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Kurihara C, Kerpel-Fronius S, Becker S, Chan A, Nagaty Y, Naseem S, Schenk J, Matsuyama K, Baroutsou V. Declaration of Helsinki: ethical norm in pursuit of common global goals. Front Med (Lausanne) 2024; 11:1360653. [PMID: 38628806 PMCID: PMC11019506 DOI: 10.3389/fmed.2024.1360653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/21/2024] [Indexed: 04/19/2024] Open
Abstract
The World Medical Association's Declaration of Helsinki is in the process of being revised. The following amendments are recommended to be incorporated in pursuit of the common goal of promoting health for all. 1. Data-driven research that facilitates broad informed consent and dynamic consent, assuring participant's rights, and the sharing of individual participant data (IPD) and research results to promote open science and generate social value. 2. Risk minimisation in a placebo-controlled study and post-trial access to the best-proven interventions for all who need them. 3. A future-oriented research framework for co-creation with all the relevant stakeholders.
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Affiliation(s)
- Chieko Kurihara
- Kanagawa Dental University, Yokosuka, Japan
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
| | - Sandor Kerpel-Fronius
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Sander Becker
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- Consultants in Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | - Anthony Chan
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- Pfizer Healthcare Ireland, Dublin, Ireland
| | - Yasmin Nagaty
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- The Middle East Association of Pharmaceutical Medicine Professionals, Cairo, Egypt
| | - Shehla Naseem
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- Academic and Research College of Family Medicine, Karachi, Pakistan
| | - Johanna Schenk
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- PPH plus GmbH & Co. KG, Hochheim am Main, Germany
| | - Kotone Matsuyama
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
- Department of Health Policy and Management, Nippon Medical School, Tokyo, Japan
| | - Varvara Baroutsou
- Ethics Working Group of International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), Woerden, Netherlands
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Bedei IA, Kniess D, Keil C, Wolter A, Schenk J, Sachs UJ, Axt-Fliedner R. Monitoring of Women with Anti-Ro/SSA and Anti-La/SSB Antibodies in Germany-Status Quo and Intensified Monitoring Concepts. J Clin Med 2024; 13:1142. [PMID: 38398455 PMCID: PMC10889801 DOI: 10.3390/jcm13041142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. Methods: To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. Results: There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. Conclusion: Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance.
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Affiliation(s)
- Ivonne Alexandra Bedei
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, Germany; (A.W.); (J.S.); (R.A.-F.)
| | - David Kniess
- Department of Prenatal Diagnosis and Fetal Therapy, Philipps-University Marburg, 35041 Marburg, Germany; (D.K.)
| | - Corinna Keil
- Department of Prenatal Diagnosis and Fetal Therapy, Philipps-University Marburg, 35041 Marburg, Germany; (D.K.)
| | - Aline Wolter
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, Germany; (A.W.); (J.S.); (R.A.-F.)
| | - Johanna Schenk
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, Germany; (A.W.); (J.S.); (R.A.-F.)
| | - Ulrich J. Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, 35392 Giessen, Germany;
- Center for Transfusion Medicine and Hemotherapy, University Hospital Giessen and Marburg, 35041 Marburg, Germany
- German Center for Fetomaternal Incompatibility (DZFI), University Hospital Giessen and Marburg, 35392 Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, 35392 Giessen, Germany; (A.W.); (J.S.); (R.A.-F.)
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Axt-Fliedner R, Nazar A, Bedei I, Schenk J, Reitz M, Rupp S, Jux C, Wolter A. Associated Anomalies and Outcome in Patients with Prenatal Diagnosis of Aortic Arch Anomalies as Aberrant Right Subclavian Artery, Right Aortic Arch and Double Aortic Arch. Diagnostics (Basel) 2024; 14:238. [PMID: 38337754 PMCID: PMC10855084 DOI: 10.3390/diagnostics14030238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
We aimed to evaluate retrospectively associated anomalies and outcome in prenatal aortic arch anomalies (AAAs). We included ninety patients with aberrant right subclavian artery (ARSA), right aortic arch (RAA) with mirror image branching (RAA-mirror) or aberrant left subclavian artery (RAA-ALSA) and double aortic arch (DAA) between 2011 and 2020. In total, 19/90 (21.1%) had chromosomal anomalies, the highest rate being within the ARSA subgroup (17/46, 37%). All (13/13) of the RAA-mirror subgroup, 10/27 (37.0%) of RAA-ALSA, 13/46 (28.3%) of ARSA and 0/4 within the DAA subgroup had additional intracardiac anomaly. The rate of extracardiac anomalies was 30.7% in RAA-mirror, 28.3% in ARSA, 25.0% in DAA and 22.2% in the RAA-ALSA subgroup. A total of 42/90 (46.7%) had isolated AAAs: three (7.1%) with chromosomal anomalies, all trisomy 21 (3/26, 11.5%) within the ARSA subgroup. Out of 90, 19 (21.1%) were lost to follow-up (FU). Two (2.2%) intrauterine deaths occurred, and six (6.7%) with chromosomal anomalies terminated their pregnancy. In total, 63 (70.0%) were liveborn, 3/63 (4.8%) with severe comorbidity had compassionate care and 3/60 (5.0%) were lost to FU. The survival rate in the intention-to-treat cohort was 53/57 (93%). Forty-one (77.4%) presented with vascular ring/sling, two (4.9%) with RAA-ALSA developed symptoms and one (2.4%) needed an operation. We conclude that intervention due to vascular ring is rarely necessary. NIPT could be useful in isolated ARSA cases without higher a priori risk for trisomy 21 and after exclusion of other anomalies.
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Affiliation(s)
- Roland Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Asia Nazar
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Ivonne Bedei
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Maleen Reitz
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
| | - Stefan Rupp
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Christian Jux
- Department of Paediatric Cardiology, Children’s Hospital, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (S.R.); (C.J.)
| | - Aline Wolter
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen and University Hospital, Giessen & Marburg, 35392 Giessen, Germany; (R.A.-F.); (A.N.); (I.B.); (J.S.); (M.R.)
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Schmand C, Misselwitz B, Hudel H, Bedei I, Wolter A, Schenk J, Keil C, Köhler S, Axt-Fliedner R. Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse. Ultraschall Med 2023; 44:e175-e183. [PMID: 35304733 DOI: 10.1055/a-1778-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM OF THE STUDY The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013. METHOD This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019. RESULTS At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction. CONCLUSION The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.
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Affiliation(s)
- Christine Schmand
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Björn Misselwitz
- Head of the office and project management, Office for Quality Assurance in Hesse, Eschborn, Germany
| | - Helge Hudel
- Department of Medical Statistics, Justus-Liebig-University, Giessen, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Corinna Keil
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Siegmund Köhler
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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Mamalis M, Koehler T, Bedei I, Wolter A, Schenk J, Widriani E, Axt-Fliedner R. Comparison of the Results of Prenatal and Postnatal Echocardiography and Postnatal Cardiac MRI in Children with a Congenital Heart Defect. J Clin Med 2023; 12:jcm12103508. [PMID: 37240614 DOI: 10.3390/jcm12103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE In fetuses with suspicion of congenital heart disease (CHD), assessment by segmental fetal echocardiography is of great importance. This study sought to examine the concordance of expert fetal echocardiography and postnatal MRI of the heart at a high-volume paediatric heart centre. METHODS The data of two hundred forty-two fetuses have been gathered under the condition of full pre- and postnatal and the presence of a pre- and postnatal diagnosis of CHD. The haemodynamically leading diagnosis was determined for each test person and was then sorted into diagnostic groups. The diagnoses and diagnostic groups were used for the comparison of diagnostic accuracy in fetal echocardiography. RESULTS All comparisons between the diagnostic methods for detection of congenital heart disease showed an "almost perfect" (Cohen's Kappa > 0.9) strength of agreement for the diagnostic groups. The diagnosis made by prenatal echocardiography showed a sensitivity of 90-100%, a specificity and a negative predictive value of 97-100%, and a positive predictive value of 85-100%. The diagnostic congruence resulted in an "almost perfect" strength of agreement for all evaluated diagnoses (transposition of great arteries, double outlet right ventricle, hypoplastic left heart, tetralogy of Fallot, atrioventricular septal defect). An agreement of Cohen's Kappa > 0.9 was achieved for all groups, with exception of the diagnosis of double outlet right ventricle (0.8) in prenatal echocardiography compared to postnatal echocardiography. This study came to the result of a sensitivity of 88-100%, a specificity and negative predictive value of 97-100%, and a positive predictive value of 84-100%. The performance of cardiac magnetic resonance imaging (MRI) as an additional measure to echocardiography had an added value in the description of the malposition of the great arteries when diagnosed with double outlet right ventricle and in the detailed description of the anatomy of the lung circulation. CONCLUSIONS Prenatal echocardiography could be shown to be a reliable method for detection of congenital heart disease when regarding the slightly lower accuracy of diagnosis for double outlet right ventricle and right heart anomalies. Furthermore, the impact of examiner experience and the consideration of follow-up examinations for further improvement of diagnosis accuracy may not be underestimated. The main advantage of an additional MRI is the possibility to obtain a detailed anatomic description of the blood vessels of the lung and the outflow tract. The conduction of further studies that include false-negative and false-positive cases, and studies that are not set within the high-risk-group, as well as studies in a less specialized setting, would allow the completion and investigation of possible differences and discrepancies when comparing the results that have been obtained in this study.
