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Shalgouny M, Bertz-Lepel J, Fischer V Weikersthal L, Herbin J, Meier-Höfig M, Mücke R, Rohe U, Stauch T, Stoll C, Troeltzsch D, Wittmann S, Kurz O, Naumann R, Huebner J. Introducing a standardized assessment of patients' interest in and usage of CAM in routine cancer care: chances and risks from patients' and physicians' point of view. J Cancer Res Clin Oncol 2023; 149:16575-16587. [PMID: 37715831 PMCID: PMC10645655 DOI: 10.1007/s00432-023-05182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Cancer patients often use complementary and alternative medicine (CAM), however, standardized assessment in clinical routine is missing. The aim of this study was to evaluate a screening questionnaire on CAM usage that was published in the S3 Guideline Complementary Medicine in the Treatment of Oncological Patients. METHODS We developed a survey questionnaire to assess the practicability of the guideline questionnaire and communication on CAM between health care providers (HCPs) and patients. We collected 258 guideline questionnaires and 116 survey questionnaires from ten clinics and held twelve semi-structured interviews with HCPs. RESULTS 85% used at least one of the listed CAM methods, 54 participants (N = 77) never disclosed usage to a physician. The most frequently used CAM methods were physical activity (76.4%) and vitamin D (46.4%). 25.2% used at least one method, that was labeled risky by the guideline. 53.4% did not know of CAM's risk of interactions and side effects. Introducing the guideline questionnaire in routine cancer care increased the rate of patients talking to an HCP regarding CAM significantly from 35.5 to 87.3%. The HCPs stated positive effects as an initiation of conversation, increased safety within CAM usage and patients feeling thankful and taken seriously. However, due to the limited amount of time available for discussions on CAM, generalized distribution to all patients was not feasible. CONCLUSION Institutions should focus on implementing standard procedures and resources that help HCPs discuss CAM on a regular basis. HCPs should meet the patient's demands for CAM counseling and make sure they are equipped professionally.
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Affiliation(s)
- M Shalgouny
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - J Bertz-Lepel
- Klinik für Hämatologie, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - L Fischer V Weikersthal
- Praxis für Hämatologie und Internistische Onkologie, Gesundheitszentrum St. Marien GmbH, Amberg, Germany
| | - J Herbin
- Onkologische Schwerpunktpraxis Berlin, Berlin, Germany
| | - M Meier-Höfig
- 3. Medizinische Klinik, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - R Mücke
- MVZ Strahlentherapie RheinMainNahe GmbH, Mainz, Germany
| | - U Rohe
- St. Barbara Klinik Hamm, Hamm, Germany
| | - T Stauch
- Klinik für Onkologie, Median Adelsbergklinik Bad Berka, Bad Berka, Germany
| | - C Stoll
- Rehaklinik für Orthopädie, Klinik Herzoghöhe Bayreuth, Bayreuth, Germany
| | - D Troeltzsch
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Wittmann
- Klinik für Onkologie, Hämatologie und Palliativmedizin, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - O Kurz
- Medizinische Klinik III, Marien Kliniken Siegen, Siegen, Germany
| | - R Naumann
- Medizinische Klinik III, Marien Kliniken Siegen, Siegen, Germany
| | - J Huebner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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Colditz C, Keinki C, Huebner J. Self-help management of patients undergoing chemotherapy: analysis of the online forum of the women's self-help association against cancer. Breast Cancer 2023; 30:926-932. [PMID: 37420142 PMCID: PMC10587254 DOI: 10.1007/s12282-023-01481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE The aim of this study was to examine threads on chemotherapy in the largest German self-help forum regarding content and emotions. METHODS All threads on the subject of chemotherapy that were published by February 6th, 2022 were included in the category "drug therapy". A total of 50 threads were analyzed. A quantitative analysis was carried out with regard to content, emotions, number of replies, number of hits, duration of the conversation, duration of access in days, number density of replies, and hits per day. RESULTS 16 threads are about side effects and in 18 threads, the emotion is fear. Threads in which the emotion fear was expressed have the highest number of replies at 3367. Shared therapy successes are posted with pleasure and achieved a higher mean value for the duration of conversation with 1374.25 days. CONCLUSION An online self-help forum is a very important source of psychosocial support for patients undergoing chemotherapy.
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Affiliation(s)
- C Colditz
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - C Keinki
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Huebner
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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3
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Cozart JS, Bruce AS, Shook RP, Befort C, Siengsukon C, Simon S, Lynch SG, Mahmoud R, Drees B, Posson P, Hibbing PR, Huebner J, Bradish T, Robichaud J, Bruce JM. Body metrics are associated with clinical, free-living, and self-report measures of mobility in a cohort of adults with obesity and multiple sclerosis. Mult Scler Relat Disord 2023; 79:105010. [PMID: 37776827 DOI: 10.1016/j.msard.2023.105010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Obesity is associated with multiple sclerosis (MS) onset and may contribute to more rapid disability accumulation. Whether obesity impacts mobility in MS is uncertain. Some studies find that obesity in MS is associated with poorer mobility; other studies find no relationship. Discrepant findings may be due to differences in measurement and methodology. In the present study, we employ a comprehensive battery of anthropometric and mobility measures in a sample of people with MS and obesity. METHODS Participants with MS (N = 74) completed a battery of adiposity measurements (weight, height, waist circumference, and full body dual-energy x-ray absorptiometry [DXA] scans). They also completed validated clinical, free-living (accelerometry), and self-report measures of mobility. Spearman's Rho correlations were used to examine the associations between mobility and obesity measures with Benjamini and Hochberg correction for multiple comparisons. Multiple linear regression was used to examine if adiposity predicted mobility outcomes in people with MS when controlling for age and disease duration. RESULTS The majority of participants (n = 70) were diagnosed with relapsing-remitting MS and reported mild MS-related disability on the Patient Determined Disease Steps (M = 0.77, SD = 1.1). Median BMI was 35.8 (SD = 5.4). Higher percentage body fat (measured via DXA) was associated with poorer self-reported physical functioning (rs = -0.52, p <0.001), less moderate-to-vigorous physical activity (rs = -0.24, p = 0.04), and worse performance on the Six Minute Walk Test (6MWT; rs = -0.44, p <0.001), the Timed 25 Foot Walk (T25FW; rs = 0.45, p <0.001), and the Timed Up and Go test (TUG; rs = 0.35, p = .003). Higher BMI and waist-to-height ratio (WtHR) were associated with worse outcomes on the 6MWT (BMI; rs = -0.35, p <0.01, WtHR; rs = -0.43, p <0.001), T25FW (BMI; rs = 0.32, p <0.01, WtHR; rs = 0.38, p <0.001), and the SF-36 (BMI; rs = -0.29, p <0.005, WtHR; rs = -0.31, p <0.05). Percentage body fat accounted for an additional 17 % of the variance in the T25FW and 6MWT performance, after controlling for age and disease duration. CONCLUSION Higher BMI, WtHR, and percentage body fat were associated with lower levels of mobility (T25FW and 6MWT) in people with MS who have class I, class II, and class III obesity. Higher percentage body fat was associated with significantly worse performance on clinical, free-living, and self-report measures of mobility in people with MS even when accounting for participant age and disease duration. These findings suggest that people with MS and obesity may show improved mobility with weight loss.
