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Carrozzo AE, Cornelissen V, Bathke AC, Claes J, Niebauer J, Zimmermann G, Treff G, Kulnik ST. Applying exercise capacity and physical activity as single vs. composite endpoints for trials of cardiac rehabilitation interventions: Rationale, use-case, and a blueprint method for sample size calculation. Arch Phys Med Rehabil 2024:S0003-9993(24)00941-9. [PMID: 38621456 DOI: 10.1016/j.apmr.2024.04.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To conceptualise a composite primary endpoint for parallel-group RCTs of exercise-based cardiac rehabilitation interventions, and to explore its application and statistical efficiency. DESIGN We conducted a statistical exploration of sample size requirements. We combined exercise capacity and physical activity for the composite endpoint, both being directly related to reduced premature mortality in cardiac patients. Based on smallest detectable and minimal clinically important changes (change in exercise capacity of 15W and change in physical activity of 10 min/day), the composite endpoint combines two dichotomous endpoints (achieved/not achieved). To examine statistical efficiency, we compared sample size requirements based on the composite endpoint to single endpoints using data from two completed cardiac rehabilitation trials. SETTING Cardiac rehabilitation phase III PARTICIPANTS: Cardiac rehabilitation patients INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE(S): Exercise capacity (Pmax assessed by incremental cycle ergometry) and physical activity (daily minutes of moderate to vigorous physical activity assessed by accelerometry) RESULTS: Expecting, e.g., a 10% between-group difference and improvement in the clinical outcome, the composite endpoint would require a sample size increase by up to 21% or 61%, depending on the dataset. When expecting a 10% difference and designing an intervention with the aim of non-deterioration, the composite endpoint would allow to reduce the sample size by up to 55% or 70%. CONCLUSIONS Trialists may consider the utility of the composite endpoint for future studies in exercise-based cardiac rehabilitation, which could reduce sample size requirements. However, perhaps surprisingly at first, the composite endpoint could also lead to an increased sample size needed, depending on the observed baseline proportions in the trial population and the aim of the intervention.
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Affiliation(s)
| | | | | | - Jomme Claes
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | | | - Gunnar Treff
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
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Windhofer CM, Neureiter J, Schauer J, Zimmermann G, Hirnsperger C. Trapeziectomy versus Maïa Prosthesis in Trapeziometacarpal Osteoarthritis. J Wrist Surg 2024; 13:142-150. [PMID: 38505211 PMCID: PMC10948241 DOI: 10.1055/s-0043-1770793] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/29/2023] [Indexed: 03/21/2024]
Abstract
Background Osteoarthritis at the base of the thumb is the most frequent osteoarthritis of the hand. Trapeziectomy in a broad variety of surgical methods have been proposed to achieve pain reduction and improvement of thumb function. A well-known disadvantage is the long recovery time. Arthroplasty of the thumb carpometacarpal joint is a competing new method for this indication with different revision and complication rates reported. Purposes The aim of this study is to assess whether there are significant differences in outcome during the first 12 months and time return to work after either, implant of a Maïa joint prosthesis, or trapeziectomy with tendon interposition after Weilby. Patients and Methods This clinical follow-up study compares the efficacy of total basal joint replacement using the Maïa prosthesis with tendon interposition arthroplasty in 59 thumbs. Clinical, functional, and radiological results at preoperative, 3-, 6-, and 12-month postoperative are presented. Results We found a significant shorter return to work in the prosthesis group with 4.5 compared with 8.6 weeks. In addition to a significant difference in pain reduction with a better Mayo wrist score in the Maïa group after 3 months. The scores are closer after 6 months and nearly match after 12 months. Measurement of the pinch grip showed a parallel course. A radiological loosening of the cup in two patients was detected after 12 months. Conclusion Implantation of Maïa prosthesis enables a significant shorter recovery but is associated with the risk of loosening and higher costs. Level of Evidence Level IV, case-control study.
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Affiliation(s)
- Christian M. Windhofer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
- Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology in AUVA Trauma Research Center, Wien, Austria
| | - Johann Neureiter
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Josef Schauer
- Department Traumatology, AUVA Trauma Center Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
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Bosque Varela P, Tabaee Damavandi P, Machegger L, Prüwasser T, Zimmermann G, Oellerer A, Steinbacher J, McCoy M, Pfaff J, Trinka E, Kuchukhidze G. Magnetic resonance imaging fingerprints of status epilepticus: A case-control study. Epilepsia 2024. [PMID: 38507291 DOI: 10.1111/epi.17949] [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: 12/13/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Status epilepticus (SE) is frequently associated with peri-ictal magnetic resonance imaging (MRI) abnormalities (PMA). However, the anatomical distribution of these alterations has not been systematically studied. The aim of this study was to assess the localization patterns of PMA in patients with SE. METHODS In this prospective case-control study, we compared the distribution and combinations of diffusion-restricted PMA to diffusion-restricted lesions caused by other neurological conditions. All patients of the SE group and the control group underwent MRI including a diffusion-weighted imaging sequence. Patients with SE were imaged within 48 h after its onset. RESULTS We enrolled 201 patients (51 with SE and 150 controls). The most frequent locations of PMA in SE were cortex (25/51, 49%), followed by hippocampus (20/51, 39%) and pulvinar of thalamus (10/51, 20%). In the control group, the cortex was involved in 80 of 150 (53%), white matter in 53 of 150 (35%), and basal ganglia in 33 of 150 (22%). In the control group, the pulvinar of thalamus was never affected and hippocampal structures were rarely involved (7/150, 5%). Involvement of the pulvinar of thalamus and the hippocampus had high specificity for SE at 100% (95% confidence interval [CI] = 98-100) and 95% (95% CI = 91-98), respectively. The sensitivity, however, was low for both locations (pulvinar of thalamus: 20%, 95% CI = 10-33; hippocampus: 39%, 95% CI = 26-54). SIGNIFICANCE Diffusion-restricted MRI lesions observed in the pulvinar of thalamus and hippocampus are strongly associated with SE. These changes may help physicians in diagnosing SE-related changes on MRI in an acute setting, especially in cases of equivocal clinical and electroencephalographic manifestations of SE.
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Affiliation(s)
- Pilar Bosque Varela
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Payam Tabaee Damavandi
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Lukas Machegger
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tanja Prüwasser
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Oellerer
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jürgen Steinbacher
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Mark McCoy
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
| | - Johannes Pfaff
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Center for Cognitive Neuroscience, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
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Schoenen S, Verbeeck J, Koletzko L, Brambilla I, Kuchenbuch M, Dirani M, Zimmermann G, Dette H, Hilgers RD, Molenberghs G, Nabbout R. Istore: a project on innovative statistical methodologies to improve rare diseases clinical trials in limited populations. Orphanet J Rare Dis 2024; 19:96. [PMID: 38431612 PMCID: PMC10909280 DOI: 10.1186/s13023-024-03103-2] [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] [Received: 04/28/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The conduct of rare disease clinical trials is still hampered by methodological problems. The number of patients suffering from a rare condition is variable, but may be very small and unfortunately statistical problems for small and finite populations have received less consideration. This paper describes the outline of the iSTORE project, its ambitions, and its methodological approaches. METHODS In very small populations, methodological challenges exacerbate. iSTORE's ambition is to develop a comprehensive perspective on natural history course modelling through multiple endpoint methodologies, subgroup similarity identification, and improving level of evidence. RESULTS The methodological approaches cover methods for sound scientific modeling of natural history course data, showing similarity between subgroups, defining, and analyzing multiple endpoints and quantifying the level of evidence in multiple endpoint trials that are often hampered by bias. CONCLUSION Through its expected results, iSTORE will contribute to the rare diseases research field by providing an approach to better inform about and thus being able to plan a clinical trial. The methodological derivations can be synchronized and transferability will be outlined.
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Affiliation(s)
- Stefanie Schoenen
- Institute of Medical Statistics, RWTH Aachen University, Pauwelsstrasse 19, 52074, Aachen, Germany
| | - Johan Verbeeck
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Lukas Koletzko
- Institute of Statistics, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Isabella Brambilla
- Dravet Italia Onlus - European Patient Advocacy Group (ePAG) EpiCARE, 37100, Verona, Italy
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Research Center for Pediatric Epilepsies, University of Verona, Via S. Francesco, 22, 37129, Verona, Italy
| | - Mathieu Kuchenbuch
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
| | - Maya Dirani
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Holger Dette
- Institute of Statistics, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ralf-Dieter Hilgers
- Institute of Medical Statistics, RWTH Aachen University, Pauwelsstrasse 19, 52074, Aachen, Germany.
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- I-BioStat, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Rima Nabbout
- Institut des Maladies Gènètiques Imagine-Necker Enfants malades Hospital, 24 Boulevard du Montparnasse, 75015, Paris, France
- Necker Enfants malades Hospital, 149 Rue de Sèvre, 75015, Paris, France
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Kartal O, Lindlbauer N, Laner-Plamberger S, Rohde E, Foettinger F, Ombres L, Zimmermann G, Mrazek C, Lauth W, Grabmer C. Collection efficiency of mononuclear cells in offline extracorporeal photopheresis: can processing time be shortened? Blood Transfus 2024; 22:150-156. [PMID: 37458722 PMCID: PMC10920072 DOI: 10.2450/bloodtransfus.442] [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] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/08/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is a well-established but lengthy and burdensome cell-based therapy for various diseases such as cutaneous T-cell lymphoma, graft-versus-host disease and organ rejection after transplantation. The number of mononuclear cells (MNCs) that needs to be collected to obtain a clinical response to ECP is still under debate. The purpose of this retrospective study was to determine the number of lymphocytes, monocytes and neutrophils in mononuclear cell products (MCP) by flow cytometry and the collection efficiency in the offline ECP setting. MATERIALS AND METHODS We collected data from 10 different patients undergoing 162 ECP procedures using the Spectra Optia device for MNC collection. White blood cell (WBC) count of MCP was determined using a hematology analyzer. MNCs were analyzed for CD45 and CD14 expression by flow cytometry to exactly determine the collected lymphocyte and monocyte fractions. RESULTS Collected MCP showed high cell yields with 55.3×106/kg MNCs and 41.1×106/kg lymphocytes. MCP were characterized by high MNC (81.3%) and low neutrophils (18.7%) percentage. Mean collection efficiency for WBCs and for MNCs was 23.9% and 62.0%, respectively. The MNC fraction showed a moderate to high correlation between peripheral blood cell count of patients and MCP count. DISCUSSION This study is one of a few reports showing the monocyte-to-lymphocyte relation in MCP for ECP determined by flow cytometry. In comparison to historical data from inline ECP, the offline ECP processing one total blood volume results in considerably higher cell yields. For this reason, and to reduce the burden on patients, we propose that the offline ECP processing time can be substantially reduced.
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Affiliation(s)
- Orkan Kartal
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Nadja Lindlbauer
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Sandra Laner-Plamberger
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Fabian Foettinger
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Laura Ombres
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - Wanda Lauth
- Team Biostatistics and Big Medical Data, IDA Lab, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Grabmer
- Department of Transfusion Medicine, Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
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Geroldinger M, Verbeeck J, Thiel KE, Molenberghs G, Bathke AC, Laimer M, Zimmermann G. A neutral comparison of statistical methods for analyzing longitudinally measured ordinal outcomes in rare diseases. Biom J 2024; 66:e2200236. [PMID: 36890631 DOI: 10.1002/bimj.202200236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 03/10/2023]
Abstract
Ordinal data in a repeated measures design of a crossover study for rare diseases usually do not allow for the use of standard parametric methods, and hence, nonparametric methods should be considered instead. However, only limited simulation studies in settings with small sample sizes exist. Therefore, starting from an Epidermolysis Bullosa simplex trial with the above-mentioned design, a rank-based approach using the R package nparLD and different generalized pairwise comparisons (GPC) methods were compared impartially in a simulation study. The results revealed that there was not one single best method for this particular design, because a trade-off exists between achieving high power, accounting for period effects, and for missing data. Specifically, nparLD as well as the unmatched GPC approaches do not address crossover aspects, and the univariate GPC variants partly ignore the longitudinal information. The matched GPC approaches, on the other hand, take the crossover effect into account in the sense of incorporating the within-subject association. Overall, the prioritized unmatched GPC method achieved the highest power in the simulation scenarios, although this may be due to the specified prioritization. The rank-based approach yielded good power even at a sample size ofN = 6 $N=6$ , whereas the matched GPC method could not control the type I error.
