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Raccagni C, Sidoroff V, Paraschiv-Ionescu A, Roth N, Schönherr G, Eskofier B, Gassner H, Kluge F, Teatini F, Seppi K, Goebel G, Benninger DH, Aminian K, Klucken J, Wenning G. Effects of physiotherapy and home-based training in parkinsonian syndromes: protocol for a randomised controlled trial (MobilityAPP). BMJ Open 2024; 14:e081317. [PMID: 38692728 DOI: 10.1136/bmjopen-2023-081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Gait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot study demonstrated a significant improvement of gait in patients with MSA of parkinsonian type (MSA-P) after physiotherapy and matching home-based exercise, as reflected by sensor-based gait parameters. In this study, we aim to investigate whether a gait-focused physiotherapy (GPT) and matching home-based exercise lead to a greater improvement of gait performance compared with a standard physiotherapy/home-based exercise programme (standard physiotherapy, SPT). METHODS AND ANALYSIS This protocol was deployed to evaluate the effects of a GPT versus an active control undergoing SPT and matching home-based exercise with regard to laboratory gait parameters, physical activity measures and clinical scales in patients with Parkinson's disease (PD), MSA-P and PSP. The primary outcomes of the trial are sensor-based laboratory gait parameters, while the secondary outcome measures comprise real-world derived parameters, clinical rating scales and patient questionnaires. We aim to enrol 48 patients per disease group into this double-blind, randomised-controlled trial. The study starts with a 1 week wearable sensor-based monitoring of physical activity. After randomisation, patients undergo a 2 week daily inpatient physiotherapy, followed by 5 week matching unsupervised home-based training. A 1 week physical activity monitoring is repeated during the last week of intervention. ETHICS AND DISSEMINATION This study, registered as 'Mobility in Atypical Parkinsonism: a Trial of Physiotherapy (Mobility_APP)' at clinicaltrials.gov (NCT04608604), received ethics approval by local committees of the involved centres. The patient's recruitment takes place at the Movement Disorders Units of Innsbruck (Austria), Erlangen (Germany), Lausanne (Switzerland), Luxembourg (Luxembourg) and Bolzano (Italy). The data resulting from this project will be submitted to peer-reviewed journals, presented at international congresses and made publicly available at the end of the trial. TRIAL REGISTRATION NUMBER NCT04608604.
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Affiliation(s)
- Cecilia Raccagni
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Sidoroff
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Nils Roth
- Artificial Intelligence in Biomedical Engineering, FAU, Erlangen, Germany
| | - Gudrun Schönherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Björn Eskofier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heiko Gassner
- Department of Molecular Neurology, Erlangen University Hospital, Erlangen, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Francesco Teatini
- Department of Neurology, Provincial Hospital of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - David H Benninger
- Service de Neurologie, Départment des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Kamiar Aminian
- Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Jochen Klucken
- Department of Molecular Neurology, Friedrich-Alexander University Erlangen, Nürnberg, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Digital Medicine - Dep. of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
- Digital Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Gregor Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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2
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Fanciulli A, Stankovic I, Avraham O, Jecmenica Lukic M, Ezra A, Leys F, Goebel G, Krismer F, Petrovic I, Svetel M, Seppi K, Kostic V, Giladi N, Poewe W, Wenning GK, Gurevich T. Early Screening for the Parkinson Variant of Multiple System Atrophy: A 6-Item Score. Mov Disord Clin Pract 2024. [PMID: 38659282 DOI: 10.1002/mdc3.14048] [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: 12/27/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND A 4-item score based on ≥2 features out of orthostatic hypotension, overactive bladder, urinary retention and postural instability was previously shown to early distinguish the Parkinson-variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) with 78% sensitivity and 86% specificity. OBJECTIVES To replicate and improve the 4-item MSA-P score. METHODS We retrospectively studied 161 patients with early parkinsonism [ie, ≤2 years disease duration or no postural instability, aged 64 (57; 68) years, 44% females] and a diagnosis of clinically established MSA-P (n = 38) or PD (n = 123) after ≥24 months follow-up. RESULTS The 4-item MSA-P score had a 92% sensitivity and 78% specificity for a final MSA-P diagnosis. By including dopaminergic responsiveness and postural deformities into a 6-item score (range: 0-6), reaching ≥3 points at early disease identified MSA-P patients with 89% sensitivity and 98% specificity. CONCLUSIONS The 6-item MSA-P score is a cost-effective tool to pinpoint individuals with early-stage MSA-P.
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Affiliation(s)
| | - Iva Stankovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Omer Avraham
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Milica Jecmenica Lukic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Adi Ezra
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Igor Petrovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Provincial Hospital of Kufstein, Kufstein, Austria
| | - Vladimir Kostic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
- School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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3
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Eschlboeck S, Goebel G, Eckhardt C, Fanciulli A, Raccagni C, Boesch S, Djamshidian A, Heim B, Mahlknecht P, Mair K, Nachbauer W, Scherfler C, Stockner H, Poewe W, Seppi K, Kiechl S, Wenning G, Krismer F. Development and Validation of a Prognostic Model to Predict Overall Survival in Multiple System Atrophy. Mov Disord Clin Pract 2023; 10:1368-1376. [PMID: 37772304 PMCID: PMC10525072 DOI: 10.1002/mdc3.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 09/30/2023] Open
Abstract
Background Multiple system atrophy (MSA) is a devastating disease characterized by a variable combination of motor and autonomic symptoms. Previous studies identified numerous clinical factors to be associated with shorter survival. Objective To enable personalized patient counseling, we aimed at developing a risk model of survival based on baseline clinical symptoms. Methods MSA patients referred to the Movement Disorders Unit in Innsbruck, Austria, between 1999 and 2016 were retrospectively analyzed. Kaplan-Meier curves and multivariate Cox regression analysis with least absolute shrinkage and selection operator penalty for variable selection were performed to identify prognostic factors. A nomogram was developed to estimate the 7 years overall survival probability. The performance of the predictive model was validated and calibrated internally using bootstrap resampling and externally using data from the prospective European MSA Study Group Natural History Study. Results A total of 210 MSA patients were included in this analysis, of which 124 patients died. The median survival was 7 years. The following clinical variables were found to significantly affect overall survival and were included in the nomogram: age at symptom onset, falls within 3 years of onset, early autonomic failure including orthostatic hypotension and urogenital failure, and lacking levodopa response. The time-dependent area under curve for internal and external validation was >0.7 within the first 7 years of the disease course. The model was well calibrated showing good overlap between predicted and actual survival probability at 7 years. Conclusion The nomogram is a simple tool to predict survival on an individual basis and may help to improve counseling and treatment of MSA patients.
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Affiliation(s)
| | - Georg Goebel
- Department of Medical Statistics Informatics and Health EconomicsInnsbruck Medical UniversityInnsbruckAustria
| | - Christine Eckhardt
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of AnesthesiaInnsbruck Medical UniversityInnsbruckAustria
| | | | - Cecilia Raccagni
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of Neurology, Provincial Hospital of BolzanoTeaching hospital of Paracelsus Medical Private UniversityBolzano‐BozenItaly
| | - Sylvia Boesch
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Beatrice Heim
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | - Katherina Mair
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | | | | | - Heike Stockner
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
- Department of NeurologyProvincial Hospital of KufsteinKufsteinAustria
| | - Stefan Kiechl
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Gregor Wenning
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
| | - Florian Krismer
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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4
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Sadeghi M, Ramos-Prats A, Neto P, Castaldi F, Crowley D, Matulewicz P, Paradiso E, Freysinger W, Ferraguti F, Goebel G. Localization and Registration of 2D Histological Mouse Brain Images in 3D Atlas Space. Neuroinformatics 2023; 21:615-630. [PMID: 37357231 PMCID: PMC10406728 DOI: 10.1007/s12021-023-09632-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/27/2023]
Abstract
To accurately explore the anatomical organization of neural circuits in the brain, it is crucial to map the experimental brain data onto a standardized system of coordinates. Studying 2D histological mouse brain slices remains the standard procedure in many laboratories. Mapping these 2D brain slices is challenging; due to deformations, artifacts, and tilted angles introduced during the standard preparation and slicing process. In addition, analysis of experimental mouse brain slices can be highly dependent on the level of expertise of the human operator. Here we propose a computational tool for Accurate Mouse Brain Image Analysis (AMBIA), to map 2D mouse brain slices on the 3D brain model with minimal human intervention. AMBIA has a modular design that comprises a localization module and a registration module. The localization module is a deep learning-based pipeline that localizes a single 2D slice in the 3D Allen Brain Atlas and generates a corresponding atlas plane. The registration module is built upon the Ardent python package that performs deformable 2D registration between the brain slice to its corresponding atlas. By comparing AMBIA's performance in localization and registration to human ratings, we demonstrate that it performs at a human expert level. AMBIA provides an intuitive and highly efficient way for accurate registration of experimental 2D mouse brain images to 3D digital mouse brain atlas. Our tool provides a graphical user interface and it is designed to be used by researchers with minimal programming knowledge.