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Affiliation(s)
- J S Cozart
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - A S Bruce
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - R P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA; Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA; School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri USA
| | - C Befort
- Department of Population Health, University Kansas Medical Center, Kansas City, Kansas, USA
| | - C Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - S Simon
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - S G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - R Mahmoud
- Department of Neurology, Saint Luke's Hospital, Kansas City, Missouri, USA; Department of Neurology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - B Drees
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Graduate School of the Stowers Institute for Medical Research, Kansas City, Missouri, USA
| | - P Posson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - P R Hibbing
- Department of Kinesiology & Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - J Huebner
- Department of Community and Family Medicine University Health Lakewood Medical Center, Medicine, Kansas City, Missouri, USA
| | - T Bradish
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - J Robichaud
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
| | - J M Bruce
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA; Departments of Neurology and Psychiatry, University Health, Kansas City, Missouri, USA
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Huebner J, Muecke R, Micke O, Prott FJ, Josfeld L, Büntzel J, Büntzel J. Lay etiology concepts of cancer patients do not correlate with their usage of complementary and/or alternative medicine. J Cancer Res Clin Oncol 2023; 149:6067-6074. [PMID: 36653538 PMCID: PMC10356643 DOI: 10.1007/s00432-022-04528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The usage of complementary and alternative medicine (CAM) is widespread among cancer patients. While reasons for and aims of using CAM have been evaluated in many studies, less is known about whether patients' concepts of how and why cancer develops has an influence on the choice of the CAM method. METHODS We pooled the data from all studies of our working group containing questions on lay etiological concepts and CAM usage and reanalyzed them with respect to the associations between these parameters. RESULTS The pooled dataset from 12 studies included 4792 patients. A third (1645 patients) reported using CAM. Most often used were supplements (55.9%), relaxation techniques (43.6%), and homeopathy (37.9%). Regarding perceived causes, patients most often marked stress (35.4%) followed by genes (31.9%). While all lay etiological beliefs were highly significantly associated with usage of CAM in general, there was no association between single lay etiological concepts and types of CAM used. Yet, in a network analysis, we found two associations: one comprising trauma, mistletoe, genes, and nutritional supplements, the other yoga, vitamin C, nutritional supplements, and TCM herbs. In the correlation heatmap, one cluster comprises etiological concepts of personality, immune system and trauma, and two clusters of CAM methods emerged: one comprising praying, yoga, meditation, and relaxation procedures, the other nutritional supplements, selenium, vitamins A and C. CONCLUSION While physicians are trained to derive treatment strategies from etiological concepts, lay people choosing CAM do not follow these rules, which may point to other needs of patients addressed by CAM.
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Affiliation(s)
- J Huebner
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - R Muecke
- Strahlentherapie RheinMain, Rüsselsheim, Germany
| | - O Micke
- Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Bielefeld, Germany
| | - F-J Prott
- RNS Praxisgemeinschaft, Radiologie und Strahlentherapie, Wiesbaden, Germany
| | - L Josfeld
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Büntzel
- Klinik für HNO-Erkrankungen, Kopf-Hals-ChirurgieInterdisziplinäre Palliativstation, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - J Büntzel
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Göttingen, Göttingen, Germany
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Boesenecker SJ, Mathies V, Buentzel J, Huebner J. How can counselling by family physicians on nutrition and physical activity be improved: trends from a survey in Germany. J Cancer Res Clin Oncol 2023; 149:3335-3347. [PMID: 35932301 PMCID: PMC10314832 DOI: 10.1007/s00432-022-04233-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Cancer and its therapy causes severe symptoms, most of which are amendable to nutrition and physical activity (PA). Counselling on nutrition and PA empowers patients to take part more actively in their treatment. Many cancer patients are yet in need of information on these topics. In this study, we investigate the perception of family physicians (FP) on nutrition and PA in cancer patient care and assess barriers and steps to improve their involvement in counselling on these topics. METHODS Based on qualitative content analysis of 5 semi-structured interviews with FP, a questionnaire was developed and completed by 61 German FP. RESULTS Most of the FP acknowledged the importance of nutrition and PA during (91.4%) and after (100%) cancer therapy. While many participants were involved in cancer patient care, 65.6% of FP viewed themselves as primary reference person to address these topics. However, a third (32.8%) of FP were unfamiliar with information thereof. Some were unsatisfied regarding timely updates on their patient's treatment course via discharge letters (25.0%) or phone calls (36.2%). FP would like to dedicate more consultation time addressing nutrition and PA than they currently do (p < 0.001). CONCLUSION Communication btween healthcare practitioners about mutual cancer patient's treatment must be improved, e.g. utilising electronic communication to quicken correspondence. Acquisition of information on nutrition and PA in cancer patient care needs to be facilitated for FP, approachable by compiling reliable information and their sources. Involvement of FP in structured treatment programs could benefit cancer patient care. TRIAL REGISTRATION NUMBER (May 7, 2021): 2021-2149-Bef.
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Affiliation(s)
- S J Boesenecker
- Clinic for Internal Medicine II, University Hospital, Bachstraße 18, 07743, Jena, Germany.
| | - V Mathies
- University Tumor Center, University Hospital, Jena, Germany
| | - J Buentzel
- Clinic for Otorhinolaryngology, Head Neck Surgery, Suedharz Klinikum, Nordhausen, Germany
| | - J Huebner
- Clinic for Internal Medicine II, University Hospital, Bachstraße 18, 07743, Jena, Germany
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Truby L, Bowles D, Casalinova S, Kwee L, Ilkayeva O, Muehlbauer M, Huebner J, Holley C, DeVore A, Patel C, Kang L, Pla MM, Gross R, McGarrah R, Schroder J, Milano C, Shah S. Metabolomic Profiling During Ex-Vivo Normothermic Perfusion Prior to Heart Transplantation Defines Patterns of Substrate Utilization and Correlates with Markers of Allograft Injury. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.168] [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: 04/05/2023] Open
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7
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Festerling L, Buentzel J, Fischer von Weikersthal L, Junghans C, Zomorodbakhsch B, Stoll C, Prott FJ, Fuxius S, Micke O, Richter A, Sallmann D, Huebner J, Hoppe C. Resilience in cancer patients and how it correlates with demographics, psychological factors, and lifestyle. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04480-6. [DOI: 10.1007/s00432-022-04480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Background
Being diagnosed with cancer is challenging. Many patients wish to be actively involved in treatment and contribute to therapy, but the patients’ coping abilities and desire for involvement differ. The individual level of resilience seems to play a major role. Our study aims to learn more about the associations of resilience and factors as demographics and psychological factors.
Methods
This multicentric cross-sectional study was conducted in ten oncological centers in Germany in summer 2021. The questionnaire collected information on demographics, resilience, self-efficacy, general satisfaction with life, and sense of coherence. Considered lifestyle-aspects were diet and physical activity. 416 patients were included in the analyses.
Results
A moderate mean resilience score was achieved (M = 69). Significant correlations in demographics were found for resilience and education (r = 0.146, p = 0.003), income (r = 0.205, p = 0.001), and time since receiving diagnosis (r = − 0.115, p = 0.021). Resilience and self-efficacy correlated on a high level (r = 0.595, p < 0.001), resilience and sense of coherence, and resilience and general satisfaction with life in a moderate way (r = 0.339, p < 0.001; r = 0.461, p = 0.001).
Conclusions
Resilience portrays an important aspect in cancer treatment. Detecting patients at risk, stabilizing, or improving resilience are important to focus on and strengthen them accordingly. Possible negatively influencing factors (e.g., low self-efficacy) need to be considered. Factors affecting resilience but difficult to influence, as educational background, should be screened for. Also, the combination of low resilience and low income seems to describe a vulnerable patient group.