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Affiliation(s)
- Marios Mamalis
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Tamara Koehler
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Johanna Schenk
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Ellyda Widriani
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine & Fetal Therapy, Department of Obstetrics & Gynecology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
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Bedei I, Gehrke T, Gloning KP, Meyer-Wittkopf M, Willner D, Krapp M, Scharf A, Degenhardt J, Heling KS, Kozlowski P, Trautmann K, Jahns KM, Geipel A, Baumüller JE, Wilhelm L, Gottschalk I, Schröer A, Graf A, Wolter A, Schenk J, Weber A, Van den Veyver IB, Axt-Fliedner R. Multicenter clinical experience with non-invasive cell-free DNA screening for monosomy X and related X-chromosome variants. Prenat Diagn 2023; 43:192-206. [PMID: 36726284 DOI: 10.1002/pd.6320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to investigate how the presence of fetal anomalies and different X chromosome variants influences Cell-free DNA (cfDNA) screening results for monosomy X. METHODS From a multicenter retrospective survey on 673 pregnancies with prenatally suspected or confirmed Turner syndrome, we analyzed the subgroup for which prenatal cfDNA screening and karyotype results were available. A cfDNA screening result was defined as true positive (TP) when confirmatory testing showed 45,X or an X-chromosome variant. RESULTS We had cfDNA results, karyotype, and phenotype data for 55 pregnancies. cfDNA results were high risk for monosomy X in 48/55, of which 23 were TP and 25 were false positive (FP). 32/48 high-risk cfDNA cases did not show fetal anomalies. Of these, 7 were TP. All were X-chromosome variants. All 16 fetuses with high-risk cfDNA result and ultrasound anomalies were TP. Of fetuses with abnormalities, those with 45,X more often had fetal hydrops/cystic hygroma, whereas those with "variant" karyotypes had different anomalies. CONCLUSION Both, 45,X or X-chromosome variants can be detected after a high-risk cfDNA result for monosomy X. When there are fetal anomalies, the result is more likely a TP. In the absence of fetal anomalies, it is most often an FP or X-chromosome variant.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Tascha Gehrke
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | | | | | - Daria Willner
- Center for Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Martin Krapp
- Center for Prenatal Medicine on Elbe Hamburg, Hamburg, Germany
| | | | | | - Kai-Sven Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Peter Kozlowski
- Prenatal Medicine and Genetics Düsseldorf, Praenatal.de, Duesseldorf, Germany
| | | | - Kai M Jahns
- Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Annegret Geipel
- Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Ingo Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | | | - Alexander Graf
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Axel Weber
- Department of Human Genetics, Justus-Liebig University, Giessen, Germany
| | - Ignatia B Van den Veyver
- Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
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Bedei I, Gloning KP, Joyeux L, Meyer-Wittkopf M, Willner D, Krapp M, Scharf A, Degenhardt J, Heling KS, Kozlowski P, Trautmann K, Jahns KM, Geipel A, Tekesin I, Elsässer M, Wilhelm L, Gottschalk I, Baumüller JE, Birdir C, Schröer A, Zöllner F, Wolter A, Schenk J, Gehrke T, Spaeth A, Axt-Fliedner R. Turner syndrome-omphalocele association: Incidence, karyotype, phenotype and fetal outcome. Prenat Diagn 2023; 43:183-191. [PMID: 36600414 DOI: 10.1002/pd.6302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Omphalocele is known to be associated with genetic anomalies like trisomy 13, 18 and Beckwith-Wiedemann syndrome, but not with Turner syndrome (TS). Our aim was to assess the incidence of omphalocele in fetuses with TS, the phenotype of this association with other anomalies, their karyotype, and the fetal outcomes. METHOD Retrospective multicenter study of fetuses with confirmed diagnosis of TS. Data were extracted from a detailed questionnaire sent to specialists in prenatal ultrasound. RESULTS 680 fetuses with TS were included in this analysis. Incidence of small omphalocele in fetuses diagnosed ≥12 weeks was 3.1%. Including fetuses diagnosed before 12 weeks, it was 5.1%. 97.1% (34/35) of the affected fetuses had one or more associated anomalies including increased nuchal translucency (≥3 mm) and/or cystic hygroma (94.3%), hydrops/skin edema (71.1%), and cardiac anomalies (40%). The karyotype was 45,X in all fetuses. Fetal outcomes were poor with only 1 fetus born alive. CONCLUSION TS with 45,X karyotype but not with X chromosome variants is associated with small omphalocele. Most of these fetuses have associated anomalies and a poor prognosis. Our data suggest an association of TS with omphalocele, which is evident from the first trimester.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Luc Joyeux
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Fetal Center, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | | | - Daria Willner
- Center for Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Martin Krapp
- Center for Prenatal Medicine on Elbe, Hamburg, Germany
| | | | | | - Kai-Sven Heling
- Center of Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Peter Kozlowski
- Praenatal.de, Prenatal Medicine and Genetics Düsseldorf, Düsseldorf, Germany
| | | | - Kai M Jahns
- Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Annegret Geipel
- Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Michael Elsässer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ingo Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | | | - Cahit Birdir
- Department of Obstetrics and Gynecology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Felix Zöllner
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Tascha Gehrke
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Alicia Spaeth
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University Giessen, Giessen, Germany
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de Sainte Fare A, Bedei I, Wolter A, Schenk J, Widriani E, Keil C, Koehler S, Bahlmann F, Strizek B, Gembruch U, Berg C, Axt-Fliedner R. The Value of Delta Middle Cerebral Artery Peak Systolic Velocity for the Prediction of Twin Anemia-Polycythemia Sequence-Analysis of a Heterogenous Cohort of Monochorionic Twins. J Clin Med 2022; 11:jcm11247541. [PMID: 36556157 PMCID: PMC9783345 DOI: 10.3390/jcm11247541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) > 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of >1.5 and <1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. Methods: A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Results: Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Conclusions: Our data shows that delta MCA-PSV > 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.