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Affiliation(s)
- Maryam Sadeghi
- Department of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
| | - Arnau Ramos-Prats
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Pedro Neto
- Faculty of Engineering, University of Porto, Porto, Portugal
| | - Federico Castaldi
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Devin Crowley
- Biomedical Engineering, Johns Hopkins University, Baltimore, United States
| | - Pawel Matulewicz
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Enrica Paradiso
- KNAW, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | | | - Francesco Ferraguti
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
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5
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Leys F, Eschlböck S, Campese N, Mahlknecht P, Peball M, Goebel G, Sidoroff V, Granata R, Bonifati V, Zschocke J, Kiechl S, Poewe W, Seppi K, Wenning GK, Fanciulli A. Family History for Neurodegeneration in Multiple System Atrophy: Does it Indicate Susceptibility? Mov Disord 2022; 37:2310-2312. [PMID: 36029213 PMCID: PMC9804463 DOI: 10.1002/mds.29202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Fabian Leys
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Sabine Eschlböck
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Nicole Campese
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria,Neurology Unit, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Marina Peball
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Victoria Sidoroff
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Roberta Granata
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Vincenzo Bonifati
- Department of Clinical GeneticsUniversity Medical CenterRotterdamThe Netherlands
| | - Johannes Zschocke
- Institute of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | - Stefan Kiechl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Gregor K. Wenning
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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6
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Lenhart L, Seiler S, Pirpamer L, Goebel G, Potrusil T, Wagner M, Dal Bianco P, Ransmayr G, Schmidt R, Benke T, Scherfler C. Anatomically Standardized Detection of MRI Atrophy Patterns in Early-Stage Alzheimer's Disease. Brain Sci 2021; 11:brainsci11111491. [PMID: 34827490 PMCID: PMC8615991 DOI: 10.3390/brainsci11111491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
MRI studies have consistently identified atrophy patterns in Alzheimer’s disease (AD) through a whole-brain voxel-based analysis, but efforts to investigate morphometric profiles using anatomically standardized and automated whole-brain ROI analyses, performed at the individual subject space, are still lacking. In this study we aimed (i) to utilize atlas-derived measurements of cortical thickness and subcortical volumes, including of the hippocampal subfields, to identify atrophy patterns in early-stage AD, and (ii) to compare cognitive profiles at baseline and during a one-year follow-up of those previously identified morphometric AD subtypes to predict disease progression. Through a prospectively recruited multi-center study, conducted at four Austrian sites, 120 patients were included with probable AD, a disease onset beyond 60 years and a clinical dementia rating of ≤1. Morphometric measures of T1-weighted images were obtained using FreeSurfer. A principal component and subsequent cluster analysis identified four morphometric subtypes, including (i) hippocampal predominant (30.8%), (ii) hippocampal-temporo-parietal (29.2%), (iii) parieto-temporal (hippocampal sparing, 20.8%) and (iv) hippocampal-temporal (19.2%) atrophy patterns that were associated with phenotypes differing predominately in the presentation and progression of verbal memory and visuospatial impairments. These morphologically distinct subtypes are based on standardized brain regions, which are anatomically defined and freely accessible so as to validate its diagnostic accuracy and enhance the prediction of disease progression.
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Affiliation(s)
- Lukas Lenhart
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Stephan Seiler
- Center for Neurosciences, Department of Neurology, University of California, Davis, CA 95616, USA;
- Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA 95616, USA
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Müllerstraße 44, 6020 Innsbruck, Austria;
| | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
| | - Michaela Wagner
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Peter Dal Bianco
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gerhard Ransmayr
- Department of Neurology, Kepler University Hospital, 4021 Linz, Austria;
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria; (L.P.); (R.S.)
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (T.P.); (T.B.)
- Correspondence: ; Tel.: +43-512-504-26276
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7
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Campese N, Goebel G, Leys F, Ndayisaba JP, Eschlboeck S, Eckhardt C, Raccagni C, Granata R, Ceravolo R, Kiechl S, Seppi K, Poewe W, Wenning GK, Fanciulli A. Orthostatic Hypotension in Parkinson's Disease: Do Height and Weight Matter? Mov Disord 2021; 36:2703-2705. [PMID: 34423874 PMCID: PMC9292422 DOI: 10.1002/mds.28768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nicole Campese
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sabine Eschlboeck
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Eckhardt
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neurology, Regional General Hospital Bolzano, Bolzano, Italy
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roberto Ceravolo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Folie S, Radlinger B, Goebel G, Salzmann K, Staudacher G, Ress C, Tilg H, Kaser S. Changing the dietary composition improves inflammation but not adipocyte thermogenesis in diet-induced obese mice. J Nutr Biochem 2021; 99:108837. [PMID: 34419570 DOI: 10.1016/j.jnutbio.2021.108837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Pronounced weight loss was shown to improve adipocyte dysfunction and insulin sensitivity in obese subjects. While bariatric surgery is frequently accompanied by adverse side effects, weight loss due to caloric restriction is often followed by weight regain. Here we aimed to determine whether switching the diet from a metabolically harmful Western type diet to a balanced standard diet is sufficient to reverse adipocyte dysfunction in diet-induced obese mice. Male C57BL/6 mice were fed a Western diet for 10 weeks and afterwards switched to a standard diet for eight more weeks (WD/SD mice) or continued to be fed a Western diet (WD/WD mice) ad libitum. Mice fed SD for 18 weeks served as control group (SD/SD). Insulin sensitivity was similar in WD/SD and SD/SD mice despite increased body weight in WD/SD mice. Beiging markers Ucp-1, Cidea and Cox8b were drastically reduced in subcutaneous adipose tissue of WD/SD mice when compared with SD/SD mice. Also, in brown adipose tissue morphologic features and markers of thermogenesis were still altered in both WD/SD and WD/WD mice. However, adipocyte size, Hif1α and macrophage infiltration were significantly lower in both, brown and white adipose tissues of WD/SD compared to WD/WD mice and additionally, a shift toward anti-inflammatory M2 phenotype was found in WD/SD mice only. In conclusion our data suggest that switching the diet is sufficient to improve adipose tissue inflammation, while western diet negatively affects thermogenic capacity of brown adipose tissue, and inhibits beiging of white adipose tissue in the long-term.
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Affiliation(s)
- Sabrina Folie
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Radlinger
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Karin Salzmann
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriele Staudacher
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Claudia Ress
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
| | - Susanne Kaser
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria.
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9
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Tiechl J, Abdel Azim S, Leitner K, Berger A, Mutz-Dehbalaie I, Goebel G, Scheier M. Screening for Open Spina Bifida in a Routine Clinical Setting at the First-Trimester Scan: A Prospective Multicentre Cohort Study. Fetal Diagn Ther 2021; 48:1-7. [PMID: 33535205 DOI: 10.1159/000512487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the performance of screening for open spina bifida (OSB) integrated into the routine first-trimester screening. METHOD This is a prospective multicentre study of 4,755 women undergoing first-trimester ultrasound scans over a 4-year period. Measurements of the brainstem (BS) diameter and brainstem-to-occipital-bone (BSOB) distance were performed. The cisterna magna (CM) was measured in the tilted axial view. RESULTS Pregnancy outcome data were available for 4,658 fetuses included in this study. There were 5 fetuses with OSB, and in all of them, the BS/BSOB ratio and the CM measurements were abnormal. The sensitivity and specificity of a BS/BSOB ratio >1 were 100%. The sensitivity of a CM width <5th centile was 100%, and the specificity was 95.1%. In 4.6% of cases, the BS/BSOB ratio was between the 95th percentile and 1. In 87.1% of these cases, the CM was normal, and 12.9% had a CM below the 5th percentile. CONCLUSION Screening for OSB is feasible in routine first-trimester scans. The BS/BSOB ratio shows a very good sensitivity and specificity. In cases with near-normal values for the BS/BSOB ratio, the CM width might be helpful for further assessment.
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Affiliation(s)
- Johanna Tiechl
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samira Abdel Azim
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria,
| | - Katharina Leitner
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Berger
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene Mutz-Dehbalaie
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Medical University of Innsbruck, Innsbruck, Austria
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10
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Fanciulli A, Campese N, Goebel G, Ndayisaba JP, Eschlboeck S, Kaindlstorfer C, Raccagni C, Granata R, Bonuccelli U, Ceravolo R, Seppi K, Poewe W, Wenning GK. Association of transient orthostatic hypotension with falls and syncope in patients with Parkinson disease. Neurology 2020; 95:e2854-e2865. [PMID: 32938788 DOI: 10.1212/wnl.0000000000010749] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in Parkinson disease (PD), we retrospectively studied 173 patients with PD and 173 age- and sex-matched controls with orthostatic intolerance, who underwent cardiovascular autonomic function testing under continuous noninvasive blood pressure (BP) monitoring. METHODS We screened for tOH (systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg resolving within the first minute upon standing) and classic OH (cOH, sustained systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg within 3 minutes upon standing). In patients with PD, we reviewed the medical records of the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance. RESULTS tOH occurred in 24% of patients with PD and 21% of controls, cOH in 19% of patients with PD and in none of the controls, independently of any clinical-demographic or PD-specific characteristic. Forty percent of patients with PD had a history of falls, in 29% of cases due to syncope. Patients with PD with history of orthostatic intolerance and syncope had a more severe systolic BP fall and lower diastolic BP rise upon standing, most pronounced in the first 30-60 seconds. CONCLUSIONS tOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD. Continuous noninvasive BP monitoring upon standing may help identify a modifiable risk factor for syncope-related falls in parkinsonian patients.