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Huebner J, Keinki C, Käsmann L. Critical remarks to the article by Khodabakhshi and colleagues reporting results from a randomized study on ketogenic diet. Clin Nutr 2022; 41:1149. [DOI: 10.1016/j.clnu.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
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9
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Laverde D, Romero-Saavedra F, Argunov DA, Enotarpi J, Krylov VB, Kalfopoulou E, Martini C, Torelli R, van der Marel GA, Sanguinetti M, Codée JDC, Nifantiev NE, Huebner J. Synthetic Oligomers Mimicking Capsular Polysaccharide Diheteroglycan are Potential Vaccine Candidates against Encapsulated Enterococcal Infections. ACS Infect Dis 2020; 6:1816-1826. [PMID: 32364376 DOI: 10.1021/acsinfecdis.0c00063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infections caused by Enterococcus spp. are a major concern in the clinical setting. In Enterococcus faecalis, the capsular polysaccharide diheteroglycan (DHG), composed of ß-d-galactofuranose-(1 → 3)-ß-d-glucopyranose repeats, has been described as an important virulence factor and as a potential vaccine candidate against encapsulated strains. Synthetic structures emulating immunogenic polysaccharides present many advantages over native polysaccharides for vaccine development. In this work, we described the synthesis of a library of DHG oligomers, differing in length and order of the monosaccharide constituents. Using suitably protected thioglycoside building blocks, oligosaccharides up to 8-mer in length built up from either Galf-Glcp or Glcp-Galf dimers were generated, and we evaluated their immunoreactivity with antibodies raised against DHG. After the screening, we selected two octasaccharides, having either a galactofuranose or glucopyranose terminus, which were conjugated to a carrier protein for the production of polyclonal antibodies. The resulting antibodies were specific toward the synthetic structures and mediated in vitro opsonophagocytic killing of different encapsulated E. feacalis strains. The evaluated oligosaccharides are the first synthetic structures described to elicit antibodies that target encapsulated E. faecalis strains and are, therefore, promising candidates for the development of a well-defined enterococcal glycoconjugate vaccine.
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Affiliation(s)
- D. Laverde
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich 80337, Germany
| | - F. Romero-Saavedra
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich 80337, Germany
| | - D. A. Argunov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow 119334, Russia
| | - J. Enotarpi
- Bio-Organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, Netherlands
| | - V. B. Krylov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow 119334, Russia
| | - E. Kalfopoulou
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich 80337, Germany
| | - C. Martini
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - R. Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome 00168, Italy
| | - G. A. van der Marel
- Bio-Organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, Netherlands
| | - M. Sanguinetti
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome 00168, Italy
| | - J. D. C. Codée
- Bio-Organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden 2333 CC, Netherlands
| | - N. E. Nifantiev
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow 119334, Russia
| | - J. Huebner
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Ludwig Maximilians University, Munich 80337, Germany
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10
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Romero-Saavedra F, Laverde D, Kalfopoulou E, Martini C, Torelli R, Martinez-Matamoros D, Sanguinetti M, Huebner J. Conjugation of Different Immunogenic Enterococcal Vaccine Target Antigens Leads to Extended Strain Coverage. J Infect Dis 2020; 220:1589-1598. [PMID: 31289829 PMCID: PMC6782101 DOI: 10.1093/infdis/jiz357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022] Open
Abstract
Enterococci have emerged as important nosocomial pathogens due to their resistance to the most commonly used antibiotics. Alternative treatments or prevention options are aimed at polysaccharides and surface-related proteins that play important roles in pathogenesis. Previously, we have shown that 2 Enterococcus faecium proteins, the secreted antigen A and the peptidyl-prolyl cis-trans isomerase, as well as the Enterococcus faecalis polysaccharide diheteroglycan, are able to induce opsonic and cross-protective antibodies. Here, we evaluate the use of glycoconjugates consisting of these proteins and an enterococcal polysaccharide to develop a vaccine with broader strain coverage. Diheteroglycan was conjugated to these 2 enterococcal proteins. Rabbit sera raised against these glycoconjugates showed Immunoglobulin G titers against the corresponding conjugate, as well as against the respective protein and carbohydrate antigens. Effective opsonophagocytic killing for the 2 sera was observed against different E. faecalis and E. faecium strains. Enzyme-linked immunosorbent assays against whole bacterial cells showed immune recognition of 22 enterococcal strains by the sera. Moreover, the sera conferred protection against E. faecalis and E. faecium strains in a mouse infection model. Our results suggest that these glycoconjugates are promising candidates for vaccine formulations with a broader coverage against these nosocomial pathogens and that the evaluated proteins are potential carrier proteins.
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Affiliation(s)
- F Romero-Saavedra
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig Maximillian's University, Munich, Germany
| | - D Laverde
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig Maximillian's University, Munich, Germany
| | - E Kalfopoulou
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig Maximillian's University, Munich, Germany
| | - C Martini
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - D Martinez-Matamoros
- Department of Chemistry, Faculty of Sciences and Center for Advanced Scientific Research (CICA), Universidade da Coruña, A Coruña, Spain
| | - M Sanguinetti
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - J Huebner
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig Maximillian's University, Munich, Germany
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11
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Erickson N, Paradies K, Buchholz D, Huebner J. Nutrition care of cancer patients-A survey among physicians and nurses. Eur J Cancer Care (Engl) 2018; 27:e12855. [DOI: 10.1111/ecc.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- N. Erickson
- Comprehensive Cancer Center; Ludwig-Maximilian-University Munich (CCC LMU); Munich Germany
| | - K. Paradies
- Working Group KOK (Conference of Oncological Nurses of the German Cancer Society); Berlin Germany
| | - D. Buchholz
- School for Dietetics; University Medical Center of the Johannes Gutenberg University Mainz; Mainz Germany
| | - J. Huebner
- Medizinische Klinik II; Universitätsklinikum Jena; Jena Germany
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Lüneberg K, Prado B, Broszat M, Dalkmann P, Díaz D, Huebner J, Amelung W, López-Vidal Y, Siemens J, Grohmann E, Siebe C. Water flow paths are hotspots for the dissemination of antibiotic resistance in soil. Chemosphere 2018; 193:1198-1206. [PMID: 29874749 DOI: 10.1016/j.chemosphere.2017.11.143] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 08/02/2017] [Revised: 11/13/2017] [Accepted: 11/23/2017] [Indexed: 05/19/2023]
Abstract
Antibiotic resistance genes in soil pose a potential risk for human health. They can enter the soil by irrigation with untreated or insufficiently treated waste water. We hypothesized that water flow paths trigger the formation of antibiotic resistance, since they transport antibiotics, multi-resistant bacteria and free resistance genes through the soil. To test this, we irrigated soil cores once or twice with waste water only, or with waste water added with sulfamethoxazole (SMX) and ciprofloxacin (CIP). The treatments also contained a dye to stain the water flow paths and allowed to sample these separately from unstained bulk soil. The fate of SMX and CIP was assessed by sorption experiments, leachate analyses and the quantification of total and extractable SMX and CIP in soil. The abundance of resistance genes to SMX (sul1 and sul2) and to CIP (qnrB and qnrS) was quantified by qPCR. The sorption of CIP was larger than the dye and SMX. Ciprofloxacin accumulated exclusively in the water flow paths but the resistance genes qnrB and qnrS were not detectable. The SMX concentration in the water flow paths doubled the concentration of the bulk soil, as did the abundance of sul genes, particularly sul1 gene. These results suggest that flow paths do function as hotspots for the accumulation of antibiotics and trigger the formation of resistance genes in soil. Their dissemination also depends on the mobility of the antibiotic, which was much larger for SMX than for CIP.
