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Jackisch C, Pronin D, Dimpfl T, Büttner R, Kunz G, Langwieder C, Rees M, Anzeneder T. 162P MammaPrint 10-year follow up results from a German breast cancer cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.197] [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: 11/01/2022] Open
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Mamounas EP, Untch M, Mano MS, Huang CS, Geyer CE, von Minckwitz G, Wolmark N, Pivot X, Kuemmel S, DiGiovanna MP, Kaufman B, Kunz G, Conlin AK, Alcedo JC, Kuehn T, Wapnir I, Fontana A, Hackmann J, Polikoff J, Saghatchian M, Brufsky A, Yang Y, Zimovjanova M, Boulet T, Liu H, Tesarowski D, Lam LH, Song C, Smitt M, Loibl S. Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE. Ann Oncol 2021; 32:1005-1014. [PMID: 33932503 DOI: 10.1016/j.annonc.2021.04.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 11/02/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. PATIENTS AND METHODS KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/axilla at surgery after NACT containing a taxane (± anthracycline, ± platinum) and trastuzumab (± pertuzumab). Patients were randomized to adjuvant T-DM1 (n = 743) or trastuzumab (n = 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). RESULTS The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (∼65% versus ∼82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade ≥3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) = 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR = 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. CONCLUSIONS T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.
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Affiliation(s)
- E P Mamounas
- NSABP Foundation and; Department of Surgery, Orlando Health UF Health Cancer Center, Orlando, USA.
| | - M Untch
- AGO-B and Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - M S Mano
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C-S Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C E Geyer
- NSABP Foundation and; NSABP Foundation and Department of Internal Medicine, Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, USA
| | | | - N Wolmark
- NSABP Foundation and; NSABP Foundation and Department of Surgery, The University of Pittsburgh, Pittsburgh, USA
| | | | - S Kuemmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany; Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M P DiGiovanna
- Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, USA
| | - B Kaufman
- Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - G Kunz
- GBG, Neu-Isenburg, Germany; St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A K Conlin
- NSABP Foundation and; NSABP Foundation and Department of Medical Oncology, Providence Cancer Institute, Portland, USA
| | - J C Alcedo
- Department of Clinical Oncology, Centro Hemato Oncologico, Panama City, Panama
| | - T Kuehn
- AGO-B and Klinikum Esslingen, Esslingen, Germany
| | - I Wapnir
- NSABP Foundation and; NSABP Foundation and Stanford University School of Medicine, Stanford, USA
| | - A Fontana
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - J Hackmann
- GBG, Neu-Isenburg, Germany; Marien-Hospital Witten, SEG, Witten, Germany
| | - J Polikoff
- NSABP Foundation and; NSABP Foundation and Department of Hematology/Oncology, Kaiser Permanente, San Diego, USA
| | - M Saghatchian
- Breast Cancer Department, Institut Gustave Roussy, Villejuif, France
| | - A Brufsky
- NSABP Foundation and; NSABP Foundation and Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Y Yang
- Division of Hematology-Oncolog, Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - M Zimovjanova
- Department of Oncology, Charles University and General University Hospital, Prague, Czech Republic
| | - T Boulet
- Department of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | - H Liu
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - D Tesarowski
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - L H Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Song
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Smitt
- Product Development Oncology, Genentech, Inc., South San Francisco, USA; Seattle Genetics, South San Francisco, USA
| | - S Loibl
- GBG, Neu-Isenburg, Germany; Center for Haematology and Oncology Bethanien, Frankfurt, Germany
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Kunz G. XXXVI. Ueber neuere nordamerikanische Edelstein- Vorkommen. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1891.19.1.478] [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: 11/24/2022]
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Untch M, Von Minckwitz G, Gerber B, Eidtmann H, Rezai M, Fasching P, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer J, Hauschild M, Fehm T, Nekljudova V, Loibl S. 1801 Neoadjuvant chemotherapy with trastuzumab or lapatinib: Survival analysis of the HER2-positive cohort of the GeparQuinto study (GBG 44). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30755-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Huober J, Solbach C, Jackisch C, Kunz G, Blohmer JU, Hauschild M, Fehm T, Nekljudova V, Gerber B, Gnauert K, Heinrich B, Prätz T, Groh U, Tanzer H, Villena C, Tulusan A, Liedtke B, Blohmer JU, Kittel K, Mau C, Potenberg J, Schilling J, Just M, Weiss E, Bückner U, Wolfgarten M, Lorenz R, Doering G, Feidicker S, Krabisch P, Deichert U, Augustin D, Kunz G, Kast K, von Minckwitz G, Nestle-Krämling C, Rezai M, Höß C, Terhaag J, Fasching P, Staib P, Aktas B, Kühn T, Khandan F, Möbus V, Solbach C, Tesch H, Stickeler E, Heinrich G, Wagner H, Abdallah A, Dewitz T, Emons G, Belau A, Rethwisch V, Lantzsch T, Thomssen C, Mattner U, Nugent A, Müller V, Noesselt T, Holms F, Müller T, Deuker JU, Schrader I, Strumberg D, Uleer C, Solomayer E, Runnebaum I, Link H, Tomé O, Ulmer HU, Conrad B, Feisel-Schwickardi G, Eidtmann H, Schumacher C, Steinmetz T, Bauerfeind I, Kremers S, Langanke D, Kullmer U, Ober A, Fischer D, Kohls A, Weikel W, Bischoff J, Freese K, Schmidt M, Wiest W, Sütterlin M, Dietrich M, Grießhammer M, Burgmann DM, Hanusch C, Rack B, Salat C, Sattler D, Tio J, von Abel E, Christensen B, Burkamp U, Köhne CH, Meinerz W, Graßhoff ST, Decker T, Overkamp F, Thalmann I, Sallmann A, Beck T, Reimer T, Bartzke G, Deryal M, Weigel M, Huober J, Weder P, Steffens CC, Lemster S, Stefek A, Ruhland F, Hofmann M, Schuster J, Simon W, Kronawitter U, Clemens M, Fehm T, Janni W, Latos K, Bauer W, Roßmann A, Bauer L, Lampe D, Heyl V, Hoffmann G, Lorenz-Salehi F, Hackmann J, Schlag R. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto)†. Ann Oncol 2014; 25:2363-2372. [PMID: 25223482 DOI: 10.1093/annonc/mdu455] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The GeparQuinto study showed that adding bevacizumab to 24 weeks of anthracycline-taxane-based neoadjuvant chemotherapy increases pathological complete response (pCR) rates overall and specifically in patients with triple-negative breast cancer (TNBC). No difference in pCR rate was observed for adding everolimus to paclitaxel in nonearly responding patients. Here, we present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1948) with HER2-negative tumors of a median tumor size of 4 cm were randomly assigned to neoadjuvant treatment with epirubicin/cyclophosphamide followed by docetaxel (EC-T) with or without eight infusions of bevacizumab every 3 weeks before surgery. Patients without clinical response to EC ± Bevacizumab were randomized to 12 weekly cycles paclitaxel with or without everolimus 5 mg/day. To detect a hazard ratio (HR) of 0.75 (α = 0.05, β = 0.8) 379 events had to be observed in the bevacizumab arms. RESULTS With a median follow-up of 3.8 years, 3-year DFS was 80.8% and 3-year OS was 89.7%. Outcome was not different for patients receiving bevacizumab (HR 1.03; P = 0.784 for DFS and HR 0.974; P = 0.842 for OS) compared with patients receiving chemotherapy alone. Patients with TNBC similarly showed no improvement in DFS (HR = 0.99; P = 0.941) and OS (HR = 1.02; P = 0.891) when treated with bevacizumab. No other predefined subgroup (HR+/HER2-; locally advanced (cT4 or cN3) or not; cT1-3 or cT4; pCR or not) showed a significant benefit. No difference in DFS (HR 0.997; P = 0.987) and OS (HR 1.11; P = 0.658) was observed for nonearly responding patients receiving paclitaxel with or without everolimus overall as well as in subgroups. CONCLUSIONS Long-term results, in opposite to the results of pCR, do not support the neoadjuvant use of bevacizumab in addition to an anthracycline-taxane-based chemotherapy or everolimus in addition to paclitaxel for nonearly responding patients. CLINICAL TRIAL NUMBER NCT 00567554, www.clinicaltrials.gov.