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Affiliation(s)
- Martin Geroldinger
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Johan Verbeeck
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
| | - Konstantin E Thiel
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Geert Molenberghs
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KULeuven, Leuven, Belgium
| | - Arne C Bathke
- Intelligent Data Analytics (IDA) Lab Salzburg, Department of Artificial Intelligence and Human Interfaces, Faculty of Digital and Analytical Sciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Martin Laimer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
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Moser T, Zimmermann G, Baumgartner A, Berger T, Bsteh G, Di Pauli F, Enzinger C, Fertl E, Heller T, Koppi S, Rommer PS, Safoschnik G, Seifert-Held T, Stepansky R, Sellner J. Long-term outcome of natalizumab-associated progressive multifocal leukoencephalopathy in Austria: a nationwide retrospective study. J Neurol 2024; 271:374-385. [PMID: 37728757 PMCID: PMC10770206 DOI: 10.1007/s00415-023-11924-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/28/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND/OBJECTIVE The use of natalizumab (NAT) in multiple sclerosis (MS) may be complicated by progressive multifocal leukoencephalopathy (PML), a rare and life-threatening opportunistic brain infection. We aimed to analyze the course of MS after PML recovery together with the long-term outcome of NAT-associated PML (NAT-PML) in Austria. METHODS Retrospective study based on identification of cases in the nationwide Austrian MS treatment registry (AMSTR) and MS centers with review of patient records. The expanded disability status scale (EDSS) was used to measure neurological disability and outcome. RESULTS As of December 2022, we identified 15 NAT-PML cases in Austria; only 20% occurred after 2016, when increased vigilance commenced. Two patients did not survive acute PML, and an additional patient died five years later, yielding a mortality rate of 20%. Seizures occurred exclusively in patients with pronounced EDSS increase. Gadolinium (Gd)-enhancement on brain magnetic resonance imaging (MRI) on PML suspicion was associated with minor changes of post-PML neurological disability. Long-term follow-up of up to 132 months (median 76 months) was available in 11/15. The overall median EDSS increased from 3.5 at pre-PML to 6.5 at the last assessment. Regarding inflammatory MS-related disease activity during the observation period, one single individual experienced an MS relapse and another patient had two Gd-enhancing brain lesions. Three patients converted to progressive MS within three years from PML and the EDSS further increased in 6/11. CONCLUSIONS The number of NAT-PML cases is decreasing over time. While many patients accumulated severe persistent neurological deficits compared to pre-PML, inflammatory MS-related disease activity after PML recovery was rare.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Anna Baumgartner
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Thomas Heller
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Stefan Koppi
- Rehabilitation Clinic Montafon, Schruns, Austria
| | - Paulus S Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Johann Sellner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrasse 67, 2130, Mistelbach, Austria.
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Geroldinger M, Verbeeck J, Hooker AC, Thiel KE, Molenberghs G, Nyberg J, Bauer J, Laimer M, Wally V, Bathke AC, Zimmermann G. Statistical recommendations for count, binary, and ordinal data in rare disease cross-over trials. Orphanet J Rare Dis 2023; 18:391. [PMID: 38115074 PMCID: PMC10729462 DOI: 10.1186/s13023-023-02990-1] [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] [Received: 08/07/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Recommendations for statistical methods in rare disease trials are scarce, especially for cross-over designs. As a result various state-of-the-art methodologies were compared as neutrally as possible using an illustrative data set from epidermolysis bullosa research to build recommendations for count, binary, and ordinal outcome variables. For this purpose, parametric (model averaging), semiparametric (generalized estimating equations type [GEE-like]) and nonparametric (generalized pairwise comparisons [GPC] and a marginal model implemented in the R package nparLD) methods were chosen by an international consortium of statisticians. RESULTS It was found that there is no uniformly best method for the aforementioned types of outcome variables, but in particular situations, there are methods that perform better than others. Especially if maximizing power is the primary goal, the prioritized unmatched GPC method was able to achieve particularly good results, besides being appropriate for prioritizing clinically relevant time points. Model averaging led to favorable results in some scenarios especially within the binary outcome setting and, like the GEE-like semiparametric method, also allows for considering period and carry-over effects properly. Inference based on the nonparametric marginal model was able to achieve high power, especially in the ordinal outcome scenario, despite small sample sizes due to separate testing of treatment periods, and is suitable when longitudinal and interaction effects have to be considered. CONCLUSION Overall, a balance has to be found between achieving high power, accounting for cross-over, period, or carry-over effects, and prioritizing clinically relevant time points.
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Affiliation(s)
- Martin Geroldinger
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Strubergasse 21, Salzburg, 5020, Austria.
- Department of Neurology, Christian Doppler Medical Centre, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Paracelsus Medical University, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria.
| | - Johan Verbeeck
- I-BioStat, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Andrew C Hooker
- Department of Pharmacy, Uppsala University, 751 24, Uppsala, Sweden
| | - Konstantin E Thiel
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Strubergasse 21, Salzburg, 5020, Austria
| | - Geert Molenberghs
- I-BioStat, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- I-BioStat, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Joakim Nyberg
- Department of Pharmacy, Uppsala University, 751 24, Uppsala, Sweden
| | - Johann Bauer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, 5020, Austria
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, 5020, Austria
| | - Martin Laimer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, 5020, Austria
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, 5020, Austria
| | - Verena Wally
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, 5020, Austria
| | - Arne C Bathke
- Intelligent Data Analytics (IDA) Lab Salzburg, Department of Artificial Intelligence and Human Interfaces, University of Salzburg, Salzburg, 5020, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Strubergasse 21, Salzburg, 5020, Austria
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9
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Rainer LJ, Kuchukhidze G, Trinka E, Braun M, Kronbichler M, Langthaler P, Zimmermann G, Kronbichler L, Said-Yürekli S, Kirschner M, Zamarian L, Schmid E, Jokeit H, Höfler J. Recognition and perception of emotions in juvenile myoclonic epilepsy. Epilepsia 2023; 64:3319-3330. [PMID: 37795683 DOI: 10.1111/epi.17783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Perception and recognition of emotions are fundamental prerequisites of human life. Patients with juvenile myoclonic epilepsy (JME) may have emotional and behavioral impairments that might influence socially desirable interactions. We aimed to investigate perception and recognition of emotions in patients with JME by means of neuropsychological tests and functional magnetic resonance imaging (fMRI). METHODS Sixty-five patients with JME (median age = 27 years, interquartile range [IQR] = 23-34) were prospectively recruited at the Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. Patients were compared to 68 healthy controls (median age = 24 years, IQR = 21-31), matched for sex, age, and education. All study participants underwent the Networks of Emotion Processing test battery (NEmo), an fMRI paradigm of "dynamic fearful faces," a structured interview for psychiatric and personality disorders, and comprehensive neuropsychological testing. RESULTS JME patients versus healthy controls demonstrated significant deficits in emotion recognition in facial and verbal tasks of all emotions, especially fear. fMRI revealed decreased amygdala activation in JME patients as compared to healthy controls. Patients were at a higher risk of experiencing psychiatric disorders as compared to healthy controls. Cognitive evaluation revealed impaired attentional and executive functioning, namely psychomotor speed, tonic alertness, divided attention, mental flexibility, and inhibition of automated reactions. Duration of epilepsy correlated negatively with parallel prosodic and facial emotion recognition in NEmo. Deficits in emotion recognition were not associated with psychiatric comorbidities, impaired attention and executive functions, types of seizures, and treatment. SIGNIFICANCE This prospective study demonstrated that as compared to healthy subjects, patients with JME had significant deficits in recognition and perception of emotions as shown by neuropsychological tests and fMRI. The results of this study may have importance for psychological/psychotherapeutic interventions in the management of patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Mario Braun
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Department of Mathematics, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, Lab for Intelligent Data Analytics Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yürekli
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Schmid
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | | | - Julia Höfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
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10
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Verbeeck J, Geroldinger M, Thiel K, Hooker AC, Ueckert S, Karlsson M, Bathke AC, Bauer JW, Molenberghs G, Zimmermann G. How to analyze continuous and discrete repeated measures in small-sample cross-over trials? Biometrics 2023; 79:3998-4011. [PMID: 37587671 DOI: 10.1111/biom.13920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
To optimize the use of data from a small number of subjects in rare disease trials, an at first sight advantageous design is the repeated measures cross-over design. However, it is unclear how these within-treatment period and within-subject clustered data are best analyzed in small-sample trials. In a real-data simulation study based upon a recent epidermolysis bullosa simplex trial using this design, we compare non-parametric marginal models, generalized pairwise comparison models, GEE-type models and parametric model averaging for both repeated binary and count data. The recommendation of which methodology to use in rare disease trials with a repeated measures cross-over design depends on the type of outcome and the number of time points the treatment has an effect on. The non-parametric marginal model testing the treatment-time-interaction effect is suitable for detecting between group differences in the shapes of the longitudinal profiles. For binary outcomes with the treatment effect on a single time point, the parametric model averaging method is recommended, while in the other cases the unmatched generalized pairwise comparison methodology is recommended. Both provide an easily interpretable effect size measure, and do not require exclusion of periods or subjects due to incompleteness.
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Affiliation(s)
- Johan Verbeeck
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
| | - Martin Geroldinger
- Team Biostatistics and Big Medical Data, Intelligent Data Analytics (IDA) Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Konstantin Thiel
- Team Biostatistics and Big Medical Data, Intelligent Data Analytics (IDA) Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | - Mats Karlsson
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Arne Cornelius Bathke
- Intelligent Data Analytics (IDA) Lab Salzburg, Department of Artificial Intelligence and Human Interfaces, University of Salzburg, Salzburg, Austria
| | - Johann Wolfgang Bauer
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria
| | - Geert Molenberghs
- Data Science Institute (DSI), Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), KULeuven, Leuven, Belgium
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, Intelligent Data Analytics (IDA) Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University Salzburg, Salzburg, Austria
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11
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Hoeggerl AD, Nunhofer V, Lauth W, Badstuber N, Held N, Zimmermann G, Grabmer C, Weidner L, Jungbauer C, Lindlbauer N, Neureiter H, Ortner T, Flamm M, Osterbrink J, Rohde E, Laner-Plamberger S. Epstein-Barr virus reactivation is not causative for post-COVID-19-syndrome in individuals with asymptomatic or mild SARS-CoV-2 disease course. BMC Infect Dis 2023; 23:800. [PMID: 37968601 PMCID: PMC10652630 DOI: 10.1186/s12879-023-08820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE Post-COVID-19-Syndrome (PCS) frequently occurs after an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, the understanding of causative mechanisms is still limited. Aim of this study was to determine the PCS rate among SARS-CoV-2 seropositive blood donors as representatives of supposedly healthy adults, who had experienced an asymptomatic or mild COVID-19 disease course, and to examine whether Epstein-Barr virus (EBV) is reactivated in individuals reporting PCS. METHODS The PCS rate was determined using questionnaires that included questions about infection and persistent symptoms. Pre-pandemic blood samples and samples collected at regular, pre-defined times after a SARS-CoV-2 infection were analysed for neopterin, a marker for antiviral immune responses, by an enzyme-linked immunosorbent assay (ELISA). Additionally, we determined the rate of SARS-CoV-2 anti-N total antibodies using an electrochemiluminescence immunoassay (ECLIA). Furthermore, quantitative real-time polymerase chain reaction (qPCR) to detect EBV DNA and ECLIA screening for EBV viral capsid-antigen (VCA) IgM, IgG and EBV nuclear antigen 1 (EBNA) IgG were performed. RESULTS Our data reveal that 18% of all infections result in PCS, with symptoms lasting for up to one year. In individuals reporting PCS, no elevated levels of neopterin were detected, indicating no persisting pro-inflammatory, antiviral immune response. SARS-CoV-2 antibody levels were declining in all participants in comparable manner over time, pointing to a successful virus clearance. In individuals with PCS, no EBV DNA could be detected. Furthermore, no differences in EBV specific antibody levels could be shown in PCS groups compared to non-PCS groups. CONCLUSION Our data suggest that PCS in per se healthy, immunocompetent adults cannot be ascribed to a reactivation of EBV.
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Affiliation(s)
- Alexandra Domnica Hoeggerl
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Verena Nunhofer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Wanda Lauth
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
- Research and Innovation Management, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
| | - Natalie Badstuber
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Nina Held
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
- Research and Innovation Management, PMU Salzburg, Strubergasse 16, Salzburg, 5020, Austria
| | - Christoph Grabmer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, Vienna, 1040, Austria
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, Vienna, 1040, Austria
| | - Nadja Lindlbauer
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Heidrun Neureiter
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
| | - Tuulia Ortner
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria
- Spinal Cord Injury and Tissue Regeneration Centre Salzburg, PMU Salzburg, Strubergasse 21, Salzburg, 5020, Austria
| | - Sandra Laner-Plamberger
- Department of Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, Salzburg, 5020, Austria.
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12
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Wiesinger AM, Bigger B, Giugliani R, Lampe C, Scarpa M, Moser T, Kampmann C, Zimmermann G, Lagler FB. RETRACTED: Wiesinger et al. An Innovative Tool for Evidence-Based, Personalized Treatment Trials in Mucopolysaccharidosis. Pharmaceutics 2023, 15, 1565. Pharmaceutics 2023; 15:2596. [PMID: 38004626 PMCID: PMC10675733 DOI: 10.3390/pharmaceutics15112596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
The journal retracts the article, An Innovative Tool for Evidence-Based, Personalized Treatment Trials in Mucopolysaccharidosis [...].
