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Familiari A, Napolitano R, Visser GHA, Lees C, Wolf H, Prefumo F. Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort. Ultrasound Obstet Gynecol 2023; 61:191-197. [PMID: 36412975 PMCID: PMC10108243 DOI: 10.1002/uog.26127] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the role of antenatal administration of corticosteroids for fetal lung maturation on the short-term perinatal outcome of pregnancy complicated by late fetal growth restriction (FGR). METHODS This cohort study was a secondary analysis of a multicenter prospective observational study, the TRUFFLE-2 feasibility study, conducted between 2017 and 2018 in 33 European perinatal centers. The study included women with a singleton pregnancy from 32 + 0 to 36 + 6 weeks of gestation with a fetus considered at risk for FGR, defined as estimated fetal weight (EFW) and/or fetal abdominal circumference < 10th percentile, or umbilicocerebral ratio (UCR) ≥ 95th percentile or a drop of more than 40 percentile points in abdominal circumference measurement from the 20-week scan. For the purposes of the current study, we identified women who received a single course of steroids to improve fetal lung maturation before delivery. Each exposed pregnancy was matched with one that did not receive antenatal corticosteroids (ACS) (control), based on gestational age at delivery and birth weight. The primary adverse outcome was a composite of abnormal condition at birth, major neonatal morbidity or perinatal death. RESULTS A total of 86 pregnancies that received ACS were matched to 86 controls. The two groups were similar with respect to gestational age (33.1 vs 33.3 weeks), EFW (1673 vs 1634 g) and UCR (0.68 vs 0.62) at inclusion, and gestational age at delivery (35.5 vs 35.9 weeks) and birth weight (1925 vs 1948 g). No significant differences were observed between the exposed and non-exposed groups in the incidence of composite adverse outcome (28% vs 24%; P = 0.73) or any of its elements. CONCLUSION The present data do not show a beneficial effect of steroids on short-term outcome of fetuses with late FGR. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Familiari
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - R. Napolitano
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - G. H. A. Visser
- Department of ObstetricsUniversity Medical CenterUtrechtThe Netherlands
| | - C. Lees
- Centre for Fetal Care, Department of Obstetrics and GynaecologyQueen Charlotte's and Chelsea Hospital, Imperial College LondonLondonUK
| | - H. Wolf
- Department of Obstetrics and GynecologyAmsterdam University Medical Center (Location AMC), University of AmsterdamAmsterdamThe Netherlands
| | - F. Prefumo
- Obstetrics and Gynecology UnitIRCCS Istituto Giannina GasliniGenoaItaly
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Zumstein N, Yamada K, Eicher S, Theill N, Geschwindner H, Wolf H, Riese F. The German version of the Mini Suffering State Examination (MSSE) for people with advanced dementia living in nursing homes. BMC Geriatr 2022; 22:595. [PMID: 35850694 PMCID: PMC9290288 DOI: 10.1186/s12877-022-03268-0] [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: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background The Mini Suffering State Examination (MSSE) has been explicitly recommended to assess suffering in dementia patients. This study aimed to develop a German version of the MSSE and assess its psychometric properties involving people with advanced dementia (PAD) in a nursing home setting. Methods The MSSE was translated into German, and 95 primary nurses administered it cross-sectionally to 124 PAD in Zurich, Switzerland. The psychometric properties of the German MSSE version were calculated for this population. Results The mean age of the PAD was 83.3 years (SD = 9.1, range = 55–102 years), and 98 of them (79.0%) were women. The Kuder-Richardson Formula 20 coefficient for the entire scale (0.58), the eight items relating to objective health conditions (0.39), and the professional and family estimation of the patient’s suffering (0.64) indicated low internal consistency. A confirmatory factor analysis indicated an unsatisfactory fit to a one-factor structure, with a comparative fit index and root mean square error of approximation of 0.71 and 0.08, respectively, and a Tucker–Lewis index of 0.64. The MSSE total score was significantly but moderately correlated with the total scores of the Symptom Management–End-of-Life with Dementia (SM-EOLD) scale (Pearson’s correlation coefficient (r) = -0.44; p < 0.05), the physical suffering scores (r = 0.41; p < 0.05), and the psychological suffering scores (r = 0.55; p < 0.05). Conclusions The German version of the MSSE questionnaire did not perform well in the nursing home setting involving PAD. The instrument had low internal consistency, doubtful validity, and could not discriminate between suffering and other distressing symptoms. We do not recommend its use in this population.
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Affiliation(s)
- Naomi Zumstein
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland. .,Department of Anthropology, McGill University, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada.
| | - Keiko Yamada
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Stefanie Eicher
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032, Zurich, Switzerland
| | - Nathan Theill
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Division of Geriatric Psychiatry, University Hospital of Psychiatry, Lenggstr. 31, 8032, Zurich, Switzerland
| | - Heike Geschwindner
- City of Zurich Nursing Homes, Eggbühlstrasse 23, 8050, Zurich, Switzerland
| | - Henrike Wolf
- Psychiatrische Dienste Graubünden, Ambulatory Psychiatric Services, Piazza Paracelsus 2, 7500, St. Moritz, Switzerland
| | - Florian Riese
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Division of Geriatric Psychiatry, University Hospital of Psychiatry, Lenggstr. 31, 8032, Zurich, Switzerland
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Wolf H, Stampalija T, Lees CC. Fetal cerebral blood-flow redistribution: analysis of Doppler reference charts and association of different thresholds with adverse perinatal outcome. Ultrasound Obstet Gynecol 2021; 58:705-715. [PMID: 33599336 PMCID: PMC8597586 DOI: 10.1002/uog.23615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES First, to compare published Doppler reference charts of the ratios of flow in the fetal middle cerebral and umbilical arteries (i.e. the cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR)). Second, to assess the association of thresholds of CPR and UCR based on these charts with short-term composite adverse perinatal outcome in a cohort of pregnancies considered to be at risk of late preterm fetal growth restriction. METHODS Studies presenting reference charts for CPR or UCR were searched for in PubMed. Formulae for plotting the median and the 10th percentile (for CPR) or the 90th percentile (for UCR) against gestational age were extracted from the publication or calculated from the published tables. Data from a prospective European multicenter observational cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks' gestation, in which fetal arterial Doppler measurements were collected longitudinally, were used to compare the different charts. Specifically, the association of UCR and CPR thresholds (CPR < 10th percentile or UCR ≥ 90th percentile and multiples of the median (MoM) values) with composite adverse perinatal outcome was analyzed. The association was also compared between chart-based thresholds and absolute thresholds. Composite adverse perinatal outcome comprised both abnormal condition at birth and major neonatal morbidity. RESULTS Ten studies presenting reference charts for CPR or UCR were retrieved. There were large differences between the charts in the 10th and 90th percentile values of CPR and UCR, respectively, while median values were more similar. In the gestational-age range of 28-36 weeks, there was no relationship between UCR or CPR and gestational age. From the prospective observational study, 856 pregnancies at risk of late-onset preterm fetal growth restriction were included in the analysis. The association of abnormal UCR or CPR with composite adverse perinatal outcome was similar for percentile thresholds or MoM values, as calculated from the charts, and for absolute thresholds, both on univariable analysis and after adjustment for gestational age at measurement, estimated fetal weight MoM and pre-eclampsia. The adjusted odds ratio for composite adverse perinatal outcome was 3.3 (95% CI, 1.7-6.4) for an absolute UCR threshold of ≥ 0.9 or an absolute CPR threshold of < 1.11 (corresponding to ≥ 1.75 MoM), and 1.6 (95% CI, 0.9-2.9) for an absolute UCR threshold of ≥ 0.7 to < 0.9 or an absolute CPR threshold of ≥ 1.11 to < 1.43 (corresponding to ≥ 1.25 to < 1.75 MoM). CONCLUSIONS In the gestational-age range of 32 to 36 weeks, adjustment of CPR or UCR for gestational age is not necessary when assessing the risk of adverse outcome in pregnancies at risk of fetal growth restriction. The adoption of absolute CPR or UCR thresholds, independent of reference charts, is feasible and makes clinical assessment simpler than if using percentiles or other gestational-age normalized units. The high variability in percentile threshold values among the commonly used UCR and CPR reference charts hinders reliable diagnosis and clinical management of late preterm fetal growth restriction. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H. Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC)University of AmsterdamAmsterdamThe Netherlands
| | - T. Stampalija
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
- Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
| | - C. C. Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonLondonUK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College NHS TrustLondonUK
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Horn A, Fernández-Rivas M, Wolf H, Ghaussy N, Møller Kruse T, Koutromanou K, Wüstenberg E. Shortened Up-Dosing With 7 Injections of Subcutaneous Allergy Immunotherapy (Alutard SQ) Is Safe and Well Tolerated. J Investig Allergol Clin Immunol 2021; 31:80-83. [PMID: 32573456 DOI: 10.18176/jiaci.0561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Horn
- ENT Practice am Neckar, Drs Horn & Choudhry, Heidelberg, Germany
| | - M Fernández-Rivas
- Allergy Dept, Hospital Clínico San Carlos, IdISSC, ARADyAL, Madrid, Spain
| | - H Wolf
- Medical Department ALK-Abelló Arzneimittel GmbH, Hamburg, Germany
| | - N Ghaussy
- Medical Department ALK-Abelló Arzneimittel GmbH, Hamburg, Germany
| | - T Møller Kruse
- ALK Global Pharmacovigilance and Clinical Development, Hørsholm, Denmark
| | - K Koutromanou
- ALK Global Pharmacovigilance and Clinical Development, Hørsholm, Denmark
| | - E Wüstenberg
- Medical Department ALK-Abelló Arzneimittel GmbH, Hamburg, Germany.,ENT Clinic Medical Faculty Carl-Gustav-Carus, Technical University, Dresden, Germany
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Marchand G, Sainz K, Wolf H, Hopewell S, Galitsky A, Anderson S, Ruther S, Brazil G, Vallejo J, Azadi A, Meassick K. In Bag Morcellation and Laparoscopic Two Port Laparoscopic Removal of Large Mucinous Cystadenoma. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.101] [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: 10/23/2022]
