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
| | - EF Solomayer
- Uniklinik Homburg, Gynäkologie, Homburg, Deutschland
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Brieu N, Gavriel C, Harrison D, Schmidt G, Caie P. Augmenting TNM staging with machine learning-based immune profiling for improved prognosis prediction in muscle-invasive bladder cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lobmaier SM, Ortiz JU, Sewald M, Müller A, Schmidt G, Haller B, Oberhoffer R, Schneider KTM, Giussani DA, Wacker-Gussmann A. Influence of gestational diabetes on fetal autonomic nervous system: a study using phase-rectified signal-averaging analysis. Ultrasound Obstet Gynecol 2018; 52:347-351. [PMID: 28782142 DOI: 10.1002/uog.18823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/02/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Maternal gestational diabetes mellitus (GDM) is known to influence fetal physiology. Phase-rectified signal averaging (PRSA) is an innovative signal-processing technique that can be used to investigate fetal heart signals. The PRSA-calculated variables average acceleration capacity (AAC) and average deceleration capacity (ADC) are established indices of autonomic nervous system (ANS) function. The aim of this study was to evaluate the influence of GDM on the fetal cardiovascular and ANS function in human pregnancy using PRSA. METHODS This was a prospective clinical case-control study of 58 mothers with diagnosed GDM and 58 gestational-age matched healthy controls in the third trimester of pregnancy. Fetal cardiotocography (CTG) recordings were performed in all cases at entry to the study, and a follow-up recording was performed in 19 GDM cases close to delivery. The AAC and ADC indices were calculated by the PRSA method and fetal heart rate short-term variation (STV) by CTG software according to Dawes-Redman criteria. RESULTS Mean gestational age of both groups at study entry was 35.7 weeks. There was a significant difference in mean AAC (1.97 ± 0.33 bpm vs 2.42 ± 0.57 bpm; P < 0.001) and ADC (1.94 ± 0.32 bpm vs 2.28 ± 0.46 bpm; P < 0.001) between controls and fetuses of diabetic mothers. This difference could not be demonstrated using standard computerized fetal CTG analysis of STV (controls, 10.8 ± 3.0 ms vs GDM group, 11.3 ± 2.5 ms; P = 0.32). Longitudinal fetal heart rate measurements in a subgroup of women with diabetes were not significantly different from those at study entry. CONCLUSIONS Our findings show increased ANS activity in fetuses of diabetic mothers in late gestation. Analysis of human fetal cardiovascular and ANS function by PRSA may offer improved surveillance over conventional techniques linking GDM pregnancy to future cardiovascular dysfunction in the offspring. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S M Lobmaier
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J U Ortiz
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Sewald
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Müller
- Medizinische Klinik und Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - G Schmidt
- Medizinische Klinik und Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - B Haller
- Institute for Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - R Oberhoffer
- Deutsches Herzzentrum München, Klinik für Kinderkardiologie und Angeborene Herzfehler, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - K T M Schneider
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - D A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - A Wacker-Gussmann
- Deutsches Herzzentrum München, Klinik für Kinderkardiologie und Angeborene Herzfehler, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Harder N, Athelogou M, Hessel H, Buchner A, Stief C, Kirchner T, Schmidt G, Huss R, Tan TH. Abstract A069: Combination of immune status and tumor microvascularization provides strong prognostic markers for prostate cancer recurrence prediction. Cancer Res 2018. [DOI: 10.1158/1538-7445.prca2017-a069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The composition of different immune cell populations in the tumor microenvironment plays an important role for tumor progression in various cancer types. In particular, tumor-associated macrophages (TAMs) and tumor-infiltrating T cells (TILs) are relevant players. On the other hand, structural changes such as neoangiogenesis triggered by cancerous tumors to increase their nutrient supplies have also been associated with tumor progression. In this work we systematically quantified these factors in prostate cancer (PCa) and correlated them with clinical outcome data using a Tissue Phenomics approach. By investigating the prognostic relevance of TAMs (CD68/CD163), TILs (CD3/CD8), and microvessels (CD34) in the tumor, tumor microenvironment (TME), and stroma we identified strong prognostic markers for PCa recurrence prediction in patients after radical prostatectomy.