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Affiliation(s)
- K Lüneberg
- Universidad Nacional Autónoma de México, Instituto de Geología, Ciudad Universitaria, Mexico City, Mexico.
| | - B Prado
- Universidad Nacional Autónoma de México, Instituto de Geología, Ciudad Universitaria, Mexico City, Mexico
| | - M Broszat
- University Medical Centre Freiburg, Division of Infectious Diseases, Freiburg, Germany
| | - P Dalkmann
- Institute of Crop Science and Resource Conservation - Soil Science and Soil Ecology, University of Bonn, Bonn, Germany
| | - D Díaz
- Universidad Nacional Autónoma de México, Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Mexico City, Mexico
| | - J Huebner
- University Medical Centre Freiburg, Division of Infectious Diseases, Freiburg, Germany; Hauner Children's Hospital, Division of Paediatric Infectious Diseases, Ludwig-Maximilians University Munich, Munich, Germany
| | - W Amelung
- Institute of Crop Science and Resource Conservation - Soil Science and Soil Ecology, University of Bonn, Bonn, Germany
| | - Y López-Vidal
- Universidad Nacional Autónoma de México, Departamento de Microbiología y Parasitología, Facultad de Medicina, Ciudad Universitaria, Mexico City, Mexico
| | - J Siemens
- Institute of Crop Science and Resource Conservation - Soil Science and Soil Ecology, University of Bonn, Bonn, Germany
| | - E Grohmann
- University Medical Centre Freiburg, Division of Infectious Diseases, Freiburg, Germany; Beuth University of Applied Sciences, Faculty of Life Sciences and Technology, Department of Microbiology, Berlin, Germany
| | - C Siebe
- Universidad Nacional Autónoma de México, Instituto de Geología, Ciudad Universitaria, Mexico City, Mexico
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13
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Araujo da Silva AR, Albernaz de Almeida Dias DC, Marques AF, Biscaia di Biase C, Murni IK, Dramowski A, Sharland M, Huebner J, Zingg W. Role of antimicrobial stewardship programmes in children: a systematic review. J Hosp Infect 2017; 99:117-123. [PMID: 28807835 DOI: 10.1016/j.jhin.2017.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
The United Nations and the World Health Organization have designated antimicrobial resistance (AMR) as a major health priority and developed action plans to reduce AMR in all healthcare settings. Establishment of institutional antimicrobial stewardship programmes (ASPs) is advocated as a key intervention to reduce antibiotic consumption in hospitals and address high rates of multi-drug-resistant (MDR) bacteria. PUBMED and the Cochrane Database of Systematic Reviews (January 2007-March 2017) were searched to identify studies reporting the effectiveness of ASPs in general paediatric wards and paediatric intensive care units (PICUs) for reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, and antibiotic resistance and healthcare-associated infections (HAIs). Neonatal units and antifungal agents were excluded. Of 2509 titles and abstracts, nine articles were eligible for inclusion in the final analysis. All studies reported a reduction in the use of broad-spectrum/restricted antibiotics or antibiotic consumption. One study reported a reduction in HAIs in a PICU, and another study evaluated bacterial resistance, showing no effect following ASP implementation. Prospective audit on antibiotic use was the most common ASP core component (eight of nine studies). Antibiotic pre-authorization was described in two studies. Other described interventions were the provision of guidelines or written information (five of nine studies), and training of healthcare professionals (one study). There is limited evidence for a reduction in antibiotic consumption and use of broad-spectrum/restricted agents following ASP implementation specifically in PICUs. Data evaluating the impact of ASPs on HAIs and AMR in PICUs are lacking. In addition, there is limited information on effective components of a successful ASP in PICUs.
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Affiliation(s)
- A R Araujo da Silva
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rio de Janeiro, Brazil.
| | - D C Albernaz de Almeida Dias
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rio de Janeiro, Brazil
| | - A F Marques
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rio de Janeiro, Brazil
| | - C Biscaia di Biase
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rio de Janeiro, Brazil
| | - I K Murni
- Department of Paediatrics, Dr Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Stellenbosch, South Africa
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's University, London, UK
| | - J Huebner
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - W Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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14
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Chaw PS, Schlinkmann KM, Raupach-Rosin H, Karch A, Huebner J, Mikolajczyk R. A retrospective analysis of paediatric inpatient data on antibiotic use in a teaching hospital in The Gambia. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605854] [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: 10/18/2022]
Affiliation(s)
- PS Chaw
- PhD Programme „Epidemiology“ Braunschweig-Hannover, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- ESME – Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale)
| | - KM Schlinkmann
- PhD Programme „Epidemiology“ Braunschweig-Hannover, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- ESME – Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
| | - H Raupach-Rosin
- ESME – Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
| | - A Karch
- PhD Programme „Epidemiology“ Braunschweig-Hannover, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- ESME – Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
| | - J Huebner
- Dr. Von Hauner Children's Hospital, Ludwig Maximilian University Munich, Division of Pediatric Infectious Diseases, Munich
| | - R Mikolajczyk
- PhD Programme „Epidemiology“ Braunschweig-Hannover, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- ESME – Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Epidemiology, Braunschweig
- Hannover Medical School, Hannover
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale)
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15
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Keinki C, Seilacher E, Ebel M, Ruetters D, Kessler I, Stellamanns J, Rudolph I, Huebner J. Information Needs of Cancer Patients and Perception of Impact of the Disease, of Self-Efficacy, and Locus of Control. J Cancer Educ 2016; 31:610-6. [PMID: 25994358 DOI: 10.1007/s13187-015-0860-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of our study was to investigate the relationship between information needs and cancer patients' perceptions of the impact of the disease, self-efficacy, and locus of control. Using a standardized questionnaire, we obtained data from patients who attended a series of lectures. The questionnaire included questions on their information needs, sources of information, satisfaction with information, and short questionnaires on self-efficacy, perception of the disease, and locus of control of reinforcement. Data was obtained from 185 patients. Our results showed that the sources of information that were most often used were physicians (84 %), print media (68 %), and the Internet (59 %); online fora (7.5 %), non-medical practitioners (9.7 %), and telephone-based counseling (8.6 %) were only used by a minority. Patients with a high perception of their own control over the disease more often used any source of information available to them and were more often interested in acquiring additional information. Higher self-efficacy was significantly associated with the need for information on all topics. Patients with a higher external locus of control significantly more often used sources of information and had significantly more need for additional information. By contrast, there were no associations with an internal locus of control. Neither external nor internal locus of control showed any associations with satisfaction with information. Information needs seem to be higher in patients with a high external locus of control and low self-efficacy. Physicians, other professionals, and institutions that provide information may take these relationships into consideration for tailoring their services to patients.
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Affiliation(s)
- C Keinki
- German Cancer Society, 14057, Berlin, Germany
| | - E Seilacher
- German Cancer Society, 14057, Berlin, Germany
| | - M Ebel
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - D Ruetters
- German Cancer Society, 14057, Berlin, Germany
| | - I Kessler
- German Cancer Society, 14057, Berlin, Germany
| | | | - I Rudolph
- German Cancer Society, 14057, Berlin, Germany
| | - J Huebner
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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16
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Ciarlo G, Liebl P, Zell J, Fessler J, Koester M, Ruetters D, Mugele K, Huebner J. Information needs of oncologists, general practitioners and other professionals caring for patients with cancer. Eur J Cancer Care (Engl) 2016; 25:1015-1023. [DOI: 10.1111/ecc.12557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Ciarlo
- Dr. Senckenberg Chronomedical Institute; J.W. Goethe University; Frankfurt Germany
| | - P. Liebl
- German Cancer Society; Berlin Germany
| | - J. Zell
- Max-Planck-Straße 6-8; Köln Germany
| | - J. Fessler
- Institut für hausärztliche Fortbildung im Deutschen Hausärzteverband (IhF) e. V.; Cologne Germany
| | | | | | - K. Mugele
- German Cancer Society; Berlin Germany
| | - J. Huebner
- Dr. Senckenberg Chronomedical Institute; J.W. Goethe University; Frankfurt Germany
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17
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Huebner J, Ebel M, Muenstedt K, Micke O, Prott FJ, Muecke R, Hoppe A. A lecture program on complementary and alternative medicine for cancer patients--evaluation of the pilot phase. J Cancer Educ 2015; 30:340-343. [PMID: 25056420 DOI: 10.1007/s13187-014-0706-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
About half of all patients with cancer use complementary or alternative medicine (CAM). In 2013, we started a lecture program for patients, followed by evidence-based recommendations on counseling on CAM. These recommendations have been published before by this working group. The aim of the program is to provide scientific facts on the most often used CAM methods in standardized presentations which help patients discuss the topic with their oncologists and support shared decision making. The article presents the evaluation of the pilot phase. Participants received a standardized questionnaire before the start of the lecture. The questionnaire comprises four parts: demographic data, data concerning experience with CAM, satisfaction with the lecture, and needs for further information on CAM. In 2013, seven lectures on CAM were given in cooperation with regional branches of the German Cancer Society in several German states. Four hundred sixty patients and relatives took part (75% females and 16% males). Forty-eight percent formerly had used CAM. Most often named sources of information on CAM were print media (48%) and the Internet (37%). Most participants rated additional written information valuable. About one third would like to have an individual consultation concerning CAM. A standardized presentation of evidence on CAM methods most often used, together with recommendations on the self-management of symptoms, is highly appreciated. The concept of a highly interactive lecture comprising is feasible and if presented in lay terminology, adequate. In order to give additional support on the topic, written information should be provided as the first step.