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Affiliation(s)
- G von Minckwitz
- Headquarter, German Breast Group, Neu-Isenburg; Department of Gynaecology and Obstetrics, University Hospital, Frankfurt.
| | - S Loibl
- Headquarter, German Breast Group, Neu-Isenburg
| | - M Untch
- Department of Gynaecology and Obstetrics, Klinikum Berlin-Buch, Berlin
| | - H Eidtmann
- Department of Gynaecology and Obstetrics, University Hospital, Kiel
| | - M Rezai
- Breast Center, Luisenkrankenhaus, Düsseldorf
| | - P A Fasching
- Department of Gynaecology and Obstetrics, University Hospital, Erlangen
| | - H Tesch
- Department of Medical Oncology, Chop GmbH, Frankfurt
| | - H Eggemann
- Department of Gynaecology and Obstetrics, University Hospital, Magdeburg
| | - I Schrader
- Department of Gynaecology and Obstetrics, Henriettenstiftung, Hannover
| | - K Kittel
- Department of Gynaecology and Obstetrics, Praxisklinik, Berlin
| | - C Hanusch
- Department of Gynaecology and Obstetrics, Rot-Kreuz-Klinikum, München
| | - J Huober
- Department of Gynaecology and Obstetrics, University Hospital, Ulm
| | - C Solbach
- Department of Gynaecology and Obstetrics, University Hospital, Frankfurt
| | - C Jackisch
- Department of Gynaecology and Obstetrics, Sana-Klinikum, Offenbach
| | - G Kunz
- Department of Gynaecology and Obstetrics, St Johannes Hospital, Dortmund
| | - J U Blohmer
- Department of Gynaecology and Obstetrics, St Gertrauden-Hospital, Berlin
| | - M Hauschild
- Department of Gynaecology and Obstetrics, Hospital, Rheinfelden
| | - T Fehm
- Department of Gynaecology and Obstetrics, University Hospital, Tübingen
| | | | - B Gerber
- Department of Gynaecology and Obstetrics, University Hospital, Rostock, Germany
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Gerber B, Loibl S, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch C, Kreienberg R, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober J, Hauschild M, Nekljudova V, Untch M, von Minckwitz G. Neoadjuvant bevacizumab and anthracycline-taxane-based chemotherapy in 678 triple-negative primary breast cancers; results from the geparquinto study (GBG 44). Ann Oncol 2013; 24:2978-84. [PMID: 24136883 DOI: 10.1093/annonc/mdt361] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). PATIENTS AND METHODS Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m(2); q3w) followed by four cycles docetaxel (100 mg/m(2); q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. RESULTS TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. CONCLUSIONS The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates.
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Affiliation(s)
- B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock, Rostock
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Melichar B, Stroyakovskiy D, Ahn J, Kopp M, Srimuninnimit V, Kunz G, Li J, van der Horst T, Muehlbauer S, Jackisch C. Pathological Complete Response to Trastuzumab Subcutaneous Fixed-Dose Formulation in the Hannah Study: Subgroup Analysis of Patient Demographics and Tumor Characteristics and Influence of Body Weight (BW) and Serum Trough Concentration (Ctrough) of Trastuzumab. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Denkert C, Kronenwett R, Loibl S, Nekljudova V, Darb-Esfahani S, Gerber B, Sinn B, Petry C, Bauerfeind I, Budczies J, Rezai M, Dietel M, Schrader I, Kunz G, Von Minckwitz G. RNA-based molecular tumor typing and immunological infiltrate as response predictors to neoadjuvant chemotherapy: Prospective validation in the GeparQuinto-PREDICT substudy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10526] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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Gerber B, Eidtmann H, Rezai M, Fasching PA, Tesch H, Eggemann H, Schrader I, Kittel K, Hanusch CA, Kreienberg R, Solbach C, Jackisch C, Kunz G, Blohmer JU, Huober JB, Hauschild M, Loibl S, Nekljudova V, Untch M, Von Minckwitz G. Neoadjuvant bevacizumab and anthracycline–taxane-based chemotherapry in 686 triple-negative primary breast cancers: Seconday endpoint analysis of the GeparQuinto study (GBG 44). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kunz G, Glas A, de Snoo F, Simon I. 0075 Use of the genomic test MammaPrint in daily clinical practice to assist in risk stratification of young breast cancer patients. Breast 2009. [DOI: 10.1016/s0960-9776(09)70120-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kunz G. Tubargravidität und kontralaterales Corpus luteum graviditatis. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kissler S, Zangos S, Kohl J, Wiegratz I, Rody A, Gätje R, Vogl T, Kunz G, Leyendecker G, Kaufmann M. Duration of dysmenorrhoea and extent of adenomyosis visualised by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2008; 137:204-9. [DOI: 10.1016/j.ejogrb.2007.01.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 12/24/2006] [Accepted: 01/19/2007] [Indexed: 11/29/2022]
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Kissler S, Schmidt M, Keller N, Wiegratz I, Kohl J, Baumann R, Kunz G, Kaufmann M, Leyendecker G. Real-Time PCR-Analyse für Östrogen-Rezeptor beta, Progesteronrezeptor und P-450-Aromatase im Menstrualblut – eine Pilotstudie über die Bedeutung des basalen Endometriums in der Pathogenese der Endometriose. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Rhythmic peristaltic contractions of the muscular wall of the non-pregnant uterus, as well as rapid sperm transport from the vagina to the Fallopian tubes, have long been documented by means of vaginal sonography and hysterosalpingoscintigraphy. Uterine peristaltic activity reaches a maximum before ovulation and is controlled via oestradiol secretion from the dominant follicle systemically and into the utero-ovarian countercurrent system; it is also enhanced by oxytocin. In this study, the effect of oxytocin and its receptor antagonist atosiban on uterine peristalsis and thus directed sperm transport during the mid and late follicular phases was examined. Atosiban did not show any effect either on frequency or on pattern of the peristaltic contractions. However, oxytocin significantly increased the rapid and directed transport of radiolabelled particles representing spermatozoa from the vagina into the Fallopian tube ipsilateral to the site of the dominant follicle (P = 0.02, 0.04 and 0.02 after 1, 16 and 32 min of documentation respectively). It seems reasonable to assume that oxytocin plays an important, although not critical, role in the mechanisms governing rapid sperm ascension that, at least in humans, were developed to rapidly preserve an aliquot of spermatozoa following intercourse.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology of St Johannes Hospital Dortmund, Dortmund, Germany.
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Kissler S, Hamscho N, Zangos S, Wiegratz I, Schlichter S, Menzel C, Doebert N, Gruenwald F, Vogl TJ, Gaetje R, Rody A, Siebzehnruebl E, Kunz G, Leyendecker G, Kaufmann M. Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility. BJOG 2006; 113:902-8. [PMID: 16753046 DOI: 10.1111/j.1471-0528.2006.00970.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease. DESIGN A prospective observational study. SETTING University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year. POPULATION Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis. METHODS All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG. MAIN OUTCOME MEASURES Influence of adenomyosis on uterotubal transport capacity in endometriosis. RESULTS In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport). CONCLUSIONS Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.