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Affiliation(s)
- Alessandra Fanciulli
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Nicole Campese
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Georg Goebel
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Jean Pierre Ndayisaba
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sabine Eschlboeck
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Christine Kaindlstorfer
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Cecilia Raccagni
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Roberta Granata
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Ubaldo Bonuccelli
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Roberto Ceravolo
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Klaus Seppi
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Werner Poewe
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregor K Wenning
- From the Departments of Neurology (A.F., N.C., J.P.N., S.E., C.K., C.R., R.G., K.S., W.P., G.K.W.) and Medical Statistics, Informatics and Health Economics (G.G.), Medical University of Innsbruck, Austria; and Neurology Unit (N.C., U.B., R.C.), Department of Clinical and Experimental Medicine, University of Pisa, Italy
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11
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Krismer F, Beliveau V, Seppi K, Mueller C, Goebel G, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Automated Analysis of Diffusion-Weighted Magnetic Resonance Imaging for the Differential Diagnosis of Multiple System Atrophy from Parkinson's Disease. Mov Disord 2020; 36:241-245. [PMID: 32935402 PMCID: PMC7891649 DOI: 10.1002/mds.28281] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background Manual region‐of‐interest analysis of putaminal and middle cerebellar peduncle diffusivity distinguishes patients with multiple system atrophy (MSA) and Parkinson's disease (PD) with high diagnostic accuracy. However, a recent meta‐analysis found substantial between‐study heterogeneity of diagnostic accuracy due to the lack of harmonized imaging protocols and standardized analyses pipelines. Objective Evaluation of diagnostic accuracy of observer‐independent analysis of microstructural integrity as measured by diffusion‐tensor imaging in patients with MSA and PD. Methods A total of 29 patients with MSA and 19 patients with PD (matched for age, gender, and disease duration) with 3 years of follow‐up were investigated with diffusion‐tensor imaging and T1‐weighted magnetic resonance imaging. Automated localization of relevant brain regions was obtained, and mean diffusivity and fractional anisotropy values were averaged within the regions of interest. The classification was performed using a C5.0 hierachical decision tree algorithm. Results Mean diffusivity of the middle cerebellar peduncle and cerebellar gray and white matter compartment as well as the putamen were significantly increased in patients with MSA and showed superior effect sizes compared to the volumetric analysis of these regions. A classifier model identified mean diffusivity of the middle cerebellar peduncle and putamen as the most predictive parameters. Cross‐validation of the classification model yields a Cohen's κ and overall diagnostic accuracy of 0.823 and 0.914, respectively. Conclusion Analysis of microstructural integrity within the middle cerebellar peduncle and putamen yielded a superior effect size compared to the volumetric measures, resulting in excellent diagnostic accuracy to discriminate patients with MSA from PD in the early to moderate disease stages. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Vincent Beliveau
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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12
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Peball M, Krismer F, Knaus HG, Djamshidian A, Werkmann M, Carbone F, Ellmerer P, Heim B, Marini K, Valent D, Goebel G, Ulmer H, Stockner H, Wenning GK, Stolz R, Krejcy K, Poewe W, Seppi K. Non-Motor Symptoms in Parkinson's Disease are Reduced by Nabilone. Ann Neurol 2020; 88:712-722. [PMID: 32757413 PMCID: PMC7540547 DOI: 10.1002/ana.25864] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy and safety of nabilone, a synthetic tetrahydrocannabinol analogue, as a treatment for non-motor symptoms (NMS) in Parkinson's disease (PD). METHODS This was a phase II placebo-controlled, double-blind, parallel-group, enriched enrollment randomized withdrawal trial conducted at the Medical University Innsbruck. A random sample of 47 patients with PD with stable motor disease and disturbing NMS defined by a score of ≥4 points on the Movement Disorder Society - Unified PD Rating Scale-I (MDS-UPDRS-I) underwent open-label nabilone titration (0.25 mg once daily to 1 mg twice daily, phase I). Responders were randomized 1:1 to continue with nabilone or switch to placebo for 4 weeks (phase II). The primary efficacy criterion was the change of the MDS-UPDRS-I between randomization and week 4. Safety was analyzed in all patients who received at least one nabilone dose. RESULTS Between October 2017 and July 2019, 19 patients received either nabilone (median dose = 0.75 mg) or placebo. At week 4, mean change of the MDS-UPDRS-I was 2.63 (95% confidence interval [CI] 1.53 to 3.74, p = 0.002, effect size = 1.15) in the placebo versus 1.00 (95% CI -0.16 to 2.16, p = 0.280, effect size = 0.42) in the nabilone-group (difference: 1.63, 95% CI 0.09 to 3.18, p = 0.030, effect size = 0.66). Seventy-seven percent of patients had adverse events (AEs) during open-label titration, most of them were transient. In the double-blind phase, similar proportions of patients in each group had AEs (42% in the placebo group and 32% in the nabilone group). There were no serious AEs. INTERPRETATION Our results highlight the potential efficacy of nabilone for patients with PD with disturbing NMS, which appears to be driven by positive effects on anxious mood and night-time sleep problems. TRIAL REGISTRY ClinicalTrials.gov (NCT03769896) and EudraCT (2017-000192-86). ANN NEUROL 2020;88:712-722.
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Affiliation(s)
- Marina Peball
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Hans-Günther Knaus
- Department for Medical Genetics, Molecular, and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Mario Werkmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Federico Carbone
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Philipp Ellmerer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Marini
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Dora Valent
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics, and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics, and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Raphaela Stolz
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kurt Krejcy
- AOP Orphan Pharmaceuticals AG, Vienna, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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13
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Mangesius J, Seppi T, Weigel R, Arnold CR, Vasiljevic D, Goebel G, Lukas P, Ganswindt U, Nevinny-Stickel M. Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol 2019; 14:231. [PMID: 31852497 PMCID: PMC6921566 DOI: 10.1186/s13014-019-1425-7] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The present study investigates the intrafractional accuracy of a frameless thermoplastic mask used for head immobilization during stereotactic radiotherapy. Non-invasive masks cannot completely prohibit head movements. Previous studies attempted to estimate the magnitude of intrafractional inaccuracy by means of pre- and postfractional measurements only. However, this might not be sufficient to accurately map also intrafractional head movements. MATERIALS AND METHODS Intrafractional deviation of mask-fixed head positions was measured in five patients during a total of 94 fractions by means of close-meshed repeated ExacTrac measurements (every 1.4 min) conducted during the entire treatment session. A median of six (range: 4 to 11) measurements were recorded per fraction, delivering a dataset of 453 measurements. RESULTS Random errors (SD) for the x, y and z axes were 0.27 mm, 0.29 mm and 0.29 mm, respectively. Median 3D deviation was 0.29 mm. Of all 3D intrafractional motions, 5.5 and 0.4% exceeded 1 mm and 2 mm, respectively. A moderate correlation between treatment duration and mean 3D displacement was determined (rs = 0.45). Mean 3D deviation increased from 0.21 mm (SD = 0.26 mm) in the first 2 min to a maximum of 0.53 mm (SD = 0.31 mm) after 10 min of treatment time. CONCLUSION Pre- and post-treatment measurement is not sufficient to adequately determine the range of intrafractional head motion. Thermoplastic masks provide both reliable interfractional and intrafractional immobilization for image-guided stereotactic hypofractionated radiotherapy. Greater positioning accuracy may be obtained by reducing treatment duration (< 6 min) and applying intrafractional correction. TRIAL REGISTRATION Clinicaltrials.gov, NCT03896555, Registered 01 April 2019 - retrospectively registered.
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Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Rocco Weigel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Danijela Vasiljevic
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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14
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Fanciulli A, Goebel G, Lazzeri G, Granata R, Kiss G, Strano S, Colosimo C, Pontieri FE, Kaufmann H, Seppi K, Poewe W, Wenning GK. Urinary retention discriminates multiple system atrophy from Parkinson's disease. Mov Disord 2019; 34:1926-1928. [PMID: 31710392 DOI: 10.1002/mds.27917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Giulia Lazzeri
- Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gusztav Kiss
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefano Strano
- Department of Heart and Great Vessels "A. Reale", Sapienza University of Rom, Rome, Italy
| | - Carlo Colosimo
- Department of Neurology, Santa Maria Hospital, Terni, Italy
| | - Francesco E Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, USA
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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15
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Schnabl D, Goebel G, Kadletz A, Gaenzer H, Steiner R, Laimer J, Kapferer-Seebacher I. Cleansing efficacy of waist-shaped inter-dental brushes. A randomized-controlled crossover study. J Clin Periodontol 2019; 47:30-35. [PMID: 31609489 PMCID: PMC6972641 DOI: 10.1111/jcpe.13210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/27/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the cleansing efficacy of waist-shaped versus cylindric inter-dental brushes in patients receiving supportive periodontal therapy. MATERIALS AND METHODS After sample size estimation, 20 periodontal maintenance patients diagnosed with periodontitis stage 3 were recruited. Brushing efficacy of waist-shaped and cylindric inter-dental brushes was evaluated in a randomized-controlled, examiner-blinded, two-period crossover study by assessment of the Turesky modification of Quigley-Hein plaque index (T-QHI) and the papillary bleeding index (PBI) at four sites per tooth. RESULTS Seventeen probands with 1,474 tooth sites finished the study. At baseline, median of overall T-QHI scores was 1.4 (interquartile range 1.38-1.92). After 1 month, T-QHI for waist-shaped inter-dental brushes was 1.24 (1.03-1.52); in 15 individuals, T-QHI 0 was the grade most often measured. T-QHI for cylindric brushes was 1.71 (1.18-2.29; p = .042), with T-QHI 0 being the grade most often measured only in seven individuals. The odds ratio for establishing plaque-free inter-dental sites with waist-shaped relative to cylindric brushes was 1.8 [95% CI 1.6-1.9] (p < .001; logistic regression analysis). There were no statistically significant differences between PBI levels of waist-shaped and cylindric brushes. CONCLUSION This study has demonstrated the superiority in cleansing efficacy of waist-shaped over cylindric inter-dental brushes in individuals receiving supportive periodontal treatment.
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Affiliation(s)
- Dagmar Schnabl
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Alice Kadletz
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanna Gaenzer
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - René Steiner
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Laimer
- University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ines Kapferer-Seebacher
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
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16
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Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Kremser C, Wildauer M, Schocke M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic Potential of Multimodal MRI Markers in Atypical Parkinsonian Disorders. JPD 2019; 9:681-691. [DOI: 10.3233/jpd-181568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Schocke
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R. Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K. Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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17
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Raccagni C, Goebel G, Gaßner H, Granata R, Ndayisaba JP, Seebacher B, Schoenherr G, Mitterhuber J, Hendriks P, Kaindlstorfer C, Eschlboeck S, Fanciulli A, Krismer F, Seppi K, Poewe W, Bloem BR, Klucken J, Wenning GK. Physiotherapy improves motor function in patients with the Parkinson variant of multiple system atrophy: A prospective trial. Parkinsonism Relat Disord 2019; 67:60-65. [PMID: 31621609 DOI: 10.1016/j.parkreldis.2019.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 07/08/2019] [Revised: 08/26/2019] [Accepted: 09/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Gait impairment and reduced mobility are disabling symptoms of multiple system atrophy. While physiotherapy is increasingly recognized as a valuable supplement to pharmacotherapy for patients with Parkinson's disease, data on the efficacy of physiotherapy for multiple system atrophy are lacking. This study aimed to explore the feasibility of two consecutive exercise-based interventions in patients with multiple system atrophy. SUBJECTS AND METHODS We included 10 patients with the parkinsonian variant of multiple system atrophy and 10 patients with Parkinson's disease, matched for gender and Hoehn & Yahr stage (≤3). Interventions consisted of a five-day inpatient physiotherapy program followed by a five-week unsupervised home-based exercise program. Outcomes included instrumented gait analysis, patient questionnaires, clinical rating scales and physical tests. Patients were examined at baseline, after the first inpatient treatment and again after the home-based intervention. Additionally, a structured telephone interview was performed immediately after the second intervention period. RESULTS Both patient groups exhibited a similar improvement of gait after the interventions, as measured by instrumented gait analysis. These effects reached their maximum level after inpatient physiotherapy and remained stable following the home-based exercise program. Patient questionnaires also showed improvements after the interventions, but motor clinical rating scales did not. CONCLUSION Our pilot results suggest that a short-term bout of physiotherapy is feasible, safe and improves gait performance in patients with multiple system atrophy. This highlights the potential of physiotherapy for this disabling condition where pharmacotherapy typically achieves poor effects. The present findings warrant a larger controlled study.