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Affiliation(s)
- Anna-Maria Wiesinger
- Institute of Congenital Metabolic Diseases, Paracelsus Medical University, 5020 Salzburg, Austria
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
| | - Brian Bigger
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Roberto Giugliani
- Department of Genetics, Medical Genetics Service and Biodiscovery Laboratory, Portal Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Casa dos Raros, Porto Alegre 90610-261, Brazil;
| | - Christina Lampe
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Department of Child Neurology, Epilepetology and Social Pediatrics, Center of Rare Diseases, University Hospital Giessen/Marburg, 35392 Giessen, Germany
| | - Maurizio Scarpa
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Regional Coordinating Center for Rare Diseases, University Hospital Udine, 33100 Udine, Italy
| | - Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Christoph Kampmann
- Department of Pediatric Cardiology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
- Research and Innovation Management, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Florian B. Lagler
- Institute of Congenital Metabolic Diseases, Paracelsus Medical University, 5020 Salzburg, Austria
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
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13
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Akamatsu S, Bottin-Rousseau S, Witusiewicz VT, Hecht U, Plapp M, Ludwig A, Mogeritsch J, Şerefoğlu M, Bergeon N, Mota FL, Sturz L, Zimmermann G, McFadden S, Sillekens W. Microgravity studies of solidification patterns in model transparent alloys onboard the International Space Station. NPJ Microgravity 2023; 9:83. [PMID: 37852993 PMCID: PMC10584907 DOI: 10.1038/s41526-023-00326-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
We review recent in situ solidification experiments using nonfaceted model transparent alloys in science-in-microgravity facilities onboard the International Space Station (ISS), namely the Transparent Alloys (TA) apparatus and the Directional Solidification Insert of the DEvice for the study of Critical Liquids and Crystallization (DECLIC-DSI). These directional-solidification devices use innovative optical videomicroscopy imaging techniques to observe the spatiotemporal dynamics of solidification patterns in real time in large samples. In contrast to laboratory conditions on ground, microgravity guarantees the absence or a reduction of convective motion in the liquid, thus ensuring a purely diffusion-controlled growth of the crystalline solid(s). This makes it possible to perform a direct theoretical analysis of the formation process of solidification microstructures with comparisons to quantitative numerical simulations. Important questions that concern multiphase growth patterns in eutectic and peritectic alloys on the one hand and single-phased, cellular and dendritic structures on the other hand have been addressed, and unprecedented results have been obtained. Complex self-organizing phenomena during steady-state and transient coupled growth in eutectics and peritectics, interfacial-anisotropy effects in cellular arrays, and promising insights into the columnar-to-equiaxed transition are highlighted.
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Affiliation(s)
- S Akamatsu
- Sorbonne Université, CNRS-UMR 7588, Institut des NanoSciences de Paris, case courrier 840, 4 place Jussieu, 75252, Paris, Cedex 05, France.
| | - S Bottin-Rousseau
- Sorbonne Université, CNRS-UMR 7588, Institut des NanoSciences de Paris, case courrier 840, 4 place Jussieu, 75252, Paris, Cedex 05, France
| | | | - U Hecht
- Access e.V., Intzestr. 5, 52072, Aachen, Germany
| | - M Plapp
- Laboratoire de Physique de la Matière Condensée, CNRS, Ecole Polytechnique, Institut Polytechnique de Paris, 91120, Palaiseau, France
| | - A Ludwig
- Department Metallurgy, University of Leoben, Franz-Josef-Str. 18, 8700, Leoben, Austria
| | - J Mogeritsch
- Department Metallurgy, University of Leoben, Franz-Josef-Str. 18, 8700, Leoben, Austria
| | - M Şerefoğlu
- Department of Metallurgical and Materials Engineering, Marmara University, 34854 Maltepe, Istanbul, Turkey
| | - N Bergeon
- Aix Marseille Univ, Université de Toulon, CNRS, IM2NP, Marseille, France
| | - F L Mota
- Aix Marseille Univ, Université de Toulon, CNRS, IM2NP, Marseille, France
| | - L Sturz
- Access e.V., Intzestr. 5, 52072, Aachen, Germany
| | - G Zimmermann
- Access e.V., Intzestr. 5, 52072, Aachen, Germany
| | - S McFadden
- School of Computing, Engineering, and Intelligent Systems, Ulster University, Northland Road, Derry/Londonderry, Northern Ireland, BT48 7JL, UK
| | - W Sillekens
- European Space Agency, ESTEC - Research and Utilisation Group, Directorate of Human and Robotic Exploration Programmes, Keplerlaan 1, 2201 AZ, Noordwijk, Netherlands
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14
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Reinhart G, Browne DJ, Kargl F, García-Moreno F, Becker M, Sondermann E, Binder K, Mullen JS, Zimmermann G, Mathiesen RH, Sillekens WH, Nguyen-Thi H. In-situ X-ray monitoring of solidification and related processes of metal alloys. NPJ Microgravity 2023; 9:70. [PMID: 37673938 PMCID: PMC10482908 DOI: 10.1038/s41526-023-00321-z] [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: 02/14/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
X-ray radioscopy enables the in-situ monitoring of metal alloy processes and then gives access to crucial information on the dynamics of the underlying phenomena. In the last decade, the utilisation of this powerful imaging technique has been adapted to microgravity platforms such as sounding rockets and parabolic flights. The combination of microgravity experimentation with X-ray radioscopy has resulted in a leap in the understanding of fundamental science and has opened new paths in the fields of materials science. The present review focuses on the short history of this research, which includes facility developments, microgravity experiments and results obtained by partners of the XRMON (In-situ X-Ray MONitoring of advanced metallurgical processes under microgravity and terrestrial conditions) research project in the framework of the MAP (Microgravity Application Promotion) programme of the European Space Agency. Three illustrative research topics that were advanced significantly through the use of X-ray radioscopy will be detailed: solidification of metal alloys, metallic foam formation and diffusion in melts.
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Affiliation(s)
- G Reinhart
- Aix-Marseille Univ, Université de Toulon, CNRS, IM2NP UMR 7334, 13397, Marseille, France.
| | - D J Browne
- School of Mechanical and Materials Engineering, University College Dublin, Belfield 4, Dublin, Ireland
| | - F Kargl
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
| | - F García-Moreno
- Institute of Applied Materials, Helmholtz-Zentrum Berlin für Materialien und Energie, Hahn-Meitner-Platz 1, 14109, Berlin, Germany
| | - M Becker
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
| | - E Sondermann
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
| | - K Binder
- Institut für Materialphysik im Weltraum, Deutsches Zentrum für Luft- und Raumfahrt (DLR), 51170, Köln, Germany
| | - J S Mullen
- School of Mechanical and Materials Engineering, University College Dublin, Belfield 4, Dublin, Ireland
| | - G Zimmermann
- Access e.V., Intzestraße 5, 52072, Aachen, Germany
| | - R H Mathiesen
- Department of Physics, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway
| | - W H Sillekens
- European Space Agency - ESTEC, Keplerlaan 1 Postbus 299, 2200 AG, Noordwijk, The Netherlands
| | - H Nguyen-Thi
- Aix-Marseille Univ, Université de Toulon, CNRS, IM2NP UMR 7334, 13397, Marseille, France
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15
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Wiesinger AM, Bigger B, Giugliani R, Lampe C, Scarpa M, Moser T, Kampmann C, Zimmermann G, Lagler FB. An Innovative Tool for Evidence-Based, Personalized Treatment Trials in Mucopolysaccharidosis. Pharmaceutics 2023; 15:1565. [PMID: 37242808 PMCID: PMC10221776 DOI: 10.3390/pharmaceutics15051565] [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: 04/28/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Mucopolysaccharidosis (MPS) is a group of rare metabolic diseases associated with reduced life expectancy and a substantial unmet medical need. Immunomodulatory drugs could be a relevant treatment approach for MPS patients, although they are not licensed for this population. Therefore, we aim to provide evidence justifying fast access to innovative individual treatment trials (ITTs) with immunomodulators and a high-quality evaluation of drug effects by implementing a risk-benefit model for MPS. The iterative methodology of our developed decision analysis framework (DAF) consists of the following steps: (i) a comprehensive literature analysis on promising treatment targets and immunomodulators for MPS; (ii) a quantitative risk-benefit assessment (RBA) of selected molecules; and (iii) allocation phenotypic profiles and a quantitative assessment. These steps allow for the personalized use of the model and are in accordance with expert and patient representatives. The following four promising immunomodulators were identified: adalimumab, abatacept, anakinra, and cladribine. An improvement in mobility is most likely with adalimumab, while anakinra might be the treatment of choice for patients with neurocognitive involvement. Nevertheless, a RBA should always be completed on an individual basis. Our evidence-based DAF model for ITTs directly addresses the substantial unmet medical need in MPS and characterizes a first approach toward precision medicine with immunomodulatory drugs.
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Affiliation(s)
- Anna-Maria Wiesinger
- Institute of Congenital Metabolic Diseases, Paracelsus Medical University, 5020 Salzburg, Austria;
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
| | - Brian Bigger
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Stem Cell and Neurotherapies, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Roberto Giugliani
- Department of Genetics, Medical Genetics Service and Biodiscovery Laboratory, Portal Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Casa dos Raros, Porto Alegre 90610-261, Brazil;
| | - Christina Lampe
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Department of Child Neurology, Epilepetology and Social Pediatrics, Center of Rare Diseases, University Hospital Giessen/Marburg, 35392 Giessen, Germany
| | - Maurizio Scarpa
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
- Regional Coordinating Center for Rare Diseases, University Hospital Udine, 33100 Udine, Italy
| | - Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Christoph Kampmann
- Department of Pediatric Cardiology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
- Research and Innovation Management, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Florian B. Lagler
- Institute of Congenital Metabolic Diseases, Paracelsus Medical University, 5020 Salzburg, Austria;
- European Reference Network for Hereditary Metabolic Diseases, MetabERN, 33100 Udine, Italy; (B.B.); (C.L.); (M.S.)
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Zimmermann G, Doyen M, Schoepfer P, Salvi P, Marie P, Joly L, Benetos A, Verger A. Les composantes de l’onde de pouls carotidienne comme biomarqueurs de l’atteinte vasculaire de la maladie d’Alzheimer : une étude transversale et prospective de TEP au 18F-FDG cérébrale. Médecine Nucléaire 2023. [DOI: 10.1016/j.mednuc.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Trinka E, Rainer LJ, Granbichler CA, Zimmermann G, Leitinger M. Mortality, and life expectancy in Epilepsy and Status epilepticus-current trends and future aspects. Front Epidemiol 2023; 3:1081757. [PMID: 38455899 PMCID: PMC10910932 DOI: 10.3389/fepid.2023.1081757] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/31/2023] [Indexed: 03/09/2024]
Abstract
Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population. The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes. People with drug resistant seizures carry the highest risk of death compared to those who are seizure free, whose risk is similar as in the general population. Most of the increased risk is directly related to the cause of epilepsy itself. Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths especially in the young and middle-aged groups. Population based studies with long-term follow up demonstrated that the first years after diagnosis carry the highest risk of death, while in the later years the mortality decreases. Improved seizure control and being exposed to a specialized comprehensive care centre may help to reduce the risk of death in patients with epilepsy. The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied. The epidemiological data on overall and cause specific mortality as well as their determinants and risk factors are critically reviewed and methodological issues pertinent to the studies on mortality of epilepsy and Status epilepticus are discussed.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Hall In Tyrol, Austria
| | - Lucas J. Rainer
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
| | | | - Georg Zimmermann
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
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Roesch S, O'Sullivan A, Zimmermann G, Mair A, Lipuš C, Mayr JA, Wortmann SB, Rasp G. Mitochondrial Disease and Hearing Loss in Children: A Systematic Review. Laryngoscope 2022; 132:2459-2472. [PMID: 35188226 PMCID: PMC9790539 DOI: 10.1002/lary.30067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Hearing loss is a clinical symptom, frequently mentioned in the context of mitochondrial disease. With no cure available for mitochondrial disease, supportive treatment of clinical symptoms like hearing loss is of the utmost importance. The aim of this study was to summarize current knowledge on hearing loss in genetically proven mitochondrial disease in children and deduce possible and necessary consequences in patient care. METHODS Systematic literature review, including Medline, Embase, and Cochrane library. Review protocol was established and registered prior to conduction (International prospective register of systematic reviews-PROSPERO: CRD42020165356). Conduction of this review was done in accordance with MOOSE criteria. RESULTS A total of 23 articles, meeting predefined criteria and providing sufficient information on 75 individuals with childhood onset hearing loss was included for analysis. Both cochlear and retro-cochlear origin of hearing loss can be identified among different types of mitochondrial disease. Analysis was hindered by inhomogeneous reporting and methodical limitations. CONCLUSION Overall, the findings do not allow for a general statement on hearing loss in children with mitochondrial disease. Retro-cochlear hearing loss seems to be found more often than expected. A common feature appears to be progression of hearing loss over time. However, hearing loss in these patients shows manifold characteristics. Therefore, awareness of mitochondrial disease as a possible causative background is important for otolaryngologists. Future attempts rely on standardized reporting and long-term follow-up. LEVEL OF EVIDENCE NA Laryngoscope, 132:2459-2472, 2022.