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Affiliation(s)
- S Kissler
- Division of Gynaecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynaecology, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
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Studer G, Huguenin PU, Davis JB, Kunz G, Lütolf UM, Glanzmann C. IMRT using simultaneously integrated boost (SIB) in head and neck cancer patients. Radiat Oncol 2006; 1:7. [PMID: 16722599 PMCID: PMC1459185 DOI: 10.1186/1748-717x-1-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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: 11/22/2005] [Accepted: 03/31/2006] [Indexed: 11/28/2022] Open
Abstract
Background Preliminary very encouraging clinical results of intensity modulated radiation therapy (IMRT) in Head Neck Cancer (HNC) are available from several large centers. Tumor control rates seem to be kept at least at the level of conventional three-dimensional radiation therapy; the benefit of normal tissue preservation with IMRT is proven for salivary function. There is still only limited experience with IMRT using simultaneously integrated boost (SIB-IMRT) in the head and neck region in terms of normal tissue response. The aim of this work was (1) to establish tumor response in HNC patients treated with SIB-IMRT, and (2) to assess tissue tolerance following different SIB-IMRT schedules. Results Between 1/2002 and 12/2004, 115 HNC patients have been curatively treated with IMRT. 70% received definitive IMRT (dIMRT), 30% were postoperatively irradiated. In 78% concomitant chemotherapy was given. SIB radiation schedules with 5–6 × 2 Gy/week to 60–70 Gy, 5 × 2.2 Gy/week to 66–68.2 Gy (according to the RTOG protocol H-0022), or 5 × 2.11 Gy/week to 69.6 Gy were used. After mean 18 months (10–44), 77% of patients were alive with no disease. Actuarial 2-year local, nodal, and distant disease free survival was 77%, 87%, and 78%, respectively. 10% were alive with disease, 10% died of disease. 20/21 locoregional failures occurred inside the high dose area. Mean tumor volume was significantly larger in locally failed (63 cc) vs controlled tumors (32 cc, p <0.01), and in definitive (43 cc) vs postoperative IMRT (25 cc, p <0.05); the locoregional failure rate was twofold higher in definitively irradiated patients. Acute reactions were mild to moderate and limited to the boost area, the persisting grade 3/4 late toxicity rate was low with 6%. The two grade 4 reactions (dysphagia, laryngeal fibrosis) were observed following the SIB schedule with 2.2 Gy per session. Conclusion SIB-IMRT in HNC using 2.0, 2.11 or 2.2 Gy per session is highly effective and safe with respect to tumor response and tolerance. SIB with 2.2 Gy is not recommended for large tumors involving laryngeal structures.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - PU Huguenin
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - JB Davis
- Department of Radiation Physics, University Hospital, Zurich, Switzerland
| | - G Kunz
- Department of Radiation Physics, University Hospital, Zurich, Switzerland
| | - UM Lütolf
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
| | - C Glanzmann
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland
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Abstract
Rhythmic peristaltic contractions of the muscular wall of the non-pregnant uterus can be demonstrated throughout the menstrual cycle, with a maximum just before ovulation. However, not only during the follicular phase but also during the luteal phase, the uterus shows remarkable contractile activity. The present study was conducted in order to examine uterine peristaltic activity and its function during the luteal phases of the human menstrual cycle. The results of vaginal sonography of uterine peristalsis, of hysterosalpingoscintigraphy and of the documentation of the sites of embryo implantation in natural and artificial cycles have shown that uterine peristalsis during the luteal phase is controlled by systemic and probably even more by local hormonal secretion from the fresh corpus luteum, and facilitates the fundal implantation of the blastocyst predominantly ipsilateral to the site of the dominant ovarian structure. Furthermore, this study suggests that the defence against the infiltration and inflammation of the upper genital tract, and thus the degradation of the implanted embryo, represents a further and phylogenetically old and genuine function of the archimetra, which in placentalia was modified in order to participate in the control of invasion of the endometrium by the trophoblast.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, St Johannes Hospital Dortmund, Dortmund, and Department of Obstetrics and Gynaecology, Academic Teaching Hospital to the University of Frankfurt, Darmstadt, Germany.
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20
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Abstract
Peristaltic activity of the non-pregnant uterus serves fundamental functions in the early process of reproduction. Hyperperistalsis of the uterus is significantly associated with the development of endometriosis and adenomyosis. In women with hyperperistalsis fragments of basal endometrium are detached during menstruation and transported into the peritoneal cavity. Fragments of basal endometrium have an increased potential of implantation and proliferation resulting in pelvic endometriosis. In addition, hyperperistalsis induces the proliferation of basal endometrium into myometrial dehiscencies. This results in endometriosis-associated adenomyosis with a prevalence of about 90%. Adenomyosis results in impaired directed sperm transport and thus constitutes an important cause of sterility in women with endometriosis. The principal mechanism of endometriosis/adenomyosis is the paracrine interference of endometrial estrogen with the cyclical endocrine control of archimyometrial peristalsis exerted by the ovary thus resulting in hyperperistalsis. Minimal endometriosis of the fertile women, endometriosis and adenomyosis of the infertile women and adenomyosis of the parous peri- and postmenopausal women are considered as phenotypes of a pathophysiological continuum with uterine peristalsis playing a prominent role.
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Affiliation(s)
- G Leyendecker
- Frauenklinik des Klinikum Darmstadt, Akademisches Lehrkrankenhaus der Universitäten Frankfurt und Heidelberg/Mannheim, Darmstadt.
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Reiner B, Burger C, Kunz G, Davis J. 276 Measurement of small volumes and the partial volume effect in PET images. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81252-6] [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: 11/29/2022]
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22
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Hartmann M, Fippel M, Kunz G. 338 Commissioning of a photon beam model for Monte Carlo dose calculation in dynamic IMRT and comparison with a treatment planning system. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 2005; 20:2309-16. [PMID: 15919780 DOI: 10.1093/humrep/dei021] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The hypothesis is tested that there is a strong association between endometriosis and adenomyosis and that adenomyosis plays a role in causing infertility in women with endometriosis. METHODS. Magnetic resonance imaging of the uteri was performed in 160 women with and 67 women without endometriosis. The findings were correlated with the stage of the disease, the age of the women and the sperm count parameters of the respective partners. RESULTS The posterior junctional zone (PJZ) was significantly thicker in women with endometriosis than in those without the disease (P<0.001). There was a positive correlation of the diameter of the PJZ with the stage of the disease and the age of the patients. The PJZ was thicker in patients with endometriosis with fertile than in patients with subfertile partners. The prevalence of adenomyotic lesions in all 160 women with endometriosis was 79%. In women with endometriosis below an age of 36 years and fertile partners, the prevalence of adenomyosis was 90% (P<0.01) CONCLUSIONS With a prevalence of up to 90%, uterine adenomyosis is significantly associated with pelvic endometriosis and constitutes an important factor of sterility in endometriosis presumably by impairing uterine sperm transport.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Klinikum Darmstadt, Darmstadt, Germany
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Gualandi F, Trabanelli C, Rimessi P, Calzolari E, Toffolatti L, Patarnello T, Kunz G, Muntoni F, Ferlini A. Multiple exon skipping and RNA circularisation contribute to the severe phenotypic expression of exon 5 dystrophin deletion. J Med Genet 2003; 40:e100. [PMID: 12920092 PMCID: PMC1735543 DOI: 10.1136/jmg.40.8.e100] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F Gualandi
- Sezione di Genetica Medica, Dipartimento di Medicina Sperimentale e Diagnostica, Università di Ferrara, Italy
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Abstract
BACKGROUND The hypothesis is tested that both adenomyotic and endometriotic lesions are derived from basal endometrium. METHODS Normal uteri and uteri with adenomyosis obtained by hysterectomy, excised endometriotic lesions and menstrual blood of women with and without endometriosis were used. Estrogen receptor (ER), progesterone receptor (PR), progesterone receptor B isoform (PR(B)) and P450 aromatase (P450A) immunohistochemistry was performed with the use of specific monoclonal antibodies. RESULTS With respect to the parameters studied there was a fundamental difference between the cyclical patterns of the basalis and the functionalis of the eutopic endometrium. The endometrium of endometriotic and adenomyotic lesions mimicked the cyclical pattern of the basalis. The peristromal muscular tissue of endometriotic and adenomyotic lesions displayed the same cyclical pattern of ER and PR expression as the archimyometrium. There was a significantly higher prevalence of fragments of shed basalis in menstrual blood of women with endometriosis than in healthy controls. CONCLUSIONS These data suggest that ectopic endometrial lesions result from dislocation of basal endometrium. Dislocated basal endometrium has stem cell character resulting in the ectopic formation of all archimetrial components such as epithelial and stromal endometrium as well as peristromal muscular tissue.
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Affiliation(s)
- G Leyendecker
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the Universities of Frankfurt and Heidelberg, Grafenstrasse 9, Germany.