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Affiliation(s)
- J Huebner
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany,
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18
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Linke B, Liebl P, Marten D, Stoll C, Jung B, Wuensch P, Huebner J. Information Concerning Endocrine Therapy and Adherence of Patients with Breast and Prostate Cancer. Clin Oncol (R Coll Radiol) 2015; 27:482-3. [PMID: 25869258 DOI: 10.1016/j.clon.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 11/15/2022]
Affiliation(s)
- B Linke
- German Cancer Society, Berlin, Germany
| | - P Liebl
- German Cancer Society, Berlin, Germany
| | - D Marten
- German Cancer Society, Berlin, Germany
| | - C Stoll
- Clinic Herzoghoehe, Bayreuth, Germany
| | - B Jung
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Frankfurt, Germany
| | - P Wuensch
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Frankfurt, Germany
| | - J Huebner
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J.W. Goethe University, Frankfurt, Germany
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Vogelhuber M, Feyerabend S, Stenzl A, Suedhoff T, Schulze M, Huebner J, Oberneder R, Wieland W, Mueller S, Eichhorn F, Heinzer H, Schmidt K, Baier M, Ruebel A, Birkholz K, Bakhshandeh-Bath A, Andreesen R, Herr W, Reichle A. Erratum to: Biomodulatory Treatment of Patients with Castration-Resistant Prostate Cancer: A Phase II Study of Imatinib with Pioglitazone, Etoricoxib, Dexamethasone and Low-Dose Treosulfan. Cancer Microenviron 2015; 8:43-4. [PMID: 25651886 DOI: 10.1007/s12307-015-0165-y] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Vogelhuber
- Department of Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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20
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Vogelhuber M, Feyerabend S, Stenzl A, Suedhoff T, Schulze M, Huebner J, Oberneder R, Wieland W, Mueller S, Eichhorn F, Heinzer H, Schmidt K, Baier M, Ruebel A, Birkholz K, Bakhshandeh-Bath A, Andreesen R, Herr W, Reichle A. Biomodulatory Treatment of Patients with Castration-Resistant Prostate Cancer: A Phase II Study of Imatinib with Pioglitazone, Etoricoxib, Dexamethasone and Low-Dose Treosulfan. Cancer Microenviron 2014; 8:33-41. [PMID: 25503648 PMCID: PMC4449347 DOI: 10.1007/s12307-014-0161-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022]
Abstract
Therapeutic options for patients with castration-resistant prostate cancer (CRPC) remain limited. In a multicenter, Phase II study, 65 patients with histologically confirmed CRPC received a biomodulatory regimen during the six-month core study. Treatment comprised daily doses of imatinib mesylate, pioglitazone, etoricoxib, treosulfan and dexamethasone. The primary endpoint was prostate-specific antigen (PSA) response. Responders could enter an extension phase until disease progression or intolerable toxicity occurred. Mean PSA was 45.3 ng/mL at baseline, and 77 % of patients had a PSA doubling time <3 months. Of the 61 evaluable patients, 37 patients (60.6 %) responded or had stable disease and 23 of them (37.7 % of 61 patients) were PSA responders. Among the 23 responders mean PSA decreased from 278.9 ± 784.1 ng/mL at baseline to 8.8 ± 11.6 ng/mL at the final visit (week 24). The progression-free survival (PFS) was 467 days in the ITT population. Of the 947 adverse events, 57.6 % were suspected to be drug-related, 13.8 % led to dose adjustment or permanent discontinuation and 40.2 % required concomitant medication. This novel combination approach led to an impressive PSA response rate of 37.7 % in CRPC patients. The good PSA response and PFS rate combined with the manageable toxicity profile suggest an alternative treatment option.
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Affiliation(s)
- M. Vogelhuber
- Department of Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - S. Feyerabend
- Department of Urology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - A. Stenzl
- Department of Urology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - T. Suedhoff
- Department of Hematology and Oncology, Hospital Passau, Innstrasse 76, 94032 Passau, Germany
| | - M. Schulze
- Outpatient Center for Urology and Oncology, Hauptstrasse 10, 04416 Markkleeberg, Germany
| | - J. Huebner
- Department of Oncology, J. W. Goethe University, Theodor-Stern-Kai 7, 60323 Frankfurt, Germany
| | - R. Oberneder
- Urologic Hospital München-Planegg, Germeringer Str. 32, 82152 Planegg, Germany
| | - W. Wieland
- Department of Urology, Hospital St. Josef, University Regensburg, Landshuter Strasse 65, 93053 Regensburg, Germany
| | - S. Mueller
- Department of Urology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - F. Eichhorn
- Outpatient Center, Rinckstrasse 7-9, 83435 Bad Reichenhall, Germany
| | - H. Heinzer
- Martini-Clinic at University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - K. Schmidt
- Novartis Pharma GmbH, Roonstrasse 25, 90429 Nuernberg, Germany
| | - M. Baier
- Novartis Pharma GmbH, Roonstrasse 25, 90429 Nuernberg, Germany
| | - A. Ruebel
- Novartis Pharma GmbH, Roonstrasse 25, 90429 Nuernberg, Germany
| | - K. Birkholz
- Novartis Pharma GmbH, Roonstrasse 25, 90429 Nuernberg, Germany
| | - A. Bakhshandeh-Bath
- Outpatient Center for Medical Oncology, Waitzstrasse 22, 22607 Hamburg, Germany
| | - R. Andreesen
- Department of Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - W. Herr
- Department of Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - A. Reichle
- Department of Hematology and Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Rossmann FS, Kropec A, Laverde D, Saaverda FR, Wobser D, Huebner J. In vitro and in vivo activity of hyperimmune globulin preparations against multiresistant nosocomial pathogens. Infection 2014; 43:169-75. [PMID: 25428225 PMCID: PMC4382538 DOI: 10.1007/s15010-014-0706-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022]
Abstract
Purpose We compared different immunoglobulin preparations containing IgG (Intraglobin/Intratect) or a mixture of IgG, IgA, and IgM (Pentaglobin) to assess the opsonic and protective efficacy of human immunoglobulin preparations against multiresistent nosocomial pathogens. Materials and methods Clinical isolates of E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Enterococcus faecium, and Staphylococcus aureus were tested by opsonophagocytic assay using immunologobulin preparations at dilutions usually obtained in patients. The target antigens of opsonic antibodies were characterized by opsonophagocytic inhibition assays, and the protective efficacy in vivo was tested in a mouse bacteremia model as previously described. Results All strains were killed to at least 50 % by Pentaglobin. One P. aeruginosa strain was not efficiently killed by Intraglobin (23 %) but the other strains were killed by Intraglobin to a similar degree compared to Pentaglobin. Opsonic IgG antibodies against E. faecalis were directed against LTA, while opsonic antibodies in Pentaglobin were primarily directed against other cell wall carbohydrates. In a mouse bacteremia model, Pentaglobin was more protective than Intratect against Staphylococcus aureus, while Intratect reduced colony counts better than normal rabbit serum or saline. Conclusions All tested human immunoglobulin preparations contain opsonic and protective antibodies against targets present on multiresistant Gram-positive and Gram-negative bacteria. Enrichment of these preparations with IgM increases the protective efficacy against some strains, probably due to antibodies directed against cell wall carbohydrates.