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Marchand G, Anderson S, Sainz K, Azadi A, Galitsky A, Wolf H, Hopewell S, Brazil G, Ruther S, Cieminski K, Meassick K. Minimally Invasive Search for a Missing Vibrator. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wolf H, Stampalija T, Monasta L, Lees CC. Ratio of umbilical and cerebral artery pulsatility indices in assessment of fetal risk: numerator and denominator matter. Ultrasound Obstet Gynecol 2020; 56:163-165. [PMID: 32118327 DOI: 10.1002/uog.22004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - L Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - C C Lees
- Imperial College School of Medicine, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - L Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - C C Lees
- Imperial College School of Medicine, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Wolf H, Gordijn SJ, Onland W, Vliegenthart RJS, Ganzevoort JW. Computerized fetal heart rate analysis in early preterm fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56:51-60. [PMID: 31605504 DOI: 10.1002/uog.21887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the value of computerized cardiotocography (cCTG) with calculation of fetal heart rate (FHR) short-term variability (STV) in early preterm fetal growth restriction (FGR) for prevention of fetal death and neonatal asphyxia, neonatal morbidity, and 2-year neurodevelopmental impairment. METHODS This was a retrospective cohort study of all women who were admitted to the Amsterdam University Medical Center-AMC between 2003 and 2015 due to FGR and/or pre-eclampsia, and who were delivered by prelabor Cesarean section, or had a fetal death, before 32 weeks' gestation. STV of all available cCTG registrations during the 5 days preceding fetal death or delivery was calculated retrospectively, and FHR decelerations were classified visually as absent, 1-2/h or recurrent (> 2/h). Adverse outcome endpoints were defined as fetal death, neonatal asphyxia at birth (including fetal death), neonatal death, major neonatal morbidity and 2-year neurodevelopmental outcome. A simulation analysis was performed to assess the incidence of adverse outcome using two thresholds for cCTG: (1) highly abnormal (STV < 2.6 ms before 29 weeks and < 3.0 ms thereafter, and/or recurrent FHR decelerations); and (2) moderately abnormal (STV < 3.5 ms before 29 weeks and < 4.0 ms thereafter, and/or recurrent FHR decelerations). Three management strategies were assessed using a strict schedule for the frequency of cCTG recordings: (1) cCTG without use of fetal arterial Doppler; (2) cCTG with additional fetal arterial Doppler after 29 weeks; and (3) cCTG with additional fetal arterial Doppler after 27 weeks. RESULTS Included were 367 pregnancies (3295 cCTG recordings), of which 20 resulted in fetal death and 347 were delivered by Cesarean section before the onset of labor. Cesarean delivery was indicated by fetal condition in 94% of cases and by maternal condition in 6%. Median gestational age at delivery was 30 (interquartile range (IQR), 28-31) weeks and median birth weight was 900 (IQR, 740-1090) g. Six cases of fetal death were not anticipated by standard practice using visual assessment of CTG. A last highly abnormal cCTG was associated with fetal death and with neonatal asphyxia (including fetal death; n = 99), but not with major neonatal morbidity and 2-year neurodevelopmental outcome. Moderately abnormal cCTG had no significant association with any endpoint. Simulation analysis showed that a strategy that combined cCTG results with umbilicocerebral ratio or umbilical absent or reversed end-diastolic flow could detect all fetal deaths. CONCLUSIONS Computerized CTG in combination with fetal arterial Doppler, with a strict protocol for the frequency of recordings, is likely to be more effective than visual CTG assessment for preventing fetal death in early preterm FGR. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Onland
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J S Vliegenthart
- Department of Neonatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
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Stampalija T, Arabin B, Wolf H, Bilardo C, Lees C. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. Am J Obstet Gynecol 2020; 222:391-392. [PMID: 31870732 DOI: 10.1016/j.ajog.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Ganzevoort W, Thornton JG, Marlow N, Thilaganathan B, Arabin B, Prefumo F, Lees C, Wolf H. Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials. Ultrasound Obstet Gynecol 2020; 55:68-74. [PMID: 31125465 PMCID: PMC6973288 DOI: 10.1002/uog.20354] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the effect on perinatal outcome of different fetal monitoring strategies for early-onset fetal growth restriction (FGR). METHODS This was a cohort analysis of individual participant data from two European multicenter trials of fetal monitoring methods for FGR: the Growth Restriction Intervention Study (GRIT) and the Trial of Umbilical and Fetal Flow in Europe (TRUFFLE). All women from GRIT (n = 238) and TRUFFLE (n = 503) who were randomized between 26 and 32 weeks' gestation were included. The women were grouped according to intervention and monitoring method: immediate delivery (GRIT) or delayed delivery with monitoring by conventional cardiotocography (CTG) (GRIT), computerized CTG (cCTG) only (GRIT and TRUFFLE) or cCTG and ductus venosus (DV) Doppler (TRUFFLE). The primary outcome was survival without neurodevelopmental impairment at 2 years of age. RESULTS Gestational age at delivery and birth weight were similar in both studies. Fetal death rate was similar between the GRIT and TRUFFLE groups, but neonatal and late death were more frequent in GRIT (18% vs 6%; P < 0.01). The rate of survival without impairment at 2 years was lowest in pregnancies that underwent immediate delivery (70% (95% CI, 61-78%)) or delayed delivery with monitoring by CTG (69% (95% CI, 57-82%)), increased in those monitored using cCTG only in both GRIT (80% (95% CI, 68-91%)) and TRUFFLE (77% (95% CI, 70-84%)), and was highest in pregnancies monitored using cCTG and DV Doppler (84% (95% CI, 80-89%)) (P < 0.01 for trend). CONCLUSIONS This analysis supports the hypothesis that the optimal method for fetal monitoring in pregnancies complicated by early-onset FGR is a combination of cCTG and DV Doppler assessment. TRIAL REGISTRATION GRIT ISRCTN41358726 and TRUFFLE ISRCTN56204499. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W. Ganzevoort
- Department of ObstetricsAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - J. G. Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of MedicineUniversity of Nottingham, Nottingham City HospitalNottinghamUK
| | - N. Marlow
- Department of Academic NeonatologyUCL Institute for Women's HealthLondonUK
| | - B. Thilaganathan
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation Trust, University of LondonLondonUK
- Vascular Biology and Research Centre, Molecular & Clinical Sciences Research InstituteSt George's University of LondonLondonUK
| | - B. Arabin
- Center for Mother and Child of the Philipps UniversityMarburgGermany
| | - F. Prefumo
- Maternal–Fetal Medicine UnitUniversity of BresciaBresciaItaly
| | - C. Lees
- Department of Obstetrics & GynaecologyRosie HospitalCambridgeUK
- Department of Obstetrics and GynecologyKU LeuvenBelgium
| | - H. Wolf
- Department of ObstetricsAmsterdam University Medical CenterAmsterdamThe Netherlands
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Bertens D, Vos S, Kehoe P, Wolf H, Nobili F, Mendonça A, van Rossum I, Hort J, Molinuevo JL, Heneka M, Petersen R, Scheltens P, Visser PJ. Use of mild cognitive impairment and prodromal AD/MCI due to AD in clinical care: a European survey. Alzheimers Res Ther 2019; 11:74. [PMID: 31439020 PMCID: PMC6706888 DOI: 10.1186/s13195-019-0525-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/22/2019] [Indexed: 01/18/2023]
Abstract
Introduction The diagnosis of mild cognitive impairment (MCI) refers to cognitive impairment not meeting dementia criteria. A survey among members of the American Association of Neurology (AAN) showed that MCI was considered a useful diagnosis. Recently, research criteria have been proposed for the diagnosis of Alzheimer’s disease (AD) in MCI based on AD biomarkers (prodromal AD/MCI due to AD). The aim of this study was to investigate the attitudes of clinicians in Europe on the clinical utility of MCI and prodromal AD/MCI due to AD criteria. We also investigated whether the prodromal AD/MCI due to AD criteria impacted management of MCI patients. Methods An online survey was performed in 2015 among 102 members of the European Academy of Neurology (EAN) and the European Alzheimer’s Disease Consortium (EADC). Questions were asked on how often criteria were used, how they were operationalized, how they changed patient management, and what were considered advantages and limitations of MCI and prodromal AD/MCI due to AD. The questionnaire consisted of 47 questions scored on a Likert scale. Results Almost all respondents (92%) used the MCI diagnosis in clinical practice. Over 80% of the EAN/EADC respondents found a MCI diagnosis useful because it helped to label the cognitive problem, involve patients in planning for the future, and start risk reduction activities. These findings were similar to those reported in the AAN survey. Research criteria for prodromal AD/MCI due to AD were used by 68% of the EAN/EADC respondents. The most common reasons to use the criteria were increased certainty of diagnosis (86%), increased possibilities to provide counseling (51%), facilitation of follow-up planning (48%), start of medical intervention (49%), and response to patients’ wish for a diagnosis (41%). Over 70% of the physicians considered that a diagnosis of prodromal AD/MCI due to AD had an added value over the MCI diagnosis. Conclusions The diagnostic criteria of MCI and prodromal AD/MCI due to AD are commonly used among EAN/EADC members. The prodromal AD/MCI due to AD were considered clinically useful and impacted patient management and communication. Electronic supplementary material The online version of this article (10.1186/s13195-019-0525-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniela Bertens
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - Stephanie Vos
- Alzheimer Centre, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Patrick Kehoe
- Learning and Research, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Henrike Wolf
- Department of Psychiatry, University of Zurich, Zürich, Switzerland
| | - Flavio Nobili
- Clinical Neurology Unit, Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Alexandre Mendonça
- Department of Neurology and Laboratory of Neurosciences, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ineke van Rossum
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Jacub Hort
- Department of Neurology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jose Luis Molinuevo
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain.,Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Michael Heneka
- Clinical Neuroscience, Department of Neurology Clinical Neuroscience Unit, and German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
| | - Ron Petersen
- Mayo Clinic Alzheimer's Disease Research Center and the Mayo Clinic Study of Aging, Rochester, MN, USA
| | - Philip Scheltens
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Centre, Department of Neurology, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. .,Alzheimer Centre, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.