Methods: In this study, we analyzed a cohort of 90 PCa patients, of whom 40 suffered from tumor progression measured by prostate cancer antigen (PSA) recurrence after prostatectomy. The cohort comprised low- and intermediate-risk PCa patients (Gleason-Score≤7b) since providing a reliable prognosis is particularly difficult for such grades. Tissue sections were immunohistochemically stained using the duplex stains CD68/CD163 for TAMs, CD3/CD8 for TILs, and CK18/p63 to identify and characterize glands as cancerous vs. noncancerous based on their expression level of p63 (in cancerous glands p63 is not expressed). To quantify tumor neoangiogenesis microvessels were stained by CD34. All sections were geometrically aligned per case (virtual multiplexing) to enable coanalysis of stains, and quantified within relevant regions-of-interest (tumor, TME, stroma) using fully automated computational methods (1, 2). In particular, we determined region-specific densities and average distances of TAMs, TILs, and microvessels, as well as ratios of all measures. We systematically analyzed the prognostic power of each measure by optimizing a cutoff with respect to the disease-free survival statistic (log-rank test) using cross-validation to avoid for overfitting.
Results: The top-ranking prognostic markers regarding robustness and prediction performance were related to microvessel density combined with immune cell densities. In particular, we found that within the TME, a coverage of CD8(+) cytotoxic T cells larger than 10% of the coverage of CD34(+) microvessels is correlated with a good prognosis and long-term disease-free survival (cross-validated p <3.1•10-7, accuracy=83%). This corresponds to high densities of CD8(+) cells and/or low microvessel densities, which both have been shown to be associated with good prognosis in prostate cancer. In addition, we found that a larger average distance of CD68(+) M1 macrophages to CD34(+) microvessels above 75.7µm in the tumor region is associated with good prognosis (cross-validated p <2.9•10-8, accuracy=82%). Again, low tumor microvessel density seems to be beneficial as well as high densities of CD68(+) macrophages. The CD68(+) M1-polarized phenotype is associated with tumor-suppressing properties, indicating that a higher density of this population compared to the tumor-promoting M2-polarized phenotype fosters disease-free survival.
Conclusion: Our results indicate a considerable prognostic potential of markers combining microvessel density with measures of TAMs and TILs to predict PSA recurrence in PCa. This application shows that systematic analysis as performed by Tissue Phenomics enables discovery of non-obvious combined prognostic markers characterizing the tumor landscape with high potential to improve patient treatment. In future work we aim to validate our findings on additional data from other clinical sites.
References:
1. Yigitsoy M, et al. Hierarchical patch-based co-registration of differently stained histopathology slides. Proc SPIE 2017. doi:10.1117/12.2254266.
2. Brieu N, et al. Slide specific models for segmentation of differently stained digital histopathology whole slide images. Proc SPIE 2016. doi:10.1117/12.2208620.
Citation Format: Nathalie Harder, Maria Athelogou, Harald Hessel, Alexander Buchner, Christian Stief, Thomas Kirchner, Günter Schmidt, Ralf Huss, Tze Heng Tan. Combination of immune status and tumor microvascularization provides strong prognostic markers for prostate cancer recurrence prediction [abstract]. In: Proceedings of the AACR Special Conference: Prostate Cancer: Advances in Basic, Translational, and Clinical Research; 2017 Dec 2-5; Orlando, Florida. Philadelphia (PA): AACR; Cancer Res 2018;78(16 Suppl):Abstract nr A069.