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Affiliation(s)
- Anthea de Sainte Fare
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
- Correspondence: ; Tel.: +49-17-68458-5617
| | - Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Ellydda Widriani
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
| | - Corinna Keil
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
| | - Siegmund Koehler
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
| | - Franz Bahlmann
- Department of Ultrasound Diagnostics and Prenatal Medicine, Buergerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, 53127 Bonn, Germany
- Department of Prenatal Medicine and Gynaecological Ultrasound, University Hospital Cologne, 50937 Cologne, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, 35392 Giessen, Germany
- Department of Prenatal Medicine and Fetal Therapy, University Hospital Marburg, 35041 Marburg, Germany
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9
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Kurihara C, Crawley FP, Baroutsou V, Becker S, Franke-Bray B, Granville CA, Matsuyama K, Naseem S, Schenk J, Kerpel-Fronius S. The continuation of clinical trials in times of war: A need to develop ethics and situationally adaptive clinical research guidelines. Front Med (Lausanne) 2022; 9:966220. [PMID: 36186768 PMCID: PMC9522896 DOI: 10.3389/fmed.2022.966220] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chieko Kurihara
- Kanagaawa Dental University, Kanagawa, Japan
- *Correspondence: Chieko Kurihara
| | - Francis P. Crawley
- Good Clinical Practice Alliance - Europe (GCPA) and Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), Leuven, Belgium
| | | | - Sander Becker
- Consultants in Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | | | | | - Kotone Matsuyama
- Department of Health Policy and Management, Nippon Medical School, Tokyo, Japan
| | - Shehla Naseem
- Academic and Research College of Family Medicine Pakistan, Karachi, Pakistan
| | | | - Sandor Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
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10
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Kerpel-Fronius S, Kurihara C, Crawley FP, Baroutsou V, Becker S, Franke-Bray B, Matsuyama K, Naseem S, Schenk J. The ethical responsibility to continue investigational treatments of research participants in situation of armed conflicts, economic sanctions or natural catastrophes. Front Med (Lausanne) 2022; 9:950409. [PMID: 36017010 PMCID: PMC9395717 DOI: 10.3389/fmed.2022.950409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
This paper discusses the effects of armed conflict, economic sanctions, and natural catastrophes on ongoing clinical trials. We suggest that • stopping the accrual of new patients in clinical trials under such extreme conditions is acceptable. • research participants already receiving trial medication in such disruptive situations are to be considered highly vulnerable due to their medical dependency for ongoing treatment according to the approved clinical study protocol. • based on the present experience in Ukraine and Russia, we conclude that finishing ongoing trial treatments according to approved or amended protocols should be considered to be an ethical obligation of trial sponsors irrespective whether trial disruption is due to war, economic sanctions, or natural catastrophes. • it is important to devote more attention to the ethical challenges raised by such fundamentally disruptive situations to clinical trials generally in any region of the world.
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Affiliation(s)
- Sandor Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | | | - Francis P. Crawley
- Good Clinical Practice Alliance—Europe (GCPA) & Strategic Initiative for Developing Capacity in Ethical Review, Leuven, Belgium
| | | | - Sander Becker
- Consultant in Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | | | - Kotone Matsuyama
- Department of Health Policy and Management, Nippon Medical School, Tokyo, Japan
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11
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Schenk J, van der Ven WH, Schuurmans J, Roerhorst S, Cherpanath TGV, Lagrand WK, Thoral P, Elbers PWG, Tuinman PR, Scheeren TWL, Bakker J, Geerts BF, Veelo DP, Paulus F, Vlaar APJ. Definition and incidence of hypotension in intensive care unit patients, an international survey of the European Society of Intensive Care Medicine. J Crit Care 2021; 65:142-148. [PMID: 34148010 DOI: 10.1016/j.jcrc.2021.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although hypotension in ICU patients is associated with adverse outcome, currently used definitions are unknown and no universally accepted definition exists. METHODS We conducted an international, peer-reviewed survey among ICU physicians and nurses to provide insight in currently used definitions, estimations of incidence, and duration of hypotension. RESULTS Out of 1394 respondents (1055 physicians (76%) and 339 nurses (24%)), 1207 (82%) completed the questionnaire. In all patient categories, hypotension definitions were predominantly based on an absolute MAP of 65 mmHg, except for the neuro(trauma) category (75 mmHg, p < 0.001), without differences between answers from physicians and nurses. Hypotension incidence was estimated at 55%, and time per day spent in hypotension at 15%, both with nurses reporting higher percentages than physicians (estimated mean difference 5%, p = 0.01; and 4%, p < 0.001). CONCLUSIONS An absolute MAP threshold of 65 mmHg is most frequently used to define hypotension in ICU patients. In neuro(trauma) patients a higher threshold was reported. The majority of ICU patients are estimated to endure hypotension during their ICU admission for a considerable amount of time, with nurses reporting a higher estimated incidence and time spent in hypotension than physicians.
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Affiliation(s)
- J Schenk
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - W H van der Ven
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - J Schuurmans
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands
| | - S Roerhorst
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - T G V Cherpanath
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands
| | - W K Lagrand
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands
| | - P Thoral
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity, de Boelelaan 1117, Amsterdam, Netherlands
| | - P W G Elbers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity, de Boelelaan 1117, Amsterdam, Netherlands
| | - P R Tuinman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity, de Boelelaan 1117, Amsterdam, Netherlands
| | - T W L Scheeren
- University Medical Center Groningen, University of Groningen, Department of Anesthesiology, Groningen, Netherlands
| | - J Bakker
- New York University Langone Medical Center, New York University Langone Health, Department of Pulmonary and Critical Care, New York, USA; Columbia University Medical Center, Columbia University, Department of Pulmonology and Critical Care, New York, USA; Erasmus MC University Medical Center, Erasmus University, Department of Intensive Care, Rotterdam, Netherlands; Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Departamento de Medicina Intensiva, Santiago, Chile
| | - B F Geerts
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - D P Veelo
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - F Paulus
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - A P J Vlaar
- Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands.
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12
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Sagova-Mareckova M, Boenigk J, Bouchez A, Cermakova K, Chonova T, Cordier T, Eisendle U, Elersek T, Fazi S, Fleituch T, Frühe L, Gajdosova M, Graupner N, Haegerbaeumer A, Kelly AM, Kopecky J, Leese F, Nõges P, Orlic S, Panksep K, Pawlowski J, Petrusek A, Piggott JJ, Rusch JC, Salis R, Schenk J, Simek K, Stovicek A, Strand DA, Vasquez MI, Vrålstad T, Zlatkovic S, Zupancic M, Stoeck T. Expanding ecological assessment by integrating microorganisms into routine freshwater biomonitoring. Water Res 2021; 191:116767. [PMID: 33418487 DOI: 10.1016/j.watres.2020.116767] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
Bioindication has become an indispensable part of water quality monitoring in most countries of the world, with the presence and abundance of bioindicator taxa, mostly multicellular eukaryotes, used for biotic indices. In contrast, microbes (bacteria, archaea and protists) are seldom used as bioindicators in routine assessments, although they have been recognized for their importance in environmental processes. Recently, the use of molecular methods has revealed unexpected diversity within known functional groups and novel metabolic pathways that are particularly important in energy and nutrient cycling. In various habitats, microbial communities respond to eutrophication, metals, and natural or anthropogenic organic pollutants through changes in diversity and function. In this review, we evaluated the common trends in these changes, documenting that they have value as bioindicators and can be used not only for monitoring but also for improving our understanding of the major processes in lotic and lentic environments. Current knowledge provides a solid foundation for exploiting microbial taxa, community structures and diversity, as well as functional genes, in novel monitoring programs. These microbial community measures can also be combined into biotic indices, improving the resolution of individual bioindicators. Here, we assess particular molecular approaches complemented by advanced bioinformatic analysis, as these are the most promising with respect to detailed bioindication value. We conclude that microbial community dynamics are a missing link important for our understanding of rapid changes in the structure and function of aquatic ecosystems, and should be addressed in the future environmental monitoring of freshwater ecosystems.