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Stempfl J, Schumacher F, Doering M, Wolf H, Streithoff F, Tacke J, Fahn H, Ehlermann P, Raake P, Klingel K, Elsner D, Groebner M. [Atrioventricular block and left ventricular wall mobility disorder in a 44-year-old female patient : A case report of a rarity with pitfalls]. Internist (Berl) 2019; 60:973-981. [PMID: 31123761 DOI: 10.1007/s00108-019-0608-5] [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] [Indexed: 10/26/2022]
Abstract
Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.
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Affiliation(s)
- J Stempfl
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.
| | - F Schumacher
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Doering
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - H Wolf
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - F Streithoff
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - J Tacke
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - H Fahn
- Klinik für Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie und Stoffwechselerkrankungen, Klinikum Passau, Passau, Deutschland
| | - P Ehlermann
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - P Raake
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - K Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - D Elsner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Groebner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
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Pels A, Mensing van Charante NA, Vollgraff Heidweiller-Schreurs CA, Limpens J, Wolf H, de Boer MA, Ganzevoort W. The prognostic accuracy of short term variation of fetal heart rate in early-onset fetal growth restriction: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 234:179-184. [PMID: 30710764 DOI: 10.1016/j.ejogrb.2019.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Cardiotocography (CTG) is an important tool for fetal surveillance in severe early-onset fetal growth restriction (FGR). Assessment of the CTG is usually performed visually (vCTG). However, it is suggested that computerized analysis of the CTG (cCTG) including short term variability (STV) could more accurately detect fetal compromise. The objective of this study was to systematically review the literature on the association between cCTG and perinatal outcome and the comparison of cCTG with vCTG. STUDY DESIGN A systematic search was performed in MEDLINE, EMBASE and Google Scholar. Studies were included that assessed prognostic accuracy of STV or compared STV to vCTG in patients with FGR. Risk of bias and concerns about applicability were assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) instrument. RESULTS Of the 885 records identified in the search, five cohort studies (387 patients) were included. We found no randomized studies comparing STV with visual CTG in patients with FGR. The risk of bias of all studies was generally judged as 'low'. One small study found an association of low STV with neonatal acidosis. One study observed no association of STV with long-term outcome. Composite analysis of all five studies showed a non-significant relative risk for acidosis after a low STV of 1.4 (95% CI 0.6-3.2, N = 387). Further meta-analysis was hampered due to heterogeneity in outcome reporting and use of different thresholds. CONCLUSION The evidence from the included studies did not support an association of STV and short or long term outcome. However, available data are limited and heterogeneous, and influenced by management based on STV. Solid evidence from a randomized controlled trial comparing STV with vCTG including long term infant outcome is needed before STV can be used clinically for timing of delivery in patients with FGR.
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Affiliation(s)
- A Pels
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - N A Mensing van Charante
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - J Limpens
- Amsterdam UMC, University of Amsterdam, Medical Library, Meibergdreef 9, Amsterdam, the Netherlands
| | - H Wolf
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W Ganzevoort
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands
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Hueluer G, Wolf H, Riese F, Theill N. COGNITIVE CHANGE AT THE END OF LIFE IN NURSING HOME RESIDENTS: DIFFERENTIAL TRAJECTORIES OF TERMINAL DECLINE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Hueluer
- University of Zurich, Zurich, Zurich, Switzerl
| | - H Wolf
- Psychiatric Services Graubuenden, St. Moritz, Switzerl
| | - F Riese
- Psychiatric University Hospital Zurich, Division of Old Age Psychiatry, Zurich, Switzerland; University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Switzerl
| | - N Theill
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Switzerl
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Wolf H. Brave new world - will AI rule healthcare? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wolf H, Vogel H, Römling L, Schenk J, Lukasczik M. Implementierung und formative Evaluation eines Gesundheitslotsen zur Beratung von Gesundheitsgästen in einem Kurort. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1668023] [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)
- H Wolf
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - H Vogel
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - L Römling
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - J Schenk
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - M Lukasczik
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
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Horbach T, Wolf H, Michaells HC, Wagner W, Hoffmann A, Schmidt A, Beck H. A Fixed-Dose Combination of Low Molecular Weight Heparin with Dihydroergotamine versus Adjusted-Dose Unfractionated Heparin in the Prevention of Deep-Vein Thrombosis after Total Hip Replacement. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe low dose heparin regimen (LDH) is not appropriate for prevention of intra- and postoperative thromboembolic complications in high risk patients, especially those undergoing elective hip replacement. Despite LDH prophylaxis, the incidence of deep-vein thrombosis (DVT) remains in a range of 20 to 35%. Adjusted-dose unfractionated heparin prophylaxis is thought to be one of the most effective regimens for thrombosis prophylaxis in this indication, but it requires two or three daily injections as well as precise monitoring of the activated partial thromboplastin time (aPTT). As an attractive alternative, we investigated the efficacy and safety of the low molecular weight heparin (LMWH) certoparin combined with dihydroergotamine (DHE) given once daily.In a randomised, open clinical trial, a total number of 305 patients undergoing total elective hip replacement were enrolled and divided into two groups, either receiving a fixed-dose combination of LMWH (3,000 IU) and DHE (0.5 mg) subcutaneously once daily, or adjusted-dose unfractionated heparin (UFH) subcutaneously every 8 h. The UFH dosage was adjusted daily to keep an aPTT of about 50 s. The aPTT was determined 3 h after the morning injection. During the study, the starting dose (15,000 IU/day) was increased to a plateau value of 28,800 ± 7,150 IU/day (mean ± SD) to maintain the aPTT in the prescribed range. The plateau value was achieved after 8 postoperative days. For analysis of efficacy 289 patients were evaluable. The occurrence of deep vein thrombosis was determined by bilateral ascending venography, which was performed on the same day in patients with clinical signs suggesting DVT; and in all remaining patients at the end of the prophylaxis period. Deep vein thrombosis was diagnosed in 17 of 142 patients (12.0%) treated with LMWH/DHE and in 13 of 147 patients (8.8%) treated with adjusted-dose UFH. Combined distal-proximal thrombosis was more frequently in patients receiving UFH (n = 5; 3.4%) compared to the LMWH/DHE group (n = 2; 1.4%). These differences are statistically not significant. In the UFH group one case of non-fatal pulmonary embolism occurred. Both prophylaxis regimens were well tolerated; wound bleeding was observed in 8 (5.3%) patients in the LMWH group and in 6 (4.0%) patients in the UFH group. Intraoperative blood-loss volume (mean±SD) was 751 ± 339 ml (LMWH/DHE) and 736 ± 380 ml (UFH), whereas postoperative drain-loss volume (mean ± SD) was found to be 523 ± 333 ml (LMWH/DHE) and 581 ± 404 ml (UFH). Whole blood transfusion volumes (mean ± SD) were 570 ± 202 ml (LMWH/DHE) and 748 ± 455 ml (UFH). Additionally, red cell replacement volumes (mean ± SD) were 804 ± 435 ml (LMWH/DHE) and 720 ± 328 ml (UHF). Revision of wound or additional drainage were necessary in 3 LMWH/DHE and 7 UFH patients. One patient needed reoperation due to bleeding, 3 (2.0%) had petechia and 1 exhibited an allergic exanthema, all of them in the UFH group. A slight erythema at the injection site was observed in 6 (3.9%) patients receiving LMWH/DHE. During the course of prophylaxis, injection hematomas were documented in 57.9% (LMWH/DHE) and in 61.4% (UFH) of the patients. All differences were statistically not significant.Single daily subcutaneous injections of LMWH/DHE appeared to be safe and efficacious compared to adjusted-dose UFH for prophylaxis of DVT in high-risk patients.
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Affiliation(s)
- T Horbach
- The Surgical Clinic and Out-Patient Department, University of Erlangen, Germany
| | - H Wolf
- Medical Department, Sandoz AG, Nuremberg, Germany
| | | | - W Wagner
- The Surgical Clinic and Out-Patient Department, University of Erlangen, Germany
| | - A Hoffmann
- The Surgical Clinic and Out-Patient Department, University of Erlangen, Germany
| | - A Schmidt
- The institute for Clinical Research, Hamburg, Germany
| | - H Beck
- The Surgical Clinic and Out-Patient Department, University of Erlangen, Germany
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Hülür G, Wolf H, Riese F, Theill N. Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline. Gerontology 2018; 65:57-67. [PMID: 30041168 DOI: 10.1159/000490614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/29/2017] [Accepted: 06/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. OBJECTIVES We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. METHODS We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument - Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. RESULTS We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. CONCLUSION Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.