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Affiliation(s)
| | | | - Harald Hessel
- 2Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany,
| | - Alexander Buchner
- 3Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Stief
- 3Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Kirchner
- 2Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany,
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Knauth A, Stabenau M, Schmidt G, Laufs H. P2. Spatial and temporal changes of electrical cortical activity induced by self-initiated finger tapping. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.646] [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: 10/28/2022]
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Weitkamp F, Elzenheimer E, Schulte-Mattler W, Schmidt G, Laufs H. P15. Multimodal mapping of nerve pathology with a multichannel approach. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sinnecker D, Cao X, Muller A, Barthel P, Schmidt G. P4844Sleep-disordered breathing assessed from cyclic variation of heart rate in Holter ECGs as a risk predictor after myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Sinnecker
- Technical University of Munich, Klinikum rechts der Isar, I. Medical Department, Munich, Germany
| | - X Cao
- Technical University of Munich, Klinikum rechts der Isar, I. Medical Department, Munich, Germany
| | - A Muller
- Technical University of Munich, Klinikum rechts der Isar, I. Medical Department, Munich, Germany
| | - P Barthel
- Technical University of Munich, Klinikum rechts der Isar, I. Medical Department, Munich, Germany
| | - G Schmidt
- Technical University of Munich, Klinikum rechts der Isar, I. Medical Department, Munich, Germany
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Huikuri HV, Junttila MJ, Willems R, Bergau L, Malik M, Vandenberg B, Vos MA, Schmidt G, Merkely B, Lubinski A, Svetsolak M, Braunschweig F, Harden M, Zabel M, Sticherling C. P605Appropriate shocks and mortality in diabetic vs. non-diabetic patients with prophylactic implantable cardioverter-defibrillator. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- H V Huikuri
- Úniversity of Oulu and University Hospital of Oulu, Research Unit of Internald Medicine, Oulu, Finland
| | - M J Junttila
- Úniversity of Oulu and University Hospital of Oulu, Research Unit of Internald Medicine, Oulu, Finland
| | - R Willems
- University of Leuven, Dpartment of Cardiovascular Sciences, Leuven, Belgium
| | - L Bergau
- University Medical Center Gottingen (UMG), Heart center, Dicision of Cardiology, Gottingen, Germany
| | - M Malik
- National Institute for Medical Research, National Heart and Lung Institue, Imperial College, London, United Kingdom
| | - B Vandenberg
- University of Leuven, Dpartment of Cardiovascular Sciences, Leuven, Belgium
| | - M A Vos
- University Medical Center Utrecht, Medical Physiology, Utrecht, Netherlands
| | - G Schmidt
- Hospital Rechts der Isar, Medizinische Klinik und Poliklinik, Munich, Germany
| | - B Merkely
- Semmelweis University Heart Center, Budapest, Hungary
| | - A Lubinski
- Medical University of Lodz, Lodz, Poland
| | - M Svetsolak
- University Hospital Bratislava, Bratislava, Slovak Republic
| | | | - M Harden
- University of Gottingen, Department of Medical Statistics, Gottingen, Germany
| | - M Zabel
- University of Gottingen, Department of Medical Statistics, Gottingen, Germany
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Hamm W, Stülpnagel L, Vdovin N, Schmidt G, Rizas KD, Bauer A. Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system. Int J Cardiol 2018; 249:1-5. [PMID: 29121716 DOI: 10.1016/j.ijcard.2017.06.091] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
Abstract
AIM Most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced left ventricular ejection fraction (LVEF >35%). Periodic repolarization dynamics (PRD) and deceleration capacity (DC) are novel ECG-based markers related to sympathetic and vagal cardiac autonomic nervous system activity. Here, we test the combination of PRD and DC to predict risk in post-infarction patients with LVEF >35%. METHODS AND RESULTS We included 823 survivors of acute MI with LVEF >35%, aged ≤80years and in sinus rhythm. PRD and DC were obtained from 30-min ECG-recordings within the second week after index infarction and dichotomized at established cut-off values of ≥5.75deg2 and ≤2.5ms, respectively. Patients were classified as having normal (CAF 0), partly abnormal (DC or PRD abnormal; CAF 1) or abnormal cardiac autonomic function (DC and PRD abnormal; CAF 2). Primary endpoint was 5-year all-cause mortality. Within the first 5years of follow-up, 51 patients died (6.2%). PRD and DC effectively stratified patients into low-risk (CAF 0; n=562), intermediate-risk (CAF 1; n=193) and high-risk patients (CAF 2; n=68) with cumulative 5-year mortality rates of 2.9%, 9.4% and 25.2%, respectively (p<0.001). On multivariable analyses, CAF was independent from established risk factors (GRACE-score, diabetes mellitus, mean heart rate, heart rate variability). Addition of CAF significantly improved the model (increase of C-statistics from 0.732 (0.651-0.812) to 0.777 (0.703-0.850), p=0.047; continuous NRI (0.400, 95% CI 0.230-0.560, p<0.001); IDI (0.056, 95% CI 0.022-0.122, p<0.001)). CONCLUSION CAF identifies new high-risk post-MI patients with LVEF >35% which might benefit from prophylactic strategies.