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Affiliation(s)
- C Raccagni
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - G Goebel
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck University, Innsbruck, Austria
| | - H Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roberta Granata
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Barbara Seebacher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Jakob Mitterhuber
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Pascalle Hendriks
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Sabine Eschlboeck
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - J Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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18
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Fanciulli A, Goebel G, Lazzeri G, Scherfler C, Gizewski ER, Granata R, Kiss G, Strano S, Colosimo C, Pontieri FE, Kaufmann H, Seppi K, Poewe W, Wenning GK. Early distinction of Parkinson-variant multiple system atrophy from Parkinson's disease. Mov Disord 2019; 34:440-441. [PMID: 30788854 DOI: 10.1002/mds.27635] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Giulia Lazzeri
- IRCCS Foundation Ca' Grande Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roberta Granata
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gusztav Kiss
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefano Strano
- Department of Heart and Great Vessels "A. Reale", Sapienza University of Rome, Rome, Italy
| | - Carlo Colosimo
- Department of Neurology, Santa Maria Hospital, Terni, Italy
| | - Francesco E Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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19
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Erba PA, Maecke H, Mikolajczak R, Decristoforo C, Zaletel K, Maina-Nock T, Peitl PK, Garnuszek P, Froberg A, Goebel G, de Jong M, Jabrocka-Hybel A, Konijnenberg M, Virgolini I, Nock B, Lenda-Tracz W, Pawlak D, Rangger C, Trofimiuk-Müldner M, Sowa-Staszczak A, Tomaszuk M, von Guggenberg E, Scarpa L, Hubalewska-Dydejczyk A. A novel CCK2/gastrin receptor-localizing radiolabeled peptide probe for personalized diagnosis and therapy of patients with progressive or metastatic medullary thyroid carcinoma: a multicenter phase I GRAN-T-MTC study. Pol Arch Intern Med 2018; 128:791-795. [PMID: 30516761 PMCID: PMC6347971 DOI: 10.20452/pamw.4387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Fischer MJ, Horvath G, Krismer M, Gnaiger E, Goebel G, Pesta DH. Evaluation of mitochondrial function in chronic myofascial trigger points - a prospective cohort pilot study using high-resolution respirometry. BMC Musculoskelet Disord 2018; 19:388. [PMID: 30376863 PMCID: PMC6208107 DOI: 10.1186/s12891-018-2307-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background Myofascial trigger points (MTrPs) are hyperirritable areas in the fascia of the affected muscle, possibly related to mitochondrial impairment. They can result in pain and hypoxic areas within the muscle. This pilot study established a minimally invasive biopsy technique to obtain high-quality MTrP tissue samples to evaluate mitochondrial function via high-resolution respirometry. Secondary objectives included the feasibility and safety of the biopsy procedure. Methods Twenty healthy males participated in this study, 10 with a diagnosis of myofascial pain in the musculus (m.) trapezius MTrP (TTP group) and 10 with a diagnosis of myofascial pain in the m. gluteus medius (GTP group). Each participant had 2 muscle biopsies taken in one session. The affected muscle was biopsied followed by a biopsy from the m. vastus lateralis to be used as a control. Measurements of oxygen consumption were carried out using high-resolution respirometry. Results Mitochondrial respiration was highest in the GTP group compared to the TTP group and the control muscle whereas no differences were observed between the GTP and the control muscle. When normalizing respiration to an internal reference state, there were no differences between muscle groups. None of the participants had hematomas or reported surgical complications. Patient-reported pain was minimal for all 3 groups. All participants reported a low procedural burden. Conclusions This pilot study used a safe and minimally invasive technique for obtaining biopsies from MTrPs suitable for high-resolution respirometry analysis of mitochondrial function. The results suggest that there are no qualitative differences in mitochondrial function of MTrPs of the trapezius and gluteus medius muscles compared to the vastus lateralis control muscle, implying that alterations of mitochondrial function do not appear to have a role in the development of MTrPs. Trial registration Registered as No. 20131128–850 at the Coordinating Center for Clinical Studies of the Medical University of Innsbruck, trial registration date: 28th November 2013 and retrospectively registered on 11th of October 2018 at ClinicalTrials.gov with the ID NCT03704311.
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Affiliation(s)
- Michael J Fischer
- Vamed Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria.,Department of Rehabilitation Medicine, Hanover Medical School, Hanover, Germany.,Department of Orthopedics, Medical University Innsbruck, Innsbruck, Austria
| | - Gergo Horvath
- Department of Medical Biochemistry, Semmelweis University, Budapest, Hungary
| | - Martin Krismer
- Department of Orthopedics, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Gnaiger
- D. Swarovski Research Laboratory, Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Dominik H Pesta
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich-Heine-University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Department of Sport Science, University of Innsbruck, Innsbruck, Austria.
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21
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Brunner C, Wieser V, Jaeger T, Lang A, Stoger H, Suppan C, Goebel G, Soleiman A, Egle D, Marth C, Hubalek M. Longterm survival benefit of neoadjuvant liposomal doxorubicin, docetaxel, and trastuzumab in HER2-overexpressing breast cancer: A retrospective and multicenter analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12653] [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: 11/20/2022] Open
Affiliation(s)
| | - Verena Wieser
- Department og Gynecology and Obstetrics, Innsbruck, Austria
| | | | - Alois Lang
- Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | | | - Christoph Suppan
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Oeconomics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Marth
- AGO-A and Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
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22
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Ress C, Paulweber M, Goebel G, Willeit K, Rufinatscha K, Strobl A, Salzmann K, Kedenko L, Tschoner A, Staudacher G, Iglseder B, Tilg H, Paulweber B, Kaser S. Circulating Wnt inhibitory factor 1 levels are associated with development of cardiovascular disease. Atherosclerosis 2018; 273:1-7. [PMID: 29649633 DOI: 10.1016/j.atherosclerosis.2018.03.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 02/12/2018] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS Wnt signaling is involved in atherosclerotic plaque formation directly and indirectly by modulating cardiovascular risk factors. We investigated whether circulating concentrations of Wnt inhibitors are associated with cardiovascular events in subjects with intermediate cardiovascular risk. METHODS 904 non-diabetic subjects participating in the SAPHIR study were assessed. In the SAPHIR study, middle-aged women without overt atherosclerotic disease at study entry were followed up for 10 years. 88 patients of our study cohort developed cardiovascular disease at follow-up (CVD group). Subjects of the CVD group were 1:2 case-control matched for age, sex, BMI and smoking behavior with subjects without overt cardiovascular disease after a 10 year-follow-up (control group). 18 patients of the CVD group and 19 subjects of the control group were retrospectively excluded due to fulfilling exclusion criteria. Baseline circulating sclerostin, dickkopf (DKK)-1, secreted frizzled-related protein (SFRP)-1 and Wnt inhibitory factor (WIF)-1 levels were assessed by ELISA. RESULTS Baseline systemic SFRP-1 and WIF-1 levels were significantly higher in patients with cardiovascular events (n = 70) when compared to healthy controls (n = 157) while DKK-1 and sclerostin levels were similar in both groups. Logistic regression analysis revealed WIF-1 as a significant predictor of future cardiovascular events. CONCLUSIONS Our data suggest that increased SFRP-1 and WIF-1 levels precede the development of symptomatic atherosclerotic disease. Assessment of systemic WIF-1 levels, which turned out to be independently associated with CVD, might help to early identify patients at intermediate cardiovascular risk.
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Affiliation(s)
- Claudia Ress
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Mariya Paulweber
- Department of Internal Medicine 1, Paracelsus Private University Salzburg, Salzburg, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Karin Willeit
- Department of Internal Medicine 1, Paracelsus Private University Salzburg, Salzburg, Austria
| | - Kerstin Rufinatscha
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Strobl
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria
| | - Karin Salzmann
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Ludmilla Kedenko
- Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria
| | - Alexander Tschoner
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriele Staudacher
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Iglseder
- Department of Geriatrics, Paracelsus Private University Salzburg, Salzburg, Austria
| | - Herbert Tilg
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine 1, Paracelsus Private University Salzburg, Salzburg, Austria
| | - Susanne Kaser
- Department of Internal Medicine 1, Medical University Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Metabolic Crosstalk, Medical University Innsbruck, Innsbruck, Austria.