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Affiliation(s)
- Gizem Hülür
- University of Zurich, University Research Priority Program "Dynamics of Healthy Aging,", Zurich, .,University of Zurich, Department of Psychology, Zurich,
| | - Henrike Wolf
- Psychiatric Services Graubünden, St. Moritz, Switzerland
| | - Florian Riese
- University of Zurich, University Research Priority Program "Dynamics of Healthy Aging,", Zurich, Switzerland.,Psychiatric University Hospital Zurich, Division of Old Age Psychiatry, Zurich, Switzerland
| | - Nathan Theill
- University of Zurich, University Research Priority Program "Dynamics of Healthy Aging,", Zurich, Switzerland
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Koppenhagen K, Adolf J, Matthes M, Tröster E, Roder JD, Haas S, Fritsche HM, Wolf H. Low Molecular Weight Heparin and Prevention of Postoperative Thrombosis in Abdominal Surgery. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648513] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a prospective, double-blind, randomized multicenter trial the efficacy and safety of low molecular weight heparin and unfractionated heparin were compared for the prevention of postoperative deep vein thrombosis in patients undergoing abdominal surgery. Six hundred and seventy-three patients were randomly allocated to the two prophylaxis groups; 20 of these, however, did not undergo surgery and did not receive any prophylaxis. Of the remaining 653 patients 323 received one subcutaneous injection of 3,000 anti-Xa units of low molecular weight heparin and 330 received subcutaneously 5,000 U heparin three times a day. Treatment was initiated 2 h preoperatively and continued for 7 to 10 days. The occurrence of DVT was determined by the 125I-labelled fibrinogen uptake test and phlebography. Venous thrombosis was diagnosed in 24 of 323 patients (7.4%) treated with low molecular weight heparin and in 26 of 330 patients (7.9%) treated with low-dose heparin. DVT of proximal veins was detected in four patients of the low molecular weight heparin group and in three patients of the low-dose heparin group. During the observation period three pulmonary emboli - one fatal and two non-fatal - occurred in patients receiving prophylaxis with low-dose heparin. No pulmonary embolism was found in patients treated with low molecular weight heparin. Both prophylactic schemes were well tolerated. Intra-and postoperative blood loss, incidence of wound hematoma, frequency and volume of intra- and postoperative blood transfusion were similar in both groups with a slight advantage for the low molecular weight heparin group. The results of this trial show that the investigated low molecular weight heparin is at least as effective and safe as low-dose heparin in preventing deep vein thrombosis in patients undergoing elective abdominal surgery.
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Affiliation(s)
- K Koppenhagen
- The Department of Nuclear Medicine, Universitätsklinikum Steglitz, Berlin, Germany
| | - J Adolf
- The Department of Surgery, University of Munich, Munich, Germany
| | - M Matthes
- The Department of Nuclear Medicine, Universitätsklinikum Steglitz, Berlin, Germany
| | - E Tröster
- The Department of Surgery, Universitätsklinikum Steglitz, Berlin, Germany
| | - J D Roder
- The Department of Surgery, University of Munich, Munich, Germany
| | - S Haas
- Institute for Experimental Surgery, University of Munich, Munich, Germany
| | - H M Fritsche
- The Department of Surgery, Teaching Hospital, Garmisch-Partenkirchen, Germany
| | - H Wolf
- The Medical Department, Sandoz AG, Nürnberg, Germany
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Haas S, Fischer M, Wesinger A, Vali L, Bauer W, Sauerwein K, Wolf H, Pehamberger H, Petzelbauer P, Handisurya A. 055 Effects of intravenous immunoglobulin administration on erythrocyte and leucocyte parameters. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.151] [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: 10/18/2022]
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Bilardo CM, Hecher K, Visser GHA, Papageorghiou AT, Marlow N, Thilaganathan B, Van Wassenaer-Leemhuis A, Todros T, Marsal K, Frusca T, Arabin B, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Ganzevoort W, Martinelli P, Ostermayer E, Schlembach D, Valensise H, Thornton J, Wolf H, Lees C. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:285-290. [PMID: 28938063 DOI: 10.1002/uog.18815] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G H A Visser
- University Medical Center, Division of Woman and Baby, Utrecht, The Netherlands
| | - A T Papageorghiou
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - N Marlow
- Department of Academic Neonatology, UCL Institute for Women's Health, London, UK
| | - B Thilaganathan
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - T Todros
- Department of Obstetrics & Gynecology, University of Turin, Turin, Italy
| | - K Marsal
- Department of Obstetrics and Gynecology, Lund University, University Hospital, Lund, Sweden
| | - T Frusca
- Maternal-Fetal Medicine Unit, University of Parma, Parma, Italy
| | - B Arabin
- Department of Perinatology, Isala Clinics, Zwolle, The Netherlands
- Center for Mother and Child of the Philipps University, Marburg, Germany
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - D Schlembach
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - H Valensise
- Department of Biomedicine, Tor Vergata University, Policlinico Casilino, Rome, Italy
| | - J Thornton
- Department of Obstetrics and Gynaecology, City Hospital, Nottingham, UK
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Visser GHA, Bilardo CM, Derks JB, Ferrazzi E, Fratelli N, Frusca T, Ganzevoort W, Lees CC, Napolitano R, Todros T, Wolf H, Hecher K. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:347-352. [PMID: 27854382 DOI: 10.1002/uog.17361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/17/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals. METHODS We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery. RESULTS Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival. CONCLUSIONS In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G H A Visser
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - N Fratelli
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University Hospital, Parma, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - R Napolitano
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant' Anna Hospital, Turin, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B, Todros T, Visser GHA, Bilardo CM, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Scheepers HCJ, Schlembach D, Schneider KTM, Valcamonico A, van Wassenaer-Leemhuis A, Ganzevoort W. Longitudinal study of computerized cardiotocography in early fetal growth restriction. Ultrasound Obstet Gynecol 2017; 50:71-78. [PMID: 27484356 DOI: 10.1002/uog.17215] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. METHODS The original TRUFFLE study assessed whether, in early FGR, delivery based on ductus venosus (DV) Doppler pulsatility index (PI), in combination with safety-net criteria of very low STV on cardiotocography (CTG) and/or recurrent FHR decelerations, could improve 2-year infant survival without neurological impairment in comparison with delivery based on CTG monitoring only. This was a secondary analysis of women who delivered before 32 weeks and had consecutive STV data recorded > 3 days before delivery and known infant outcome at 2 years of age. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values, except the last one before delivery, were calculated. Life tables and Cox regression analysis were used to calculate the daily risk for low STV or very low STV and/or FHR decelerations (below DV group safety-net criteria) and to assess which parameters were associated with this risk. Furthermore, it was assessed whether STV pattern, last STV value or recurrent FHR decelerations were associated with 2-year infant outcome. RESULTS One hundred and forty-nine women from the original TRUFFLE study met the inclusion criteria. Using the individual STV regression lines, prediction of a last STV below the cut-off used by the CTG monitoring group had sensitivity of 42% and specificity of 91%. For each day after study inclusion, the median risk for low STV (CTG group cut-off) was 4% (interquartile range (IQR), 2-7%) and for very low STV and/or recurrent FHR decelerations (below DV group safety-net criteria) was 5% (IQR, 4-7%). Measures of STV pattern, fetal Doppler (arterial or venous), birth-weight multiples of the median and gestational age did not usefully improve daily risk prediction. There was no association of STV regression coefficients, a low last STV and/or recurrent FHR decelerations with short- or long-term infant outcomes. CONCLUSION The TRUFFLE study showed that a strategy of DV monitoring with safety-net criteria of very low STV and/or recurrent FHR decelerations for delivery indication could increase 2-year infant survival without neurological impairment. This post-hoc analysis demonstrates that, in early FGR, the daily risk of abnormal CTG, as defined by the DV group safety-net criteria, is 5%, and that prediction is not possible. This supports the rationale for CTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent FHR decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DV-PI is within normal range. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Prefumo
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - T Todros
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - G H A Visser
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - N Marlow
- Department of Neonatology, Institute for Women's Health, University College Hospitals London, London, UK
| | - P Martinelli
- Department of Neuroscience, Dentistry and Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - E Ostermayer
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - H C J Scheepers
- Department of Obstetrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A Valcamonico
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - A van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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Ganzevoort W, Mensing Van Charante N, Thilaganathan B, Prefumo F, Arabin B, Bilardo CM, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Todros T, Valcamonico A, Visser GHA, Van Wassenaer-Leemhuis A, Lees CC, Wolf H. How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post-hoc analysis of TRUFFLE study. Ultrasound Obstet Gynecol 2017; 49:769-777. [PMID: 28182335 DOI: 10.1002/uog.17433] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In the recent TRUFFLE study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks' gestation, monitoring of the fetal ductus venosus (DV) waveform combined with computed cardiotocography (CTG) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV monitoring appeared to be associated with a non-significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death. METHODS Monitoring data of 317 pregnancies with FGR that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short-term variation (STV) on CTG; (2) early changes in fetal DV waveform; and (3) late changes in fetal DV waveform. Primary outcome was 2-year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS Two-year survival without neurological impairment occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however, the difference was not statistically significant (P = 0.21). Among the surviving infants in the DV groups, 93% were free of neurological impairment vs 85% of surviving infants in the CTG-STV group (P = 0.049). All fetal deaths (n = 7) occurred in the groups with DV monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight-to-50th percentile ratio and lower umbilical artery pulsatility index (PI)/fetal middle cerebral artery-PI ratio were significantly associated with normal outcome. Allocation to DV monitoring had a smaller effect on outcome, but remained in the model (P < 0.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG-STV group. In contrast, abnormal DV flow was the only monitoring parameter associated with adverse outcome in the DV groups, while fetal arterial Doppler, STV below the cut-off used in the CTG-STV group and recurrent decelerations in fetal heart rate were not. CONCLUSIONS In accordance with the findings of the TRUFFLE study on monitoring and intervention management of very preterm FGR, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV waveform vs reduced STV on CTG. The uneven distribution of fetal deaths towards the DV groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV-PI or STV and/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long-term outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N Mensing Van Charante