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Kunz G, Britzen S, Busch HP. [Influence of tandem optics and television tube of modern digital fluoroscopy equipment on image quality]. Z Med Phys 2001; 11:124-30. [PMID: 11480370 DOI: 10.1016/s0939-3889(15)70500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The influence of the tandem optics and the TV-tube to the image quality of 1k- and 2k-radiographs of a modern fluoroscopy equipment should be assessed on the basis of objective parameters and clinical requirements. Radiographs of different phantoms with 1k- and 2k-image matrix, different illumination point corrections (IPC) and signal gray levels were taken, examined and evaluated, in order to determine the objective image parameters and the clinical relevancy of these parameters. On the one hand, the digital images data could be used directly for evaluation; on the other hand, the radiographs could be visually evaluated by experienced radiologists within the framework of a blind study. The IPC is controlled by the aperture of the iris diaphragm and the insertion of a neutral gray filter in the tandem optics. The larger the aperture of the iris diaphragm (at constant image receiver dose) the higher were gradation, signal to noise ratio (SNR) and image homogeneity. Furthermore, the larger the aperture, the lower was the square wave response function (SWRF). The insertion of a gray filter in the tandem optics decreases gradation, SNR and homogeneity, and improves the SWRF.
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Affiliation(s)
- G Kunz
- Klinik für Radio-Onkologie, Universitätsspital Zürich
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27
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Breier F, Khanakah G, Stanek G, Kunz G, Aberer E, Schmidt B, Tappeiner G. Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus. Br J Dermatol 2001; 144:387-92. [PMID: 11251580 DOI: 10.1046/j.1365-2133.2001.04034.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 64-year-old woman presented with bullous and ulcerating lichen sclerosus et atrophicus (LSA) on the neck, trunk, genital and perigenital area and the extremities. Histology of lesional skin showed the typical manifestations of LSA; in one of the biopsies spirochaetes were detected by silver staining. Despite treatment with four courses of ceftriaxone with or without methylprednisone for up to 20 days, progression of LSA was only stopped for a maximum of 1 year. Spirochaetes were isolated from skin cultures obtained from enlarging LSA lesions. These spirochaetes were identified as Borrelia afzelii by sodium dodecyl sulphate--polyacrylamide gel electrophoresis and polymerase chain reaction (PCR) analyses. However, serology for B. burgdorferi sensu lato was repeatedly negative. After one further 28-day course of ceftriaxone the lesions stopped expanding and sclerosis of the skin was diminished. At this time cultures for spirochaetes and PCR of lesional skin for B. afzelii DNA remained negative. These findings suggest a pathogenetic role for B. afzelii in the development of LSA and a beneficial effect of appropriate antibiotic treatment.
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Affiliation(s)
- F Breier
- Department of Dermatology, Lainz Municipal Hospital, Wolkersbergenstrasse 1, A-1130 Vienna, Austria.
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28
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Warner D, Catto A, Kunz G, Ireland H, Grant PJ, Lane DA. The thrombomodulin gene mutation G(127)-->A (Ala25Thr) and cerebrovascular disease. Cerebrovasc Dis 2000; 10:359-63. [PMID: 10971021 DOI: 10.1159/000016091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Thrombomodulin is an integral part of the protein C anticoagulation pathway, and polymorphisms of its gene have been implicated in thrombosis. The point mutation G(127)-->A has recently been found to be associated with myocardial infarction. METHODS We investigated this mutation in 465 patients with acute stroke and 353 control subjects. Genomic DNA containing the region of interest was amplified by PCR, and differing genotypes were identified by RFLP. RESULTS The A allele frequency was not statistically significantly different in the two groups, being 0.5% in the stroke group and 0.7% in the control group. CONCLUSIONS The point mutation G(127)-->A is an uncommon finding and, in this population, is unlikely to be a major risk factor for cerebrovascular disease.
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Affiliation(s)
- D Warner
- Unit of Molecular Vascular Medicine, Research School of Medicine, General Infirmary, Leeds, UK. darren_warner@lineone-net
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29
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Abstract
PURPOSE The image quality of 1k- and 2k-radiographs from digital fluoroscopy equipments (Sireskop SX and Polystar SX--Siemens) are characterized by comparison with each other to evaluate the relevance of this technique in clinical routine. MATERIAL AND METHODS We examined fabricated and evaluated images with 1k- and 2k-image matrix from several high and low contrast phantoms and from skeleton phantoms. On the one hand, the digital image values can be used directly for the evaluation, on the other hand the comparing evaluation by experienced radiologists resulted from a visual consideration in a blind study. RESULTS The quality difference of the 1k- and 2k-images depends mainly on the distance of the investigated sector of the object to the image intensifier and on the scattering of the radiation in the object positioned between the investigated sector and the image intensifier. The nearer the investigated object is located to the intensifier and the smaller the radiation is scattered in the object, the more the image quality of a radiograph with a 2k-matrix is increasing in comparison to an image with 1k-matrix. The higher the tube voltage, the smaller are the differences. CONCLUSION The image quality enhancement because of the more sensitive sampling of the Saticon target in the 2k-matrix is limited by the opening of the iris positioned in the light distributor. Therefore the image quality differences of medical 1k- and 2k-radiographs in many cases are small.
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Affiliation(s)
- G Kunz
- Abteilung für Radiologie, Krankenhaus der Barmherzigen Brüder Trier.
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30
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Kunz G, Ireland HA, Stubbs PJ, Kahan M, Coulton GC, Lane DA. Identification and characterization of a thrombomodulin gene mutation coding for an elongated protein with reduced expression in a kindred with myocardial infarction. Blood 2000; 95:569-76. [PMID: 10627464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Thrombomodulin is an endothelial cell receptor for thrombin. It functions as a natural anticoagulant by greatly accelerating activation of protein C by thrombin. Using a direct gene screening strategy we identified a frameshift insertion mutation, insT 1689, in the thrombomodulin gene of a patient with myocardial infarction. The mutation predicts an elongated gene product because of substitution of the 12 C-terminal amino acids by 61 abnormal residues. Pedigree analysis showed that the mutation was also likely to have been present in a sibling who had had fatal myocardial infarction. Carriers of the mutant allele express significantly lower amounts of thrombomodulin on the surface of their monocytes detected by flow cytometry and have lower levels of soluble thrombomodulin in plasma. Wild type and the mutant thrombomodulin were expressed in COS-7 cells. Cellular distribution of the expressed proteins was evaluated by immunofluorescence microscopy, which showed reduced cell surface expression and intense juxtanuclear localization of the abnormal protein. This suggests impaired translocation through the endoplasmic reticulum/Golgi apparatus. Cells expressing abnormal thrombomodulin had reduced ability ( approximately 2.5-fold) to accelerate the thrombin mediated activation of protein C. This is the first demonstration of reduced expression arising from a natural thrombomodulin gene mutation. The results provide support for the suggestion that gene mutation of thrombomodulin may be important in the pathogenesis of some cases of occlusive thrombotic disease. (Blood. 2000;95:569-576)
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Affiliation(s)
- G Kunz
- Division of Investigative Science, National Heart and Lung Institute, Division of Biomedical Sciences, Imperial College School of Medicine, London
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31
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Kunz G, Beil D, Huppert P, Leyendecker G. Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging. Hum Reprod 2000; 15:76-82. [PMID: 10611192 DOI: 10.1093/humrep/15.1.76] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In women with endometriosis, the peristaltic activity of the uterus is significantly enhanced and may even become dysperistaltic at midcycle. Since uterine peristalsis is confined to the endometrium and the subendometrial myometrium with its predominantly circular arrangement of muscular fibres it was assumed that this dysfunction might be associated with structural abnormalities that could be visualized by high resolution ultrasonography and magnetic resonance imaging (MRI). Therefore, the uteri of women with and without endometriosis were subjected to endovaginal sonography (EVS) and to MRI. In EVS, women with laparoscopically proven endometriosis and infertility exhibited an infiltrative expansion of the archimetra in that the halo surrounding the uterine endometrium and representing the subendometrial myometrium was significantly enlarged compared with controls. The expansion was more pronounced in older than in younger women. There was, however, no relationship between the width of the expansion and the severity of the endometriotic disease. Similar data were obtained by MRI in that the 'junctional zone' in women with endometriosis and infertility was expanded in comparison with controls. The results of this study provide further support to the notion that endometriosis is primarily a uterine disease.