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23
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Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Steiger R, Wildauer M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic potential of dentatorubrothalamic tract analysis in progressive supranuclear palsy. Parkinsonism Relat Disord 2018; 49:81-87. [PMID: 29463454 DOI: 10.1016/j.parkreldis.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differentiation of progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) remains a major clinical challenge. OBJECTIVES To evaluate the diagnostic potential of observer-independent assessments of microstructural integrity within infratentorial brain regions to differentiate PSP-Richardson's syndrome (PSP-RS), PSP-P and PD. METHODS 3T MRI parameters of mean diffusivity, fractional anisotropy, grey and white matter volumes from patients with PSP-RS (n = 12), PSP-P (n = 12) and mean disease duration of 2.4 ± 1.7 years were compared with PD patients (n = 20) and healthy controls (n = 23) by using statistical parametric mapping and the spatially unbiased infratentorial template. Subsequently MRI measurements of the dentatorubrothalamic tract were determined observer-independently by a validated probabilistic infratentorial atlas. The impairment of gait and postural stability was evaluated by a sum-score derived from the Unified Parkinson Disease Rating Scale. RESULTS Significant mean diffusivity increases, fractional anisotropy decreases and corresponding volume loss were localized in mesencephalic tegmentum, superior cerebellar peduncle, decussation of superior cerebellar peduncle and dentate nucleus in PSP-RS and PSP-P compared to PD and healthy controls. Altered microstructural integrity of the dentatorubrothalamic tract in PSP-RS was significantly more pronounced compared to PSP-P and correlated significantly with the gait and postural stability sum-score. Linear discriminant analysis identified diffusion tensor imaging measures of the dentatorubrothalamic tract and the gait and postural stability sum-score to classify correctly 95.5% of PRP-RS, PSP-P and PD patients. CONCLUSIONS Observer-independent analysis of microstructural integrity within the dentatorubrothalamic tract in combination with assessments of gait and postural stability differentiate PSP-P from PSP-RS and PD in early to moderately advanced stages.
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Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | | | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
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24
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Abstract
Summary
Objectives:
Changes in the status of DNA methylation, known as epigenetic alterations, are among the most common molecular alterations in human neoplasia. For the first time, we reported on the analysis of fecal DNA from patients with CRC to determine the feasibility, sensitivity and specificity of this approach. We want to present basic information about DNA methylation analysis in the context of bioinformatics, the study design and several statistical experiences with gene methylation data. Additionally we outline chances and new research questions in the field of DNA methylation.
Methods:
We present current approaches to DNA methylation analysis based on one reference study. Its study design and the statistical analysis is reflected in the context of biomarker development. Finally we outline perspectives and research questions for statisticians and bioinformaticians.
Results:
Identification of at least three genes as potential DNA methylation-based tumor marker genes (SFRP2, SFRP5, PGR).
Conclusions:
DNA methylation analysis is a rising topic in molecular genetics. Gene methylation will push the extension of biobanks to include new types of genetic data. Study design and statistical methods for the detection of methylation biomarkers must be improved. For the purpose of establishing methylation analysis as a new diagnostic/prognostic tool the adaptation of several approaches has become a challenging field of research activity.
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25
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Jahn B, Arvandi M, Rochau U, Fiegl H, Goebel G, Marth C, Siebert U. Development of a novel prognostic score for breast cancer patients using mRNA expression of CHAC1. J Comp Eff Res 2017; 6:563-574. [PMID: 29091014 DOI: 10.2217/cer-2017-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/31/2022] Open
Abstract
AIM To develop a prognostic score for primary breast cancer patients integrating conventional predictors and the novel biomarker CHAC1 to aid adjuvant chemotherapy decisions. PATIENTS & METHODS A prognostic score for overall survival was developed using: conventional predictors from a dataset of 1777 patients and the weight of CHAC1 mRNA expression from an independent dataset of 106 patients using multivariate Cox regression. RESULTS The new score includes: CHAC1 mRNA expression, age, tumor size, HER2 neu status, lymph node status and degree of malignancy. Using a cut-off value of 11 score points, 10-year survival was 82% in low-risk (n = 34) and 43% in high-risk patients (n = 72). The addition of CHAC1 resulted in 16% reclassification. CONCLUSION Including CHAC1 in prognostic prediction may aid (and change) personalized treatment selection.
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Affiliation(s)
- Beate Jahn
- Institute of Public Health, Medical Decision Making & Health Technology Assessment, Department of Public Health, Health Services Research & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall in Tirol, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making & Health Technology Assessment, Department of Public Health, Health Services Research & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall in Tirol, Austria
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making & Health Technology Assessment, Department of Public Health, Health Services Research & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall in Tirol, Austria.,ONCOTYROL, Division of Health Technology Assessment & Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Heidi Fiegl
- Department of Obstetrics & Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics & Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics & Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making & Health Technology Assessment, Department of Public Health, Health Services Research & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Hall in Tirol, Austria.,ONCOTYROL, Division of Health Technology Assessment & Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.,Center for Health Decision Science, Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment & Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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26
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Hubalewska-Dydejczyk A, Erba P, Decristoforo C, Zaletel K, Mikolajczak R, Maecke H, Maina-Nock T, Konijnenberg M, Kolenc-Peitl P, Trofimiuk-Muldner M, Przybylik-Mazurek E, Virgolini I, Pawlak D, de JM, Froberg AC, Rangger C, Goebel G, Scarpa L, Skorkiewicz K, Lezaic L, Garnuszek P, Sowa-Staszczak A, Nock BA, Bergant D, Rep S, Glowa B. Theranostic management of medullary thyroid cancer (MTC) with (111In/177Lu) CP04: how close are we to a clinical solution? ACTA ACUST UNITED AC 2017. [DOI: 10.1530/endoabs.49.ep1445] [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: 11/08/2022]
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27
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Hofer-Picout P, Pichler H, Eder J, Neururer SB, Müller H, Reihs R, Holub P, Insam T, Goebel G. Conception and Implementation of an Austrian Biobank Directory Integration Framework. Biopreserv Biobank 2017; 15:332-340. [PMID: 28380303 DOI: 10.1089/bio.2016.0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/12/2022] Open
Abstract
INTRODUCTION Sample collections and data are hosted within different biobanks at diverse institutions across Europe. Our data integration framework aims at incorporating data about sample collections from different biobanks into a common research infrastructure, facilitating researchers' abilities to obtain high-quality samples to conduct their research. The resulting information must be locally gathered and distributed to searchable higher level information biobank directories to maximize the visibility on the national and European levels. Therefore, biobanks and sample collections must be clearly described and unambiguously identified. We describe how to tackle the challenges of integrating biobank-related data between biobank directories using heterogeneous data schemas and different technical environments. METHODS To establish a data exchange infrastructure between all biobank directories involved, we propose the following steps: (A) identification of core entities, terminology, and semantic relationships, (B) harmonization of heterogeneous data schemas of different Biobanking and Biomolecular Resources Research Infrastructure (BBMRI) directories, and (C) formulation of technical core principles for biobank data exchange between directories. RESULTS (A) We identified the major core elements to describe biobanks in biobank directories. Since all directory data models were partially based on Minimum Information About BIobank Data Sharing (MIABIS) 2.0, the MIABIS 2.0 core model was used for compatibility. (B) Different projection scenarios were elaborated in collaboration with all BBMRI.at partners. A minimum set of mandatory and optional core entities and data items was defined for mapping across all directory levels. (C) Major core data exchange principles were formulated and data interfaces implemented by all biobank directories involved. DISCUSSION We agreed on a MIABIS 2.0-based core set of harmonized biobank attributes and established a list of data exchange core principles for integrating biobank directories on different levels. This generic approach and the data exchange core principles proposed herein can also be applied in related tasks like integration and harmonization of biobank data on the individual sample and patient levels.
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Affiliation(s)
- Philipp Hofer-Picout
- 1 Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck , Innsbruck, Austria
| | - Horst Pichler
- 2 Department of Information and Communication Systems, University of Klagenfurt , Klagenfurt, Austria
| | - Johann Eder
- 2 Department of Information and Communication Systems, University of Klagenfurt , Klagenfurt, Austria
| | - Sabrina B Neururer
- 1 Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck , Innsbruck, Austria
| | - Heimo Müller
- 3 Institute of Pathology, Medical University Graz , Graz, Austria
| | - Robert Reihs
- 3 Institute of Pathology, Medical University Graz , Graz, Austria
| | - Petr Holub
- 4 Institute of Computer Science, Masaryk University , Brno, Czech Republic .,5 Biobanking and Biomolecular Resources Research Infrastructure (BBMRI-ERIC) , Graz, Austria
| | - Thomas Insam
- 6 Department of Obstetrics and Gynecology, Medical University of Innsbruck , Innsbruck, Austria
| | - Georg Goebel
- 1 Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck , Innsbruck, Austria
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Wolf B, Goebel G, Hackl H, Fiegl H. Reduced mRNA expression levels of NFE2L2 are associated with poor outcome in breast cancer patients. BMC Cancer 2016; 16:821. [PMID: 27770790 PMCID: PMC5075160 DOI: 10.1186/s12885-016-2840-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022] Open
Abstract
Background The transcription factor nuclear factor erythroid 2-related factor 2 (NFE2L2; previously known as NRF2) is a crucial regulator of the intracellular antioxidant response. It controls the expression of genes involved in the detoxification and elimination of reactive oxidants and electrophilic agents. The role of NFE2L2 in cancer is subject of controversial discussion, as it has been reported to have both pro-and anti-tumourigenic functions. To shed some light on this paradox, we analysed the NFE2L2 mRNA expression levels in breast cancer and its association with clinicopathological features and survival. Methods We retrospectively evaluated the NFE2L2 mRNA expression levels in tumour tissue of two independent breast cancer patient cohorts. In the training set we analysed data from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC). In the test set we measured the NFE2L2 mRNA expression levels in 176 breast tumour tissues by quantitative real-time reverse transcription PCR (qRT-PCR). Group differences were analysed using Mann–Whitney U-test, and associations between NFE2L2 mRNA expression levels and clinicopathological features were examined by means of univariate and multivariate survival analyses. Furthermore, we compared NFE2L2 mRNA expression levels between tumour and normal breast tissue samples by means of 108 paired samples from the The Cancer Genome Atlas (TCGA) dataset. Results In the training set we identified an independent predictive value for high NFE2L2 mRNA expression levels [HRdisease specific death 0.8 (0.6–1.0), P = 0.041; HRdeath 0.8 (0.6–1.0), P = 0.023] especially in the subgroup of oestrogen receptor (ER) positive tumours [HRdisease specific death 0.6 (0.4–0.9), P = 0.008; HRdeath 0.6 (0.4–0.8), P = 0.001]. Similarly, we found this association also in the test set [HRrelapse 0.4 (0.2–0.9), P = 0.031] and again, more pronounced in patients with ER positive tumours [HRrelapse 0.2 (0.1–0.7), P = 0.012]. In addition, we observed generally lower NFE2L2 expression levels in tumour tissues than in normal breast tissues. Conclusion We concluded that reduced NFE2L2 mRNA expression in tumour tissues is an independent predictor of shortened survival in breast cancer patients.