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - F Prefumo
- Maternal Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - C Brezinka
- Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Children's Hospital, Buzzi, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Marlow
- University College London Institute for Women's Health Ringgold Standard Institution - Neonatology, London, UK
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - T Todros
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - A Valcamonico
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - G H A Visser
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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Wimmer-Puchinger B, Wolf H, El-Jelede U. Weibliche Genitalverstümmelung: Ein unterschätztes Problem? – Das Wiener Kooperationsmodell von Care to Cure. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1598126] [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: 10/20/2022] Open
Affiliation(s)
| | - H Wolf
- Frauengesundheitszentrum FEM Süd, Wien
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28
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Van Wassenaer-Leemhuis AG, Marlow N, Lees C, Wolf H. The association of neonatal morbidity with long-term neurological outcome in infants who were growth restricted and preterm at birth: secondary analyses from TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe). BJOG 2017; 124:1072-1078. [DOI: 10.1111/1471-0528.14511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - N Marlow
- Department of Academic Neonatology; Institute for Women's Health; University College London; London UK
| | - C Lees
- Department of Obstetrics; Imperial College; London UK
| | - H Wolf
- Department of Obstetrics; Academic Medical Center; Amsterdam the Netherlands
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Lerche D, Wolf H. Direkte quantitative Bestimmung des Konzentrationsverlaufs in Diffusionsschichten an Membranen mit Hilfe der Laserinterferometrie. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1974-25517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Eicher S, Theill N, Geschwindner H, Moor C, Wettstein A, Bieri-Brüning G, Hock C, Martin M, Wolf H, Riese F. The last phase of life with dementia in Swiss nursing homes: the study protocol of the longitudinal and prospective ZULIDAD study. BMC Palliat Care 2016; 15:80. [PMID: 27557934 PMCID: PMC4997715 DOI: 10.1186/s12904-016-0151-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of older people with advanced dementia who will die in nursing homes is constantly growing. However, little is known about the dying phase, the type of symptoms, the management of symptoms and the quality of life and dying in people with advanced dementia. The ZULIDAD (Zurich Life and Death with Advanced Dementia) study aims at extending the current scientific knowledge by providing first data from Switzerland. METHODS The ZULIDAD study employs a prospective design to study nursing home residents with advanced dementia for three years or until their death in eleven nursing homes in Zurich. Observational data from quarterly questionnaires for relatives and primary nurses is combined with data from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS). Special focus is put on 1) the cross-sectional analysis of baseline and post-mortem data regarding quality of life and quality of dying and how the perceptions of these measures differ between relatives and primary nurses, 2) the longitudinal analyses of established health outcome measures (e.g., EOLD, MSSE, BISAD, QUALID) in order to understand their trajectories and 3) international comparisons of cross-sectional and longitudinal data. DISCUSSION The ZULIDAD study is one of the few existing prospective studies on end-of-life care in dementia and it is the first prospective study to describe the situation in Switzerland. Its multi-perspective approach allows a comprehensive approximation to central health outcome measures at the end of life such as pain, suffering or quality of life. Providing insights into the current provision of care, it can serve as a basis for improving dementia end-of-life care in Switzerland and internationally.
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Affiliation(s)
- Stefanie Eicher
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Andreasstrasse 15, 8050 Zurich, Switzerland
- Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | - Nathan Theill
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Andreasstrasse 15, 8050 Zurich, Switzerland
- Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Lenggstr. 31, 8032 Zurich, Switzerland
| | - Heike Geschwindner
- City of Zurich Nursing Homes, Walchestrasse 31, 8021 Zurich, Switzerland
| | - Caroline Moor
- Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | - Albert Wettstein
- Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | | | - Christoph Hock
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Lenggstr. 31, 8032 Zurich, Switzerland
| | - Mike Martin
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Andreasstrasse 15, 8050 Zurich, Switzerland
- Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
| | - Henrike Wolf
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Lenggstr. 31, 8032 Zurich, Switzerland
| | - Florian Riese
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Andreasstrasse 15, 8050 Zurich, Switzerland
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Lenggstr. 31, 8032 Zurich, Switzerland
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Affiliation(s)
- G.-F. von Tempelhoff
- Department of Obstetrics and Gynecology City Hospital of Ruesselsheim Teaching Hospital of the University of Mainz Germany
| | - H. Wolf
- Department of Obstetrics and Gynecology City Hospital of Ruesselsheim Teaching Hospital of the University of Mainz Germany
| | - B. Herrle
- Department of Obstetrics and Gynecology City Hospital of Ruesselsheim Teaching Hospital of the University of Mainz Germany
| | - B. Hojnacki
- Department of Obstetrics and Gynecology City Hospital of Ruesselsheim Teaching Hospital of the University of Mainz Germany
| | - L. Heilmann
- Department of Obstetrics and Gynecology City Hospital of Ruesselsheim Teaching Hospital of the University of Mainz Germany
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Wolf H, Krall C, Pajenda G, Hajdu S, Widhalm H, Leitgeb J, Sarahrudi K. Preliminary findings on biomarker levels from extracerebral sources in patients undergoing trauma surgery: Potential implications for TBI outcome studies. Brain Inj 2016; 30:1220-5. [PMID: 27295302 DOI: 10.3109/02699052.2016.1170883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/13/2022]
Abstract
BACKGROUND Despite several experimental studies on the role of S100B and NSE in fractures, no studies on the influence of surgery on the biomarker serum levels have been performed yet. METHODS The serum levels of S100B and NSE were analysed in patients with fractures that were located in the spine (group 1, n = 35) or in the lower extremity (group 2, n = 32) pre- and post-operatively. RESULTS The mean S100B serum level showed a significant increase (p = 0.04) post-surgery in the patients of group 1. In patients undergoing acute surgery (< 24 hours) the mean S100B serum level was 0.23 ± 0.22 μg L(-1) pre-operatively and 1.24 ± 1.38 μg L(-1) post-operatively. Likewise, the mean S100B serum level significantly increased in group 2 after surgery (p < 0.0001). In this group patients undergoing acute surgery showed a mean S100B serum level of 0.23 ± 0.14 μg L(-1) and 1.11 ± 0.73 μg L(-1) pre- and post-operatively. CONCLUSION This study demonstrates significant alterations of the biomarker S100B serum levels in patients undergoing surgery. Higher S100B serum levels were found within 24 hours and might be related to the acute fracture. The NSE serum levels were unchanged and this biomarker may offer the probability to serve as a future outcome predictor in studies with patients with traumatic brain injury and additional extracerebral injuries.
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Affiliation(s)
- H Wolf
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria.,b Faculty of Health Care and Social Work, Department of Public Health , University of Trnava , Slovakia.,c INRO (International Neurotrauma Research Organisation) , Vienna , Austria
| | - C Krall
- b Faculty of Health Care and Social Work, Department of Public Health , University of Trnava , Slovakia.,d Department for Medical Statistics , Medical University of Vienna , Vienna , Austria
| | - G Pajenda
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - S Hajdu
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - H Widhalm
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - J Leitgeb
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
| | - K Sarahrudi
- a Department for Trauma Surgery , Medical University of Vienna , Vienna , Austria
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Klimek L, Mewes T, Wolf H, Hansen I, Schnitker J, Mann WJ. The Effects of Short-Term Immunotherapy Using Molecular Standardized Grass and Rye Allergens Compared with Symptomatic Drug Treatment on Rhinoconjunctivitis Symptoms, Skin Sensitivity, and Specific Nasal Reactivity. Otolaryngol Head Neck Surg 2016; 133:538-43. [PMID: 16213926 DOI: 10.1016/j.otohns.2005.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: The efficacy and safety of short-term immunotherapy with molecular standardized allergens (STI) has been demonstrated by double-blind placebo-controlled clinical trials. The aim of this study was to compare STI with symptomatic drug treatment. METHODS: Forty-eight patients with rhinoconjunctivitis to grass and/or rye pollen were treated either with STI (ALK7, n = 24) plus anti-allergic drugs or anti-allergic drugs, alone (n = 24) in a prospective, randomized study. Symptoms and use of drugs were reported in patient diaries and titrated nasal provocation and skin prick tests were performed at baseline, before, and after season. RESULTS: Median overall symptom ( P = 0.022, U test) and medication scores ( P = 0.003) were significantly lower in the STI group, as was the result for a simultaneous analysis of conjunctival, nasal, and bronchial symptom scores and medication ( P = 0.005). Sensitivity in the nasal provocation test decreased in the STI group but not in the drug-treated group. These differences became significant directly after STI ( P = 0.027) as well as after the grass pollen season ( P < 0.001). Skin sensitivity did not change in the STI group but increased in the drug-treated group after season, with a significant difference between the two groups for the erythema ( P < 0.001). CONCLUSIONS: STI reduces grass pollen-induced rhinoconjunctivitis symptoms and drug use, and specific nasal reactivity and skin sensitivity, more efficiently than a standard symptomatic treatment.