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Affiliation(s)
- F. S. Rossmann
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- Faculty of Biology, Albert-Ludwigs-University Freiburg, Freiburg University, Freiburg im Breisgau, Germany
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, Munich, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - A. Kropec
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - D. Laverde
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - F. R. Saaverda
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - D. Wobser
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - J. Huebner
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, Munich, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
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22
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Wuensch P, Hahne A, Haidinger R, Meißler K, Tenter B, Stoll C, Senf B, Huebner J. Discontinuation and non-adherence to endocrine therapy in breast cancer patients: is lack of communication the decisive factor? J Cancer Res Clin Oncol 2014; 141:55-60. [PMID: 25085010 DOI: 10.1007/s00432-014-1779-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Non-adherence to anti-hormonal therapy is a major problem in gynecologic oncology. Reasons reported are side effects and lack of support. The aim of our study was an analysis of influence of experiences of patients with endocrine therapy and communication and information on this topic and their influence on adherence. METHODS We developed a structured questionnaire which was tested in a pilot version and then programmed as online questionnaire and presented to patient members of self-help and breast cancer organizations. RESULTS Patients only had received scarce information on endocrine therapy. Only 12.8% stated that their questions were answered in detail, 43.2% got no answers or only non-detailed answers. 76% had side effects limiting functions of daily life. 60% of physicians did not react on these side effects. There is a significant correlation between number and intensity of side effects and non-adherence or disruption of therapy (p = 0.029 and p < 0.01, respectively). Women who reported having received detailed answers to their questions also reported better adherence (p = 0.014). CONCLUSION In order to improve adherence, detailed information on side effects and answers in case of symptoms are most important. Physicians should not rely on presenting written information but should mainly engage in direct communication.
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Affiliation(s)
- P Wuensch
- Working Group Integrative Oncology, Dr. Senckenberg Chronomedical Institute, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Huebner J. Multiresistente Erreger in Klinik und Praxis. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Henf A, Wesselmann S, Huthmann D, Muenstedt K, Huebner J, Huebner J. Complementary and Alternative Medicine in German Cancer Centers. Oncol Res Treat 2014. [DOI: 10.1159/000364897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Trimborn A, Senf B, Muenstedt K, Buentzel J, Micke O, Muecke R, Prott FJ, Wicker S, Huebner J. Attitude of employees of a university clinic to complementary and alternative medicine in oncology. Ann Oncol 2013; 24:2641-2645. [PMID: 23942776 DOI: 10.1093/annonc/mdt299] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer patients often use complementary and alternative medicine (CAM), yet discussion with the oncologist is often missing and oncologists lack knowledge in CAM. PATIENTS AND METHODS In order to learn more about the attitude of professionals in oncology toward CAM, a survey was conducted on employees of a German university clinic using a structured questionnaire. RESULTS In total, 547 employees took part in the survey. One-third would definitely use CAM on cancer patients. Female employees are more interested in CAM than males (80% versus 20%; P = 0.001); physicians are less interested than nurses (57% versus 72%; P = 0.008). 2.5% of physicians and 9% of nurses are convinced that CAM is as effective as conventional therapy in cancer. Fifty-two percent of physicians and 12% of nurses agree that adverse effects due to CAM may be possible. Seventy-three percent did not consider themselves adequately informed on CAM for their professional work. CONCLUSIONS As a substantial part of participants would use CAM on cancer patients and most are interested in but not trained on this topic, there is a need for training of professionals from different professions working in oncology.
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Affiliation(s)
| | - B Senf
- Department of Psychooncology, J.W. Goethe University, Frankfurt/Main
| | - K Muenstedt
- Department of Gynecology and Obstetrics, University Clinic, Gießen
| | - J Buentzel
- Department of Head and Neck Diseases, Municipal Hospital, Nordhausen
| | - O Micke
- Department of Radiooncology, St. Franziskus Hospital, Bielefeld
| | - R Muecke
- Department of Radiotherapy and Radiation Oncology, Ruhr University Bochum, Bochum
| | - F J Prott
- RNS Praxisgemeinschaft Radioonology, Wiesbaden
| | - S Wicker
- Occupational Health Service, University Clinic, Frankfurt/Main, Germany
| | - J Huebner
- Dr. Senckenberg Chronomedical Institute.
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Huebner J, Rosé C, Geissler J, Gleiter CH, Prott FJ, Muenstedt K, Micke O, Muecke R, Buentzel J, Bottomley A, Hofheinz RD. Integrating cancer patients' perspectives into treatment decisions and treatment evaluation using patient-reported outcomes--a concept paper. Eur J Cancer Care (Engl) 2013; 23:173-9. [PMID: 23889081 DOI: 10.1111/ecc.12095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
Abstract
Patient-reported outcomes are an important tool in clinical research. In the setting of cancer treatments, benefit of therapy is essentially characterised by improvement of survival as well as quality of life (QoL). A standardised instrument to assess QoL is the standardised QoL questionnaire of the European Organisation for Research and Treatment (EORTC QLQ-C30 questionnaire). QoL instruments provide data on different aspects (domains) of the framework of QoL. Using these questionnaires in studies provides data on how a treatment affects QoL in a group of patients. The goal of our concept is to individualise QoL and to use validated instruments in order to integrate patients' perspectives and aims into treatment assessment, planning and control. We propose to use the domains of the EORTC QLQ-C30 and to ask the patient to determine which objectives besides survival are relevant for him and should be achieved by treatment. These individual goals can be used in a process of shared decision-making to choose and monitor treatment. In clinical studies, this approach would allow to recruit more patients who would most probably benefit from the therapy. In addition, supportive data could be gathered in correlation to treatment goals and actual benefits.
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Affiliation(s)
- J Huebner
- Dr. Senckenberg Chronomedical Institute, J. W. Goethe University Frankfurt/Main, Frankfurt
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Huebner J, Rack-Hoch A, Pecar A, Schmid I, Klein C, Borde J. Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie. Klin Padiatr 2013; 225:223-9. [DOI: 10.1055/s-0033-1349063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J. Huebner
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
| | - A. Rack-Hoch
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
| | - A. Pecar
- Apotheke, Klinikum der Ludwig-Maximilians-Universität München
| | - I. Schmid
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
| | - C. Klein
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
| | - J. Borde
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München
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Huebner J, Follmann M. Complementary medicine in guidelines of the German Guideline Program in Oncology: comparison of the evidence base between complementary and conventional therapy. huebner@med.uni-frankfurt.de. J Cancer Res Clin Oncol 2013; 139:1481-8. [PMID: 23817695 DOI: 10.1007/s00432-013-1464-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 06/18/2013] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The German Guideline Program in Oncology (GGPO) comprises guidelines aiming at epidemiology, prevention, diagnosis, treatment and aftercare of different types of cancer. As many patients in Germany use complementary and alternative medicine (CAM), the aim of our study was to assess the information on CAM presented in these guidelines compared to conventional, supportive and psychosocial therapy. METHODS We assessed all recommendations and statements from guidelines published from 2010 to 2012 from the program according to level of evidence (LoE) as given in the guideline. We differentiated between conventional cancer treatment, conventional supportive treatment, psychosocial interventions and complementary treatment. RESULTS A total of 9 guidelines (ovarian, colorectal, pancreatic, gastric, breast, prostate, oral cancer, melanoma and Hodgkin lymphoma) were included in our analysis. The total number of statements is highly diverse, ranging from 35 to 150. Only few statements and recommendations are given regarding supportive, psychosocial or complementary therapy. Regarding conventional treatments, only two guidelines (ovarian and oral cancer) have more than 50 % statements and recommendations on level 1. Considering supportive treatments, the LoE is lower, except the guideline on pancreatic cancer (40 % level 1). In breast cancer, all statements are based on expert consensus. Four guidelines do not include any statement at all. All guidelines beside that on Hodgkin lymphoma include at least one statement or recommendation on psychosocial therapy. Most recommendations are GCP.CAM is discussed in 8 guidelines; LoE is low with GCP statements dominating. DISCUSSION There may be different reasons for the low number of statements and recommendations on supportive, psychosocial and CAM therapies. Often, these topics are considered less important, and evidence is assumed as being low. In the GGPO, guidelines focusing on psychosocial and supportive therapy are under development. Thus, cancer-specific guidelines will be able to refer to these guidelines and only include recommendations on psychosocial care and supportive therapy which are specific for the type of cancer. A national guideline on CAM would close the gap of information for physicians and patients. In case of missing or low evidence, a transparent description of this uncertainty would be valuable information to professionals and patients.