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Affiliation(s)
- M Sagova-Mareckova
- Dept. of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences, Kamýcká 129, Prague 6, 16500, Czechia.
| | - J Boenigk
- Biodiversity, University of Duisburg-Essen, Universitaetsstraße 5, 45141 Essen, Germany
| | - A Bouchez
- UMR CARRTEL, INRAE, UMR Carrtel, 75 av. de Corzent, FR-74203 Thonon les Bains cedex, France; University Savoie Mont-Blanc, UMR CARRTEL, FR-73370 Le Bourget du Lac, France
| | - K Cermakova
- ID-Gene Ecodiagnostics, Campus Biotech Innovation Park, 15, av. Sécheron, 1202 Geneva, Switzerland
| | - T Chonova
- UMR CARRTEL, INRAE, UMR Carrtel, 75 av. de Corzent, FR-74203 Thonon les Bains cedex, France; University Savoie Mont-Blanc, UMR CARRTEL, FR-73370 Le Bourget du Lac, France
| | - T Cordier
- Department of Genetics and Evolution, University of Geneva, Science III, 4 Boulevard d'Yvoy, 1205 Geneva, Switzerland
| | - U Eisendle
- University of Salzburg, Hellbrunnerstraße 34, 5020 Salzburg, Austria
| | - T Elersek
- National Institute of Biology, Vecna pot 111, SI-1000 Ljubljana, Slovenia
| | - S Fazi
- Water Research Institute, National Research Council of Italy (IRSA-CNR), Via Salaria km 29,300 - C.P. 10, 00015 Monterotondo St., Rome, Italy
| | - T Fleituch
- Institute of Nature Conservation, Polish Academy of Sciences, ul. Adama Mickiewicza 33, 31-120 Krakow, Poland
| | - L Frühe
- Ecology Group, Technische Universität Kaiserslautern, D-67663 Kaiserslautern, Germany
| | - M Gajdosova
- Dept. of Ecology, Faculty of Science, Charles University, Viničná 7, 12844 Prague, Czechia
| | - N Graupner
- Biodiversity, University of Duisburg-Essen, Universitaetsstraße 5, 45141 Essen, Germany
| | - A Haegerbaeumer
- Dept. of Animal Ecology, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany
| | - A-M Kelly
- School of Natural Sciences, Trinity College Dublin, University of Dublin, College Green, Dublin 2, D02 PN40, Ireland
| | - J Kopecky
- Epidemiology and Ecology of Microoganisms, Crop Research Institute, Drnovská 507, 16106 Prague 6, Czechia
| | - F Leese
- Biodiversity, University of Duisburg-Essen, Universitaetsstraße 5, 45141 Essen, Germany; Aquatic Ecosystem Resarch, University of Duisburg-Essen, Universitaetsstrasse 5 D-45141 Essen, Germany
| | - P Nõges
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Kreutzwaldi 5, Tartu 51006, Estonia
| | - S Orlic
- Institute Ruđer Bošković, Bijenička 54, 10000 Zagreb, Croatia; Center of Excellence for Science and Technology Integrating Mediterranean, Bijenička 54,10 000 Zagreb, Croatia
| | - K Panksep
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Kreutzwaldi 5, Tartu 51006, Estonia
| | - J Pawlowski
- ID-Gene Ecodiagnostics, Campus Biotech Innovation Park, 15, av. Sécheron, 1202 Geneva, Switzerland; Department of Genetics and Evolution, University of Geneva, Science III, 4 Boulevard d'Yvoy, 1205 Geneva, Switzerland; Institute of Oceanology, Polish Academy of Sciences, Powstańców Warszawy 55, 81-712 Sopot, Poland
| | - A Petrusek
- Dept. of Ecology, Faculty of Science, Charles University, Viničná 7, 12844 Prague, Czechia
| | - J J Piggott
- School of Natural Sciences, Trinity College Dublin, University of Dublin, College Green, Dublin 2, D02 PN40, Ireland
| | - J C Rusch
- Norwegian Veterinary Institute, P.O. Box 750, Sentrum, NO-0106 Oslo, Norway; Department of Biosciences, University of Oslo, P.O. Box 1066, Blindern, NO-0316 Oslo, Norway
| | - R Salis
- Department of Biology, Faculty of Science, Lund University, Sölvegatan 37, 223 62 Lund, Sweden
| | - J Schenk
- Dept. of Animal Ecology, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany
| | - K Simek
- Institute of Hydrobiology, Biology Centre CAS, Branišovská 31, 370 05 České Budějovice, Czechia
| | - A Stovicek
- Dept. of Microbiology, Nutrition and Dietetics, Czech University of Life Sciences, Kamýcká 129, Prague 6, 16500, Czechia
| | - D A Strand
- Norwegian Veterinary Institute, P.O. Box 750, Sentrum, NO-0106 Oslo, Norway
| | - M I Vasquez
- Department of Chemical Engineering, Cyprus University of Technology, 30 Arch. Kyprianos Str., 3036 Limassol, Cyprus
| | - T Vrålstad
- Norwegian Veterinary Institute, P.O. Box 750, Sentrum, NO-0106 Oslo, Norway
| | - S Zlatkovic
- Ministry of Environmental Protection, Omladinskih brigada 1, 11070 Belgrade, Serbia; Agency "Akvatorija", 11. krajiške divizije 49, 11090 Belgrade, Serbia
| | - M Zupancic
- National Institute of Biology, Vecna pot 111, SI-1000 Ljubljana, Slovenia
| | - T Stoeck
- Ecology Group, Technische Universität Kaiserslautern, D-67663 Kaiserslautern, Germany
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13
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Kurihara C, Baroutsou V, Becker S, Brun J, Franke-Bray B, Carlesi R, Chan A, Collia LF, Kleist P, Laranjeira LF, Matsuyama K, Naseem S, Schenk J, Silva H, Kerpel-Fronius S. Corrigendum: Linking the Declarations of Helsinki and of Taipei: Critical Challenges of Future-Oriented Research Ethics. Front Pharmacol 2021; 11:637775. [PMID: 33628190 PMCID: PMC7897664 DOI: 10.3389/fphar.2020.637775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Chieko Kurihara
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Varvara Baroutsou
- Independent Medical Consultant, and Consultant, Pharmaceutical Medicine, Athens, Greece
| | - Sander Becker
- Consultants in Pharmaceutical Medicine, Dover Heights, Australia
| | | | | | | | - Anthony Chan
- Pfizer Biopharmaceuticals Group, Dublin, Ireland
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14
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Wijnberge M, Schenk J, Bulle E, Vlaar AP, Maheshwari K, Hollmann MW, Binnekade JM, Geerts BF, Veelo DP. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open 2021; 5:6073395. [PMID: 33609377 PMCID: PMC7893468 DOI: 10.1093/bjsopen/zraa018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality. Methods MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity. Results The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent. Conclusion Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic.
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Affiliation(s)
- M Wijnberge
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J Schenk
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - E Bulle
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - A P Vlaar
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K Maheshwari
- Department of General Anaesthesiology, Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - J M Binnekade
- Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - B F Geerts
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - D P Veelo
- Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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15
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Kerpel-Fronius S, Baroutsou V, Becker S, Carlesi R, Collia L, Franke-Bray B, Kleist P, Kurihara C, Laranjeira LF, Matsuyama K, Naseem S, Schenk J, Silva H. Development and Use of Gene Therapy Orphan Drugs-Ethical Needs for a Broader Cooperation Between the Pharmaceutical Industry and Society. Front Med (Lausanne) 2020; 7:608249. [PMID: 33425952 PMCID: PMC7785873 DOI: 10.3389/fmed.2020.608249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 01/28/2023] Open
Abstract
Gene therapy orphan medicinal products constitute a unique group of new drugs which in case of hereditary diseases are usually administered only once at an early age, in the hope to provide sufficient gene product to last for the entire life of the patients. The combination of an exceptionally large single payment and the life-long clinical follow-up needed for understanding the long-term benefits and safety of gene therapy, represent new types of scientific, financial, social and ethical challenges for the pharmaceutical industry, regulators and society. With special consideration of the uniqueness and importance of gene therapy, the authors propose a three points plan for a close cooperation between the pharmaceutical industry and society to develop orphan gene therapy. (1) In fully transparent health technology negotiations a close and long-lasting, contractually fixed cooperation should be established between the manufacturers and local health-care stakeholders for sharing the medical and scientific benefits, the financial risks as well as the burdens of the post-authorization clinical and regulatory development. (2) The parties should agree on a fair, locally affordable drug price without the usually very high premium price calculated to compensate for the low number of patients. In case of high manufacturing costs, the companies should offer prolonged, 15–20 years long payment by installment with risk-sharing, especially considering that the late outcome of the treatment is unknown. Society should assist scientifically and financially organizing a specific patient registry, treatment in specialized hospitals and adequate long-term follow-up of patients, the coordinated management of financial transactions related to the risk sharing program. (3) The post-authorization treatment and prolonged observation of additional new cases coordinated by society should provide real world data needed for the modern complex regulatory evaluation of gene therapy products by the competent authorities. We assume that fair sharing of the benefits and risks as well as a well-organized cooperation of society with the industry in collecting real world evidence might result in better drug evaluation and improved accessibility due to lower prices. The outlined concept might support gene therapy more efficiently than the presently requested outstandingly high prices.