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Affiliation(s)
- G Kunz
- Departments of Obstetrics and Gynaecology and Radiology I, Klinikum Darmstadt, Academic Teaching Hospital to the University of Frankfurt, Darmstadt, Germany
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Leyendecker G, Kunz G, Noe M, Herbertz M, Beil D, Huppert P, Mall G. Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/s004440050126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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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Kunz G, Bengtsson P, Leyendecker G. O-208. The effect of atosiban on uterine peristalsis in normal women and those with endometriosis. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.116] [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: 11/13/2022] Open
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Kunz G, Beil D, Huppert P, Leyendecker G. O-210. Effect of exogenous oxytocin on rapid sperm transport in the female genital tract. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Noe M, Kunz G, Herbertz M, Mall G, Leyendecker G. The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: characterization of the endometrial-subendometrial unit. Hum Reprod 1999; 14:190-7. [PMID: 10374119 DOI: 10.1093/humrep/14.1.190] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Immunocytochemistry of oestrogen receptor (ER) and progesterone receptor (PR) expression of the whole uterine muscular wall and the endometrium was performed in order to obtain morphological and functional insights into the regulation of cyclic uterine peristalsis, which is confined to the endometrium and the subendometrial myometrium and serves functions such as rapid and sustained sperm transport. The study revealed that the subendometrial myometrium or stratum subvasculare with a predominantly circular arrangement of muscular fibres exhibits a cyclic pattern of ER and PR expression that parallels that of the endometrium, whereas the outer portion of the uterine wall composed of the stratum vasculare and supravasculare, which represents the bulk of the uterine musculature, does not exhibit a cyclic pattern of ER and PR expression. According to ontogenetic and phylogenetic data from the literature, the outer myometrium is of non-paramesonephric origin with functions confined to parturition, while the inner myometrial layer together with the glandular epithelium and the stroma of the endometrium is of paramesonephric origin with various functions during the cycle in addition to those during pregnancy and parturition. The inner quarter of the stratum vasculare adjacent to the stratum subvasculare constitutes a transitional zone in that the cyclicity of receptor staining becomes, in radial direction, gradually less expressed. Morphologically this zone corresponds to the inner part of the stratum vasculare where its muscular fibres blend with those of the stratum subvasculare.
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Affiliation(s)
- M Noe
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt Academic Teaching Hospital, University of Frankfurt, Germany
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36
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Doggen CJ, Kunz G, Rosendaal FR, Lane DA, Vos HL, Stubbs PJ, Manger Cats V, Ireland H. A mutation in the thrombomodulin gene, 127G to A coding for Ala25Thr, and the risk of myocardial infarction in men. Thromb Haemost 1998; 80:743-8. [PMID: 9843165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Thrombomodulin is an endothelial cell surface receptor that transforms the procoagulant thrombin into an anticoagulant. A mutation in the thrombomodulin gene is a potential risk factor for venous and arterial thrombosis. We screened a region within the coding sequence of the thrombomodulin gene by single-strand conformation polymorphism analysis (SSCP) in a pilot study of 104 patients with myocardial infarction and 104 age, sex and race matched controls. We identified a 127G to A mutation in the gene, which predicts an Ala25Thr substitution, in 2 out of 104 patients (1 man and 1 woman) with myocardial infarction but in no controls. We assessed the risk of myocardial infarction associated with the mutation in a larger "Study of Myocardial Infarctions Leiden" (SMILE). Among 560 men with a first myocardial infarction before the age of 70, 12 were carriers of the Ala25Thr substitution. In a control group of 646 men, frequency-matched for age, seven were carriers of the Ala25Thr substitution. The allelic frequencies were 1.07% among patients and 0.54% among controls suggesting risk associated with the mutation [odds ratio (OR) 2.0, 95% confidence interval (CI) 0.8-5.1]. In patients aged below 50, the predicted risk was almost seven times increased (OR 6.5, CI 0.8-54.2). In the presence of additional risk factors, such as smoking and a metabolic risk factor, the predicted risk increased to 9-fold (OR 8.8. CI 1.8-42.2) and 4-fold (OR 4.4, CI 0.9-21.3), respectively. While not conclusive, these results strongly suggest that the Ala25Thr substitution is a risk factor for myocardial infarction, especially in young men, and when in the presence of additional risk factors.
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Affiliation(s)
- C J Doggen
- Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
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37
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Kunz G, Noe M, Herbertz M, Leyendecker G. Uterine peristalsis during the follicular phase of the menstrual cycle: effects of oestrogen, antioestrogen and oxytocin. Hum Reprod Update 1998; 4:647-54. [PMID: 10027618 DOI: 10.1093/humupd/4.5.647] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Uterine peristalsis, directing sustained and rapid sperm transport from the external cervical os or the cervical crypts to the isthmic part of the tube ipsilateral to the dominant follicle, changes in direction and frequency during the menstrual cycle, with lowest activity during menstruation and highest activity at mid cycle. It was therefore suggested that uterine peristalsis is under the control of the dominant follicle with the additional involvement of oxytocin. To test this hypothesis, vaginal sonography of uterine peristalsis was performed in the early, mid and late proliferative phases, respectively, of cycles of women treated with oestradiol valerate and with human menopausal gonadotrophin following pituitary downregulation, with clomiphene citrate and with intravenous oxytocin, respectively. Administration of oestradiol valerate resulted in oestradiol serum concentrations comparable with the normal cycle with a simulation of the normal frequency of peristaltic contractions. Elevated oestradiol concentrations and bolus injections of oxytocin resulted in a significant increase in the frequency of peristaltic contractions in the early and mid follicular phases, respectively. Chlomiphene tended, though insignificantly so, to suppress the frequency of peristaltic waves in the presence of elevated oestradiol concentrations. In the late follicular phase of the cycle extremely elevated oestradiol concentrations as well as the injection of oxytocin resulted only in an insignificant further increase of peristaltic frequency. In the normal cycles, as well as during extremely elevated oestradiol concentrations and following oxytocin administration, the peristaltic contractions were always confined to the subendometrial layer of the muscular wall. The results and the review of literature indicate that uterine peristalsis during the follicular phase of the menstrual cycle is controlled by oestradiol released from the dominant follicle with the probable involvement of oxytocin, which is presumably stimulated together with its receptor within the endometrial-subendometrial unit and therefore acting in an autocrine/paracrine fashion. Since unphysiological stimulation with oestradiol and oxytocin did not significantly increase the frequency of uterine peristalsis in the late follicular phase of the cycle it is assumed that normal preovulatory frequency of uterine peristalsis is at a level which cannot be significantly surpassed due to phenomena of refractoriness of the system.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the University of Frankfurt, Germany
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Abstract
Endometriosis is considered primarily a disease of the endometrial-subendometrial unit or archimetra. The clinical picture of endometriosis characterises this disease as a hyperactivation of genuine archimetrial functions such as proliferation, inflammatory defence and peristalsis. While the aetiology of the disease remains to be elucidated, a key event appears to consist in the local production of extraovarian oestrogen by a pathological expression of the P450 aromatase. The starting event may consist in a hyperactivity of the endometrial inflammatory defence, a hyperactivity of the endometrial oxytocin/oxytocin receptor system or in the pathological expression of the P450 aromatase system itself. Regardless of which of these levels the starting event is localized in, they influence each other on both the level of the archimetra and the endometriotic lesions. Locally elevated oestrogen levels inevitably up-regulate the endometrial oxytocin mRNA and increased levels of oxytocin result in uterine hyperperistalsis, increased transtubal seeding of endometrial tissue fragments and finally subfertility and infertility by impairment of the uterine mechanism of rapid and sustained sperm transport. Locally increased levels of oestrogen lead, on both the level of the endometrial-subendometrial unit and the endometriotic lesion, to processes of hyperproliferation. These processes result, on the level of the uterus, in an infiltrative growth of elements of the archimetra into the neometra and, on the level of the endometriotic lesion, in infiltrative endometriosis. There is circumstantial evidence that trauma might be an important initial event that induces the specific biochemical and cellular responses of the archimetra. This model is able to explain both the pleiomorphic appearance of endometriosis and the, up until now, enigmatic infertility associated with mild and moderate endometriosis.