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MESH Headings
- Adolescent
- Adult
- Antigens, Plant/therapeutic use
- Conjunctivitis, Allergic/complications
- Conjunctivitis, Allergic/immunology
- Conjunctivitis, Allergic/therapy
- Desensitization, Immunologic
- Female
- Follow-Up Studies
- Histamine H1 Antagonists/therapeutic use
- Humans
- Male
- Middle Aged
- Nasal Provocation Tests
- Poaceae
- Prospective Studies
- Respiratory System Agents/therapeutic use
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/therapy
- Skin Tests
- Treatment Outcome
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Affiliation(s)
- L Klimek
- Department of Otorhinolaryngology, Mainz University Hospital, Bielefeld, Germany
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Feistel R, Wielgosz R, Bell SA, Camões MF, Cooper JR, Dexter P, Dickson AG, Fisicaro P, Harvey AH, Heinonen M, Hellmuth O, Kretzschmar HJ, Lovell-Smith JW, McDougall TJ, Pawlowicz R, Ridout P, Seitz S, Spitzer P, Stoica D, Wolf H. Metrological challenges for measurements of key climatological observables: Oceanic salinity and pH, and atmospheric humidity. Part 1: Overview. Metrologia 2016; 53:R1-R11. [PMID: 26900179 PMCID: PMC4759657 DOI: 10.1088/0026-1394/53/1/r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Water in its three ambient phases plays the central thermodynamic role in the terrestrial climate system. Clouds control Earth's radiation balance, atmospheric water vapour is the strongest "greenhouse" gas, and non-equilibrium relative humidity at the air-sea interface drives evaporation and latent heat export from the ocean. On climatic time scales, melting ice caps and regional deviations of the hydrological cycle result in changes of seawater salinity, which in turn may modify the global circulation of the oceans and their ability to store heat and to buffer anthropogenically produced carbon dioxide. In this paper, together with three companion articles, we examine the climatologically relevant quantities ocean salinity, seawater pH and atmospheric relative humidity, noting fundamental deficiencies in the definitions of those key observables, and their lack of secure foundation on the International System of Units, the SI. The metrological histories of those three quantities are reviewed, problems with their current definitions and measurement practices are analysed, and options for future improvements are discussed in conjunction with the recent seawater standard TEOS-10. It is concluded that the International Bureau of Weights and Measures, BIPM, in cooperation with the International Association for the Properties of Water and Steam, IAPWS, along with other international organisations and institutions, can make significant contributions by developing and recommending state-of-the-art solutions for these long standing metrological problems in climatology.
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Affiliation(s)
- R Feistel
- Leibniz Institute for Baltic Sea Research (IOW), D-18119 Warnemünde, Germany
| | - R Wielgosz
- Bureau International des Poids et Mesures (BIPM), Pavillon de Breteuil, F-92312 Sèvres Cedex France
| | - S A Bell
- National Physical Laboratory (NPL), Hampton Road, Teddington, Middlesex, TW11 0LW, UK
| | - M F Camões
- Centro de Química Estrutural, Faculdade de Ciências, University of Lisbon (FCUL), 1749-016 Lisbon, Portugal
| | - J R Cooper
- Queen Mary, University of London (QMUL), Mile End Road, London, E1 4NS, UK
| | - P Dexter
- Bureau of Meteorology (ABN), GPO Box 1289, Melbourne, VIC 3001, Australia
| | - A G Dickson
- University of California, San Diego (UCSD), La Jolla, CA 92093-0244, USA
| | - P Fisicaro
- Laboratoire National de Métrologie et d'Essais (LNE), F-75724 Paris Cedex 15, France
| | - A H Harvey
- National Institute of Standards and Technology (NIST), Boulder, CO 80305-3337, USA
| | - M Heinonen
- MIKES Metrology, VTT Technical Research Centre of Finland Ltd, Tekniikantie 1, FI-02151 Espoo, Finland
| | - O Hellmuth
- Leibniz Institute for Tropospheric Research (TROPOS), D-04318 Leipzig, Germany
| | - H-J Kretzschmar
- Zittau/Goerlitz University of Applied Sciences (HSZG), D-02763 Zittau, Germany
| | - J W Lovell-Smith
- Measurement Standards Laboratory (MSL), PO Box 31-310, Lower Hutt, New Zealand
| | - T J McDougall
- University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - R Pawlowicz
- University of British Columbia (UBC), Vancouver, B.C., V6T 1Z4, Canada
| | - P Ridout
- Ocean Scientific International Ltd. (OSIL), Culkin House, Penner Road, Havant, PO9 1QN, UK
| | - S Seitz
- Physikalisch-Technische Bundesanstalt (PTB), D-38116 Braunschweig, Germany
| | - P Spitzer
- Physikalisch-Technische Bundesanstalt (PTB), D-38116 Braunschweig, Germany
| | - D Stoica
- Laboratoire National de Métrologie et d'Essais (LNE), F-75724 Paris Cedex 15, France
| | - H Wolf
- Physikalisch-Technische Bundesanstalt (PTB), D-38116 Braunschweig, Germany
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Alujević N, Wolf H, Depraetere B, Zhao G, Domazet Z, Pluymers B, Desmet W. Self-Tuneable Velocity Feedback for Active Isolation of Random Vibrations in Subcritical Two Degree Of Freedom Systems. ACTA ACUST UNITED AC 2015. [DOI: 10.3813/aaa.918890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wagner R, Deml L, Teeuwsen V, Heeney J, Yiming S, Wolf H. A recombinant HIV-1 virus-like particle vaccine: from concepts to a field study. Antibiot Chemother (1971) 2015; 48:68-83. [PMID: 8726508 DOI: 10.1159/000425160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R Wagner
- Institute of Medical Microbiology and Hygiene, University of Regensburg, Germany
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Wagner R, Deml L, Wolf H. Polyvalent, recombinant HIV-1 virus-like particles: novel HIV-1 vaccine strategies. Antibiot Chemother (1971) 2015; 46:48-61. [PMID: 7826039 DOI: 10.1159/000423633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Wagner
- Institut für medizinische Mikrobiologie, Regensburg, BRD
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40
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Frisoni GB, Jack CR, Bocchetta M, Bauer C, Frederiksen KS, Liu Y, Preboske G, Swihart T, Blair M, Cavedo E, Grothe MJ, Lanfredi M, Martinez O, Nishikawa M, Portegies M, Stoub T, Ward C, Apostolova LG, Ganzola R, Wolf D, Barkhof F, Bartzokis G, DeCarli C, Csernansky JG, deToledo-Morrell L, Geerlings MI, Kaye J, Killiany RJ, Lehéricy S, Matsuda H, O'Brien J, Silbert LC, Scheltens P, Soininen H, Teipel S, Waldemar G, Fellgiebel A, Barnes J, Firbank M, Gerritsen L, Henneman W, Malykhin N, Pruessner JC, Wang L, Watson C, Wolf H, deLeon M, Pantel J, Ferrari C, Bosco P, Pasqualetti P, Duchesne S, Duvernoy H, Boccardi M. The EADC-ADNI Harmonized Protocol for manual hippocampal segmentation on magnetic resonance: evidence of validity. Alzheimers Dement 2014; 11:111-25. [PMID: 25267715 DOI: 10.1016/j.jalz.2014.05.1756] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 05/05/2014] [Accepted: 05/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND An international Delphi panel has defined a harmonized protocol (HarP) for the manual segmentation of the hippocampus on MR. The aim of this study is to study the concurrent validity of the HarP toward local protocols, and its major sources of variance. METHODS Fourteen tracers segmented 10 Alzheimer's Disease Neuroimaging Initiative (ADNI) cases scanned at 1.5 T and 3T following local protocols, qualified for segmentation based on the HarP through a standard web-platform and resegmented following the HarP. The five most accurate tracers followed the HarP to segment 15 ADNI cases acquired at three time points on both 1.5 T and 3T. RESULTS The agreement among tracers was relatively low with the local protocols (absolute left/right ICC 0.44/0.43) and much higher with the HarP (absolute left/right ICC 0.88/0.89). On the larger set of 15 cases, the HarP agreement within (left/right ICC range: 0.94/0.95 to 0.99/0.99) and among tracers (left/right ICC range: 0.89/0.90) was very high. The volume variance due to different tracers was 0.9% of the total, comparing favorably to variance due to scanner manufacturer (1.2), atrophy rates (3.5), hemispheric asymmetry (3.7), field strength (4.4), and significantly smaller than the variance due to atrophy (33.5%, P < .001), and physiological variability (49.2%, P < .001). CONCLUSIONS The HarP has high measurement stability compared with local segmentation protocols, and good reproducibility within and among human tracers. Hippocampi segmented with the HarP can be used as a reference for the qualification of human tracers and automated segmentation algorithms.