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Affiliation(s)
- Sandor Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Varvara Baroutsou
- Independent Medical Consultant & Pharmaceutical Medicine Consultant, Athens, Greece
| | - Sander Becker
- Consultants in Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | | | | | | | | | - Chieko Kurihara
- Quality Assurance and Audit Office, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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16
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Kurihara C, Baroutsou V, Becker S, Brun J, Franke-Bray B, Carlesi R, Chan A, Collia LF, Kleist P, Laranjeira LF, Matsuyama K, Naseem S, Schenk J, Silva H, Kerpel-Fronius S. Linking the Declarations of Helsinki and of Taipei: Critical Challenges of Future-Oriented Research Ethics. Front Pharmacol 2020; 11:579714. [PMID: 33324212 PMCID: PMC7723451 DOI: 10.3389/fphar.2020.579714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
Expansion of data-driven research in the 21st century has posed challenges in the evolution of the international agreed framework of research ethics. The World Medical Association (WMA)'s Declaration of Helsinki (DoH) has provided ethical principles for medical research involving humans since 1964, with the last update in 2013. To complement the DoH, WMA issued the Declaration of Taipei (DoT) in 2016 to provide additional principles for health databases and biobanks. However, the ethical principles for secondary use of data or material obtained in research remain unclear. With such a perspective, the Working Group on Ethics (WGE) of the International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP) suggests a closer scientific linkage in the DoH to the (Declaration of Taipei) DoT focusing specifically on areas that will facilitate data-driven research, and to further strengthen the protection of research participants.
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Affiliation(s)
- Chieko Kurihara
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Varvara Baroutsou
- Independent Medical Consultant, and Consultant, Pharmaceutical Medicine, Athens, Greece
| | - Sander Becker
- Consultants in Pharmaceutical Medicine, Dover Heights, Australia
| | | | | | | | - Anthony Chan
- Pfizer Biopharmaceuticals Group, Dublin, Ireland
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Wijnberge M, Schenk J, Terwindt LE, Mulder MP, Hollmann MW, Vlaar AP, Veelo DP, Geerts BF. The use of a machine-learning algorithm that predicts hypotension during surgery in combination with personalized treatment guidance: study protocol for a randomized clinical trial. Trials 2019; 20:582. [PMID: 31601239 PMCID: PMC6788048 DOI: 10.1186/s13063-019-3637-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/08/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intraoperative hypotension is associated with increased morbidity and mortality. Current treatment is mostly reactive. The Hypotension Prediction Index (HPI) algorithm is able to predict hypotension minutes before the blood pressure actually decreases. Internal and external validation of this algorithm has shown good sensitivity and specificity. We hypothesize that the use of this algorithm in combination with a personalized treatment protocol will reduce the time weighted average (TWA) in hypotension during surgery spent in hypotension intraoperatively. METHODS/DESIGN We aim to include 100 adult patients undergoing non-cardiac surgery with an anticipated duration of more than 2 h, necessitating the use of an arterial line, and an intraoperatively targeted mean arterial pressure (MAP) of > 65 mmHg. This study is divided into two parts; in phase A baseline TWA data from 40 patients will be collected prospectively. A device (HemoSphere) with HPI software will be connected but fully covered. Phase B is designed as a single-center, randomized controlled trial were 60 patients will be randomized with computer-generated blocks of four, six or eight, with an allocation ratio of 1:1. In the intervention arm the HemoSphere with HPI will be used to guide treatment; in the control arm the HemoSphere with HPI software will be connected but fully covered. The primary outcome is the TWA in hypotension during surgery. DISCUSSION The aim of this trial is to explore whether the use of a machine-learning algorithm intraoperatively can result in less hypotension. To test this, the treating anesthesiologist will need to change treatment behavior from reactive to proactive. TRIAL REGISTRATION This trial has been registered with the NIH, U.S. National Library of Medicine at ClinicalTrials.gov, ID: NCT03376347 . The trial was submitted on 4 November 2017 and accepted for registration on 18 December 2017.
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Affiliation(s)
- M Wijnberge
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
| | - J Schenk
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
| | - L E Terwindt
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
| | - M P Mulder
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands.,Department of Technical Medicine, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - M W Hollmann
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
| | - A P Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
| | - D P Veelo
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands.
| | - B F Geerts
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, The Netherlands
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Kerpel-Fronius S, Becker S, Barrett J, Brun J, Carlesi R, Chan A, Collia LF, Dubois DJ, Kleist P, Koski G, Kurihara C, Laranjeira LF, Schenk J, Silva H. The Shared Ethical Responsibility of Medically and Non-medically Qualified Experts in Human Drug Development Teams. Front Pharmacol 2018; 9:843. [PMID: 30233356 PMCID: PMC6130227 DOI: 10.3389/fphar.2018.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 11/13/2022] Open
Abstract
The complexity of developing and applying increasingly sophisticated new medicinal products has led to the participation of many non-medically qualified scientists in multi-disciplinary non-clinical and clinical drug development teams world-wide. In this introductory paper to the "IFAPP International Ethics Framework for Pharmaceutical Physicians and Medicines Development Scientists" it is argued that all members of such multidisciplinary teams must share the scientific and ethical responsibilities since they all influence directly or indirectly both the outcome of the various phases of the medicines development projects and the safety of the research subjects involved. The participating medical practitioner retains the overriding responsibility and the final decision to stop a trial if the well-being of the research subjects is seriously endangered. All the team members should follow the main ethical principles governing human research, the respect for autonomy, justice, beneficence and non-maleficence. Nevertheless, the weighing of these principles might be different under various conditions according to the specialty of the members.