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Affiliation(s)
- G Leyendecker
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the University of Frankfurt, Germany
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Kunz G, Herbertz M, Noe M, Leyendecker G. Sonographic evidence for the involvement of the utero-ovarian counter-current system in the ovarian control of directed uterine sperm transport. Hum Reprod Update 1998; 4:667-72. [PMID: 10027620 DOI: 10.1093/humupd/4.5.667] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sperm transport from the cervix into the tube is an important uterine function within the process of reproduction. This function is exerted by uterine peristalsis and is controlled by the dominant ovarian structure via a cascade of endocrine events. The uterine peristaltic activity involves only the stratum subvasculare of the myometrium, which exhibits a predominantly circular arrangement of muscular fibres that separate at the fundal level into the fibres of the cornua and continue into the circular muscles of the respective tubes. Since spermatozoa are transported preferentially into the tube ipsilateral to the dominant follicle, this asymmetric uterine function may be controlled by the ovary via direct effects utilizing the utero-ovarian counter-current system, in addition to the systemic circulation. To test this possibility the sonographic characteristics of the uterine vascular bed were studied during different phases of the menstrual cycle. Vaginal sonography with the measurement of Doppler flow characteristics of both uterine arteries and of the arterial anastomoses of the uterine and ovarian arteries (junctional vessels) in the cornual region of both sides of the uterus during the menstrual phase of regular-cycling women demonstrated significant lower resistance indices of the junctional vessels ipsilateral to the side of the dominant ovarian structure as compared with the corresponding arteries contralaterally. By the use of the perfusion mode technique, it could be observed that vascular perfusion of the fundal myometrium was significantly increased ipsilateral to the dominant follicle during the late follicular phase of the cycle. These results show that the endocrine control of the dominant ovarian structure over uterine function is not only exerted via the systemic circulation but also directly, most probably utilizing the utero-ovarian counter-current system.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the University of Frankfurt, Germany
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Rowland FS, Blake DR, Larsen BR, Lindskog A, Peterson PJ, Williams WP, Wallington TJ, Pilling MJ, Carslaw N, Creasey DJ, Heard DE, Jacobs P, Lee J, Lewis AC, McQuaid JB, Stockwell WR, Frank H, Sacco P, Cocheo V, Lynge E, Andersen A, Nilsson R, Barlow L, Pukkala E, Nordlinder R, Boffetta P, Grandjean P, Heikkil P, Hürte LG, Jakobsson R, Lundberg I, Moen B, Partanen T, Riise T, Borowiak A, De Saeger E, Schnitzler KG, Gravenhorst G, Jacobi HW, Moelders S, Lammel G, Busch G, Beese FO, Dentener FJ, Feichter J, Fraedrich K, Roelofs GJ, Friedrich R, Reis S, Voehringer F, Simpson D, Moussiopoulos N, Sahm P, Tourlou PM, Salmons R, Papameletiou D, Maqueda JM, Suhr PB, Bell W, Paton-Walsh C, Woods PT, Partridge RH, Slemr J, Slemr F, Schmidbauer N, Ravishankara AR, Jenkin ME, de Leeuw G, van Eijk AM, Flossmann AI, Wobrock W, Mestayer PG, Tranchant B, Ljungström E, Karlsson R, Larsen SE, Roemer M, Builtjes PJ, Koffi B, Koffi EN, De Saeger E, Ro-Poulsen H, Mikkelsen TN, Hummelshøj P, Hovmand MF, Simoneit BR, van der Meulen A, Meyer MB, Berndt T, Böge O, Stratmann F, Cass GR, Harrison RM, Shi JP, Hoffmann T, Warscheid B, Bandur R, Marggraf U, Nigge W, Kamens R, Jang M, Strommen M, Chien CJ, Leach K, Ammann M, Kalberer M, Arens F, Lavanchy V, Gâggeler HW, Baltensperger U, Davies JA, Cox RA, Alonso SG, Pastor RP, Argüello GA, Willner H, Berndt T, Böge O, Bogillo VI, Pokrovskiy VA, Kuraev OV, Gozhyk PF, Bolzacchini E, Bruschi M, Fantucci P, Meinardi S, Orlandi M, Rindone B, Bolzacchini E, Bohn B, Rindone B, Bruschi M, Zetzsch C, Brussol C, Duane M, Larsen B, Carlier P, Kotzias D, Caracena AB, Aznar AM, Ferradás EG, Christensen CS, Skov H, Hummelshøj P, Jensen NO, Lohse C, Cocheo V, Sacco P, Chatzis C, Cocheo V, Sacco P, Boaretto C, Quaglio F, Zaratin L, Pagani D, Cocheo L, Cocheo V, Asnar AM, Baldan A, Ballesta PP, Boaretto C, Caracena AB, Ferradas EG, Gonzalez-Flesca N, Goelen E, Hansen AB, Sacco P, De Saeger E, Skov H, Consonni V, Gramatica P, Santagostino A, Galvani P, Bolzacchini E, Consonni V, Gramatica P, Todeschini R, Dippel G, Reinhardt H, Zellner R, Dämmer K, Bednarek G, Breil M, Zellner R, Febo A, Allegrini I, Giliberti C, Perrino C, Fogg PG, Geiger H, Barnes I, Becker KH, Maurer T, Geyskens F, Bormans R, Lambrechts M, Goelen E, Giese M, Frank H, Glasius M, Hornung P, Jacobsen JK, Klausen HS, Klitgaard KC, Møller CK, Petersen AP, Petersen LS, Wessel S, Hansen TS, Lohse C, Boaretto E, Heinemeier J, Glasius M, Di Bella D, Lahaniati M, Calogirou A, Jensen NR, Hjorth J, Kotzias D, Larsen BR, Gonzalez-Flesca N, Cicolella A, Bates M, Bastin E, Gurbanov MA, Akhmedly KM, Balayev VS, Haselmann KF, Ketola R, Laturnus F, Lauritsen FR, Grøn C, Herrmann H, Ervens B, Reese A, Umschlag T, Wicktor F, Zellner R, Herrmann H, Umschlag T, Müller K, Bolzacchini E, Meinardi S, Rindone B, Jenkin ME, Hayman GD, Jensen NO, Courtney M, Hummelshøj P, Christensen CS, Larsen BR, Johnson MS, Hegelund F, Nelander B, Kirchner F, Klotz B, Barnes I, Sørensen S, Becker KH, Etzkorn T, Platt U, Wirtz K, Martín-Reviejo M, Laturnus F, Martinez E, Cabañas B, Aranda A, Martín P, Salgado S, Rodriguez D, Masclet P, Jaffrezo JL, Hillamo R, Mellouki A, Le Calvé S, Le Bras G, Moriarty J, O'Donnell S, Wenger J, Sidebottom H, Mingarrol MT, Cosin S, Pastor RP, Alonso SG, Sanz MJ, Bravo I, Gonzalez D, Pérez MA, Mustafaev I, Mammadova S, Noda J, Hallquist M, Langer S, Ljungström E, Nohara K, Kutsuna S, Ibusuki T, Oehme M, Kölliker S, Brombacher S, Merz L, Pastor RP, Alonso SG, Cabezas AQ, Peeters J, Vereecken L, El Yazal J, Pfeffer HU, Breuer L, Platz J, Nielsen OJ, Sehested J, Wallington TJ, Ball JC, Hurley MD, Straccia AM, Schneider WF, Pérez-Casany MP, Nebot-Gil I, Sánchez-Marín J, Putz E, Folberth G, Pfister G, Weissflog L, Elansky NP, Sørensen S, Barnes I, Becker KH, Shao M, Heiden AC, Kley D, Rockel P, Wildt J, Silva GV, Vasconcelos MT, Fernandes EO, Santos AM, Skov H, Hansen A, Løfstrøm P, Lorenzen G, Stabel JR, Wolkoff P, Pedersen T, Strom AB, Skov H, Hertel O, Jensen FP, Hjorth J, Galle B, Wallin S, Theloke J, Libuda HG, Zabel F, Touaty M, Bonsang B, Ullerstam M, Langer S, Ljungström E, Wenger J, Bonard A, Manning M, Nolan S, O'Sullivan N, Sidebottom H, Wenger J, Collins E, Moriarty J, O'Donnell S, Sidebottom H, Wenger J, Collins E, Moriarty J, O'Donnell S, Sidebottom H, Wenger J, Sidebottom H, Chadwick P, O'Leary B, Treacy J, Wolkoff P, Clausen PA, Wilkins CK, Hougaard KS, Nielsen GD, Zilinskis V, Jansons G, Peksens A, Lazdins A, Arinci YV, Erdöl N, Ekinci E, Okutan H, Manlafalioglu I, Bakeas EB, Siskos PA, Viras LG, Smirnioudi VN, Bottenheim JW, Biesenthal T, Gong W, Makar P, Delmas V, Menard T, Tatry V, Moussafir J, Thomas D, Coppalle A, Ellermann T, Hertel O, Skov H, Frohn L, Manscher OH, Friis J, Girgzdiene R, Girgzdys A, Gurevich NA, Gårdfeldt K, Langer S, Hermans C, Vandaele AC, Carleer M, Fally S, Colin R, Bernath PF, Jenouvrier A, Coquart B, Mérienne MF, Hertel O, Frohn L, Skov H, Ellermann T, Huntrieser