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Affiliation(s)
- Sebastian Roesch
- Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical UniversitySalzburgAustria
| | - Anna O'Sullivan
- Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical UniversitySalzburgAustria,Insitute of PathologyParacelsus Medical UniversitySalzburgAustria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab SalzburgParacelsus Medical UniversitySalzburgAustria,Department of Research and InnovationParacelsus Medical UniversitySalzburgAustria
| | - Alois Mair
- Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical UniversitySalzburgAustria
| | - Cvetka Lipuš
- PMU University LibraryParacelsus Medical UniversitySalzburgAustria
| | - Johannes A. Mayr
- University Children's HospitalParacelsus Medical UniversitySalzburgAustria
| | - Saskia B. Wortmann
- University Children's HospitalParacelsus Medical UniversitySalzburgAustria,Amalia Children's Hospital, RadboudumcNijmegenThe Netherlands
| | - Gerd Rasp
- Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical UniversitySalzburgAustria
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Genitrini M, Fritz J, Zimmermann G, Schwameder H. Downhill Sections Are Crucial for Performance in Trail Running Ultramarathons-A Pacing Strategy Analysis. J Funct Morphol Kinesiol 2022; 7:jfmk7040103. [PMID: 36412765 PMCID: PMC9680470 DOI: 10.3390/jfmk7040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Trail running is an increasingly popular discipline, especially over long-distance races (>42.195 km). Pacing strategy, i.e., how athletes modulate running speed for managing their energies during a race, appears to have a significant impact on overall performance. The aims of this study were to investigate whether performance level, terrain (i.e., uphill or downhill) and race stage affect pacing strategy and whether any interactions between these factors are evident. Race data from four race courses, with multiple editions (total races = 16), were retrieved from their respective events websites. A linear mixed effect model was applied to the full dataset, as well as to two subgroups of the top 10 male and female finishers, to assess potential differences in pacing strategy (i.e., investigated in terms of relative speed). Better finishers (i.e., athletes ranking in the best positions) tend to run downhill sections at higher relative speeds and uphill sections at lower relative speeds than slower counterparts (p < 0.001). In the later race stages, the relative speed decrease is larger in downhill sections than in uphill ones (p < 0.001) and in downhill sections, slower finishers perform systematically worse than faster ones, but the performance difference (i.e., between slower and faster finishers) becomes significantly larger in the later race stages (p < 0.001). Among elite athletes, no difference in pacing strategy between faster and slower finishers was found (p > 0.05). Both men (p < 0.001) and women (p < 0.001), in the later race stages, slow down more in downhill sections than in uphill ones. Moreover, elite women tend to slow down more than men (p < 0.001) in the later race stages, regardless of the terrain, in contrast to previous studies focusing on road ultramarathons. In conclusion, running downhill sections at higher relative speeds, most likely due to less accentuated fatigue effects, as well as minimizing performance decrease in the later race stages in downhill sections, appears to be a hallmark of the better finishers.
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Affiliation(s)
- Matteo Genitrini
- Department of Sport and Exercise Science, University of Salzburg, 5400 Hallein-Rif, Austria
| | | | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab, 5020 Salzburg, Austria
- Research Management & Technology Transfer, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Hermann Schwameder
- Department of Sport and Exercise Science, University of Salzburg, 5400 Hallein-Rif, Austria
- Correspondence:
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20
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Machegger L, Bosque Varela P, Kuchukhidze G, Steinbacher J, Öllerer A, Prüwasser T, Zimmermann G, Pikija S, Pfaff J, Trinka E, Mc Coy M. Quantitative Analysis of Diffusion-Restricted Lesions in a Differential Diagnosis of Status Epilepticus and Acute Ischemic Stroke. Front Neurol 2022; 13:926381. [PMID: 35873780 PMCID: PMC9301206 DOI: 10.3389/fneur.2022.926381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Distinction between acute ischemic stroke (AIS) and status epilepticus (SE) on MRI can be challenging as restricted diffusion may occur in both conditions. In this study, we aimed to test a tool, which could help in differentiating AIS from SE when restricted diffusion was present on MRI. Materials and Methods In diffusion weighted imaging (DWI) with a b-value of 1,000 and apparent diffusion coefficient (ADC) maps, we compared the ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side in patients with AIS and SE. Patients were recruited prospectively between February 2019 and October 2021. All patients underwent MRI and EEG within the first 48 h of symptom onset. Results We identified 26 patients with SE and 164 patients with AIS. All patients had diffusion-restricted lesions with a hyperintensity in DWI and ADC signal decrease. Diffusion restriction was significantly more intense in patients with AIS as compared to patients with SE. The median ratios of intensities of gray values of diffusion-restricted lesions to the healthy mirror side for DWI were 1.42 (interquartile range [IQR] 1.32–1.47) in SE and 1.67 (IQR 1.49–1.90) in AIS (p < 0.001). ADC decrease was more significant in AIS as compared to SE with median ratios of 0.80 (IQR 0.72–0.89) vs. 0.61 (IQR 0.50–0.71), respectively (p < 0.001). A cutoff value for ratios of DWI signal was 1.495 with a sensitivity of 75% and a specificity of 85%. Values lower than 1.495 were more likely to be associated with SE and higher values were with AIS. A cutoff value for ADC ratios was 0.735 with a sensitivity of 73% and a specificity of 84%. Values lower than 0.735 were more likely to be associated with AIS and higher values were with SE. Conclusion Diffusion restriction and ADC decrease were significantly more intense in patients with AIS as compared to SE. Therefore, quantitative analysis of diffusion restriction may be a helpful tool for differentiating between AIS and SE when restricted diffusion is present on MRI.
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Affiliation(s)
- Lukas Machegger
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Pilar Bosque Varela
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- *Correspondence: Giorgi Kuchukhidze
| | - Jürgen Steinbacher
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Öllerer
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tanja Prüwasser
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Mathematics, Paris-Lodron University, Salzburg, Austria
- IDA Lab Salzburg, Team Biostatistics and Big Medical Data, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Slaven Pikija
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Johannes Pfaff
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Mark Mc Coy
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg, Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
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Rainer LJ, Kronbichler M, Kuchukhidze G, Trinka E, Langthaler PB, Kronbichler L, Said-Yuerekli S, Kirschner M, Zimmermann G, Höfler J, Schmid E, Braun M. Emotional Word Processing in Patients With Juvenile Myoclonic Epilepsy. Front Neurol 2022; 13:875950. [PMID: 35720080 PMCID: PMC9201996 DOI: 10.3389/fneur.2022.875950] [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: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective According to Panksepp's hierarchical emotion model, emotion processing relies on three functionally and neuroanatomically distinct levels. These levels comprise subcortical networks (primary level), the limbic system (secondary level), and the neocortex (tertiary level) and are suggested to serve differential emotional processing. We aimed to validate and extend previous evidence of discrete and dimensional emotion processing in patient with juvenile myoclonic epilepsy (JME). Methods We recorded brain activity of patients with JME and healthy controls in response to lexical decisions to words reflecting the discrete emotion fear and the affective dimension negativity previously suggested to rely on different brain regions and to reflect different levels of processing. In all study participants, we tested verbal cognitive functions, as well as the relationship of psychiatric conditions, seizure types and duration of epilepsy and emotional word processing. Results In support of the hierarchical emotion model, we found an interaction of discrete emotion and affective dimensional processing in the right amygdala likely to reflect secondary level processing. Brain activity related to affective dimensional processing was found in the right inferior frontal gyrus and is suggested to reflect tertiary level processing. Psychiatric conditions, type of seizure nor mono- vs. polytherapy and duration of epilepsy within patients did not have any effect on the processing of emotional words. In addition, no differences in brain activity or response times between patients and controls were observed, despite neuropsychological testing revealed slightly decreased verbal intelligence, verbal fluency and reading speed in patients with JME. Significance These results were interpreted to be in line with the hierarchical emotion model and to highlight the amygdala's role in processing biologically relevant stimuli, as well as to suggest a semantic foundation of affective dimensional processing in prefrontal cortex. A lack of differences in brain activity of patients with JME and healthy controls in response to the emotional content of words could point to unaffected implicit emotion processing in patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Patrick Benjamin Langthaler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Naturwissenschaftliche Fakultaet, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yuerekli
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Mario Braun
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
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22
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Aleksovska K, Kobulashvili T, Costa J, Zimmermann G, Ritchie K, Reinhard C, Vignatelli L, Fanciulli A, Damian M, Pavlakova L, Burgunder JM, Kopishinskaya S, Rakusa M, Kovacs N, Erdogan FF, Linton LR, Copetti M, Lamperti C, Servidei S, Evangelista T, Ayme S, Pareyson D, Sellner J, Krarup C, de Visser M, van den Bergh P, Toscano A, Graessner H, Berger T, Bassetti C, Vidailhet M, Trinka E, Deuschl G, Federico A, Leone MA. European Academy of Neurology guidance for developing and reporting clinical practice guidelines on rare neurological diseases. Eur J Neurol 2022; 29:1571-1586. [PMID: 35318776 DOI: 10.1111/ene.15267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Rare diseases affect up to 29 million people in the European Union, and almost 50% of them affect the nervous system or muscles. Delays in diagnosis and treatment onset and insufficient treatment choices are common. Clinical practice guidelines (CPGs) may improve the diagnosis and treatment of patients and optimize care pathways, delivering the best scientific evidence to all clinicians treating these patients. Recommendations are set for developing and reporting high-quality CPGs on rare neurological diseases (RNDs) within the European Academy of Neurology (EAN), through a consensus procedure. METHODS A group of 27 experts generated an initial list of items that were evaluated through a two-step Delphi consensus procedure and a face-to-face meeting. The final list of items was reviewed by an external review group of 58 members. RESULTS The consensus procedure yielded 63 final items. Items are listed according to the domains of the AGREE instruments and concern scope and purpose, stakeholder involvement, rigour of development, and applicability. Additional items consider reporting and ethical issues. Recommendations are supported by practical examples derived from published guidelines and are presented in two tables: (1) items specific to RND CPGs, and general guideline items of special importance for RNDs, or often neglected; (2) items for guideline development within the EAN. CONCLUSIONS This guidance aims to provide solutions to the issues specific to RNDs. This consensus document, produced by many experts in various fields, is considered to serve as a starting point for further harmonization and for increasing the quality of CPGs in the field of RNDs.