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Affiliation(s)
- Sandor Kerpel-Fronius
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Sander Becker
- Pharmaceutical Medicine, Dover Heights, NSW, Australia
| | - Jane Barrett
- Pharmaceutical Medicine, Cheshire, United Kingdom
| | | | | | | | | | - Dominique J. Dubois
- PHARMED Post-Graduate Programme in Pharmaceutical Medicine and Medicines Development Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Greg Koski
- Alliance for Clinical Research Excellence and Safety, Harvard Medical School, Boston, MA, United States
| | - Chieko Kurihara
- Quality Assurance and Audit Office, National Institute of Radiological Sciences, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
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Wolf H, Vogel H, Römling L, Schenk J, Lukasczik M. Implementierung und formative Evaluation eines Gesundheitslotsen zur Beratung von Gesundheitsgästen in einem Kurort. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1668023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H Wolf
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - H Vogel
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - L Römling
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - J Schenk
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
| | - M Lukasczik
- Universität Würzburg, Abteilung für Medizinische Psychologie, Würzburg, Deutschland
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Schenk J, Jelusic D, Wittmann M, Schultz K, Schuler M. Erfassung von Angst bei COPD – Faktorielle Validität und Messinvarianz über die Zeit des Generalized Anxiety Disorder Questionnaire (GAD-7). Pneumologie 2017. [DOI: 10.1055/s-0037-1598581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Schenk
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg
| | - D Jelusic
- Klinik Bad Reichenhall der Drv Bayern Süd
| | - M Wittmann
- Klinik Bad Reichenhall der Drv Bayern Süd
| | - K Schultz
- Klinik Bad Reichenhall der Drv Bayern Süd
| | - M Schuler
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg
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21
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Schenk J. Elastografie bei Kindern. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Kaestner F, Coulee L, Bedersdorfer M, Kaiser R, Böhmer P, Linn O, Trudzinski F, Tauchnitz M, Seiler F, Alqudrah M, Langer F, Klingele M, Wilkens H, Fähndrich S, Schenk J, Bals R, Lepper PM. Transfusion von Blutprodukten und Substitution von Gerinnungsfaktoren während ECMO bei Patienten im Lungenversagen. Pneumologie 2015. [DOI: 10.1055/s-0035-1544707] [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: 10/24/2022]
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23
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Kaestner F, Coulee L, Bedersdorfer M, Kaiser R, Böhmer P, Linn O, Trudzinski F, Tauchnitz M, Seiler F, Alqudrah M, Schenk J, Wilkens H, Langer F, Fähndrich S, Klingele M, Bals R, Lepper PM. ECMO-Therapie bei akutem Lungenversagen: Entwicklung der Bilirubinwerte und deren Einfluss auf die Mortalität. Pneumologie 2015. [DOI: 10.1055/s-0035-1544703] [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: 10/24/2022]
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Silva H, Stonier P, Buhler F, Deslypere JP, Criscuolo D, Nell G, Massud J, Geary S, Schenk J, Kerpel-Fronius S, Koski G, Clemens N, Klingmann I, Kesselring G, van Olden R, Dubois D. Corrigendum: Core competencies for pharmaceutical physicians and drug development scientists. Front Pharmacol 2015; 5:297. [PMID: 25639272 PMCID: PMC4295522 DOI: 10.3389/fphar.2014.00297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Honorio Silva
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Peter Stonier
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Fritz Buhler
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Jean P Deslypere
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Domenico Criscuolo
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Gerfried Nell
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Joao Massud
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Stewart Geary
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Johanna Schenk
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Sandor Kerpel-Fronius
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Greg Koski
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Norbert Clemens
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Ingrid Klingmann
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Gustavo Kesselring
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Rudolf van Olden
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
| | - Dominique Dubois
- International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine, Special Secretariat Service Woerden, Netherlands
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Silva H, Stonier P, Buhler F, Deslypere JP, Criscuolo D, Nell G, Massud J, Geary S, Schenk J, Kerpel-Fronius S, Koski G, Clemens N, Klingmann I, Kesselring G, van Olden R, Dubois D. Core competencies for pharmaceutical physicians and drug development scientists. Front Pharmacol 2013; 4:105. [PMID: 23986704 PMCID: PMC3752461 DOI: 10.3389/fphar.2013.00105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022] Open
Abstract
Professional groups, such as IFAPP (International Federation of Pharmaceutical Physicians and Pharmaceutical Medicine), are expected to produce the defined core competencies to orient the discipline and the academic programs for the development of future competent professionals and to advance the profession. On the other hand, PharmaTrain, an Innovative Medicines Initiative project, has become the largest public-private partnership in biomedicine in the European Continent and aims to provide postgraduate courses that are designed to meet the needs of professionals working in medicines development. A working group was formed within IFAPP including representatives from PharmaTrain, academic institutions and national member associations, with special interest and experience on Quality Improvement through education. The objectives were: to define a set of core competencies for pharmaceutical physicians and drug development scientists, to be summarized in a Statement of Competence and to benchmark and align these identified core competencies with the Learning Outcomes (LO) of the PharmaTrain Base Course. The objectives were successfully achieved. Seven domains and 60 core competencies were identified and aligned accordingly. The effective implementation of training programs using the competencies or the PharmaTrain LO anywhere in the world may transform the drug development process to an efficient and integrated process for better and safer medicines. The PharmaTrain Base Course might provide the cognitive framework to achieve the desired Statement of Competence for Pharmaceutical Physicians and Drug Development Scientists worldwide.
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Affiliation(s)
- Honorio Silva
- IFAPP Working Group on Competencies in Pharmaceutical Medicine Netherlands
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Birschmann I, Klamroth R, Eichler H, Schenk J, Kirchmaier CM, Halimeh S. Results of the WIRK prospective, non-interventional observational study of recombinant activated factor VII (rFVIIa) in patients with congenital haemophilia with inhibitors and other bleeding disorders. Haemophilia 2013; 19:679-85. [DOI: 10.1111/hae.12156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- I. Birschmann
- Institute for Laboratory and Transfusion Medicine; Heart and Diabetes Center; Ruhr University Bochum; Bad Oeynhausen; Germany
| | - R. Klamroth
- Department of Internal Medicine - Angiology; Haemostasis and Coagulation Disorders; Vivantes Hospital im Friedrichshain; Berlin; Germany
| | - H. Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine; Saarland University Hospital; Homburg/Saar; Germany
| | - J. Schenk
- Institute of Clinical Hemostaseology and Transfusion Medicine; Saarland University Hospital; Homburg/Saar; Germany
| | - C. M. Kirchmaier
- Section Internal Medicine I - Angiology and Haemostaseology; German Diagnostic Clinic; Wiesbaden; Germany
| | - S. Halimeh
- Coagulation Centre Rhine-Ruhr, Outpatient and Specialist Laboratory for Coagulation Disorders/Haemophilia; Duisburg; Germany
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Jenelten U, Helling C, Both S, Schenk J, Strube J. Model-based Design of Plant-based Extraction Processes. CHEM-ING-TECH 2012. [DOI: 10.1002/cite.201250542] [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: 11/10/2022]
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Kassing M, Jenelten U, Schenk J, Hänsch R, Strube J. Combination of Rigorous and Statistical Modeling for Process Development of Plant-Based Extractions Based on Mass Balances and Biological Aspects. Chem Eng Technol 2011. [DOI: 10.1002/ceat.201100268] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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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Dupuy A, Athes V, Schenk J, Jenelten U, Souchon I. Experimental and theoretical considerations on breakthrough pressure in membrane-based solvent extraction: Focus on citrus essential oil/hydro-alcoholic solvent systems with low interfacial tension. J Memb Sci 2011. [DOI: 10.1016/j.memsci.2011.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dupuy A, Athes V, Schenk J, Jenelten U, Souchon I. Solvent extraction of highly valuable oxygenated terpenes from lemon essential oil using a polypropylene membrane contactor: potential and limitations. FLAVOUR FRAG J 2011. [DOI: 10.1002/ffj.2052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Dupuy
- UMR 782 Laboratoire de Génie et Microbiologie des Procédés Alimentaires AgroParistech, INRA; 78850; Thiverval Grignon; France
| | - V. Athes
- UMR 782 Laboratoire de Génie et Microbiologie des Procédés Alimentaires AgroParistech, INRA; 78850; Thiverval Grignon; France
| | - J. Schenk
- Process Science Group, Corporate R&D Division, Firmenich S.A.; La Jonction, Route des Jeunes 1; 1211; Geneva 8; Switzerland
| | - U. Jenelten
- Process Science Group, Corporate R&D Division, Firmenich S.A.; La Jonction, Route des Jeunes 1; 1211; Geneva 8; Switzerland
| | - I. Souchon
- UMR 782 Laboratoire de Génie et Microbiologie des Procédés Alimentaires AgroParistech, INRA; 78850; Thiverval Grignon; France
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Miesbach W, Schenk J, Alesci S, Lindhoff-Last E. Comparison of the fibrinogen Clauss assay and the fibrinogen PT derived method in patients with dysfibrinogenemia. Thromb Res 2010; 126:e428-33. [DOI: 10.1016/j.thromres.2010.09.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 11/26/2022]
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Mergenthaler U, Heymanns J, Köppler H, Thomalla J, van Roye C, Schenk J, Weide R. Evaluation of psychosocial distress in patients treated in a community-based oncology group practice in Germany. Ann Oncol 2010; 22:931-938. [PMID: 20926545 PMCID: PMC3065878 DOI: 10.1093/annonc/mdq455] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Systematic evaluation of psychosocial distress in oncology outpatients is an important issue. We assessed feasibility and benefit of standardized routine screening using the Distress Thermometer (DT) and Problem List (PL) in all patients of our community-based hematooncology group practice. Patients and methods: One thousand four hundred forty-six patients were screened between July 2008 and September 2008. Five hundred randomly selected patients were sent a feedback form. Results: The average distress level was 4.7, with 37% indicating a distress level >5. Patients with nonmalignant diseases (81% autoimmune diseases or hereditary hemochromatosis) showed the highest distress level of 5.2. Most distressed were patients who just learned about relapse or metastases (6.4), patients receiving best supportive care (5.4) and patients receiving adjuvant antihormonal therapy (5.4). Ninety-seven percent of patients appreciated to speak to their doctor about their distress. Fifty-six percent felt better than usual after this consultation. Conclusion: DT and PL are feasible instruments to measure distress in hematooncology outpatients receiving routine care. DT and PL are able to improve doctor–patient communication and thus should be implemented in routine patient care. The study shows that distress is distributed differently between individuals, disease groups and treatment phases.