H, Schlager H, Feigl C, Kemp K, Palmgren F, Kiilsholm S, Rasmussen A, Sørensen JH, Klemm O, Lange H, Larsen RW, Larsen NW, Nicolaisen F, Sørensen GO, Beukes JA, Larsen PB, Jensen SS, Fenger J, de Leeuw G, Kunz G, Cohen L, Schlünzen H, Muller F, Schulz M, Tamm S, Geernaert G, Hertel O, Pedersen B, Geernaert LL, Lund S, Vignati E, Jickells T, Spokes L, Matei C, Jinga OA, Jinga DC, Moliner R, Braekman-Danheux C, Fontana A, Suelves I, Thieman T, Vassilev S, Skov H, Hertel O, Zlatev Z, Brandt J, Bastrup-Birk A, Ellermann T, Frohn L, Vandaele AC, Hermans C, Carleer M, Tsouli A, Colin R, Windsperger AM, Turi K, Dworak O, Zellweger C, Weingartner E, Rüttimann R, Hofer P, Baltensperger U, Ziv A, Iakovleva E, Palmgren F, Berkovicz R, Skov H, Alastuey A, Querol X, Chaves A, Lopez-Soler A, Ruiz C, Andrees JM, Allegrini I, Febo A, Giusto M, Angeloni M, Di Filippo P, D'Innocenzio F, Lepore L, Marconi A, Arshinov MY, Belan BD, Davydov DK, Kovaleskii VK, Plotinov AP, Pokrovskii EV, Sklyadneva TK, Tolmachev GN, Arshinov MY, Belan BD, Sklyadneva TK, Behnke W, Elend M, Krüger U, Zetzsch C, Belan BD, Arshinov MY, Davydov DK, Kovalevskii VK, Plotnikov AP, Pokrovskii EV, Rasskazchikova TM, Sklyadneva TK, Tolmachev GN, Belan BD, Arshinov MY, Simonenkov DV, Tolmachev GN, Bilde M, Aker PM, Börensen C, Kirchner U, Scheer V, Vogt R, Ellermann T, Geernaert LL, Pryor SC, Barthelmie RJ, Feilberg A, Nielsen T, Kamens RM, Freitas MC, Marques AP, Reis MA, Alves LC, Ilyinskikh NN, Ilyinskikh IN, Ilyinskikh EN, Johansen K, Stavnsbjerg P, Gabrielsson P, Bak F, Andersen E, Autrup H, Kamens R, Jang M, Strommen M, Leach K, Kirchner U, Scheer V, Börensen C, Vogt R, Igor K, Svjatoslav G, Anatoliy B, Komov IL, Istchenko AA, Lourenço MG, Mactavish D, Sirois A, Masclet P, Jaffrezo JL, van der Meulen A, Milukaite A, Morkunas V, Jurgutis P, Mikelinskiene A, Nielsen T, Feilberg A, Binderup ML, Pineda M, Palacios JM, Garcia E, Cilleruelo C, Moliner R, Popovitcheva OB, Trukhin ME, Persiantseva NM, Buriko Y, Starik AM, Demirdjian B, Suzanne J, Probst TU, Rietz B, Alfassi ZB, Pokrovskiy VA, Zenobi R, Bogatyr'ov VM, Gun'ko VM, Querol X, Alastuey A, Lopez-Soler A, Mantilla E, Plana F, Artiño B, Rauterberg-Wulff A, Israël GW, Rocha TA, Duarte AC, Röhrl A, Lammel G, Spindler G, Müller K, Herrmann H, Strommen MR, Vignati E, de Leeuw G, Berkowicz R. Abstracts of the 6th FECS Conference 1998 Lectures. Environ Sci Pollut Res Int 1998; 5:119-96. [PMID: 19002640 DOI: 10.1007/bf02986409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- F S Rowland
- Department of Chemistry, University of California, Irvine, 92697, California, USA
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Kunz G, Beil D, Deiniger H, Einspanier A, Mall G, Leyendecker G. The uterine peristaltic pump. Normal and impeded sperm transport within the female genital tract. Adv Exp Med Biol 1997; 424:267-77. [PMID: 9361805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Rapid as well as sustained sperm transport from the cervical canal to the isthmical part of the fallopian tube is provided by cervico-fundal uterine peristaltic contractions that can be visualized by vaginal sonography. The peristaltic contractions increase in frequency and presumably also in intensity as the proliferative phase progresses. As shown by placement of labeled albumin macrospheres of sperm size at the external cervical os and serial hysterosalpingoscintigraphy (HSSG) sperm reach, following their vaginal deposition, the uterine cavity within minutes. In the early follicular phase a large proportion of the macrospheres remains at the site of application, while a smaller proportion enters the uterine cavity with even a smaller one reaching the isthmical part of the tubes. In the mid-follicular phase of the cycle with increased frequency and intensity of the uterine contractions the proportion of macrospheres entering the uterine cavity as well as the tubes has significantly increased. In the late follicular phase with maximum frequency and intensity of uterine peristalsis the proportion of macrospheres entering the tube increases further at the expense of those at the site of application as well as within the uterine cavity. The transport of the macrospheres into the tube is preferentially directed into the tube ipsilateral to the dominant follicle, which becomes apparent in the mid-follicular phase as soon as a dominant follicle can be identified by ultrasound. Since the macrosphere are inert particles the directed sperm transport into the tube ipsilateral to the dominant follicle is not functionally related to a mechanism such as chemotaxis but is rather provided by uterine contraction of which the direction may be controlled by a specific myometrial architecture in combination with an asymmetric distribution of myometrial oestradiol receptors. Women with infertility and mostly mild endometriosis display on VSUP a uterine hyperperistalsis with nearly double the frequency of contractions during the early and mid- as well as midluteal phase in comparison to the fertile and healthy controls. During midcycle these women display a considerable uterine dysperistalsis in that the normally long and regular cervico-fundal contractions during this phase of the cycle have become more or less undirected and convulsive in character. Hyperperistalsis results in the transport of inert particles from the cervix into the tubes within minutes already during the early follicular phase, and may therefore constitute the mechanical cause for the development of endometriosis in that it transports detached endometrial cells and tissue fragments via the tubes into the peritoneal cavity. Moreover, dysperistalsis may contribute to the infertility in these patients since it results in a break down of sperm transport within the female genital tract.
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Affiliation(s)
- G Kunz
- Department of Obstetrics and Gynecology, Academic Teaching Hospital, University of Frankfurt, Darmstadt, Germany
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Abstract
BACKGROUND Thrombomodulin is an important receptor for thrombin on the endothelial cell surface of most blood vessels, including those of the heart. Thrombin-bound thrombomodulin activates protein C, which inhibits thrombin generation by degrading factors Va and VIIIa. The aim of this study was to analyze the 5' region of the thrombomodulin gene to determine whether mutations contribute a risk for myocardial infarction. METHODS AND RESULTS We screened the promoter region of the thrombomodulin gene by single-stranded conformation polymorphism analysis in 104 patients with diagnosed myocardial infarction. Five mutations (three distinct) were identified (GG-9/-10AT, G-33A, and C-133A). The dinucleotide mutation GG-9/-10AT was identified in 3 individuals (2 heterozygous, 1 homozygous). Only one of the three different mutations was identified in 104 patient control subjects matched for age, sex, and race (G-33A in a single individual). All mutations identified were in close proximity to consensus sequences for transcription control elements within the thrombomodulin gene. In contrast, no difference was observed between patients and control subjects for the allelic frequency of a previously identified neutral polymorphism GCC/GTC coding for Ala/Val455, with 3 individuals homozygous for GTC (Val) in both groups. CONCLUSIONS The findings suggest that mutations in the promoter region of the thrombomodulin gene may constitute a risk for arterial thrombosis.