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Affiliation(s)
- Giovanni B Frisoni
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS - Istituto Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Clifford R Jack
- Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS - Istituto Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Corinna Bauer
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Kristian S Frederiksen
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Gregory Preboske
- Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tim Swihart
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Melanie Blair
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Enrica Cavedo
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS - Istituto Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Michel J Grothe
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS - Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Oliver Martinez
- Department of Neurology, University of California, Davis, CA, USA
| | | | - Marileen Portegies
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Travis Stoub
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Chadwich Ward
- Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Liana G Apostolova
- Mary S. Easton Center for Alzheimer's Disease Research and Laboratory of NeuroImaging, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Rossana Ganzola
- Department of Radiology, Université Laval and Centre de Recherche de l'Institut universitaire de santé mentale de Québec, Quebec City, Canada
| | - Dominik Wolf
- Klinik für Psychiatrie und Psychotherapie, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - George Bartzokis
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | | | | | - Mirjam I Geerlings
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ronald J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Stephane Lehéricy
- Service de Neuroradiologie, Hopital de la Pitie-Salpetriere, Paris, France
| | | | - John O'Brien
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa C Silbert
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Cente and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Hilkka Soininen
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Gunhild Waldemar
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Fellgiebel
- Klinik für Psychiatrie und Psychotherapie, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Josephine Barnes
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Firbank
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Lotte Gerritsen
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; Department of Medical epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Wouter Henneman
- Department of Radiology and Nuclear Medicine, Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Nikolai Malykhin
- Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
| | - Jens C Pruessner
- Department of Psychiatry, McGill Centre for Studies in Aging, McGill University, Montreal, Quebec, Canada
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig Watson
- Department of Neurology, University of California, Davis, CA, USA
| | - Henrike Wolf
- Department of Psychiatry Research and Geriatric Psychiatry, Psychiatric University Hospitals, University of Zurich, Zurich, Switzerland; German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Mony deLeon
- New York University School of Medicine, Center for Brain Health, New York, NY, USA
| | - Johannes Pantel
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Clarissa Ferrari
- Unit of Psychiatry, IRCCS - Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Paolo Bosco
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS - Istituto Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy
| | - Patrizio Pasqualetti
- SeSMIT (Service for Medical Statistics and Information Technology), AFaR (Fatebenefratelli Association for Research), Fatebenefratelli Hospital, Rome, Italy; Unit of Clinical and Molecular Epidemiology, IRCCS "San Raffaele Pisana", Rome, Italy
| | - Simon Duchesne
- Department of Radiology, Université Laval and Centre de Recherche de l'Institut universitaire de santé mentale de Québec, Quebec City, Canada
| | | | - Marina Boccardi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS - Istituto Centro S. Giovanni di Dio - Fatebenefratelli, Brescia, Italy.
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Bocchetta M, Galluzzi S, Kehoe PG, Aguera E, Bernabei R, Bullock R, Ceccaldi M, Dartigues JF, de Mendonça A, Didic M, Eriksdotter M, Félician O, Frölich L, Gertz HJ, Hallikainen M, Hasselbalch SG, Hausner L, Heuser I, Jessen F, Jones RW, Kurz A, Lawlor B, Lleo A, Martinez-Lage P, Mecocci P, Mehrabian S, Monsch A, Nobili F, Nordberg A, Rikkert MO, Orgogozo JM, Pasquier F, Peters O, Salmon E, Sánchez-Castellano C, Santana I, Sarazin M, Traykov L, Tsolaki M, Visser PJ, Wallin ÅK, Wilcock G, Wilkinson D, Wolf H, Yener G, Zekry D, Frisoni GB. The use of biomarkers for the etiologic diagnosis of MCI in Europe: an EADC survey. Alzheimers Dement 2014; 11:195-206.e1. [PMID: 25150733 DOI: 10.1016/j.jalz.2014.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/27/2014] [Accepted: 06/11/2014] [Indexed: 12/27/2022]
Abstract
We investigated the use of Alzheimer's disease (AD) biomarkers in European Alzheimer's Disease Consortium centers and assessed their perceived usefulness for the etiologic diagnosis of mild cognitive impairment (MCI). We surveyed availability, frequency of use, and confidence in diagnostic usefulness of markers of brain amyloidosis (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] Aβ42) and neurodegeneration (medial temporal atrophy [MTA] on MR, fluorodeoxyglucose positron emission tomography [FDG-PET], CSF tau). The most frequently used biomarker is visually rated MTA (75% of the 37 responders reported using it "always/frequently") followed by CSF markers (22%), FDG-PET (16%), and amyloid-PET (3%). Only 45% of responders perceive MTA as contributing to diagnostic confidence, where the contribution was rated as "moderate". Seventy-nine percent of responders felt "very/extremely" comfortable delivering a diagnosis of MCI due to AD when both amyloid and neuronal injury biomarkers were abnormal (P < .02 versus any individual biomarker). Responders largely agreed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative AD signature.
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Affiliation(s)
- Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Samantha Galluzzi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Patrick Gavin Kehoe
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Frenchay Hospital, Bristol, UK
| | - Eduardo Aguera
- Servicio Neurologia, Hospital Universitario Reina Sofía Córdoba, Spain
| | - Roberto Bernabei
- Department of Gerontological, Geriatric and Psychiatric Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mathieu Ceccaldi
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | | | | | - Mira Didic
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Olivier Félician
- Service de Neurologie et Neuropsychologie, CHU Timone and INSERM U1106, Aix-Marseille Univ, Marseille, France
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische, Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hermann-Josef Gertz
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | | | | | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische, Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Isabell Heuser
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Disease (DZNE), Bonn, Germany
| | - Roy W Jones
- RICE - The Research Institute for the Care of Older People, Royal United Hospital, Bath, UK
| | - Alexander Kurz
- Technische Universität Psychiatrische Klinik, Munchen, Germany
| | - Brian Lawlor
- Mercer's Institue for Research on Ageing, St James' Hospital, Dublin, Ireland
| | - Alberto Lleo
- Memory Unit, Neurology Service, Hospital Santa Creu i, Sant Pau, Barcelona, Spain
| | | | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Shima Mehrabian
- Department of Neurology, Univ Hospital Alexandrovska, Sofia, Bulgaria
| | - Andreas Monsch
- Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital, Basel, Switzerland
| | - Flavio Nobili
- Clinical Neurology, Dept of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marcel Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Centre, Radboud Alzheimer Centre, Nijmegen, Netherlands
| | | | | | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Salmon
- Université de Liège, Cyclotron Research Centre, Liege, Belgium
| | | | - Isabel Santana
- Neurology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, Centre Hospitalier Sainte Anne, Paris, France
| | - Latchezar Traykov
- Department of Neurology, Univ Hospital Alexandrovska, Sofia, Bulgaria
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pieter Jelle Visser
- Alzheimer Centre, Vrije Univ Medical Centre, Amsterdam, Netherlands; Alzheimer centre Maastricht University, Maastricht, Netherlands
| | - Åsa K Wallin
- Clinical Memory Research Unit, Lund University, Memory Clinic Malmö, Sweden
| | - Gordon Wilcock
- University of Oxford, Nuffield Dept of Medicine, John Radcliffe Hospital, Oxford, UK
| | - David Wilkinson
- Memory Assessment and Research Centre MARC, Moorgreen Hospital, Southampton, UK
| | - Henrike Wolf
- German Center for Neurodegenerative Disease (DZNE), Bonn, Germany; Department of Psychiatry Research, Zurich, Switzerland
| | | | - Dina Zekry
- Department of Internal Medicine and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS Istituto Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and Laboratoire de Neuroimagerie du Vieillissement (LANVIE), University Hospitals and University of Geneva, Geneva, Switzerland.
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Riese F, Wolf H, Ballach O, Suliman H, Hock C. P2‐207: HIPPOCAMPAL CAVITIES IN ELDERLY SUBJECTS ARE ASSOCIATED WITH EPISODIC MEMORY DECLINE. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.884] [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: 10/24/2022]
Affiliation(s)
- Florian Riese
- Psychiatric University Hospital ZurichZurichSwitzerland
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Breteler MM, Wolf H. P2‐135: THE RHINELAND STUDY: A NOVEL PLATFORM FOR EPIDEMIOLOGIC RESEARCH INTO ALZHEIMER DISEASE AND RELATED DISORDERS. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.810] [Citation(s) in RCA: 5] [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] [Indexed: 11/15/2022]
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Abstract
Diluted aqueous solutions of some proteins (bovine serum albumin, β-Lactoglobubin, Peroxidase) show weak phosphorescence lasting over several minutes after they have been irradiated with light in the range 3500-4200 A. Addition of Eosin after the irradiation amplifies in some cases the intensity of luminescence to a value of about hundred. If Eosin is present at the irradiation process the excitation to phosphorescence is possible with light of the wavelength 5460 A.
After denaturation processes which destroy the configuration of proteins (Urea, Guanidine-HCI. detergents, heat at higher pH) the ability of phosphorescence disappears altogether; likewise after blocking the SH-groups by benzochinone or a total oxidation or reduction of the SS-groups which causes an complete unfolding of the peptide chain.
In solutions of bovine serum-albumin irradiated with 3650 Å at room temperature and afterwards frozen to -178°C no radicals could be observed by measurements of electron-spin-resonance but they were detectable if the irradiation took place in the presence of H2O2.
The reactions Xanthinoxidase-Xanthine-O2, Peroxidase-H2O2 and bovine serum-albumin-H2O2-Fe (II) EDTA are accompanied by chemiluminescence. By comparison with the behaviour of oxidised serum-albumin it could be shown that the chemical reaction produces an excited state of the native protein.
The observations lead to the conclusion that the weak phosphorescence of long duration originates from a triplet-state which is sufficiently populated only as the consequence of cooperative phenomena attending the undisturbed α-Helix-structure of the protein.
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Affiliation(s)
- J. Stauff
- Aus dem Institut für physikalische Biochemie und Kolloidchemie im Institut für physikalische Chemie der Universität Frankfurt am Main
| | - H. Wolf
- Aus dem Institut für physikalische Biochemie und Kolloidchemie im Institut für physikalische Chemie der Universität Frankfurt am Main
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Kindler W, Wolf H, Thier K, Oberndorfer S. Facial palsy as an initial symptom of Lyme neuroborreliosis in an Austrian/INS; endemic area. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2169] [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: 10/26/2022]
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Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, Duvekot J, Frusca T, Diemert A, Ferrazzi E, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Thilaganathan B, Todros T, van Wassenaer-Leemhuis A, Valcamonico A, Visser GHA, Wolf H. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013; 42:400-408. [PMID: 24078432 DOI: 10.1002/uog.13190] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early-onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early-onset fetal growth restriction based on time of antenatal diagnosis and delivery. METHODS We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26-32 weeks of gestation, with abdominal circumference < 10(th) percentile and umbilical artery Doppler pulsatility index > 95(th) percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis. RESULTS Five-hundred and three of 542 eligible women formed the study group. Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g; 12 (2.4%) babies died in utero. Gestational age at delivery was 30.7 ± 2.3 weeks, and birth weight was 1013 ± 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 ± 251 g) and born earlier (29.6 ± 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre-eclampsia and 3 days for HELLP syndrome. CONCLUSIONS Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions.