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Affiliation(s)
- Katina Aleksovska
- European Academy of Neurology, Vienna, Austria.,SC Neurology, Department of Emergency and Critical Care, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy.,Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, N. Macedonia
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria
| | - Joao Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria.,Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | | | - Carola Reinhard
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Maxwel Damian
- Neurology and Neurointensive Care, Cambridge University Hospitals and Ipswich Hospital, Cambridge, UK
| | | | - Jean-Marc Burgunder
- Swiss Huntington Center, Neurozentrum Siloah AG, Gümligen, Switzerland.,Department of Neurology, University of Bern, Bern, Switzerland
| | | | - Martin Rakusa
- Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Norbert Kovacs
- Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, N. Macedonia.,Department of Neurology, Medical School, University of Pecs, Pecs, Hungary
| | | | - Lori Renna Linton
- EuroHSP, Federation of National Groups Related With Hereditary Spastic Paraplegia, Paris, France
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | - Costanza Lamperti
- Division of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario IRCCS Roma, Università Cattolica del Sacro Cuore, Italy
| | - Theresina Evangelista
- Neuromuscular Morphology Unit, Myology Institute, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile de France, Sorbonne Université - Inserm UMRS 974, Paris, France
| | - Segolene Ayme
- Paris Brain Institute-ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Universite, Paris, France
| | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Christian Krarup
- Clinical Neurophysiology, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine and Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centre, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter van den Bergh
- Neuromuscular Reference Centre UCL St-Luc, University Hospital St-Luc, Brussels, Belgium
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, Neurology and Neuromuscular Disorders Unit, AOU Policlinico di Messina, Messina, Italy
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Claudio Bassetti
- Neurology Department, Medical Faculty, University Hospital, Bern, Switzerland
| | - Marie Vidailhet
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department de Neurologie, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Hospital Salpetriere, Sorbonne Université, Paris, France
| | - Eugene Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated Partner of the ERN EpiCARE, Salzburg, Austria.,Neuroscience Institute, Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Guenther Deuschl
- Department of Neurology, Christian Albrecht's University, Kiel, Germany
| | - Antonio Federico
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,Department Medicine, Surgery and Neurosciences, Medical School, University of Siena, Siena, Italy
| | - Maurizio A Leone
- SC Neurology, Department of Emergency and Critical Care, Fondazione IRCCS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
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Nunhofer V, Weidner L, Hoeggerl AD, Zimmermann G, Badstuber N, Grabmer C, Jungbauer C, Lindlbauer N, Held N, Pascariuc M, Ortner T, Rohde E, Laner-Plamberger S. Persistence of Naturally Acquired and Functional SARS-CoV-2 Antibodies in Blood Donors One Year after Infection. Viruses 2022; 14:v14030637. [PMID: 35337044 PMCID: PMC8953712 DOI: 10.3390/v14030637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/02/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
The developmental course of antibodies produced after a SARS-CoV-2 infection has been insufficiently investigated so far. Therefore, the aim of this study was to investigate the dynamics of SARS-CoV-2 antibody levels against the viral nucleocapsid- and spike-protein among Austrian blood donors as a representative group of a supposedly healthy population within the first year after a SARS-CoV-2 infection. The impact of age, sex, vaccination status, AB0-blood group and awareness about the infection was evaluated. Our study shows that the level of anti-N antibodies is declining, while anti-S antibody levels remain stable. Antibodies detected were functional in vitro. Age, sex and blood group do not influence antibody dynamics. However, blood group AB shows significantly lower antibody levels and in vitro functionality compared to other blood groups. Our data reveal that one out of five individuals was not aware of a previous SARS-CoV-2 infection and that the disease course neither affects the level of antibody production nor the in vitro functionality. We also found that 14% of participants show persisting COVID-19-related symptoms for up to nine months. Our results provide valuable insights into the dynamics of the immune response after a SARS-CoV-2 infection in a representative cohort of adult blood donors in Central Europe.
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Affiliation(s)
- Verena Nunhofer
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, 1040 Vienna, Austria; (L.W.); (C.J.)
| | - Alexandra Domnica Hoeggerl
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, PMU Salzburg, Strubergasse 16, 5020 Salzburg, Austria;
- Research and Innovation Management, PMU Salzburg, Strubergasse 16, 5020 Salzburg, Austria
| | - Natalie Badstuber
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, 5020 Salzburg, Austria; (N.B.); (T.O.)
| | - Christoph Grabmer
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Wiedner Hauptstraße 32, 1040 Vienna, Austria; (L.W.); (C.J.)
| | - Nadja Lindlbauer
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Nina Held
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Monica Pascariuc
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
| | - Tuulia Ortner
- Department of Psychological Assessment, Institute of Psychology, Paris-Lodron-University of Salzburg, 5020 Salzburg, Austria; (N.B.); (T.O.)
| | - Eva Rohde
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Centre Salzburg, PMU Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Sandra Laner-Plamberger
- Department for Transfusion Medicine, University Hospital of Salzburg (SALK), Paracelsus Medical University (PMU) Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria; (V.N.); (A.D.H.); (C.G.); (N.L.); (N.H.); (M.P.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Centre Salzburg, PMU Salzburg, Strubergasse 21, 5020 Salzburg, Austria
- Correspondence:
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Astner-Rohracher A, Zimmermann G, Avigdor T, Abdallah C, Barot N, Brázdil M, Doležalová I, Gotman J, Hall JA, Ikeda K, Kahane P, Kalss G, Kokkinos V, Leitinger M, Mindruta I, Minotti L, Mizera MM, Oane I, Richardson M, Schuele SU, Trinka E, Urban A, Whatley B, Dubeau F, Frauscher B. Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography. JAMA Neurol 2021; 79:70-79. [PMID: 34870697 PMCID: PMC8649918 DOI: 10.1001/jamaneurol.2021.4405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Stereoelectroencephalography (SEEG) has become the criterion standard in case of inconclusive noninvasive presurgical epilepsy workup. However, up to 40% of patients are subsequently not offered surgery because the seizure-onset zone is less focal than expected or cannot be identified. Objective To predict focality of the seizure-onset zone in SEEG, the 5-point 5-SENSE score was developed and validated. Design, Setting, and Participants This was a monocentric cohort study for score development followed by multicenter validation with patient selection intervals between February 2002 to October 2018 and May 2002 to December 2019. The minimum follow-up period was 1 year. Patients with drug-resistant epilepsy undergoing SEEG at the Montreal Neurological Institute were analyzed to identify a focal seizure-onset zone. Selection criteria were 2 or more seizures in electroencephalography and availability of complete neuropsychological and neuroimaging data sets. For validation, patients from 9 epilepsy centers meeting these criteria were included. Analysis took place between May and July 2021. Main Outcomes and Measures Based on SEEG, patients were grouped as focal and nonfocal seizure-onset zone. Demographic, clinical, electroencephalography, neuroimaging, and neuropsychology data were analyzed, and a multiple logistic regression model for developing a score to predict SEEG focality was created and validated in an independent sample. Results A total of 128 patients (57 women [44.5%]; median [range] age, 31 [13-58] years) were analyzed for score development and 207 patients (97 women [46.9%]; median [range] age, 32 [16-70] years) were analyzed for validation. The score comprised the following 5 predictive variables: focal lesion on structural magnetic resonance imaging, absence of bilateral independent spikes in scalp electroencephalography, localizing neuropsychological deficit, strongly localizing semiology, and regional ictal scalp electroencephalography onset. The 5-SENSE score had an optimal mean (SD) probability cutoff for identifying a focal seizure-onset zone of 37.6 (3.5). Area under the curve, specificity, and sensitivity were 0.83, 76.3% (95% CI, 66.7-85.8), and 83.3% (95% CI, 72.30-94.1), respectively. Validation showed 76.0% (95% CI, 67.5-84.0) specificity and 52.3% (95% CI, 43.0-61.5) sensitivity. Conclusions and Relevance High specificity in score development and validation confirms that the 5-SENSE score predicts patients where SEEG is unlikely to identify a focal seizure-onset zone. It is a simple and useful tool for assisting clinicians to reduce unnecessary invasive diagnostic burden on patients and overutilization of limited health care resources.
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Affiliation(s)
- Alexandra Astner-Rohracher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience Paracelsus Medical University Hospital Salzburg, affiliated Member of the Epicare Reference Network, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Tamir Avigdor
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Chifaou Abdallah
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nirav Barot
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Milan Brázdil
- Department of Neurology, Faculty of Medicine, Masaryk University and St Ann's University Hospital, Brno, Czech Republic
| | - Irena Doležalová
- Department of Neurology, Faculty of Medicine, Masaryk University and St Ann's University Hospital, Brno, Czech Republic
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jeffery Alan Hall
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Kirsten Ikeda
- Dalhousie University and Hospital, Division of Neurology, Halifax, Nova Scotia, Canada
| | - Philippe Kahane
- CHU Grenoble-Alpes, Université Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience Paracelsus Medical University Hospital Salzburg, affiliated Member of the Epicare Reference Network, Salzburg, Austria
| | | | - Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience Paracelsus Medical University Hospital Salzburg, affiliated Member of the Epicare Reference Network, Salzburg, Austria
| | - Ioana Mindruta
- Neurology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lorella Minotti
- CHU Grenoble-Alpes, Université Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, Grenoble, France
| | | | - Irina Oane
- Neurology Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston
| | | | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Centre for Cognitive Neuroscience Paracelsus Medical University Hospital Salzburg, affiliated Member of the Epicare Reference Network, Salzburg, Austria.,Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience Paracelsus Medical University Hospital Salzburg, Salzburg, Austria.,Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Whatley
- Dalhousie University and Hospital, Division of Neurology, Halifax, Nova Scotia, Canada
| | - François Dubeau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Venard G, Pina Brito V, Eeckhout P, Zimmermann G, Van Petegem S. Quand le parent veut trop bien faire : état de la littérature sur le phénomène de surprotection parentale. Psychologie Française 2021. [DOI: 10.1016/j.psfr.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Egger-Rainer A, Hettegger SM, Feldner R, Arnold S, Bosselmann C, Hamer H, Hengsberger A, Lang J, Lorenzl S, Lerche H, Noachtar S, Pataraia E, Schulze-Bonhage A, Staack AM, Trinka E, Unterberger I, Zimmermann G. Do all patients in the epilepsy monitoring unit experience the same level of comfort? A quantitative exploratory secondary analysis. J Adv Nurs 2021; 78:2004-2014. [PMID: 34837405 PMCID: PMC9299695 DOI: 10.1111/jan.15105] [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: 05/09/2021] [Revised: 09/22/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
Aims To find out which variables may be associated with comfort of patients in an epilepsy monitoring unit. Design Exploratory, quantitative study design. Methods Data were collected from October 2018 to November 2019 in Austria and Southern Germany. A total of 267 patients of 10 epilepsy centres completed the Epilepsy Monitoring Unit Comfort Questionnaire which is based on Kolcaba's General Comfort Questionnaire. Secondary data analysis were conducted by using descriptive statistics and an exploratory model building approach, including different linear regression models and several sensitivity analyses. Results Total comfort scores ranged from 83 to 235 points. Gender, occupation and centre turned out to be possible influential variables. On average, women had a total comfort score 4.69 points higher than men, and retired persons 28.2 points higher than high school students ≥18 years. Comfort scores of younger patients were lower than those of older patients. However, age did not show a statistically significant effect. The same could be observed in marital status and educational levels. Conclusion When implementing comfort measures, nurses must be aware of variables which could influence the intervention negatively. Especially, high school students ≥18 years should be supported by epilepsy specialist nurses, in order to reduce uncertainty, anxiety and discomfort. But, since the identified variables account only for a small proportion of the inter‐individual variability in comfort scores, further studies are needed to find out additional relevant aspects and to examine centre‐specific effects more closely. Impact Nurses ensure patient comfort during a hospital stay. However, there are variables that may impair the effectiveness of the nursing measures. Our study showed that the experience of comfort was highly individual and could be explained by sociodemographic variables only to a limited extent. Nurses must be aware that additional factors, such as the situation in the individual setting, may be relevant.
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Affiliation(s)
- Andrea Egger-Rainer
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | | | - Raphael Feldner
- Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Stephan Arnold
- Epilepsy Unit, Department of Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Christian Bosselmann
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Erlangen, Germany
| | - Anna Hengsberger
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Johannes Lang
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Soheyl Noachtar
- Department of Neurology, Epilepsy Center, University of Munich Hospital, Ludwig-Maximilian University, Munich, Germany
| | | | | | | | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria.,Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Iris Unterberger
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria.,Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
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27
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Affiliation(s)
- Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Edgar Brunner
- Department of Medical Statistics, University of Göttingen, Göttingen, Germany
| | - Werner Brannath
- Competence Centre for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Happ
- Team Smart Analytics, IDA Lab Salzburg, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Arne C. Bathke
- Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
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28
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Aleksovska K, Kobulashvili T, Costa J, Zimmermann G, Ritchie K, Reinhard C, Vignatelli L, Fanciulli A, Damian M, Pavlakova L, Burgunder JM, Rakusa M, Kovacs N, Erdogan F, Linton L, Copetti M, Lamperti C, Servidei S, Evangelista T, Ayme S, Pareyson D, Sellner J, Kopishinskaya S, Krarup C, De Visser M, Van Den Bergh P, Toscano A, Graessner H, Berger T, Bassetti C, Vidailhet M, Trinka E, Deuschl G, Federico A, Leone M. EAN guidance for developing and reporting clinical practice guidelines on rare neurological diseases. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119938] [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: 10/20/2022]
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Konietschke F, Cao C, Gunawardana A, Zimmermann G. Analysis of covariance under variance heteroscedasticity in general factorial designs. Stat Med 2021; 40:4732-4749. [PMID: 34128244 DOI: 10.1002/sim.9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/06/2022]
Abstract
Adjusting for baseline values and covariates is a recurrent statistical problem in medical science. In particular, variance heteroscedasticity is non-negligible in experimental designs and ignoring it might result in false conclusions. Approximate inference methods are developed to test null hypotheses formulated in terms of adjusted treatment effects and regression parameters in general analysis of covariance designs with arbitrary numbers of factors. Variance homoscedasticity is not assumed. The distributions of the test statistics are approximated using Box-type approximation methods. Extensive simulation studies show that the procedures are particularly suitable when sample sizes are rather small. A real data set illustrates the application of the methods.