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Affiliation(s)
- Barbara Wolf
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Heidi Fiegl
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Müller S, Huber H, Goebel G, Wimmer G, Kapferer-Seebacher I. Pain perception during debridement of hypersensitive teeth elicited by two ultrasonic scalers. Clin Oral Investig 2016; 21:1559-1564. [PMID: 27743214 PMCID: PMC5442201 DOI: 10.1007/s00784-016-1971-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/04/2016] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The ultrasonic NO PAIN technology (Electro Medical Systems, Nyon, CH) promises minimal pain during debridement due to linear oscillating action combined with a sinusoidal power output and feedback control. The aim of the present study was to measure pain perception on a visual analogue scale (VAS) during supportive periodontal therapy including debridement of hypersensitive teeth. Two ultrasonic scalers were used, one with and one without NO PAIN technology. MATERIAL AND METHODS In a randomized-controlled clinical study with split-mouth design, 100 hypersensitive teeth matched for air blast hypersensitivity were either treated with the ultrasonic device Piezon Master 700 or the Mini Piezon (both EMS, Nyon, CH). Pain perception during debridement was assessed by a VAS (range 0-10). RESULTS The average VAS for the test device Piezon Master 700 with NO PAIN technology was 3.16 ± 2.10, and for the control device Mini Piezon without NO PAIN technology 3.40 ± 2.59 (p = 0.490). Placing an arbitrary threshold at the VAS score of 3 for significant pain experience, 60 % of the subjects experienced no significant pain with either instrument. CONCLUSION No statistically significant difference in perceived pain between the instruments used was found. CLINICAL RELEVANCE Both ultrasonic devices showed very small pain intensities during debridement of highly hypersensitive teeth and can therefore be recommended for supportive periodontal therapy.
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Affiliation(s)
- S Müller
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - H Huber
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - G Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schöpfstr. 41, 6020, Innsbruck, Austria
| | - G Wimmer
- Department of Restaurative Dentistry, Periodontology and Prosthodontics, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria
| | - I Kapferer-Seebacher
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Lutz M, Rudisch A, Kralinger F, Smekal V, Goebel G, Gabl M, Pechlaner S. Sagittal Wrist Motion of Carpal Bones Following Intraarticular Fractures of the Distal Radius. ACTA ACUST UNITED AC 2016; 30:282-7. [PMID: 15862369 DOI: 10.1016/j.jhsb.2004.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2003] [Accepted: 12/29/2004] [Indexed: 10/25/2022]
Abstract
Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6°, a mean ulnar tilt of 18° and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23°, lunate flexion of 15°, capitate extension of 62°, capitate flexion of 40°. There was a significant correlation between articular surface depth and radiocarpal motion.
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Affiliation(s)
- M Lutz
- Department of Trauma Surgery, University of Innsbruck, Austria.
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Frech A, Pellegrini L, Fraedrich G, Goebel G, Klocker J. Long-term Clinical Outcome and Functional Status After Arterial Reconstruction in Upper Extremity Injury. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.05.055] [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: 11/16/2022]
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Frech A, Pellegrini L, Fraedrich G, Goebel G, Klocker J. Long-term Clinical Outcome and Functional Status After Arterial Reconstruction in Upper Extremity Injury. Eur J Vasc Endovasc Surg 2016; 52:119-23. [DOI: 10.1016/j.ejvs.2016.03.028] [Citation(s) in RCA: 4] [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] [Received: 02/04/2015] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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Ndayisaba JP, Fanciulli A, Granata R, Duerr S, Hintringer F, Goebel G, Krismer F, Wenning GK. Erratum to: Sex and age effects on cardiovascular autonomic function in healthy adults. Clin Auton Res 2016; 26:169-70. [DOI: 10.1007/s10286-015-0335-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hofer P, Neururer S, Goebel G. Semi-Automated Annotation of Biobank Data Using Standard Medical Terminologies in a Graph Database. Stud Health Technol Inform 2016; 228:755-759. [PMID: 27577487] [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: 06/06/2023]
Abstract
Data describing biobank resources frequently contains unstructured free-text information or insufficient coding standards. (Bio-) medical ontologies like Orphanet Rare Diseases Ontology (ORDO) or the Human Disease Ontology (DOID) provide a high number of concepts, synonyms and entity relationship properties. Such standard terminologies increase quality and granularity of input data by adding comprehensive semantic background knowledge from validated entity relationships. Moreover, cross-references between terminology concepts facilitate data integration across databases using different coding standards. In order to encourage the use of standard terminologies, our aim is to identify and link relevant concepts with free-text diagnosis inputs within a biobank registry. Relevant concepts are selected automatically by lexical matching and SPARQL queries against a RDF triplestore. To ensure correctness of annotations, proposed concepts have to be confirmed by medical data administration experts before they are entered into the registry database. Relevant (bio-) medical terminologies describing diseases and phenotypes were identified and stored in a graph database which was tied to a local biobank registry. Concept recommendations during data input trigger a structured description of medical data and facilitate data linkage between heterogeneous systems.
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Affiliation(s)
- Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economy, Medical University of Innsbruck
| | - Sabrina Neururer
- Department of Medical Statistics, Informatics and Health Economy, Medical University of Innsbruck
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economy, Medical University of Innsbruck
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Fanciulli A, Goebel G, Metzler B, Sprenger F, Poewe W, Wenning GK, Seppi K. Elastic Abdominal Binders Attenuate Orthostatic Hypotension in Parkinson's Disease. Mov Disord Clin Pract 2015; 3:156-160. [PMID: 30363559 DOI: 10.1002/mdc3.12270] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 03/29/2015] [Revised: 07/16/2015] [Accepted: 08/19/2015] [Indexed: 11/09/2022] Open
Abstract
Background and Methods To investigate the possible efficacy of an elastic abdominal binder to control orthostatic hypotension (OH) associated with Parkinson's disease (PD), 15 patients with PD and OH were enrolled in a single-blind crossover study with elastic abdominal versus placebo binder on two different days, separated by a 1-day interval, followed by a 4-week open-label follow-up. Results Intervention significantly reduced blood pressure fall upon tilting. The mean difference (standard deviation; 95% confidence intervals) between abdominal binder versus placebo was +10 mm Hg (10.2; +3.5, +16.5; P = 0.006). No significant effect on supine mean blood pressure values was observed compared to placebo (P = 0.3). Symptoms of OH decreased significantly during follow-up (P = 0.003), as assessed by means of the Orthostatic Hypotension Questionnaire. Conclusions Our findings suggest that elastic abdominal binders may be a simple complementary tool to alleviate OH in PD.
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Affiliation(s)
- Alessandra Fanciulli
- Department of Neurology Innsbruck Medical University Innsbruck Austria.,Department of Neuroscience Mental Health and Sensory Organs "Sapienza" University of Rome Rome Italy
| | - Georg Goebel
- Department of Medical Statistics Informatics and Health Economics Innsbruck Medical University Innsbruck Austria
| | - Bernhard Metzler
- Third Department of Internal Medicine Innsbruck Medical University Innsbruck Austria
| | - Fabienne Sprenger
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Werner Poewe
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Gregor K Wenning
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Innsbruck Medical University Innsbruck Austria
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Ndayisaba JP, Fanciulli A, Granata R, Duerr S, Hintringer F, Goebel G, Krismer F, Wenning GK. Sex and age effects on cardiovascular autonomic function in healthy adults. Clin Auton Res 2015; 25:317-26. [DOI: 10.1007/s10286-015-0310-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/08/2015] [Indexed: 01/23/2023]
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Zenner HP, Delb W, Kröner-Herwig B, Jäger B, Peroz I, Hesse G, Mazurek B, Goebel G, Gerloff C, Trollmann R, Biesinger E, Seidler H, Langguth B. [On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus]. HNO 2015; 63:419-27. [PMID: 26054729 DOI: 10.1007/s00106-015-0011-z] [Citation(s) in RCA: 18] [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: 11/30/2022]
Abstract
INTRODUCTION Tinnitus is a frequent symptom, which, particularly in combination with comorbidities, can result in a severe disease-related burden. Chronic idiopathic tinnitus (CIT) is the most frequent type of tinnitus. A considerable number of treatment strategies are used to treat CIT-for many of which there is no evidence of efficacy. In order to enable scientific evidence-based treatment of CIT, German interdisciplinary S3 guidelines have recently been constructed for the first time. Here we present a short form of these S3 guidelines. MATERIALS AND METHODS The guidelines were constructed based on a meta-analysis of the treatment of chronic tinnitus performed by the authors. Additionally, a systematic literature search was performed in the PubMed and Cochrane Library databases. Furthermore, a systematic search for international guidelines was performed in Google, as well as in the Guidelines International Network and National Guideline Clearinghouse (USA) database. Evidence was classified according to the Oxford Centre for Evidence-Based Medicine system. RESULTS According to the guidelines, alongside counselling, manualized structured tinnitus-specific cognitive behavioral therapy (tCBT) with a validated treatment manual is available as evidence-based therapy. In addition, the guidelines recommend concurrent treatment of comorbidities, including drug-based treatment, where appropriate. Particularly important is treatment of anxiety and depression. Where a psychic or psychiatric comorbidity is suspected, further diagnosis and treatment should be performed by an appropriately qualified specialist (psychiatrist, neurologist, psychosomatic medicine consultant) or psychological psychotherapist. In cases accompanied by deafness or hearing loss bordering on deafness, cochlear implants may be indicated. CONCLUSION No recommendations can be made for drug-based treatment of CIT, audiotherapy, transcranial magnetic or electrical stimulation, specific forms of acoustic stimulation or music therapy; or such recommendations must remain open due to the lack of available evidence. Polypragmatic tinnitus treatment with therapeutic strategies for which there is no evidence of efficacy from controlled studies is to be refused.