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Affiliation(s)
- J Huebner
- German Cancer Society, Berlin, Germany.
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Henrotin Y, Kraus V, Huebner J, Helleputte T, Deberg M. OP0031 Baseline Measurements of Coll2-1 and Coll2-1NO2 in Urine are Highly Predictive of Joint Space Narrowing in Knee Osteoarthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.236] [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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Zeller T, Muenstedt K, Stoll C, Schweder J, Senf B, Ruckhaeberle E, Becker S, Serve H, Huebner J. Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center. J Cancer Res Clin Oncol 2012; 139:357-65. [DOI: 10.1007/s00432-012-1336-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
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Hogendorf W, Kropec A, Filippov D, Overkleeft H, Huebner J, van der Marel G, Codée J. Light fluorous synthesis of glucosylated glycerol teichoic acids. Carbohydr Res 2012; 356:142-51. [DOI: 10.1016/j.carres.2012.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 02/24/2012] [Indexed: 01/08/2023]
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Kropec A, Sava IG, Vonend C, Sakinc T, Grohmann E, Huebner J. Identification of SagA as a novel vaccine target for the prevention of Enterococcus faecium infections. Microbiology (Reading) 2011; 157:3429-3434. [DOI: 10.1099/mic.0.053207-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Infections caused by multiresistant Gram-positive bacteria represent a major health burden in the community as well as in hospitalized patients. Enterococci, especially Enterococcus faecium, are well-known pathogens of hospitalized patients and are frequently linked with resistance against multiple antibiotics, which compromises effective therapy. Rabbit immune serum raised against heat-killed E. faecium E155, a HiRECC clone, was used in an opsonophagocytic assay, an inhibition assay and a mouse bacteraemia model to identify targets of opsonic and protective antibodies. Serum against whole heat-killed bacteria was opsonic and recognized a protein of about 72 kDa that was abundantly secreted. This protein, identified as SagA by LC-ES-MS/MS, was expressed in Escherichia coli and purified. Rabbit serum raised against the purified protein showed opsonic killing activity that was inhibited by almost 100 % using 100 µg purified protein ml−1. In a mouse bacteraemia model, a statistically significant reduction of the colony counts in blood was shown with immune rabbit serum compared with preimmune serum using the homologous and a heterologous vancomycin-resistant enterococci (VRE) strain. These results indicate that SagA could be used as a promising vaccine target to treat and/or prevent VRE bacteraemia.
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Affiliation(s)
- A. Kropec
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - I. G. Sava
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Vonend
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - T. Sakinc
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - E. Grohmann
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - J. Huebner
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Abstract
Enterococcus faecalis and Enterococcus faecium have emerged as multi-resistant nosocomial pathogens in immunocompromised and critically ill patients. Multi-resistant strains have acquired virulence genes resulting in hospital-adapted clones. The following review summarizes several proteins and carbohydrate- or glycoconjugates that have been identified as putative virulence factors involved in the pathogenesis of enterococcal infections and may be used as targets for alternative therapies. Several studies describing the host immune response against enterococci are also summarized.
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Affiliation(s)
- I G Sava
- Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Germany
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Sava IG, Heikens E, Kropec A, Theilacker C, Willems R, Huebner J. Enterococcal surface protein contributes to persistence in the host but is not a target of opsonic and protective antibodies in Enterococcus faecium infection. J Med Microbiol 2010; 59:1001-1004. [DOI: 10.1099/jmm.0.020578-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Enterococci are important nosocomial pathogens with multiple intrinsic and acquired resistances to antibiotics. In the past, the majority of infections were caused by Enterococcus faecalis; however, an increase in Enterococcus faecium clinical isolates has been observed in recent years. The enterococcal surface protein (Esp) is expressed on the surface of most E. faecium clinical isolates and has been shown to be involved in biofilm formation. Here, E. faecium E1162 and its previously created insertion-deletion mutant of the esp gene, E. faecium E1162Δesp, were compared in a mouse bacteraemia model. Anti-Esp serum was tested for its capacity to mediate opsonophagocytic killing of E1162 in vitro and to protect against E. faecium bacteraemia. The inactivation of esp attenuated E. faecium virulence with reduced numbers of bacteria recovered from the kidneys in animals infected with the mutant compared to the wild-type strain (P=0.035). Passive immunization with rabbit polyclonal serum raised against the recombinant N-terminal Esp protein did not protect mice against E. faecium bacteraemia (P>0.05). In contrast, mice passively immunized with polyclonal antiserum raised against lipoteichoic acid (LTA) from E. faecalis had lower numbers of E. faecium E1162 in the blood compared to mice immunized with normal rabbit serum. These results suggest that Esp contributes to E. faecium persistence in the host. However, in contrast to LTA, Esp does not seem to be a target for protective antibodies in E. faecium strain E1162 in mouse bacteraemia.
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Affiliation(s)
- I. G. Sava
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - E. Heikens
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A. Kropec
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Theilacker
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - R. Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - J. Huebner
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
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Wolkewitz M, Dettenkofer M, Bertz H, Schumacher M, Huebner J. Statistical epidemic modeling with hospital outbreak data. Stat Med 2008; 27:6522-31. [DOI: 10.1002/sim.3419] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huebner J, Franz C, Kopp M. Probiotika - evidenzbasierte Medizin oder alternativmedizinischer Hokuspokus? Dtsch Med Wochenschr 2008; 133:367-9. [DOI: 10.1055/s-2008-1046721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- J Huebner
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg, Germany
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Toma I, Theilacker C, Sava I, Kropec A, Hammer F, Huebner J. P1799 Antibodies against LTA isolated from E. faecalis 12030 recog-nize LTA from heterologous enterococcal strains but mediate opsonophagocytic killing only to CPS-A and CPS-B strains. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71638-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fetsch A, Huebner J, Langbein I, Mueller E, Borchers K. Ermittlung des Immunstatus bei Pferden mit bzw. ohne equine Keratokonjunktivitis unter besonderer Berücksichtigung einer EHV-2-Infektion. Tierarztl Prax Ausg G Grosstiere Nutztiere 2007. [DOI: 10.1055/s-0037-1621643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Zusammenfassung
Gegenstand und Ziel: Die Rolle des in der Pferdepopulation weit verbreiteten EHV-2 als Pathogen ist umstritten, aber eine Beteiligung bei respiratorischen Infektionen und Keratokonjunktivitis mehrfach belegt. Neueste Befunde, die auf einer optimierten Probennahme und der sensitiven PCR-Technik basierten, zeigten jedoch auch bei augengesunden Pferden einen hohen Anteil an EHV-2-positiven Tupferproben. Da serologische Befunde keine diagnostische Aussagekraft bei der EHV-2-bedingten Keratokonjunktivitis haben, wurde nach einem weiteren diagnostisch verwertbaren Parameter gesucht. Material und Methoden: EHV-2 liegt in B-Zellen latent vor und hat möglicherweise eine immunsupprimierende Wirkung. Deshalb wurden Blutproben von augengesunden und augenkranken Pferden mittels PCR auf EHV-2 untersucht und zusätzlich die relativen Anteile der B- und T-Lymphozyten im peripheren Blut durchflusszytometrisch bestimmt. Die Testgruppe umfasste 10 EHV-2-positive Pferde, bei denen das Virus per PCR in peripheren Blutleukozyten oder Augentupfern nachgewiesen wurde. Die Kontrollgruppe bestand aus 21 EHV-2-negativen Pferden. Beide Gruppen beinhalteten augenkranke und augengesunde Pferde. Ergebnisse: Zwischen augenkranken und augengesunden Test- und Kontrolltieren ergaben sich bezüglich der T-Zell-Zahlen im Vergleich zum Referenzbereich keine signifikanten Unterschiede. Dagegen waren bei vier von sechs augengesunden EHV-2-positiven Pferden erniedrigte B-Lymphozyten-Zahlen zu verzeichnen. Die Häufigkeit des Vorkommens von erhöhten B-Lymphozyten-Anteilen differierte dagegen zwischen den vier Gruppen nicht signifikant. Schlussfolgerungen: Augengesunde Testtiere wiesen signifikant häufiger verminderte B-Lymphozyten- Zahlen auf als augenkranke bzw. augengesunde Kontrolltiere. Aufgrund des geringen Stichprobenumfangs sollten diese Ergebnisse jedoch nur als erste Indizien für einen möglichen Einfluss einer EHV- 2-Infektion auf den Immunstatus angesehen werden. Klinische Relevanz: Weitere Studien müssen klären, ob die Bestimmung des Immunstatus mittels Durchflusszytometrie ein hilfreicher diagnostischer und möglicherweise prognostischer Parameter bei der EHV-2-induzierten equinen Keratokonjunktivitis darstellt.