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Affiliation(s)
- Frank Konietschke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Cong Cao
- PPD Development, Hamilton, New Jersey, USA
| | - Asanka Gunawardana
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria.,Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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Weichselbaum N, Oberladstätter D, Schlimp CJ, Zipperle J, Voelckel W, Grottke O, Zimmermann G, Osuchowski M, Schöchl H. High Interleukin-6 Plasma Concentration upon Admission Is Predictive of Massive Transfusion in Severely Injured Patients. J Clin Med 2021; 10:jcm10112268. [PMID: 34073768 PMCID: PMC8197216 DOI: 10.3390/jcm10112268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Severe bleeding remains a prominent cause of early in-hospital mortality in major trauma patients. Thus, prompt prediction of patients at risk of massive transfusion (MT) is crucial. We investigated the ability of the inflammatory marker interleukin (IL)-6 to forecast MT in severely injured trauma patients. IL-6 plasma levels were measured upon admission. Receiver operating characteristic curves (ROCs) were calculated, and sensitivity and specificity were determined. In this retrospective study, a total of 468 predominantly male (77.8%) patients, with a median injury severity score (ISS) of 25 (17–34), were included. The Youden index for the prediction of MT within 6 and 24 h was 351 pg/mL. Patients were dichotomized into two groups: (i) low-IL-6 < 350 pg/mL and (ii) high-IL-6 ≥ 350 pg/mL. IL-6 ≥ 350 pg/mL was associated with a lower prothrombin time index, a higher activated partial thromboplastin time, and a lower fibrinogen concentration compared with IL-6 < 350 pg/mL (p <0.0001 for all). Thromboelastometric parameters were significantly different between groups (p <0.03 in all). More patients in the high-IL-6 group received MT (p <0.0001). The ROCs revealed an area under the curve of 0.76 vs. 0.82 for the high-IL-6 group for receiving MT in the first 6 and 24 h. IL-6 ≥ 350 pg/mL predicted MT within 6 and 24 h with a sensitivity of 45% and 58%, respectively, and a specificity of 89%. IL-6 ≥ 350 pg/mL appears to be a reasonable early predictor for coagulopathy and MT within the first 6 and 24 h intervals. Large-scale prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Nadja Weichselbaum
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (N.W.); (D.O.); (W.V.)
- Paracelsus Medical University, 5020 Salzburg, Austria
| | - Daniel Oberladstätter
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (N.W.); (D.O.); (W.V.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria; (C.J.S.); (J.Z.); (M.O.)
| | - Christoph J. Schlimp
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria; (C.J.S.); (J.Z.); (M.O.)
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, 4010 Linz, Austria
| | - Johannes Zipperle
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria; (C.J.S.); (J.Z.); (M.O.)
| | - Wolfgang Voelckel
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (N.W.); (D.O.); (W.V.)
| | - Oliver Grottke
- Department of Anaesthesiology, RWTH Aachen University Hospital, 52074 Aachen, Germany;
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Research and Innovation, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria; (C.J.S.); (J.Z.); (M.O.)
| | - Herbert Schöchl
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (N.W.); (D.O.); (W.V.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, 1020 Vienna, Austria; (C.J.S.); (J.Z.); (M.O.)
- Correspondence: ; Tel.: +43-59393-44-357
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31
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Pilz J, Hehenwarter L, Zimmermann G, Rendl G, Schweighofer-Zwink G, Beheshti M, Pirich C. Feasibility of equivalent performance of 3D TOF [ 18F]-FDG PET/CT with reduced acquisition time using clinical and semiquantitative parameters. EJNMMI Res 2021; 11:44. [PMID: 33934218 PMCID: PMC8088415 DOI: 10.1186/s13550-021-00784-9] [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: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background High-performance time-of-flight (TOF) positron emission tomography (PET) systems have the capability for rapid data acquisition while preserving diagnostic image quality. However, determining a reliable and clinically applicable cut-off of the acquisition time plays an important role in routine practice. This study aimed to assess the diagnostic equivalence of short acquisition time of 57 with routine 75 seconds per bed position (s/BP) of [18F]-fluoro-deoxy-glucose (FDG) PET. Phantom studies applying EARL criteria suggested the feasibility of shortened acquisition time in routine clinical imaging by 3D TOF PET/CT scanners. Ninety-six patients with melanoma, lung or head and neck cancer underwent a standard whole-body, skull base-to-thigh or vertex-to-thigh [18F]-FDG PET/CT examination using the 3D TOF Ingenuity TF PET/CT system (Philips, Cleveland, OH). The [18F]-FDG activity applied was equal to 4MBq per kg body weight. Retrospectively, PET list-mode data were used to calculate a second PET study per patient with a reduced acquisition time of 57 s instead of routine 75 s/BP. PET/CT data were reconstructed using a 3D OSEM TOF algorithm. Blinded patient data were analysed by two nuclear medicine physicians. The number of [18F]-FDG-avid lesions per body region (head&neck, thorax, abdomen, bone, extremity) and image quality (grade 1–5) were evaluated. Semiquantitative analyses were performed by standardized uptake value (SUV) measurements using 3D volume of interests (VOI). The visual and semiquantitative diagnostic equivalence of 214 [18F]-FDG-avid lesions were analysed in the routine standard (75 s/BP) as well as the calculated PET/CT studies with short acquisition time. Statistical analyses were performed by equivalence testing and Bland–Altman plots. Results Lesion detection rate per patient’s body region agreed in > 98% comparing 57 s/BP and 75 s/BP datasets. Overall image quality was determined as equal or superior to 75 s in 80% and 69%, respectively. In the semiquantitative lesion-based analyses, a significant equivalence was found between the 75 s/BP and 57 s/BP PET/CT images both for SUVmax (p = 0.004) and SUVmean (p = 0.003). Conclusion The results of this study demonstrate significant clinical and semiquantitative equivalence between short acquisition time of 57 s/BP and standard 75 s/BP 3D TOF [18F]-FDG PET/CT scanning, which may improve the patient’s workflow in routine practice.
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Affiliation(s)
- Julia Pilz
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Hehenwarter
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gundula Rendl
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
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Abstract
AbstractSkewed citation distribution is a major limitation of the Journal Impact Factor (JIF) representing an outlier-sensitive mean citation value per journal The present study focuses primarily on this phenomenon in the medical literature by investigating a total of n = 982 journals from two medical categories of the Journal Citation Report (JCR). In addition, the three highest-ranking journals from each JCR category were included in order to extend the analyses to non-medical journals. For the journals in these cohorts, the citation data (2018) of articles published in 2016 and 2017 classified as citable items (CI) were analysed using various descriptive approaches including e.g. the skewness, the Gini coefficient, and, the percentage of CI contributing 50% or 90% of the journal’s citations. All of these measures clearly indicated an unequal, skewed distribution with highly-cited articles as outliers. The %CI contributing 50% or 90% of the journal’s citations was in agreement with previously published studies with median values of 13–18% CI or 44–60% CI generating 50 or 90% of the journal’s citations, respectively. Replacing the mean citation values (corresponding to the JIF) with the median to represent the central tendency of the citation distributions resulted in markedly lower numerical values ranging from − 30 to − 50%. Up to 39% of journals showed a median citation number of zero in one medical journal category. For the two medical cohorts, median-based journal ranking was similar to mean-based ranking although the number of possible rank positions was reduced to 13. Correlation of mean citations with the measures of citation inequality indicated that the unequal distribution of citations per journal is more prominent and, thus, relevant for journals with lower citation rates. By using various indicators in parallel and the hitherto probably largest journal sample, the present study provides comprehensive up-to-date results on the prevalence, extent and consequences of citation inequality across medical and all-category journals listed in the JCR.
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Leitinger M, Poppert KN, Mauritz M, Rossini F, Zimmermann G, Rohracher A, Kalss G, Kuchukhidze G, Höfler J, Bosque Varela P, Kreidenhuber R, Volna K, Neuray C, Kobulashvili T, Granbichler CA, Siebert U, Trinka E. Status epilepticus admissions during the COVID-19 pandemic in Salzburg-A population-based study. Epilepsia 2020; 61:e198-e203. [PMID: 33140437 PMCID: PMC7756208 DOI: 10.1111/epi.16737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
Several emergencies were admitted less frequently to the hospital during the coronavirus disease 2019 (COVID‐19) pandemic. To investigate whether this also occurred with status epilepticus (SE) we compared admissions due to first SE from March to April 2020 (“Time of COVID,” TOC) with January to February 2020 (“pre‐COVID,” preCOV). We also compared admission numbers in TOC and preCOV with the respective 2‐month periods in 2018 and 2019 in a retrospective cohort analysis. Two investigators independently searched the hospital patient database for various forms of SE. There was no significant change in the 2‐month incidences of first SE in the city of Salzburg from preCOV of 6.1 (95% confidence interval [CI] 2.9‐12.3) to TOC of 6.9/100 000 adults (95% CI 3.4‐13.3). Admission numbers did not differ significantly from previous years. Estimated adjusted incidence was in line with a recent 5‐year epidemiological study in Salzburg. However, a trend toward less‐frequent nonconvulsive SE (NCSE) and loss of female predominance were indirect hints of underdiagnosing SE. In contrast to other medical conditions, SE most often presents clinically with impaired consciousness, which may promote admission to emergency departments even in times of lock‐down. Further research of medical support of women and patients with NCSE during pandemic‐related restrictions is warranted.
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Affiliation(s)
- Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Kai-Nicolas Poppert
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Matthias Mauritz
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Fabio Rossini
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Alexandra Rohracher
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Pilar Bosque Varela
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria
| | - Rudolf Kreidenhuber
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Kamila Volna
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Caroline Neuray
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Queen Square Institute of Neurology, University College London (UCL), London, UK
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria
| | - Claudia A Granbichler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria.,Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Affiliated partner of the ERN EpiCARE, Salzburg, Austria.,Centre of Neuroscience, Christian Doppler University Hospital Salzburg, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Zimmermann G, Trinka E. Accounting for individual variability in baseline seizure frequencies when planning randomized clinical trials remains challenging. Epilepsia 2020; 61:2321-2322. [PMID: 32996125 DOI: 10.1111/epi.16676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.,Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
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Leitinger M, Trinka E, Zimmermann G, Granbichler CA, Kobulashvili T, Siebert U. Epidemiology of status epilepticus in adults: Apples, pears, and oranges - A critical review. Epilepsy Behav 2020; 103:106720. [PMID: 31902646 DOI: 10.1016/j.yebeh.2019.106720] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 09/22/2019] [Revised: 11/02/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Status epilepticus (SE) is a severe neurologic condition associated with high morbidity and mortality. Population-based studies in adults have found a wide range of incidences in various regions in the world. Although the incidence of SE increases almost exponentially in the elderly, data on census-based population statistics in these studies are scarce. This study provides a critical review with an emphasis on census-based population statistics and study characteristics in adults. METHODS We performed a systematic search of population-based studies on SE in adults in PubMed using "status epilepticus" in combination with "epidemiology", "population", and "incidence" as search terms, and also screened references. For each identified study, we assessed and extracted the respective population pyramids of study and reference population, and study characteristics. RESULTS We identified 22 population-based studies (eleven from Europe, six from North America, three from Asia, one from Africa, and one from Australasia). Incidence rates of patients with SE ranged from 1.29 to 73.7/100,000 adults (95% confidence interval (CI): 76.6-80.3) and of SE episodes up to 81.1/100,000 adults (95% CI: 75.8-87.0). The proportions of elderly and very old patients varied by a factor of 2.6 and 8.5, respectively, depending on study period and place. Further major reasons for heterogeneity were retrospective or prospective study design, definition of time to diagnose SE, variable detection of nonconvulsive SE (NCSE), different etiologies, inclusion of children, recurrent episodes, postanoxic patients, exclusion of patients with preexisting epilepsy or patients identified outside the emergency department, and choice of reference population for age- and gender adjustment. The most recent definition and classification of SE by the International League Against Epilepsy (ILAE) 2015 was used in two studies. Four studies (18.2%) reported incidences per ten-year age strata necessary for age adjustment to various reference populations. CONCLUSIONS This critical review reveals a marked heterogeneity among population-based studies on SE in adults. It provides comprehensive details on census-based population statistics in study and reference populations and various study designs and characteristics essential for direct comparisons between studies. Reporting on these essential key features should be improved in population-based studies on SE.