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Affiliation(s)
- W Hamm
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany
| | - L Stülpnagel
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany
| | - N Vdovin
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany
| | - G Schmidt
- German Center for Cardiovascular Research (DZHK), Germany; I. Medizinische Klinik, Technical University of Munich, Munich, Germany
| | - K D Rizas
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany
| | - A Bauer
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany; German Center for Cardiovascular Research (DZHK), Germany.
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Vieillard-Baron A, Naeije R, Haddad F, Bogaard HJ, Bull TM, Fletcher N, Lahm T, Magder S, Orde S, Schmidt G, Pinsky MR. Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper. Intensive Care Med 2018; 44:774-790. [PMID: 29744563 DOI: 10.1007/s00134-018-5172-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/07/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. RESULTS The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation. While no universal definition of RVF is accepted, we propose that RVF may be defined as a state in which the right ventricle is unable to meet the demands for blood flow without excessive use of the Frank-Starling mechanism (i.e. increase in stroke volume associated with increased preload). Both echocardiography and hemodynamic monitoring play a central role in the evaluation of RVF in the ICU. Management of RVF includes treatment of the causes, respiratory optimization and hemodynamic support. The administration of fluids is potentially deleterious and unlikely to lead to improvement in cardiac output in the majority of cases. Vasopressors are needed in the setting of shock to restore the systemic pressure and avoid RV ischemia; inotropic drug or inodilator therapies may also be needed. In the most severe cases, recent mechanical circulatory support devices are proposed to unload the RV and improve organ perfusion CONCLUSION: RV function evaluation is key in the critically-ill patients for hemodynamic management, as fluid optimization, vasopressor strategy and respiratory support. RV failure may be diagnosed by the association of different devices and parameters, while echocardiography is crucial.
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Affiliation(s)
- Antoine Vieillard-Baron
- Service de Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
| | - R Naeije
- Professor Emeritus at the Université Libre de Bruxelles, Brussels, Belgium
| | - F Haddad
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, USA
| | - H J Bogaard
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - T M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Fletcher
- Department of Cardiothoracic Critical Care, St Georges University Hospital NHS Trust, London, SW17 0QT, UK
| | - T Lahm
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - S Magder
- Department of Critical Care, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - S Orde
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW, Australia
| | - G Schmidt
- Department of Internal Medicine and Critical Care, University of Iowa, Iowa City, USA
| | - M R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
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Harder N, Athelogou M, Hessel H, Brieu N, Yigitsoy M, Zimmermann J, Baatz M, Buchner A, Stief CG, Kirchner T, Binnig G, Schmidt G, Huss R. Tissue Phenomics for prognostic biomarker discovery in low- and intermediate-risk prostate cancer. Sci Rep 2018. [PMID: 29535336 PMCID: PMC5849604 DOI: 10.1038/s41598-018-22564-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 01/17/2023] Open
Abstract
Tissue Phenomics is the discipline of mining tissue images to identify patterns that are related to clinical outcome providing potential prognostic and predictive value. This involves the discovery process from assay development, image analysis, and data mining to the final interpretation and validation of the findings. Importantly, this process is not linear but allows backward steps and optimization loops over multiple sub-processes. We provide a detailed description of the Tissue Phenomics methodology while exemplifying each step on the application of prostate cancer recurrence prediction. In particular, we automatically identified tissue-based biomarkers having significant prognostic value for low- and intermediate-risk prostate cancer patients (Gleason scores 6–7b) after radical prostatectomy. We found that promising phenes were related to CD8(+) and CD68(+) cells in the microenvironment of cancerous glands in combination with the local micro-vascularization. Recurrence prediction based on the selected phenes yielded accuracies up to 83% thereby clearly outperforming prediction based on the Gleason score. Moreover, we compared different machine learning algorithms to combine the most relevant phenes resulting in increased accuracies of 88% for tumor progression prediction. These findings will be of potential use for future prognostic tests for prostate cancer patients and provide a proof-of-principle of the Tissue Phenomics approach.