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Affiliation(s)
- H-P Zenner
- Universitätsklinik für HNO-Heilkunde, Elfriede-Aulhorn-Str. 5, 72076, Tübingen, Deutschland,
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Mahlknecht P, Iranzo A, Högl B, Frauscher B, Müller C, Santamaría J, Tolosa E, Serradell M, Mitterling T, Gschliesser V, Goebel G, Brugger F, Scherfler C, Poewe W, Seppi K. Olfactory dysfunction predicts early transition to a Lewy body disease in idiopathic RBD. Neurology 2015; 84:654-8. [PMID: 25609758 DOI: 10.1212/wnl.0000000000001265] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the present study was to determine the predictive value of olfactory dysfunction for the early development of a synuclein-mediated neurodegenerative disease in subjects with idiopathic REM sleep behavior disorder (iRBD) over an observational period of 5 years. METHODS Thirty-four patients with polysomnography-confirmed iRBD underwent olfactory testing using the entire Sniffin' Sticks test assessing odor identification, odor discrimination, and olfactory threshold. Patients with iRBD were prospectively followed up over a period of 4.9 ± 0.3 years (mean ± SD). The diagnosis of neurodegenerative diseases was based on current clinical diagnostic criteria. RESULTS After 2.4 ± 1.7 years (mean ± SD), 9 patients (26.5%) with iRBD developed a Lewy body disease (6 Parkinson disease and 3 dementia with Lewy bodies). The entire Sniffin' Sticks test and the identification subtest had the same overall diagnostic accuracy of 82.4% (95% confidence interval: 66.1%-92.0%) in predicting conversion. The relative risk for a Lewy body disease in the lowest tertile of olfactory function was 7.3 (95% confidence interval: 1.8-29.6) compared with the top 2 tertiles. CONCLUSIONS Assessment of olfactory function, particularly odor identification, may help to predict the development of a Lewy body disease in patients with iRBD over a relatively short time period and thus to identify patients suitable for future disease modification trials.
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Affiliation(s)
- Philipp Mahlknecht
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Alex Iranzo
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain.
| | - Birgit Högl
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Birgit Frauscher
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Christoph Müller
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Joan Santamaría
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Eduardo Tolosa
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Monica Serradell
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Thomas Mitterling
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Viola Gschliesser
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Georg Goebel
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Florian Brugger
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Christoph Scherfler
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Werner Poewe
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain
| | - Klaus Seppi
- From the Department of Neurology (P.M., B.H., B.F., C.M., T.M., V.G., F.B., C.S., W.P., K.S.), Medical University Innsbruck; Department of Medical Statistics, Informatics and Health Economics (G.G.), Medical University Innsbruck, Austria; Neurology Service (A.I., J.S., E.T., M.S.), Hospital Clinic, Barcelona; Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED) (A.I., J.S., E.T., M.S.); and IDIBAPS (A.I., J.S., E.T., M.S.), Barcelona, Spain.
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Oberguggenberger A, Goebel G, Beer B, Oberacher H, Meraner V, Sztankay M, Sperner-Unterweger B, Zeimet AG, Marth C, Hubalek M, Holzner B. Getting the Whole Picture: Adding Patient-reported Outcomes to Adjuvant Endocrine Treatment Evaluation in Premenopausal Breast Cancer Patients. Breast J 2014; 20:555-7. [DOI: 10.1111/tbj.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry and Psychotherapy; Innsbruck Medical University; Innsbruck Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Beate Beer
- Institute of Legal Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Herbert Oberacher
- Institute of Legal Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Verena Meraner
- Department of Psychiatry and Psychotherapy; Innsbruck Medical University; Innsbruck Austria
| | - Monika Sztankay
- Department of Psychiatry and Psychotherapy; Innsbruck Medical University; Innsbruck Austria
| | | | - Alan G. Zeimet
- Department of Obstetrics and Gynecology; Innsbruck Medical University; Innsbruck Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology; Innsbruck Medical University; Innsbruck Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology; Innsbruck Medical University; Innsbruck Austria
| | - Bernhard Holzner
- Department of Psychiatry and Psychotherapy; Innsbruck Medical University; Innsbruck Austria
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Ratzinger G, Mitteregger S, Wolf B, Berger R, Zelger B, Weinlich G, Fritsch P, Goebel G, Fiegl H. Association of TNFRSF10D DNA-methylation with the survival of melanoma patients. Int J Mol Sci 2014; 15:11984-95. [PMID: 25003639 PMCID: PMC4139825 DOI: 10.3390/ijms150711984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/01/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/31/2022] Open
Abstract
In this retrospective pilot study, the DNA-methylation status of genes that have been demonstrated to be involved in melanoma carcinogenesis was analyzed in order to identify novel biomarkers for the risk assessment of melanoma patients. We analyzed DNA extracted from punch-biopsies from 68 formalin-fixed paraffin-embedded (FFPE) melanoma specimens. Using MethyLight PCR, we examined 20 genes in specimens from a training set comprising 36 melanoma patients. Selected candidate genes were validated in a test set using FFPE tissue samples from 32 melanoma patients. First, we identified the TNFRSF10D DNA-methylation status (TNFRSF10D methylated vs. unmethylated) as a prognostic marker for overall (p = 0.001) and for relapse-free survival (p = 0.008) in the training set. This finding was confirmed in the independent test set (n = 32; overall survival p = 0.041; relapse-free survival p = 0.012). In a multivariate Cox-regression analysis including all patients, the TNFRSF10D DNA-methylation status remained as the most significant prognostic parameter for overall and relapse-free survival (relative-risk (RR) of death, 4.6 (95% CI: 2.0–11.0; p < 0.001), RR of relapse, 7.2 (95% CI: 2.8–18.3; p < 0.001)). In this study, we demonstrate that TNFRSF10D DNA-methylation analysis of a small tissue-punch from archival FFPE melanoma tissue is a promising approach to provide prognostic information in patients with melanoma.
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Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Simone Mitteregger
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Barbara Wolf
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Regina Berger
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Bernhard Zelger
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Georg Weinlich
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Peter Fritsch
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck 6020, Austria.
| | - Heidelinde Fiegl
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck 6020, Austria.
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Fanciulli A, Strano S, Ndayisaba JP, Goebel G, Gioffrè L, Rizzo M, Colosimo C, Caltagirone C, Poewe W, Wenning GK, Pontieri FE. Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J Neurol 2014; 261:1291-9. [DOI: 10.1007/s00415-014-7339-2] [Citation(s) in RCA: 39] [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: 02/11/2014] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
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Nowosielski M, Wiestler B, Goebel G, Hutterer M, Schlemmer HP, Stockhammer G, Wick W, Bendszus M, Radbruch A. Progression types after antiangiogenic therapy are related to outcome in recurrent glioblastoma. Neurology 2014; 82:1684-92. [PMID: 24727314 DOI: 10.1212/wnl.0000000000000402] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This retrospective study analyzed whether the type of radiologic progression, classified according to contrast enhancement on MRI T1-weighted sequences and changes in T2-hyperintense signal, is relevant for outcome in patients with progressive glioblastoma (pGB) treated with bevacizumab. METHODS MRI scans of 83 patients with pGB treated with bevacizumab were evaluated prior to and at disease progression. Based on initial decrease in and subsequent flare-up of contrast enhancement in T1 and 2 patterns of T2-hyperintense tumor progression, progression types (PTs) were categorized as cT1 flare-up, T2-diffuse, T2-circumscribed, or primary nonresponder. Overall survival (OS), survival from start of bevacizumab therapy (OS_Bev), survival after bevacizumab failure (OS_PostBev), time from initial diagnosis until initiation of bevacizumab therapy (StartBevT), and time to bevacizumab progression were evaluated using Kaplan-Meier curves, log-rank test, and Cox regression analyses. RESULTS The time observed for development of a T2-diffuse (n = 15) or a cT1 flare-up (n = 35) progression was longer than for progression in primary nonresponders (n = 16) or T2-circumscribed progression (n = 17). The T2-diffuse PT showed longer OS, OS_Bev, OS_PostBev, and StartBevT compared to the other PTs. Postprogression therapy tended to be relevant only for patients with a T2-circumscribed PT. CONCLUSIONS Radiologic PTs following bevacizumab treatment failure show differences in time to development and are related to outcome. We therefore hypothesize that these PTs reflect a different glioma biology, including differential resistance mechanisms to bevacizumab, and may be associated with different responses to postprogression therapy.