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Affiliation(s)
- H Ireland
- Department of Haematology, Charing Cross and Westminster Medical School, London, UK.
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Kunz G, Leyendecker G. O-231. Uterine peristalsis is controlled by oestradiol and enhanced by oxytocin. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.114-a] [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: 11/14/2022] Open
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Abstract
Results of a random survey of 2574 adults in East and West Germany in 1992 show virtually no differences in subjective health status for the populations of East versus West Germany and only slight differences for men versus women. A closer analysis via multiple regression indicates, however, that contrary to previous results from other countries West German women have a better health status than men. Of the four gender groups analyzed separately East German men are the best off, while owing to a number of socio-economic status discrepancies, East German women report the worst health status. Surprisingly, West German men show a poorer subjective health status than East German men, although a number of factors like participation in sport, better income and younger age would predict otherwise. It is suggested that their health situation is negatively influenced not only by their work situation but also by outside private commitments not accounted for in this analysis. Also difficult to explain from the present data is the relatively good health status of East German men. Despite an insecure job and a difficult work situation they may experience unification in sociopolitical terms and their present social status as something positive. Overall, conditions in the system of West Germany show a tendency to favor women, while those in East Germany clearly favor men.
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Affiliation(s)
- G Lüschen
- Department of Sociology, University of Alabama at Birmingham, USA
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Simmonds RE, Ireland H, Kunz G, Lane DA. Identification of 19 protein S gene mutations in patients with phenotypic protein S deficiency and thrombosis. Protein S Study Group. Blood 1996; 88:4195-204. [PMID: 8943854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Protein S is a protein C-dependent and independent inhibitor of the coagulation cascade. Deficiency of protein S is an established risk factor for venous thromboembolism. We have used a strategy of specific amplification of the coding regions and intron/exon boundaries of the active protein S gene (PROS1) and direct single-strand solid phase sequencing, to seek mutations in 35 individuals with phenotypic protein S deficiency. Nineteen point mutations (16 novel) in 19 probands (or relatives of probands) with venous thromboembolism are reported here. Fifteen of the 19 mutations were expected to be causal and included 10 missense mutations (Lys9Glu, Glu26Ala, Gly54Glu, Cys145Tyr, Cys200Ser, Ser283Pro, Gly340Asp, Cys408Ser, Ser460Pro, and Cys625Arg). Three of the 15 mutations resulted in premature stop codons (delete T 635 producing a stop codon at position 126, Lys368stop and Tyr595stop) and two were at intron/exon boundaries (+1 G to A in intron d and +3 A to C in intron j). Of the remaining four mutations, three were within intronic sequence and one was a silent mutation within the coding region and did not alter amino acid composition. In two of the 10 missense mutations, reduced plasma protein S activity compared with antigen level suggested the presence of variant (type II) protein S.
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Affiliation(s)
- R E Simmonds
- Department of Haematology, Charing Cross and West-minster Medical School, London, United Kingdom
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Abstract
Thrombomodulin is a principle thrombin receptor located on the vascular endothelium. Thrombomodulin alters the specificity of thrombin, redirecting its procoagulant function to an anticoagulant function by making it a more efficient activator of protein C. While mutation of the genes of other components of this anticoagulant mechanism, protein C, protein S and factor V, is known to predispose towards venous thromboembolism, there are only a few reports of the investigation of thrombomodulin gene mutation. We present the design and evaluation of a strategy to investigate thrombomodulin gene mutation in arterial and venous thrombosis.
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Affiliation(s)
- H Ireland
- Department of Haematology, Charing Cross and Westminster Medical School, London
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Kunz G, Plath T, Leyendecker G. [Comparison of laparoscopically assisted vaginal hysterectomy with abdominal hysterectomy. Technique and results]. Geburtshilfe Frauenheilkd 1996; 56:453-7. [PMID: 8991841 DOI: 10.1055/s-2007-1022286] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Technique and Results: The aim of this prospective randomised study was to compare laparoscopy-assisted vaginal hysterectomy (LAVH, group A) with abdominal hysterectomy (abd. HE, group B). Therefore, 35 hysterectomies due to non-malignant diseases such as uterine fibroma were performed in each group. A rather simple technique of LAVH was developed. In respect of the indication for hysterectomy, mean duration of operation and the size of the excised uteri there were no statistical differences between the two groups. One severe complication of haemorrhage was observed after LAVH in a patient suffering from a coagulopathy. The requirements for analgesics were significantly lower after LAVH compared to abd. HE during the postoperative period. A significantly lower serum concentration of the c-reactive protein on the first and third days after operation was found in group A. The patients of group A were discharged on the average 5 days after operation and 11 days in group B, respectively. Hence LAVH should replace abd. HE in most cases with the advantages of shorter hospitalisation, minimised requirements for analgesics and cost reduction.
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Affiliation(s)
- G Kunz
- Frauenklinik des Klinikums Darmstadt
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48
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Leyendecker G, Kunz G, Wildt L, Beil D, Deininger H. Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility. Hum Reprod 1996; 11:1542-51. [PMID: 8671502 DOI: 10.1093/oxfordjournals.humrep.a019435] [Citation(s) in RCA: 165] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Women suffering from infertility in association with mostly mild endometriosis were subjected to vaginal sonography of uterine peristalsis during the menstrual period, the early, mid- and late follicular phases, and the mid-luteal phase of the menstrual cycle. The data obtained were compared with those of healthy controls. Women with endometriosis displayed a marked uterine hyperperistalsis that differed significantly from the peristalsis of the controls during the early and mid-follicular and mid-luteal phases. During the late follicular phase of the cycle, uterine peristalsis in women with endometriosis became dysperistaltic, arrhythmic and convulsive in character, while in controls peristalsis continued to show long and regular cervico-fundal contractions. Hysterosalpingoscintigraphy during the early, mid- and late follicular phases revealed that hyperperistalsis in the early and mid-follicular phases of patients with endometriosis resulted in a dramatic increase in the transport of inert particles from the vaginal depot, through the uterus into the tubes and also into the peritoneal cavity. During the late follicular phase of the cycle, the dysperistalsis observed in women with endometriosis resulted in a dramatic reduction of uterine transport capacity in comparison with the healthy controls. We consider uterine hyperperistalsis to be the mechanical cause of endometriosis rather than retrograde menstruation. Dysperistalsis in the late follicular phase of patients with endometriosis may compromise rapid sperm transport. Uterine hyperperistalsis and dysperistalsis are considered to be responsible for both reduced fertility and the development of endometriosis.
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Affiliation(s)
- G Leyendecker
- Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Academic Teaching Hospital to the University of Frankfurt, Darmstadt, Germany
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49
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Abstract
Antithrombin is the major proteinase inhibitor of thrombin and other blood coagulation proteinases. Antithrombin has two functional domains, a heparin binding site and a reactive centre (that complexes and inactivates the proteinase). Its deficiency results in an increased risk of venous thromboembolism. Appreciable progress has been made in recent years in understanding the structure and function of this protein, the genetic cause of inherited deficiency and its clinical consequence. The structure of antithrombin is now considered in terms of the models derived from X-ray crystallography, which have provided explanations for the function of its heparin interaction site and of its reactive loop. The structural organization of the antithrombin gene has been defined and numerous mutations have been identified that are responsible for antithrombin deficiency: these may reduce the level of the protein (Type I deficiency), alter the function of the protein (Type II deficiency, altering heparin binding or reactive sites), or even have multiple or 'pleiotropic effects' (Type II deficiency, altering both functional domains and the level of protein).
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Affiliation(s)
- D A Lane
- Department of Haematology, Charing Cross and Westminister Medical School, Hammersmith, London, UK
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50
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Simmonds RE, Ireland H, Kunz G, Bhavani M, Castaman G, Hambley H, Laffan M, O??Connor N, Tew CJ, Walker ID, Lane DA. Identification of 19 protein S gene mutations in patients with phenotypic protein S deficiency and thrombosis. Blood Coagul Fibrinolysis 1996. [DOI: 10.1097/00001721-199604000-00025] [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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