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Affiliation(s)
| | | | - Harald Hessel
- Institute for Pathology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Mehmet Yigitsoy
- Definiens AG, Munich, Germany.,Carl Zeiss Meditec AG, Munich, Germany
| | | | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Kirchner
- Institute for Pathology, Ludwig-Maximilians-University, Munich, Germany
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Scholz C, Golas MM, Weber RG, Hartmann C, Lehmann U, Sahm F, Schmidt G, Auber B, Sturm M, Schlegelberger B, Illig T, Steinemann D, Hofmann W. Rare compound heterozygous variants in PNKP identified by whole exome sequencing in a German patient with ataxia-oculomotor apraxia 4 and pilocytic astrocytoma. Clin Genet 2018; 94:185-186. [PMID: 29498415 DOI: 10.1111/cge.13216] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 02/02/2023]
Abstract
Ataxia-oculomotor apraxia type 4 (AOA4) is a rare autosomal recessive neurologic disorder. The phenotype is characterized by ataxia, oculomotor apraxia, peripheral neuropathy and dystonia. AOA4 is caused by biallelic pathogenic variants in the PNKP gene encoding a polynucleotide kinase 3'-phosphatase with an important function in DNA-damage repair. By whole exome sequencing, we identified 2 variants within the PNKP gene in a 27-year-old German woman with a clinical AOA phenotype combined with a cerebellar pilocytic astrocytoma diagnosed at 23 years of age. One variant, a duplication in exon 14 resulting in the frameshift c.1253_1269dup p.(Thr424fs*49), has previously been described as pathogenic, for example, in cases of AOA4. The second variant, representing a nonsense mutation in exon 17, c.1545C>G p.(Tyr515*), has not yet been described and is predicted to cause a loss of the 7 C-terminal amino acids. This is the first description of AOA4 in a patient with central European descent. Furthermore, the occurrence of a pilocytic astrocytoma has not been described before in an AOA4 patient. Our data demonstrate compound heterozygous PNKP germline variants in a German patient with AOA4 and provide evidence for a possible link with tumor predisposition. Localization of the 2 variants in human PNKP NP_009185.2. NM_007254.3:c.1253_1269dup p.(Thr424fs*49) is predicted to cause a frameshift within the kinase domain, NM_007254.3:c.1545C>G p.(Tyr515*) is predicted to cause loss of 2 C-terminal amino acids of the kinase domain and 5 additional C-terminal amino acids.
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Affiliation(s)
- C Scholz
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - M M Golas
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - R G Weber
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - C Hartmann
- Department of Neuropathology, Hannover Medical School, Hanover, Germany.,Institute of Pathology, Hannover Medical School, Hanover, Germany
| | - U Lehmann
- Institute of Pathology, Hannover Medical School, Hanover, Germany
| | - F Sahm
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany
| | - G Schmidt
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - B Auber
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - M Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - B Schlegelberger
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - T Illig
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - D Steinemann
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - W Hofmann
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
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Steger A, Hapfelmeier A, Sinnecker D, Dommasch M, Mueller A, Barthel P, Schmidt G. 211Machine learning in risk prediction of post-MI patients. Europace 2018. [DOI: 10.1093/europace/euy015.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Steger
- Technical University of Munich, Cardiology, Munich, Germany
| | - A Hapfelmeier
- Technical University of Munich, Institut für Medizinische Informatik, Statistik und Epidemiologie, Munich, Germany
| | - D Sinnecker
- Technical University of Munich, Cardiology, Munich, Germany
| | - M Dommasch
- Technical University of Munich, Cardiology, Munich, Germany
| | - A Mueller
- Technical University of Munich, Cardiology, Munich, Germany
| | - P Barthel
- Technical University of Munich, Cardiology, Munich, Germany
| | - G Schmidt
- Technical University of Munich, Cardiology, Munich, Germany
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Schmidt G. Dokumentation in der Jugendpsychiatrie. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Der Versuch einer das ganze jugendpsychiatrische Krankenblatt umfassenden Dokumentation auf Maschinenlochkarten erwies sich als praktisch nicht durchführbar. Es wurde deshalb ein gestufter Ausbau vorgenommen. Schrittweise wurden Anamneseschema, Formblätter im Krankenblatt, eine aus diesen erstellte Kartei der Zwischenbelege und der Code aufeinander abgestimmt. Das Vorgehen und das Organisationsschema werden dargelegt. Dieser Aufbau ermöglicht es, die Kartei der Zwischenbelege als Zähl- und Suchkartei zu benutzen sowie ihre Übertragung auf Maschinenlochkarten vorzunehmen.