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Affiliation(s)
| | | | | | | | | | - J Schenk
- Radiology Group Practice, Mammography Screening Unit Mittelrhein, Koblenz, Germany
| | - R Weide
- Hematology/Oncology Group Practice.
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Kerl R, Kaßing M, Schenk J, Jenelten U, Strube J. Standardisierte Vorgehensweise zur Verfahrensauslegung und -optimierung von Phytoextraktionsprozessen. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050622] [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: 11/09/2022]
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Karl J, Borgya A, Gallusser A, Huber E, Krueger K, Rollinger W, Schenk J. Development of a novel, N-Terminal-proBNP (NT-proBNP) assay with a low detection limit. Scandinavian Journal of Clinical and Laboratory Investigation 2010. [DOI: 10.1080/00365519909168341] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Becker S, Allen C, Schenk J, Clemens N. Shaping IFAPP’s Future. Pharmaceut Med 2010. [DOI: 10.1007/bf03256792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mergenthaler U, Heymanns J, Köppler H, Thomalla J, van Roye C, Schenk J, Weide R. 3009 Evaluation of psycho-social distress in patients treated in a community based oncology group practice in Germany. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70608-1] [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: 10/20/2022] Open
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Kaßing M, Strube J, Jenelten U, Schenk J. Status der Fest-Flüssig-Extraktion von Pflanzenmaterial - Stand der Technik und Modellierung. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sturn J, Voglsam S, Weiss B, Schenk J, Winter F. Evaluation of the Limiting Regime in Iron Ore Fines Reduction with H2-Rich Gases in Fluidized Beds: Fe2O3to Fe3O4. Chem Eng Technol 2009. [DOI: 10.1002/ceat.200800579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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Sturn J, Voglsam S, Weiss B, Winter F, Schenk J. Alternative Feineisenerzreduktion mit H 2-reichen Gasen unter Wirbel- schichtbedingungen. CHEM-ING-TECH 2008. [DOI: 10.1002/cite.200750463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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41
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Xu J, Guo Z, Su L, Nedambale TL, Zhang J, Schenk J, Moreno JF, Dinnyés A, Ji W, Tian XC, Yang X, Du F. Developmental potential of vitrified holstein cattle embryos fertilized in vitro with sex-sorted sperm. J Dairy Sci 2006; 89:2510-8. [PMID: 16772569 DOI: 10.3168/jds.s0022-0302(06)72326-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In vitro fertilization (IVF) is a feasible way to utilize sex-sorted sperm to produce offspring of a predetermined sex in the livestock industry. The objective of the present study was to examine the effects of various factors on bovine IVF and to systematically improve the efficiency of IVF production using sex-sorted sperm. Both bulls and sorting contributed to the variability among differential development rates of embryos fertilized by sexed sperm. Increased sorting pressures (275.8 to 344.75 kPa) did not have a significant effect on the in vitro fertility of the sorted sperm; neither did an extended period of 9 to 14 h from semen collection to sorting. As few as 600 sorted sperm were used to fertilize an oocyte, resulting in blastocyst development of 33.2%. Postwarming of vitrified sexed IVF embryos resulted in high morphological survival (96.3%) and hatching (84.4%) rates, similar to those fertilized by nonsexed sperm (93.1 and 80.6%, respectively). A 40.9% pregnancy rate was established following the transfer of 3,627 vitrified, sexed embryos into synchronized recipients. This was not different from the rates with nonsexed IVF (41.9%, n = 481), or in vivo-produced (53.1%, n = 192) embryos. Of 458 calves born, 442 (96.5%) were female and 99.6% appeared normal. These technologies (sperm sexing-IVF-vitrification-embryo transfer) provide farmers, as well as the livestock industry, with a valuable option for herd expansion and heifer replacement programs. In summary, calves were produced using embryos fertilized by sex-sorted sperm in vitro and cryopreserved by rapid cooling vitrification.
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Affiliation(s)
- J Xu
- Evergen Biotechnologies, Inc., Storrs, CT 06269, USA
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Boger-Megiddo I, Langeberg W, Schenk J, Li C. Neoplasms During Pregnancy and Risk of Adverse Birth Outcomes. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s50-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schenk J, Crichton E. 351 INSEMINATION OF HOLSTEIN HEIFERS WITH SEXED SPERM PROCESSED WITH OR WITHOUT EGG YOLK IN THE GLYCEROL-CONTAINING FREEZING MEDIUM. Reprod Fertil Dev 2006. [DOI: 10.1071/rdv18n2ab351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preparation of media for use in processing sorted sperm is laborious and expensive. The objective was to determine whether pregnancy rates in heifers following AI of frozen/thawed X chromosome-bearing sperm were equivalent for sperm processed for cryopreservation using glycerol-containing medium with or without egg yolk. X chromosome-bearing sperm from each of two Holstein bulls were isolated on the basis of DNA content using a flow cytometer. Sorted sperm were collected in 50-mL plastic tubes containing 2-mL of 20% egg yolk-TRIS extender without glycerol until each tube contained 12.4 mL and approximately 12 million sperm. Sorted sperm were cooled (5�C) over 90 min before the addition of 12% glycerol-containing TIS medium with or without 20% egg yolk, as two equal volumes (6.5 mL) at 15-min intervals. Tubes containing 25 mL were centrifuged at 850g for 20 min (5�C). After the supernatant was removed, sperm pellets within treatments and bulls were pooled. Sperm concentration was adjusted to 10 � 106/mL with medium containing 6% glycerol and 20% egg yolk-TRIS. Sorted sperm were packaged and frozen in 0.25 mL-coded straws on freezing racks in LN2 vapor. Straws from each bull-treatment combination were equally packaged in goblets to assure random use. Post-thaw sperm progressive motility, determined with time-lapse photography ('track motility'), was 44% for non-egg yolk and 43% for 20% egg yolk-glycerol-containing media. Nonsynchronized Holstein heifers (n = 119) were inseminated 4, 12, or 24 h after observed standing estrus. Sperm were deposited into the uterine body anterior to the internal cervical os. Approximately 1 month after insemination, pregnancy was determined using ultrasound. Data were subjected to ANOVA. The pregnancy rate and 95% confidence interval for sorted sperm processed with non-egg yolk-glycerol-containing medium was 56% (49-73; n = 59), and 55% (38-62; n = 60) for the 20% egg yolk-glycerol-containing medium (P > 0.1). Bull or inseminator effects on pregnancy rates were not significant (P > 0.01). Pregnancy rates as a function of time of insemination at 4, 12, or 24 h relative to observed estrus were 62% n = 65; 48% n = 48; and 50% n = 6, respectively (P > 0.1). Even though the scope of the field trial was limited, omission of egg yolk from the glycerol-containing medium did not adversely affect pregnancy rates. Preparation of non-egg yolk-glycerol-containing medium greatly reduces associated time, labor, and expense. This study also resulted in quite acceptable pregnancy rates with insemination doses of 2 � 106 total sorted frozen/thawed sperm.