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Affiliation(s)
- Martha Nowosielski
- From the Departments of Neurology (M.N., M.H., G.S.) and Medical Statistics, Informatics and Health Economics (G.G.), Innsbruck Medical University, Austria; the Department of Neurooncology (B.W., W.W.), Neurology Clinic and National Center for Tumor Diseases, and the Department of Neuroradiology (M.N., M.B., A.R.), University of Heidelberg; the Department of Neurology (M.H.), Regensburg Medical University; the Department of Radiology (H.P.S.), the Clinical Cooperation Unit Neurooncology (B.W., W.W.), and Department of Radiology, Neurooncologic Imaging (E012) (A.R.), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Klocker J, Koell A, Erlmeier M, Goebel G, Jaschke W, Fraedrich G. Ischemia and functional status of the left arm and quality of life after left subclavian artery coverage during stent grafting of thoracic aortic diseases. J Vasc Surg 2014; 60:64-9. [PMID: 24657299 DOI: 10.1016/j.jvs.2014.01.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The objective of this study was to report on the incidence of left arm ischemia, left arm function, and quality of life after thoracic endovascular aortic repair (TEVAR) by stent grafting with and without coverage of the left subclavian artery (LSA). METHODS All patients who underwent TEVAR since 1996 in our institution were included. Basic demographic parameters, underlying disease, details of TEVAR, long-term left arm function (Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire), and quality of life (12-Item Short Form Health Survey) were analyzed. End points were left arm ischemia, need for LSA revascularization (before or after TEVAR), long-term functional impairment, and quality of life. RESULTS A total of 138 patients underwent TEVAR for degenerative aneurysm (n = 64), traumatic aortic injury (TAI; n = 38), or Stanford type B dissection (n = 36). Seventy-three patients (52.9%) had LSA coverage, which led to partial or complete LSA occlusion in 49 (35.5%). Selectively, nine patients (6.5%) had primary LSA revascularization. After TEVAR, left arm ischemia was observed in only one patient, who consecutively needed a left carotid to subclavian bypass. During a mean follow-up period of 4.1 ± 3.7 years, no additional patient needed secondary LSA revascularization. In comparing patients with occluded vs patent LSA, the Physical Component Summary (PCS) and Mental Component Summary (MCS) health scores (12-Item Short Form Health Survey) as well as DASH scores were similar. However, subgroup analysis showed better PCS scores for TAI patients with patent LSA, whereas MCS and DASH scores were similar in TAI patients, and scores were indifferent within thoracic aortic aneurysm and Stanford type B dissection subgroups. In comparing different subgroups, TAI patients had significantly better PCS, MCS, and DASH scores. CONCLUSIONS TEVAR is associated with a low risk of peri-interventional left arm ischemia. During long-term follow-up, secondary LSA revascularization is uncommon. Coverage of the LSA has no impact on left arm function and quality of life, probably with the exception of physical health scores in patients with TAI.
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Affiliation(s)
- Josef Klocker
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
| | - Anna Koell
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Maximilian Erlmeier
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Jaschke
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
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Hofer P, Fiegl H, Angerer J, Mueller-Holzner E, Chamson M, Klocker H, Steiner E, Hauffe H, Zschocke J, Goebel G. A concept of a MIABIS based register of biosample collections at the Medical University of Innsbruck. Stud Health Technol Inform 2014; 205:293-297. [PMID: 25160193] [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: 06/03/2023]
Abstract
The knowledge about the quality of samples and associated clinical data in biospecimen collections is a premise of clinical research. An electronic biosample register aims to facilitate the discovery of information about biosample collections in a hospital. Moreover, it might improve scientific collaboration and research quality through a shared access to harmonized sample collection description data. The aim of this paper is to present a concept of a web-based biosample register of the existing biosample collections at the Medical University of Innsbruck. A uniform description model is built based on an analysis of the sample collection data of independent sample management systems from two departments within the hospital. An extended set of attributes of the minimum dataset used by the Swedish sample collection register (MIABIS) has been applied to all biosample collections as a common description model. The results of the analysis and the data model are presented together with a first concept of a sample collection search register.
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Affiliation(s)
- Philipp Hofer
- Department of Medical Informatics, Statistics and Health Economics, Medical University, Innsbruck
| | - Heidi Fiegl
- Department of Gynaecology and Obstetrics, Medical University, Innsbruck
| | - Justina Angerer
- Department of Gynaecology and Obstetrics, Medical University, Innsbruck
| | | | - Martina Chamson
- Department of Gynaecology and Obstetrics, Medical University, Innsbruck
| | | | | | - Helga Hauffe
- Department of Urology, Medical University, Innsbruck
| | | | - Georg Goebel
- Department of Medical Informatics, Statistics and Health Economics, Medical University, Innsbruck
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Brunner C, Jaeger T, Suppan C, Mueller-Holzner E, Jasarevic Z, Balic M, Goebel G, Marth C, Stoeger H, Samonigg H, Hubalek M, Lang A. Cardiac safety and efficacy of concomitant liposomal doxorubicin, docetaxel, and trastuzumab as neoadjuvant therapy in HER2-overexpressing breast cancer: A retrospective analysis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.583] [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
583 Background: Concurrent therapy of trastuzumab, anthracycline and taxane for the neoadjuvant treatment of breast cancer (BC) results in an improved rate of pathological complete response (pCR). However, there is considerable concern about the cardiac safety of this combination. The use of liposomal doxorubicin might be a valuable alternative with lower cardiotoxicity. We report cardiac safety and pCR-rate of a single arm, retrospective, multicenter analysis of neoadjuvant treatment for BC with liposomal doxorubicin, trastuzumab, and docetaxel. Methods: In this study 84 women with BC and HER2 overexpression were investigated in 3 oncological departments in Austria. All patients were treated with liposomal doxorubicin (50 - 60 mg/m²), docetaxel (75 mg/m²) and concurrent with trastuzumab for 6 cycles as neoadjuvant therapy. All patients were free of cardiovascular disease and had a left ventricular ejection fraction (LVEF) of ≥ 55%. Cardiac function was by LVEF and was examined at regular intervals(cycles 0-3, cycle 6, FU). Clinical response was evaluated by diagnostic breast imaging after cycles 3 and 6. All patients underwent surgery after neoadjuvant chemotherapy. The absence of any residual invasive cancer in the breast and axilla was defined as pathological complete response (pCR). Median follow up was 2.4 years. Results: Median age of the patients was 50 years. After 6 cycles of treatment the pCR rate was 46%. In this cohort a negative estrogen-and/or progesteron receptor was predictive for pCR (p<0.001). No patient progressed during treatment. None of the patients suffered symptomatic heart failure. Only one patient (1.6%) with asymptomatic LVEF of 45% was observed during follow-up. Conclusions: In this multicenter analysis we observed a considerably high rate of pCR in HER2-positive BC treated with liposomal doxorubicin, docetaxel and trastuzumab. The addition of liposomal doxorubicin instead of conventional doxorubicin or epirubicin entails a very favorable cardiotoxicity profile. This regimen is a safe treatment option in patients with HER-2 positive breast cancer.
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Affiliation(s)
| | | | - Christoph Suppan
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | | | | | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Oeconomics, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Hellmut Samonigg
- Department of Medical Oncology, Medical University of Graz, Graz, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Alois Lang
- Academic Teaching Hospital, Feldkirch, Feldkirch, Austria
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Rantner B, Goebel G, Bonati L, Ringleb P, Mas JL, Fraedrich G. The risk of carotid artery stenting compared with carotid endarterectomy is greatest in patients treated within 7 days of symptoms. J Vasc Surg 2013; 57:619-626.e2; discussion 625-6. [DOI: 10.1016/j.jvs.2012.08.107] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/13/2012] [Accepted: 08/19/2012] [Indexed: 10/27/2022]
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Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Köllensperger M, Goebel G, Pfeiffer KP, Barone P, Pellecchia MT, Quinn NP, Koukouni V, Fowler CJ, Schrag A, Mathias CJ, Giladi N, Gurevich T, Dupont E, Ostergaard K, Nilsson CF, Widner H, Oertel W, Eggert KM, Albanese A, del Sorbo F, Tolosa E, Cardozo A, Deuschl G, Hellriegel H, Klockgether T, Dodel R, Sampaio C, Coelho M, Djaldetti R, Melamed E, Gasser T, Kamm C, Meco G, Colosimo C, Rascol O, Meissner WG, Tison F, Poewe W. The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 2013; 12:264-74. [PMID: 23391524 PMCID: PMC3581815 DOI: 10.1016/s1474-4422(12)70327-7] [Citation(s) in RCA: 343] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. METHODS Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. FINDINGS 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size estimation showed that an interventional trial with 258 patients (129 per group) would be able to detect a 30% effect size in 1-year UMSARS motor examination decline rates at 80% power. INTERPRETATION Our prospective dataset provides new insights into the evolution of MSA based on a follow-up period that exceeds that of previous studies. It also represents a useful resource for patient counselling and planning of multicentre trials.
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Affiliation(s)
- Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Burger H, Sperzel J, Chow J, Goebel G, Ehrlich W, Walther T, Ziegelhöffer T. New and more efficient CRT-implantation technique based on the advantages of the multipolar left ventricular lead (Quartet™): A single centre comparison between conventional and new strategy. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332472] [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: 10/27/2022]
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Burger H, Goebel G, Chow J, Blumenstein J, Sperzel J, Walther T, Ziegelhöffer T. Necessity and benefit of an additional atrial lead in patients with atrial fibrillation and Cardiac Resynchronization Therapy – a single center experience. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332470] [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: 10/27/2022]
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Halbmayer WM, Weigel G, Quehenberger P, Tomasits J, Haushofer AC, Aspoeck G, Loacker L, Schnapka-Koepf M, Goebel G, Griesmacher A. Interference of the new oral anticoagulant dabigatran with frequently used coagulation tests. Clin Chem Lab Med 2013; 50:1601-5. [PMID: 23100377 DOI: 10.1515/cclm-2011-0888] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/06/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dabigatran etexilate is a new oral anticoagulant for the therapy and prophylaxis of venous thromboembolism and stroke prevention in patients with atrial fibrillation. To investigate the extent of interactions of this new anticoagulant with frequently used coagulation assays, we completed a multicenter in vitro trial with Conformité Européenne(CE)-labeled dabigatran-spiked plasma samples. METHODS Lyophilized plasma samples with dabigatran concentrations ranging from 0.00 to 0.48 μg/mL were sent to the coagulation laboratories of six major Austrian hospitals for evaluation. Coagulation assays were performed under routine conditions using standard reagents and analyzer. RESULTS Dabigatran led to a dose-dependent prolongation of the clotting times in coagulometric tests and influenced the majority of the parameters measured. Statistically significant interference could be observed with the prothrombin time (PT), activated partial thromboplastin time (aPTT) and PT/aPTT-based assays (extrinsic/intrinsic factors, APC-resistance test) as well as lupus anticoagulant testing. Even non-clotting tests, such as the colorimetric factor XIII activity assay and to a minor extent the amidolytic antithrombin activity assay (via factor IIa) were affected. CONCLUSIONS This multicenter trial confirms and also adds to existing data, demonstrating that laboratories should expect to observe strong interferences of coagulation tests with increasing concentrations of dabigatran. This finding might become particularly important in the elderly and in patients with renal impairment as well as patients whose blood is drawn at peak levels of dabigatran.
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