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Linch M, Goh G, Hiley C, Shanmugabavan Y, McGranahan N, Rowan A, Wong YNS, King H, Furness A, Freeman A, Linares J, Akarca A, Herrero J, Rosenthal R, Harder N, Schmidt G, Wilson GA, Birkbak NJ, Mitter R, Dentro S, Cathcart P, Arya M, Johnston E, Scott R, Hung M, Emberton M, Attard G, Szallasi Z, Punwani S, Quezada SA, Marafioti T, Gerlinger M, Ahmed HU, Swanton C. Intratumoural evolutionary landscape of high-risk prostate cancer: the PROGENY study of genomic and immune parameters. Ann Oncol 2017; 28:2472-2480. [PMID: 28961847 PMCID: PMC5815564 DOI: 10.1093/annonc/mdx355] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intratumoural heterogeneity (ITH) is well recognised in prostate cancer (PC), but its role in high-risk disease is uncertain. A prospective, single-arm, translational study using targeted multiregion prostate biopsies was carried out to study genomic and T-cell ITH in clinically high-risk PC aiming to identify drivers and potential therapeutic strategies. PATIENTS AND METHODS Forty-nine men with elevated prostate-specific antigen and multiparametric-magnetic resonance imaging detected PC underwent image-guided multiregion transperineal biopsy. Seventy-nine tumour regions from 25 patients with PC underwent sequencing, analysis of mutations, copy number and neoepitopes combined with tumour infiltrating T-cell subset quantification. RESULTS We demonstrated extensive somatic nucleotide variation and somatic copy number alteration heterogeneity in high-risk PC. Overall, the mutational burden was low (0.93/Megabase), but two patients had hypermutation, with loss of mismatch repair (MMR) proteins, MSH2 and MSH6. Somatic copy number alteration burden was higher in patients with metastatic hormone-naive PC (mHNPC) than in those with high-risk localised PC (hrlPC), independent of Gleason grade. Mutations were rarely ubiquitous and mutational frequencies were similar for mHNPC and hrlPC patients. Enrichment of focal 3q26.2 and 3q21.3, regions containing putative metastasis drivers, was seen in mHNPC patients. We found evidence of parallel evolution with three separate clones containing activating mutations of β-catenin in a single patient. We demonstrated extensive intratumoural and intertumoural T-cell heterogeneity and high inflammatory infiltrate in the MMR-deficient (MMRD) patients and the patient with parallel evolution of β-catenin. Analysis of all patients with activating Wnt/β-catenin mutations demonstrated a low CD8+/FOXP3+ ratio, a potential surrogate marker of immune evasion. CONCLUSIONS The PROGENY (PROstate cancer GENomic heterogeneitY) study provides a diagnostic platform suitable for studying tumour ITH. Genetic aberrations in clinically high-risk PC are associated with altered patterns of immune infiltrate in tumours. Activating mutations of Wnt/β-catenin signalling pathway or MMRD could be considered as potential biomarkers for immunomodulation therapies. CLINICAL TRIALS.GOV IDENTIFIER NCT02022371.
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Affiliation(s)
- M Linch
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Goh
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - C Hiley
- Division of Cancer Studies, King's College London, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y Shanmugabavan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N McGranahan
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - A Rowan
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - Y N S Wong
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - H King
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK
| | - A Furness
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - A Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Linares
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Akarca
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | - R Rosenthal
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Bill Lyons Informatics Centre, UCL Cancer Institute, London, UK
| | | | | | - G A Wilson
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - N J Birkbak
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - R Mitter
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - S Dentro
- Cancer Genomics Laboratory, The Francis Crick Institute, London, UK;; Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Cambridge, UK
| | - P Cathcart
- The Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - M Arya
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - E Johnston
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - R Scott
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Hung
- Division of Surgery and Interventional Science, University College London, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, London, UK;; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - G Attard
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - Z Szallasi
- Centre for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark;; Computational Health Informatics Program (CHIP), Harvard Medical School, Boston, USA;; MTA-SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
| | - S Punwani
- Centre for Medical Imaging, Universtiy College London, London, UK
| | - S A Quezada
- Cancer Immunology Unit, UCL Cancer Institute, London, UK;; Research Department of Haematology, UCL Cancer Institute, London, UK
| | - T Marafioti
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Gerlinger
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK;; Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK;; Division of Surgery, Department of Surgery and Cancer, Imperial College London, UK;; Department of Urology, Imperial College Healthcare NHS Trust, London, UK.
| | - C Swanton
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London, UK;; Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK;; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK;.
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