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Jeschke E, Ostermann T, Lueke C, Buchwald D, Huebner J, Tabali M, Matthes H. Risk Assessment of Medicines Containing Extracts from Compositae in a German Pharmacovigilance Network of Anthroposophical Physicians in Primary Care. Drug Saf 2007. [DOI: 10.2165/00002018-200730100-00084] [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: 11/02/2022]
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Hufnagel M, Carey VJ, Baldassarri L, Reinert RR, Huebner J. Distribution of four capsular serotypes of Enterococcus faecalis among clinical isolates from different geographical origins and infection sites. Infection 2006; 34:22-5. [PMID: 16501898 DOI: 10.1007/s15010-006-4100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 04/27/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Enterococci possess capsular polysaccharide antigens that are the targets of opsonic antibodies. These antibodies are potential candidates for development as immunotherapy. MATERIAL AND METHODS The present study analyzes the distribution of four capsular serotypes within a collection of 157 isolates of Enterococcus faecalis from four countries with different sites of clinical infection. RESULTS By using a capsular polysaccharide-specific ELISA, 42% of the isolates were grouped into one of four serogroups, and another 9% showed cross-reactivity between two serotype-specific sera. Heterogeneity of serotype distribution by both geographical origin and infection site was observed. CONCLUSION Half of the strain collection could be typed with four serotype-specific sera. No serotype from a given country or infection site clearly predominated.
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Affiliation(s)
- M Hufnagel
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Enterococci are natural inhabitants of the gastrointestinal tract and of the female genital tract of humans and many animals. In recent years, enterococci have been increasingly recognized as important human pathogens causing infections associated with medical devices. Their resistance to most antimicrobial agents and their ability to form biofilm has contributed to the increasing incidence of nosocomial enterococcal infections. Enterococci possess a capsular polysaccharide composed of a glycerol-teichoic acid-like molecule consisting of repeating units of 6-alfa-D-glucose-1-2-glycerol-3-PO4 , substituted on carbon 2 with a alfa-2,1-linked molecule of glucose. Using both immunologic and genetic data E. faecalis can be assigned to specific serotypes based on capsular polysaccharides. Clinical examples of foreign-body infections due to enterococci are described, comprising infections of artificial joints, implanted intravascular catheters, artificial hearts and artificial valves, stents, liquor shunt devices, and intraocular infections. Methods to prevent and/or treat enterococcal infections are presented.
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Affiliation(s)
- F Fabretti
- Divison of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg, Germany
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Affiliation(s)
- J Huebner
- Zentrum Infektiologie und Reisemedizin, Medizinische Universitätsklinik und Poliklinik, Universitätsklinikum Freiburg, Freiburg.
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Hufnagel M, Huebner J. Analysis of the Specific Immune Response against Capsular Polysaccharides of Two Patients with Systemic Enterococcal Infections. Infection 2005; 33:373-6. [PMID: 16258870 DOI: 10.1007/s15010-005-5062-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Accepted: 08/15/2005] [Indexed: 10/25/2022]
Abstract
Systemic enterococcal infections often lead to life-threatening disease. By analyzing the immune response of two patients with systemic enterococcal infections against enterococcal polysaccharide antigens, we found that both patients had antibodies against all four of the capsular serotypes identified to date. Antibody concentrations against the causative capsular serotype were in the same range as antibodies against the other three capsular protoserotypes. Interestingly, we noted a difference between the two patients with respect to opsonic activity in the killing assay: one patient showed better killing of all four capsular prototypes than the other. However, killing against the infecting serotype was not increased in comparison to killing of the other serotypes in the two patients. This finding supports previously published data that most healthy humans possess preexisting, naturally acquired, anti-enterococcal antibodies. We conclude, therefore, that systemic infection with enterococci does not lead to higher antibody concentrations or better opsonic killing against the causative capsular serotype.
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Affiliation(s)
- M Hufnagel
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Kropec A, Hufnagel M, Zimmermann K, Huebner J. In vitro Assessment of the Host Response against Enterococcus faecalis Used in Probiotic Preparations. Infection 2005; 33:377-9. [PMID: 16258871 DOI: 10.1007/s15010-005-5063-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2005] [Accepted: 08/09/2005] [Indexed: 12/01/2022]
Abstract
Along with other lactic acid bacteria, enterococci are used in food products and as health promoting agents. The safety of these products must be ensured, because they contain potentially pathogenic microorganisms. Here we present an in vitro opsonophagocytic assay that closely mimics the protective human immune response to Enterococcus faecalis and Enterococcus faecium. A collection of closely related E. faecalis isolates used as probiotics showed different susceptibilities to opsonic killing, suggesting that some of these isolates possess a capsule while other do not. This information may be helpful in assessing the safety of a given bacterial isolate used and could detect likely enterococcal candidates for probiotic preparations.
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Affiliation(s)
- A Kropec
- Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Walker RI, Blanchard T, Braun JM, Cebra JJ, Cross AS, Fattom A, Giannasca PJ, Holder IA, Huebner J, Matthews R, Pier GB, Romani L, von Specht BU, Trautmann M. Meeting summary. Vaccine 2004; 22:801-4. [PMID: 15040930 DOI: 10.1016/j.vaccine.2003.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Antibiotic resistance has become a worldwide problem. However, the reasons for the uneven geographic distribution of antibiotic-resistant microorganisms are not fully understood. For instance, there are striking differences in the epidemiology of multiresistant gram-positive cocci between the USA and Germany. According to recent reports, the prevalence of high-level penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in clinically relevant isolates of hospitalised patients in the USA and Germany are: PRP, 14% versus less than 1%; MRSA, 36% versus 15%; and VRE, 15% versus 1%. These disparities may be explained by several determinants: (1) diagnostic practice and laboratory recognition (all three pathogens); (2) clonal differences and pathogen transmissibility (VRE); (3) antibiotic prescribing practices (all three pathogens); (4) population characteristics, including extensive daycare exposure in the USA (PRP); (5) cultural factors (all three pathogens); (6) factors related to the health-care and legal system (all three pathogens); and (7) infection-control practices (MRSA and VRE). Understanding these determinants is important for preventing further spread of multiresistant cocci within the USA. A rational approach to national surveillance is urgently needed in Germany to preserve the favourable situation and decrease MRSA transmission. Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms.
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Affiliation(s)
- S Harbarth
- Children's Hospital, and Harvard Medical School, Boston, USA.
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