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Affiliation(s)
- Markus Leitinger
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria; Centre of Neuroscience, Christian Doppler University Hospital, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria; Centre of Neuroscience, Christian Doppler University Hospital, Salzburg, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics nd Technology, Hall in Tirol, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria; Department of Mathematics, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Claudia A Granbichler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria; Sheba Medical Center, Department of Neurology, Tel Hashomer, Israel
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria; Centre of Neuroscience, Christian Doppler University Hospital, Salzburg, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics nd Technology, Hall in Tirol, Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Leitinger M, Trinka E, Zimmermann G, Beniczky S. Salzburg criteria for nonconvulsive status epilepticus: Details matter. Epilepsia 2019; 60:2334-2336. [PMID: 31595496 PMCID: PMC6972514 DOI: 10.1111/epi.16361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/23/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Markus Leitinger
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Grassner L, Wutte C, Zimmermann G, Grillhösl A, Schmid K, Weiβ T, Maier W, Hauck S, Hollerith T, Vogel M, Bierschneider M, Vastmans J, Thomé C, Gonschorek O, Strowitzki M. Influence of Preoperative Magnetic Resonance Imaging on Surgical Decision Making for Patients with Acute Traumatic Cervical Spinal Cord Injury: A Survey Among Experienced Spine Surgeons. World Neurosurg 2019; 131:e586-e592. [PMID: 31404692 DOI: 10.1016/j.wneu.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Early decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial, but optimal management is unclear. The aim of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in addition to computed tomography (CT) in surgical decision making for acute cervical SCI. METHODS All patients with cervical SCI between 2008 and 2016 who had preoperative CT and MRI (n = 63) at the Trauma Center Murnau, Germany, were included. We administered a survey to 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. First, the surgeons were shown clinical information and CT scans. Two months later, the survey was repeated with additional MRI. Corresponding percentages of change and agreement were obtained for each rater and survey item. Finally, results from both parts of the survey were compared with the definitive treatment option (i.e., real-world decision). RESULTS MRI modified surgical timing in a median of 41% of patients (interquartile range 38%-56%). In almost every fifth patient (17%), no surgery would have been indicated with CT alone. The advocated surgical approach was changed in almost half of patients (median 48%, interquartile range 33%-49%). Surgically addressed levels were changed in a median of 57% of patients (interquartile range 56%-60%). MRI led to higher agreement with the real-world decision concerning addressed levels (median 35% vs. 73%), timing (median 51% vs. 57%), and approach (median 44% vs. 65%). CONCLUSIONS Preoperative MRI influenced surgical decision making substantially in our cohort and has become a new standard for patients with cervical SCI in our institution if medically possible.
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Affiliation(s)
- Lukas Grassner
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany; Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany; Institute for Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
| | - Christof Wutte
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | - Georg Zimmermann
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Christian Doppler Medical Center and Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Neuroradiology, BG Trauma Center Murnau, Murnau, Germany
| | - Katharina Schmid
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Thomas Weiβ
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Walter Maier
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Stefan Hauck
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Tobias Hollerith
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Matthias Vogel
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | | | - Jan Vastmans
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Oliver Gonschorek
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Martin Strowitzki
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
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Zimmermann G, Bolter L, Sluka R, Höller Y, Bathke AC, Thomschewski A, Leis S, Lattanzi S, Brigo F, Trinka E. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: A systematic review. J Evid Based Med 2019; 12:200-208. [PMID: 31231977 PMCID: PMC6771853 DOI: 10.1111/jebm.12356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/12/2019] [Indexed: 12/13/2022]
Abstract
AIM Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small-sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. METHODS We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health-related outcomes was assessed by means of a hypothesis test. If at least one group had a size <20, the study was classified as a small sample size study. PubMed was searched for eligible studies; subsequently, data on sample sizes and statistical methods were extracted and summarized descriptively. RESULTS Out of 8897 studies 207 were included. Median total sample size was 18 (range 4-582). Small sample sizes were found in 167/207 (81%) studies, resulting limitations and implications for statistical analyses were mentioned in 109/167 (65%) studies. CONCLUSIONS Although most recent SCI trials have been conducted with small samples, the consequences on statistical analysis methods and the validity of the results are rarely acknowledged.
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Affiliation(s)
- Georg Zimmermann
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | | | - Ronny Sluka
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Yvonne Höller
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Arne C. Bathke
- Department of MathematicsParis Lodron UniversitySalzburgAustria
| | - Aljoscha Thomschewski
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Spinal Cord Injury and Tissue Regeneration Centre SalzburgParacelsus Medical UniversitySalzburgAustria
- Department of PsychologyParis Lodron UniversitySalzburgAustria
| | - Stefan Leis
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Division of NeurologyFranz Tappeiner HospitalMeranoItaly
| | - Eugen Trinka
- Department of NeurologyChristian Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
- Department of Public HealthHealth Services Research and Health Technology Assessment, UMITHall i. T.Austria
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Zimmermann G, Kieser M, Bathke AC. Sample size calculation and blinded recalculation for analysis of covariance models with multiple random covariates. J Biopharm Stat 2019; 30:143-159. [PMID: 31327284 DOI: 10.1080/10543406.2019.1632871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When testing for superiority in a parallel-group setting with a continuous outcome, adjusting for covariates is usually recommended. For this purpose, the analysis of covariance is frequently used, and recently several exact and approximate sample size calculation procedures have been proposed. However, in case of multiple covariates, the planning might pose some practical challenges and pitfalls. Therefore, we propose a method, which allows for blinded re-estimation of the sample size during the course of the trial. Simulations confirm that the proposed method provides reliable results in many practically relevant situations, and applicability is illustrated by a real-life data example.
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Affiliation(s)
- Georg Zimmermann
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Department of Statistics, University of Kentucky, Lexington, KY, USA
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Schraml M, Sommer F, Pur B, Köhler W, Zimmermann G, Witusiewicz VT, Sturz L. Measurement of non-isothermal transport coefficients in a near-eutectic succinonitrile/(d)camphor mixture. J Chem Phys 2019; 150:204508. [PMID: 31153215 DOI: 10.1063/1.5098879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We have determined nonisothermal diffusive transport coefficients of a succinonitrile-(d)camphor mixture with a composition of c = 0.239 wt.-frac. (d)camphor at a temperature of 318.2 K, which is close to the eutectic point. The employed experimental techniques are optical beam deflection in a Soret cell and photon correlation spectroscopy. The diffusion coefficient is D = (1.43 ± 0.04) × 10-10 m2 s-1, the thermodiffusion coefficient is DT = (2.00 ± 0.06) × 10-12 m2 s-1 K-1, and the Soret coefficient is ST = (1.40 ± 0.02) × 10-2 K-1. Camphor migrates toward the lower and succinonitrile migrates toward the higher temperatures. While the diffusion coefficient is in good agreement with the literature, the Soret coefficient has been determined for the first time. Our analysis shows that a significant concentration shift can be established in the liquid mixture in the presence of a temperature gradient. The mixture has a negative separation ratio, which leads to convective instabilities if heated from above.
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Affiliation(s)
- M Schraml
- Physikalisches Institut, Universität Bayreuth, D-95440 Bayreuth, Germany
| | - F Sommer
- Physikalisches Institut, Universität Bayreuth, D-95440 Bayreuth, Germany
| | - B Pur
- Physikalisches Institut, Universität Bayreuth, D-95440 Bayreuth, Germany
| | - W Köhler
- Physikalisches Institut, Universität Bayreuth, D-95440 Bayreuth, Germany
| | | | | | - L Sturz
- Access e.V., Aachen, Germany
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Zimmermann G, Pauly M, Bathke AC. Small-sample performance and underlying assumptions of a bootstrap-based inference method for a general analysis of covariance model with possibly heteroskedastic and nonnormal errors. Stat Methods Med Res 2019; 28:3808-3821. [PMID: 30600769 DOI: 10.1177/0962280218817796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is well known that the standard F test is severely affected by heteroskedasticity in unbalanced analysis of covariance models. Currently available potential remedies for such a scenario are based on heteroskedasticity-consistent covariance matrix estimation (HCCME). However, the HCCME approach tends to be liberal in small samples. Therefore, in the present paper, we propose a combination of HCCME and a wild bootstrap technique, with the aim of improving the small-sample performance. We precisely state a set of assumptions for the general analysis of covariance model and discuss their practical interpretation in detail, since this issue may have been somewhat neglected in applied research so far. We prove that these assumptions are sufficient to ensure the asymptotic validity of the combined HCCME-wild bootstrap analysis of covariance. The results of our simulation study indicate that our proposed test remedies the problems of the analysis of covariance F test and its heteroskedasticity-consistent alternatives in small to moderate sample size scenarios. Our test only requires very mild conditions, thus being applicable in a broad range of real-life settings, as illustrated by the detailed discussion of a dataset from preclinical research on spinal cord injury. Our proposed method is ready-to-use and allows for valid hypothesis testing in frequently encountered settings (e.g., comparing group means while adjusting for baseline measurements in a randomized controlled clinical trial).
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Affiliation(s)
- Georg Zimmermann
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Markus Pauly
- Institute of Statistics, University of Ulm, Ulm, Germany
| | - Arne C Bathke
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Department of Statistics, University of Kentucky, Lexington, KY, USA
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Leitinger M, Trinka E, Giovannini G, Zimmermann G, Florea C, Rohracher A, Kalss G, Neuray C, Kreidenhuber R, Höfler J, Kuchukhidze G, Granbichler C, Dobesberger J, Novak HF, Pilz G, Meletti S, Siebert U. Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes. Epilepsia 2018; 60:53-62. [PMID: 30478910 PMCID: PMC7380005 DOI: 10.1111/epi.14607] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
Abstract
Objective In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic–clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population‐based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome. Methods We conducted a retrospective population‐based incidence study of all adult patients with SE residing in the city of Salzburg between January 2011 and December 2015. Patients with hypoxic encephalopathy were excluded. SE was defined and classified according to the ILAE 2015. Results We identified 221 patients with a median age of 69 years (range 20‐99 years). The age‐ and sex‐adjusted incidence of a first episode of SE, NCSE, and SE with prominent motor phenomena (including CSE) was 36.1 (95% confidence interval [CI] 26.2‐48.5), 12.1 (95% CI 6.8‐20.0), and 24.0 (95% CI 16.0‐34.5; including CSE 15.8 [95% CI 9.4‐24.8]) per 100 000 adults per year, respectively. None of the patients whose SE ended with or consisted of only bilateral tonic–clonic activity died. In all other clinical presentations, case fatality was lower in awake patients (8.2%) compared with patients with impaired consciousness (33%). Significance This first population‐based study using the ILAE 2015 definition and classification of SE found an increase of incidence of 10% compared to previous definitions. We also provide epidemiologic evidence that different patterns of status evolution and LOCs have strong prognostic implications.
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Affiliation(s)
- Markus Leitinger
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Giada Giovannini
- Unit of Neurology, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria.,Department of Mathematics, Paris Lodron University, Salzburg, Austria
| | - Cristina Florea
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Alexandra Rohracher
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Caroline Neuray
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Rudolf Kreidenhuber
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Claudia Granbichler
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Helmut F Novak
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Center for Neuroscience, Christian Doppler Medical Center, Salzburg, Austria
| | - Stefano Meletti
- Unit of Neurology, OCSAE Hospital, Azienda Ospedaliera Universitaria, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Institute for Technology Assessment and Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Kobulashvili T, Kuchukhidze G, Brigo F, Zimmermann G, Höfler J, Leitinger M, Dobesberger J, Kalss G, Rohracher A, Neuray C, Wakonig A, Ernst F, Braun KPJ, Mouthaan BE, Van Eijsden P, Ryvlin P, Cross JH, Trinka E. Diagnostic and prognostic value of noninvasive long-term video-electroencephalographic monitoring in epilepsy surgery: A systematic review and meta-analysis from the E-PILEPSY consortium. Epilepsia 2018; 59:2272-2283. [PMID: 30511441 DOI: 10.1111/epi.14598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY network (now continuing within the European Reference Network for rare and complex epilepsies [EpiCARE]) aims to harmonize and optimize presurgical diagnostic procedures by creating and implementing evidence-based guidelines across Europe. The present study evaluates the current evidence on the diagnostic accuracy of long-term video-electroencephalographic monitoring (LTM) in identifying the epileptogenic zone in epilepsy surgery candidates. METHODS MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched for relevant articles. First, we used random-effects meta-analytical models to calculate pooled estimates of sensitivity and specificity with respect to postsurgical seizure freedom. In a second phase, we analyzed individual patient data in an exploratory fashion, assessing diagnostic accuracy within lesional and nonlesional temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) patients. We also evaluated seizure freedom rate in the presence of "localizing" or "nonlocalizing" LTM within each group. The quality of evidence was assessed using the QUADAS-2 tool and the GRADE approach. RESULTS Ninety-four studies were eligible. Forty-four were included in sensitivity meta-analysis and 34 in specificity meta-analysis. Pooled sensitivity was 0.70 (95% confidence interval [CI] = 0.60-0.80) and specificity was 0.40 (95% CI = 0.27-0.54). Subgroup analysis was based on individual data of 534 patients (41% men). In lesional TLE patients, sensitivity was 0.85 (95% CI = 0.81-0.89) and specificity was -0.19 (95% CI = 0.13-0.28). In lesional ETLE patients, a sensitivity of 0.47 (95% CI = 0.36-0.58) and specificity of 0.35 (95% CI = 0.21-0.53) were observed. In lesional TLE, if LTM was localizing and concordant with resection site, the seizure freedom rate was 247 of 333 (74%), whereas in lesional ETLE it was 34 of 56 (61%). The quality of evidence was assigned as "very low." SIGNIFICANCE Long-term video-electroencephalographic monitoring is associated with moderate sensitivity and low specificity in identification of the epileptogenic zone. Sensitivity is remarkably higher in lesional TLE compared to lesional ETLE. Substantial heterogeneity across the studies indicates the need for improved design and quality of reporting.