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Affiliation(s)
- C Lees
- Department of Obstetrics & Gynaecology, Rosie Hospital, Cambridge, UK; Department of Obstetrics and Gynecology, KU Leuven, Belgium
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Kleinrouweler CE, Bossuyt PMM, Thilaganathan B, Vollebregt KC, Arenas Ramírez J, Ohkuchi A, Deurloo KL, Macleod M, Diab AE, Wolf H, van der Post JAM, Mol BWJ, Pajkrt E. Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia: an individual patient data meta-analysis. Ultrasound Obstet Gynecol 2013; 42:257-267. [PMID: 23417857 DOI: 10.1002/uog.12435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/28/2013] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the value of adding second-trimester uterine artery Doppler ultrasound to patient characteristics in the identification of nulliparous women at risk for pre-eclampsia. METHODS For this individual patient data meta-analysis, studies published between January 1995 and December 2009 were identified in MEDLINE and EMBASE. Studies were eligible in which Doppler assessment of the uterine arteries had been performed among pregnant women and in which gestational age at ultrasound, Doppler ultrasound findings and data on the occurrence of pre-eclampsia were available. We invited corresponding authors to share their original datasets. Data were included of nulliparous women who had had a second-trimester uterine artery Doppler ultrasound examination. Shared data were checked for consistency, recoded to acquire uniformity and merged into a single dataset. We constructed random intercept logistic regression models for each of the patient and Doppler characteristics in isolation and for combinations. We compared goodness of fit, discrimination and calibration. RESULTS We analyzed eight datasets, reporting on 6708 nulliparous women, of whom 302 (4.5%) developed pre-eclampsia. Doppler findings included higher, lower and mean pulsatility index (PI) and resistance index (RI) and any or bilateral notching. Of these, the best predictors were combinations of mean PI or RI and bilateral notching, with areas under the receiver-operating characteristics curve (AUC) of 0.75 (95% confidence interval (CI), 0.56-0.95) and 0.70 (95% CI, 0.66-0.74), respectively. Addition of Doppler findings to the patient characteristics blood pressure or body mass index (BMI) significantly improved discrimination. A model with blood pressure, PI and bilateral notching had an AUC of 0.85 (95% CI, 0.67-1.00). CONCLUSIONS The addition of Doppler characteristics of mean PI or RI and bilateral notching to patient characteristics of blood pressure or BMI improves the identification of nulliparous women at risk for pre-eclampsia.
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Affiliation(s)
- C E Kleinrouweler
- Department of Obstetrics and Gynaecology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
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Wagner JP, Bonacker G, Wolf H, Frömel M, Leonhardt K, Schulz A. AB0980 Long term tolerability and effectiveness of a single injection of 6ml hylan G-F 20 in 451 patients with knee osteoarthritis pain. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kohlova M, Ribeiro S, do Sameiro-Faria M, Rocha-Pereira P, Fernandes J, Reis F, Miranda V, Quintanilha A, Bronze-da-Rocha E, Belo L, Costa E, Santos-Silva A, Arias-Guillen M, Maduell F, Masso E, Fontsere N, Carrera M, Ojeda R, Vera M, Cases A, Campistol J, Di Benedetto A, Ciotola A, Stuard S, Marcelli D, Canaud B, Kim MJ, Lee SW, Kweon SH, Song JH, Rosales LM, Abbas S, Zhu F, Flores C, Carter M, Apruzzese R, Kotanko P, Levin NW, Mann H, Seyffart G, Ensminger A, Goksel T, Stiller S, Zaluska W, Kotlinska-Hasiec E, Rzecki Z, Rybojad B, Zaluska A, Da'browski W, Ponce P, Chung T, Kreuzberg U, Pedrini L, Francois K, Wissing KM, Jacobs R, Boone D, Jacobs K, Tielemans C, Agar BU, Culleton BF, Fluck R, Leypoldt JK, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, Pellanda V, de Cal M, Clementi A, Insalaco M, Dell'Aquila R, Panichi V, Rosati A, Casani A, Conti P, Capitanini A, Migliori M, Scatena A, Giusti R, Malagnino E, Betti G, Bernabini G, Gabbrielli C, Rollo S, Caiani D, Pizzarelli F, Cantaluppi V, Medica D, Quercia AD, Gai M, Leonardi G, Anania P, Guarena C, Giovinazzo G, Ferraresi M, Merlo I, Deambrosis I, Giaretta F, Biancone L, Segoloni GP, Surace A, Pieri M, Rovatti P, Steckiph D, Mambelli E, Mancini E, Santoro A, Devine E, Krieter D, Lemke HD, Frasca GM, Sagripanti S, Boggi R, Del Rosso G, Gattiani A, Mosconi G, Oliva S, Rigotti A, Sopranzi F, Tetta C, Cavallari C, Fonsato V, Maffei S, Collino F, Camussi G, Ksiazek A, Waniewski J, Debowska M, Wojcik-Zaluska A, Zaluska W, Maduell F, Wieneke P, Arias-Guillen M, Fontsere N, Vera M, Ojeda R, Carrera M, Cases A, Campistol J, Bunia J, Ziebig R, Wolf H, Ahrenholz P, Donadio C, Kanaki A, Sami N, Tognotti D, Goubella A, Gankam-Kengne F, Baudoux T, Fagnoul D, Husson C, Ghisdal L, Broeders NE, Nortier JL, von Albertini B, Mathieu C, Cherpillod A, Boesch A, Romo M, Zhou J, Tang L, Kong D, Zhang L, Shi S, Lv Y, Chen X, Sakurai K, Saito T, Ishii D, Fievet P, Delpierre A, Faucher J, Ghazali A, Soltani ON, Lefevre M, Stephan R, Demontis R, Hougardy JM, Husson C, Gastaldello K, Nortier JL, Mishkin GJ, McLean A, Palant C, Fievet P, Faucher J, Delpierre A, Ghazali A, Demontis R, Glorieux G, Hulko M, Speidel R, Brodbeck K, Krause B, Vanholder R, Rovatti P, Grandi E, Stefani D, Ruffo M, Solem K, Olde B, Santoro A, Sterner G, Lee YK, Lee HW, Choi KH, Kim BS, Sakurai K, Saito T, Wakabayasi Y, Djuric P, Bulatovic A, Jankovic A, Tosic J, Popovic J, Djuric Z, Bajcetic S, Dimkovic N, Golubev RV, Soltysiak J, Malke A, Warzywoda A, Blumczynski A, Silska-Dittmar M, Musielak A, Ostalska-Nowicka D, Zachwieja J, Ashcroft R, Williams G, Brown C, Chess J, Mikhail A, Steckiph D, Bertucci A, Petrarulo M, Baldini C, Calabrese G, Gonella M. Extracorporeal dialysis: techniques and adequacy II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wolf H, Gross F, Merz A, Schuler A. [Liver segment anatomy in ultrasound--examinations to define the frontier between segment II/III and literature review]. Z Gastroenterol 2013; 51:271-7. [PMID: 23487356 DOI: 10.1055/s-0032-1325353] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Liver segment definition due to Couinaud is the basis for localisation of focal liver lesions in imaging, in the follow-up or for planning operations. A literature review shows variety in segment definition and the frontier between segment II and III in the left liver lobe, in the course of the portal vein level and in variations of liver veins. The aim of this study is to demonstrate liver segment anatomy in sonography compared to anatomic preparations and the literature. This leads to a proposal for a unique nomenclature and illustration. MATERIAL AND METHODS 152 liver healthy persons (77 F, 75 M, mean age 63.3 years (18 - 91 years) were examined with standardised abdominal ultrasound in longitudinal, transversal and axis planes. (Angle) measurements were taken to define the left hepatic vein (Fissura sinistra), the Ramus umbilicalis of the portal vein (Fissura umbilicalis), the portal vein level and the amount and variations of the liver veins. RESULTS The left hepatic vein was found with a mean angle of 24° (0 - 70°) left to the median axis, the Pars umbilicalis of the portal vein wasalmost strictly in the mid axis. The portal vein level was located with a mean angle of 61° (5 - 110°) right to the median with no variations of the two main branches. 27 (18 %) out of the remaining 151 patients showed variations of the liver veins: 7 × (4.6 %) a doubled mid hepatic vein, 12 × (8 %) a doubled left hepatic vein, 4 × (2.7 %) 3 left liver veins were found with a short (≤ 1 cm) common trunk, 1 × each (0.7 %) four left liver veins with a short common trunk, one trifurcation of the mid hepatic vein, one doubled right liver vein and one common trunk (2 cm) of all 3 main liver veins leading to the inferior V. cava. DISCUSSION The surgical functional liver segment definition by Couinaud is the basis for localisation of focal liver lesions. The frontier between segment II and III is mainly described as a horizontal plane in the literature. The course of the left liver vein (fissura sinistra) has a mean angle of 24° left to the median and not like the umbilical fissure, which is found almost strictly in the median plane. The left hepatic vein(s), their course and liver vein variations are well demonstrated by sonography (99.3 % in this study). Anatomic landmarks as well as variations and a unique nomenclature should be well known and considered in the localisation of focal liver lesions, their feeding vessels and liver segment anatomy.
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Affiliation(s)
- H Wolf
- Facharzt für Allgemeinmedizin, Niederstotzingen, Germany.
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