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Abstract
The recommended use of sexed sperm has been limited to heifers. The objective of this field trial was to determine pregnancy rates in lactating dairy cows following artificial insemination of 2 or 10 � 106 sexed or 10 � 106 unsexed frozen/thawed sperm. Sperm were separated into X chromosome-bearing populations at rates of 3000-5000/s, on the basis of DNA content, with a flow cytometer/sperm sorter operating at 40 psi and using 150 mW of laser intensity. Sperm were sorted, collected and cryopreserved in a Tris-based medium. Holstein cows, averaging 2.4 lactations (range: 1-9), were presynchronized with prostaglandin F2� (PGF)2�; (25 mg) i.m. at 40-58 days in milk (DIM) (average, 44 days). A second dose of PGF2� (25 mg) i.m. was administered 14 days later. All cows were screened with ultrasound 14 days later, and those with normal ovarian and uterine status were used for this study. Qualifying cows received 100 �g gonadotropin-releasing hormone (GnRH) i.m. (average, 72 DIM) and 25 mg PGF2� i.m. 7 days later, and then 100 �g GnRH i.m. 2 days after the prostaglandin. Cows (n = 172) were fixed-timed inseminated 16-19 h after the last GnRH treatment, balanced over three sperm insemination treatments, two Holstein bulls, and two inseminators. Both 32-day pregnancy and 60-day fetal sex were determined using ultrasound. Cows carrying fetuses identified as dying at the 32-day ultrasound check were considered not pregnant. Data were subjected to ANOVA. Effects of sperm treatment, bulls, inseminators, and subsequent interactions on pregnancy rate were not significant (P > 0.05). The 32-day pregnancy rate and 95% confidence interval for 10 � 106 unsexed, 10 � 106 sexed, and 2 � 106 sexed inseminates were 55.6 (42.5-68.6), 43.9 (31.6-57.0), and 40.4% (28.4-53.6), respectively. Additionally, DIM or cow parity did not affect pregnancy rate (P > 0.05). Fetal death (<32 days) for unsexed inseminates was 5.5% (two pregnancies) compared to 9.5% (four pregnancies) for pooled sexed inseminates (P > 0.05). There were four confirmed pregnancies of sexed sperm that also aborted between Days 32-60. Fetal sex ratio was significantly altered (P < 0.05) for sexed (93% female fetuses) compared to unsexed (52% female fetuses) inseminates. Pregnancy rate in these selected lactating cows inseminated with sexed sperm was not significantly lower (P > 0.05) than that for unsexed sperm. However, these results should be viewed cautiously due to the limited numbers of cows used. Successful use of sexed sperm in dairy cows, which approached an elective waiting period of 80 DIM, was achieved with cows that were selected for reproductive status prior to insemination.
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Schenk J. [Not Available]. Spieg Hist 2001; 17:576-83. [PMID: 11633290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
In this article, we report on a family in which five examined members showed clinical signs of Fechtner syndrome, a condition which consists of hearing loss (49%), macro-thrombocytopenia (100%), leukocyte inclusion bodies (100%), eye anomalies (54.3%), and nephritis (38.7%). Hearing loss in Fechtner syndrome appears to be sensorineural with the higher frequencies primarily affected. One aim of the present report was to work out the clinical appearance of hearing loss compared to hearing loss in Alport's syndrome. The most striking difference between hearing loss in Fechtner syndrome and that in Alport's syndrome was that the vast majority of hearing disorders in the latter occur in male patients, which is not the case in Fechtner syndrome. Hearing loss in Fechtner syndrome develops from the second decade of life and progresses slowly with several episodes of sudden deafness.
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Affiliation(s)
- W Delb
- Universitätsklinik und Poliklinik für Hals-Nasen- Ohrenheilkunde, Homburg/Saar.
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Radziwon P, Schenk J, Boczkowska-Radziwon B, Wojtukiewicz MZ, Giedrojc J, Kloczko J, Breddin HK. The effects of polysulfonate derivative (GL 2021) on coagulation in vitro and thrombosis in vivo. Thromb Res 2000; 99:99-104. [PMID: 10904107 DOI: 10.1016/s0049-3848(00)00223-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Radziwon
- Department of Haematology, Medical Academy of Bialystok, Bialystok, Poland.
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Mörsdorf S, Pistorius G, Orthleb R, Pindur G, Schenk J. [Late onset of heparin-induced thrombocytopenia with recurrent arterial thromboses and amputation]. Dtsch Med Wochenschr 1999; 124:1271-4. [PMID: 10587714 DOI: 10.1055/s-2007-1024531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY An 80-year-old woman had been hospitalized in a psychiatric clinic where, on the 22nd day, she sustained a fracture of the neck of the left femur, which was treated by internal screw fixation. The postoperative course was at first without complication. But 9 days postoperatively her platelet count had fallen to 59,000/microliter. As heparin induced type II thrombocytopenia (HIT II) was suspected, the thrombosis prophylaxis with low-molecular heparin was replaced by sodium danaparoid (twice 750 units subcutaneously). Despite this, ischaemia of the right lower leg developed and required amputation. On the following day the left lower leg and foot also became ischemic, where upon she was admitted to the author's hospital (37 days after her admission to the psychiatric clinic). ADMISSION FINDINGS The patient was in a reduced general condition (body-mass index 19.5 kg/m2). She was disoriented as to place and time. Her blood pressure was 140/80 mmHg, her pulse irregular with a ventricular rate of 100/min. The skin below the middle of the left lower leg was cold and livid and the pedal pulses were not palpable. LABORATORY TESTS Haemoglobin content was 9.7 g/dl, the white cell count 9,200/microliter, and platelet count 54,000/microliter. Electrolytes and creatinine were within normal limits. TREATMENT AND COURSE Thrombendarterectomy was performed once via the left groin under danaparoid anticoagulation. There was no re-occlusion and the patient was able to walk again.--It was ascertained subsequently, she had already been given ordinary heparin in the psychiatric clinic for 20 days. Her platelet count of around 70,000/microliter returned to normal even though heparin administration was continued. CONCLUSION A reduction in platelet count by more than half during heparin treatment suggests heparin-induced thrombocytopenia, in which case heparin should be discontinued at once. In high-risk patients adequate treatment should be initiated with other anticoagulants even before the occurrence of thromboembolism.
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Affiliation(s)
- S Mörsdorf
- Abteilung für klinische Hämostaseologie und Transfusionsmedizin, Universitätskliniken des Saarlandes.
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Karl J, Borgya A, Gallusser A, Huber E, Krueger K, Rollinger W, Schenk J. Development of a novel, N-terminal-proBNP (NT-proBNP) assay with a low detection limit. Scand J Clin Lab Invest Suppl 1999; 230:177-81. [PMID: 10389216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
A novel, highly sensitive and specific N-Terminal-proBNP (NT-proBNP) assay based on a sandwich format has been developed. The assay time is below 2 hours and no extraction process is needed. The calibration curve covers a NT-proBNP concentration range from 0 pmol/L up to 600 pmol/L. The analytical detection limit of the assay was estimated to be 2.7 pmol/L (3 SD). The intra-assay coefficient of variation is 5.7% (at 50 pmol/L) and 6.1% (at 250 pmol/L), while the inter-assay CVs are 15.8% (15 pmol/L) and 8.2% (250 pmol/L). There is no significant interference by bilirubin (up to 900 mumol/L), haemoglobin (up to 10 g/L), rheumatoid factors (up to 975 IU/mL), triglycerides (up to 20.5 mmol/L), biotin (up to 50 micrograms/L), digoxin (up to 100 micrograms/L) and digitoxin (up to 200 micrograms/L). The analyte NT-proBNP is fully stable in whole blood over 3 days and in EDTA-plasma over 24 hours. This good stability of NT-proBNP compared to other less stable natriuretic peptides is a significant advantage and a main prerequisite for a routine diagnostic marker. Preliminary results of using this new assay in clinical studies for diagnosing and monitoring left ventricular dysfunction demonstrate that there is a significant gain in diagnostic validity.
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Affiliation(s)
- J Karl
- Roche Diagnostics GmbH, Tutzing, Germany
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Karl J, Borgya A, Gallusser A, Huber E, Krueger K, Rollinger W, Schenk J. Development of a novel, N-Terminal-proBNP (NT-proBNP) assay with a low detection limit. Scand J of Clinical & Lab Investigation 1999. [DOI: 10.3109/00365519909168341] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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