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Affiliation(s)
- Teia Kobulashvili
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine, and Movement Science, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Georg Zimmermann
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Judith Dobesberger
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Gudrun Kalss
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Alexandra Rohracher
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Caroline Neuray
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Antonia Wakonig
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria
| | | | - Kees P J Braun
- Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brian E Mouthaan
- Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter Van Eijsden
- Department of Child Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Lausanne, France.,European Epilepsy Monitoring Unit Association, Bron, France
| | - J Helen Cross
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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Schmid E, Thomschewski A, Taylor A, Zimmermann G, Kirschner M, Kobulashvili T, Brigo F, Rados M, Helmstaedter C, Braun K, Trinka E. Diagnostic accuracy of functional magnetic resonance imaging, Wada test, magnetoencephalography, and functional transcranial Doppler sonography for memory and language outcome after epilepsy surgery: A systematic review. Epilepsia 2018; 59:2305-2317. [PMID: 30374948 DOI: 10.1111/epi.14588] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The European Union-funded E-PILEPSY project was launched to develop guidelines and recommendations for epilepsy surgery. In this systematic review, we aimed to assess the diagnostic accuracy of functional magnetic resonance imaging (fMRI), Wada test, magnetoencephalography (MEG), and functional transcranial Doppler sonography (fTCD) for memory and language decline after surgery. METHODS The literature search was conducted using PubMed, Embase, and CENTRAL. The diagnostic accuracy was expressed in terms of sensitivity and specificity for postoperative language or memory decline, as determined by pre- and postoperative neuropsychological assessments. If two or more estimates of sensitivity or specificity were extracted from a study, two meta-analyses were conducted, using the maximum ("best case") and the minimum ("worst case") of the extracted estimates, respectively. RESULTS Twenty-eight papers were eligible for data extraction and further analysis. All tests for heterogeneity were highly significant, indicating large between-study variability (P < 0.001). For memory outcomes, meta-analyses were conducted for Wada tests (n = 17) using both memory and language laterality quotients. In the best case, meta-analyses yielded a sensitivity estimate of 0.79 (95% confidence interval [CI] = 0.67-0.92) and a specificity estimate of 0.65 (95% CI = 0.47-0.83). For the worst case, meta-analyses yielded a sensitivity estimate of 0.65 (95% CI = 0.48-0.82) and a specificity estimate of 0.46 (95% CI = 0.28-0.65). The overall quality of evidence, which was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology, was rated as very low. Meta-analyses concerning diagnostic accuracy of fMRI, fTCD, and MEG were not feasible due to small numbers of studies (fMRI, n = 4; fTCD, n = 1; MEG, n = 0). This also applied to studies concerning language outcomes (Wada test, n = 6; fMRI, n = 2; fTCD, n = 1; MEG, n = 0). SIGNIFICANCE Meta-analyses could only be conducted in a few subgroups for the Wada test with low-quality evidence. Thus, more evidence from high-quality studies and improved data reporting are required. Moreover, the large between-study heterogeneity underlines the necessity for more homogeneous and thus comparable studies in future research.
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Affiliation(s)
- Elisabeth Schmid
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
| | - Alexandra Taylor
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Matea Rados
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | | | - Kees Braun
- Department of Child Neurology, University Medical Center, Utrecht, The Netherlands
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria
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Schneider AM, Weghuber D, Hetzer B, Entenmann A, Müller T, Zimmermann G, Schütz S, Huber WD, Pichler J. Vedolizumab use after failure of TNF-α antagonists in children and adolescents with inflammatory bowel disease. BMC Gastroenterol 2018; 18:140. [PMID: 30219028 PMCID: PMC6139155 DOI: 10.1186/s12876-018-0868-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/03/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vedolizumab is safe and effective in adult patients with Crohn's disease (CD) and ulcerative colitis (UC); however, data in children with inflammatory bowel disease (IBD) are scarce. Therefore, we evaluated vedolizumab use in a cohort of Austrian paediatric patients with IBD. METHODS Twelve patients (7 female; 7 CD; 5 UC), aged 8-17 years (median, 15 years), with severe IBD who received vedolizumab after tumour necrosis factor α antagonist treatment were retrospectively analysed. Clinical activity scores, relevant laboratory parameters, and auxological measures were obtained at infusion visits. RESULTS In the CD group, 1/7 patient discontinued therapy due to a severe systemic allergic reaction; 1/7 and 2/7 patients achieved complete and partial response, respectively, at week 14; and 3/7 patients discontinued therapy due to a primary non-response or loss of response. In the UC group, complete clinical remission was achieved at weeks 2, 6, and 14 in 2/5, 1/5 and 1/5 patients respectively; partial response was observed in one patient at week 2. CD activity scores did not significantly change from baseline to week 38 (median 47.5 vs. 40 points, p = 1,0), while median UC activity scores changed from 70 to 5 points (p < 0,001). Substantial weight gain and increased albumin and haemoglobin levels were observed in both groups. CONCLUSION These results demonstrate that vedolizumab can be an effective treatment for individual paediatric patients with IBD who are unresponsive, intolerant, or experience a loss of efficacy in other therapies. However, vedolizumab appears to be more effective in paediatric UC than in paediatric CD.
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Affiliation(s)
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Benjamin Hetzer
- Departments of Pediatrics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Andreas Entenmann
- Departments of Pediatrics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Thomas Müller
- Departments of Pediatrics, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg Zimmermann
- Department of Mathematics, Paris Lodron University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sebastian Schütz
- Department of Mathematics, Paris Lodron University, Salzburg, Austria
| | - Wolf-Dietrich Huber
- Department of Pediatric Nephrology and Gastroenterology, Medical University Vienna, Vienna, Austria
| | - Judith Pichler
- Department of Pediatric Nephrology and Gastroenterology, Medical University Vienna, Vienna, Austria
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Rohracher A, Zimmermann G, Villanueva V, Garamendi I, Sander JW, Wehner T, Shankar R, Ben-Menachem E, Brodie MJ, Pensel MC, Di Gennaro G, Maurousset A, Strzelczyk A, Rheims S, Rácz A, Menzler K, Bertol-Alegre V, García-Morales I, López-González FJ, Toledo M, Carpenter KJ, Trinka E. Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data. Epilepsia 2018; 59:1727-1739. [DOI: 10.1111/epi.14520] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/02/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Alexandra Rohracher
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
| | - Georg Zimmermann
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Department of Mathematics; Paris Lodron University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
| | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
| | - Tim Wehner
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Ruhr-Epileptology; Department of Neurology; Knappschaftskrankenhaus Bochum; Bochum Germany
| | | | | | | | - Max C. Pensel
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | | | - Aude Maurousset
- University Hospital Bretonneau and INSERM U 930; Tours France
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main; Goethe University; Frankfurt Germany
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon and University of Lyon; Lyon France
| | - Attila Rácz
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | - Katja Menzler
- Epilepsy Center Hessen; University Hospital Marburg; Marburg Germany
| | | | | | | | | | | | - Eugen Trinka
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
- Institute of Public Health; Medical Decision Making and HTA; Private University for Health Sciences Medical Informatics and Technology; Hall in Tyrol Austria
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Dobesberger J, Höfler J, Leitinger M, Kuchukhidze G, Zimmermann G, Thomschewski A, Unterberger I, Walser G, Kalss G, Rohracher A, Neuray C, Kobulashvili T, Höller Y, Trinka E. Personalized safety measures reduce the adverse event rate of long-term video EEG. Epilepsia Open 2018; 2:400-414. [PMID: 29588971 PMCID: PMC5862109 DOI: 10.1002/epi4.12078] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/07/2022] Open
Abstract
Objective Safety in epilepsy monitoring units (EMUs) has become an increasing concern because adverse events occur in up to 10% of patients undergoing long‐term video EEG in EMUs. The aim of this study was to assess the effectiveness of a specific safety protocol in an EMU. Methods We retrospectively assessed the adverse event rates in a group without (group 1, 84‐month period, Innsbruck, Austria) and a group with (group 2, 33‐month period, Salzburg, Austria) personalized safety measures utilizing a standardized protocol for long‐term epilepsy monitoring in high‐risk patients. Differences in adverse event rates during and after long‐term video EEG between the two groups were calculated and compared. Results In group 1, 44/507 (9%, 95% confidence interval [CI] 6.5–11.5%) patients experienced 53 adverse events: 20/507 (4%, 95% CI 2.6–6.0%) patients had psychiatric events, 15/507 (3%, 95% CI 1.8–4.8%) patients sustained a total of 19 injuries during seizures, and 10/507 (2%, 95% CI 1.1–3.6%) patients had 13 episodes of status epilepticus; one adverse event was treatment‐related (valproic acid–induced encephalopathy; 1/507, 0.2%, 95% CI 0.0–1.1%). By using the new safety protocol in group 2, the adverse event rate was only 5% (95% CI 3.4–7.6%; 30 adverse events in 26/491; 45% reduction; p = 0.036), in contrast. These events included 13 psychiatric complications in 13/491 (2%, 95% CI 1.6–4.5%, p = 0.252) patients, 12 seizure‐related injuries in 9/491 (2%, 95% CI 1.0–3.4%, p = 0.250) patients, and 5 episodes of status epilepticus in 4/491 (1%, 95% CI 0.3–2.1%, p = 0.120) patients. Significance Implementation of personalized safety measures in high‐risk patients resulted in a clinically relevant reduction of adverse events in the EMU. Safety protocols are a valid tool to reduce the occurrence of adverse events in EMUs.
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Affiliation(s)
- Judith Dobesberger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Julia Höfler
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Markus Leitinger
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Giorgi Kuchukhidze
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Georg Zimmermann
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria.,Department of Mathematics Paris Lodron University Salzburg Austria.,Spinal Cord Injury and Tissue Regeneration Center Paracelsus Medical University Salzburg Austria
| | - Iris Unterberger
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gerald Walser
- Department of Neurology Medical Innsbruck University Innsbruck Austria
| | - Gudrun Kalss
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Alexandra Rohracher
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Caroline Neuray
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Teia Kobulashvili
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Yvonne Höller
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
| | - Eugen Trinka
- Department of Neurology Centre for Cognitive Neuroscience Paracelsus Medical University Salzburg Austria
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Leuschner G, Reiter F, Stocker F, Crispin A, Kneidinger N, Veit T, Klenner F, Ceelen F, Zimmermann G, Leuchte H, Reu S, Dinkel J, Behr J, Neurohr C. Idiopathische Lungenfibrose bei jungen Patienten – ernstzunehmend und nicht so selten. Pneumologie 2018. [DOI: 10.1055/s-0037-1619240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Reiter
- Medizinische Klinik und Polikinik V, Klinikum Großhadern
| | - F Stocker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Klenner
- Medizinische Klinik und Polikinik V, Klinikum Großhadern
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - G Zimmermann
- Pneumologie, Medizinische Klinik und Poliklinik I; Klinikum Großhadern der Ludwig-Maximilians-Universität München
| | | | - S Reu
- Institute of Pathology, Ludwig Maximilian University of Munich
| | - J Dinkel
- Institut für Klinische Radiologie; Klinikum der Universität München
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU München; Comprehensive Pneumology Center
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Schwerpunkt Pneumologie, Klinikum der Universität München, Großhadern
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Stelzer D, Weber A, Ihle F, Matthes S, Ceelen F, Zimmermann G, Kneidinger N, Schramm R, Winter H, Zoller M, Vogeser M, Behr J, Neurohr C. Posaconazole liquid vs tablet formulation in lung transplant recipients. Mycoses 2017; 61:186-194. [DOI: 10.1111/myc.12724] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/13/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Affiliation(s)
- D. Stelzer
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
- Hospital Pharmacy; LMU-Munich; Munich Germany
| | - A. Weber
- Hospital Pharmacy; LMU-Munich; Munich Germany
| | - F. Ihle
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - S. Matthes
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - F. Ceelen
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - G. Zimmermann
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - N. Kneidinger
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - R. Schramm
- Department of Cardiac Surgery; LMU-Munich; Munich Germany
| | - H. Winter
- Department of Thoracic Surgery; LMU-Munich; Munich Germany
| | - M. Zoller
- Department of Anesthesiology; LMU-Munich; Munich Germany
| | - M. Vogeser
- Institute of Laboratory Medicine; LMU-Munich; Munich Germany
| | - J. Behr
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
| | - C. Neurohr
- Department of Internal Medicine V; LMU-Munich; Munich Germany
- Comprehensive Pneumology Center; Member of the German Center for Lung Research DZL; Munich Germany
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