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Francis JJ, Goacher E, Fuge J, Hanrahan JG, Zhang J, Davies B, Trivedi R, Laing R, Mannion R. Lumbar decompression surgery for cauda equina syndrome - comparison of complication rates between daytime and overnight operating. Acta Neurochir (Wien) 2022; 164:1203-1208. [PMID: 35237869 DOI: 10.1007/s00701-022-05173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the incidence of complications from lumbar decompression ± discectomy surgery for cauda equina syndrome (CES), assessing whether time of day is associated with a change in the incidence of complications. METHODS Electronic clinical and operative notes for all lumbar decompression operations undertaken at our institution for CES over a 2-year time period were retrospectively reviewed. "Overnight" surgery was defined as any surgery occurring between 18:00 and 08:00 on any day. Clinicopathological characteristics, surgical technique, and peri/post-operative complications were recorded. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. RESULTS A total of 81 lumbar decompression operations were performed in the 2-year period and analysed. A total of 29 (36%) operations occurred overnight. Complete CES (CESR) was seen in 13 cases (16%) in total, 7 of whom underwent surgery during the day. Exactly 27 complications occurred in 24 (30%) patients. The most frequently occurring complication was a dural tear (n = 21, 26%), followed by post-operative haematoma, infection, and residual disc. Complication rates in the CESR cohort (54%) were significantly greater than in the CES incomplete (CESI) cohort (25%) (p = 0.04). On multivariable analysis, overnight surgery was independently associated with a significantly increased complication rate (OR 2.83, CI 1.02-7.89). CONCLUSIONS Lumbar decompressions performed overnight for CES were more than twice as likely to suffer a complication, in comparison to those performed within daytime hours. Our study suggests that out-of-hours operating, particularly at night, must be clinically justified and should not be influenced by day-time operating capacity.
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Affiliation(s)
- Jibin J Francis
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK.
| | - Edward Goacher
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Joshua Fuge
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John G Hanrahan
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin Davies
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Rodney Laing
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Richard Mannion
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
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Hlauschek G, Sinclair B, Brinkmann B, Fuge J, Kwan P, O'Brien TJ, Vivash L. The effect of injection time on rates of epileptogenic zone localization using SISCOM and STATISCOM. Epilepsy Behav 2021; 118:107945. [PMID: 33845344 DOI: 10.1016/j.yebeh.2021.107945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The identification of hyperperfusion on ictal single-photon emission computed tomography (SPECT) scan is a technique for the localization of the epileptogenic zone (EZ) in patients with focal epilepsy undergoing presurgical evaluation. The accuracy of this technique has been improved by subtraction from an interictal image and coregistration with magnetic resonance imaging (MRI) (subtraction ictal SPECT coregistered to MRI (SISCOM)), and subsequently by the development of Statistical Ictal SPECT Co-registered to MRI (STATISCOM) which is reported to further improve localization accuracy by statistically accounting for random variation between images. However, the use of ictal SPECT is limited by the necessity for rapid injection of the radiotracer. The purpose of this study was to investigate the effect of tracer injection time on EZ localization rates using both STATISCOM and SISCOM. METHODS Consecutive patients with drug-resistant focal epilepsy who had an ictal SPECT scan while admitted to the video-electroencephalography (EEG) monitoring unit at the Royal Melbourne Hospital, Victoria, Australia, and a subsequent interictal scan, between 2009 and 2017 were included. The information collected included age, sex, seizure type, epilepsy diagnosis, and injection time. Statistical Ictal SPECT Co-registered to MRI and SISCOM images were generated and reviewed by two blinded reviewers. The rates of potential localization of the EZ, and the agreement with the EEG, were determined for each scan. Localization rates were compared between ictal scans with different radiotracer injection time windows (<30 s, 30-45 s, 45-60 s, 60-90 s, 90-120 s, >120 s). RESULTS Seventy patients (male = 32, 16-67 years) were included in the study. Overall agreement between the primary raters was moderate for STATISCOM (k = 0.44) and SISCOM (k = 0.57). The ability of SPECT to localize the potential EZ was 69% (48/70) for STATISCOM and 59% (41/70) for SISCOM. Injection time was not associated with the rate of localizing the potential EZ for STATISCOM (p = 0.64), whereas for SISCOM there was a trend that shorter injection times were associated with better ability to localize the potential EZ (p = 0.06). Agreement between SPECT and video-EEG data was 54% (38/70) for STATISCOM and 39% (27/70) for SISCOM. Statistical Ictal SPECT Co-registered to MRI did not show any difference of agreement across injection time groups (p = 0.42) whereas SISCOM showed better agreement with video-EEG data in the earlier injection time groups (p = 0.02). No differences in agreement between SPECT and video-EEG data were seen between patients with and without MRI lesions for either STATISCOM or SISCOM. Statistical Ictal SPECT Co-registered to MRI showed significantly better agreement for temporal than extratemporal seizures, with no difference of agreement between early (<45 s) and late (>45 s) injections. CONCLUSION Statistical Ictal SPECT Co-registered to MRI showed overall higher agreement rates with EZ localization by video-EEG than SISCOM, which was not affected by the injection times. Statistical Ictal SPECT Co-registered to MRI may provide localizing information for "late" injections where visual reads and SISCOM are inconclusive.
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Affiliation(s)
- Gernot Hlauschek
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway; Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Benjamin Sinclair
- Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Benjamin Brinkmann
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, USA
| | - Joshua Fuge
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Lucy Vivash
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.
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van den Ameele J, Fuge J, Pitceathly RDS, Berry S, McIntyre Z, Hanna MG, Lee M, Chinnery PF. Chronic pain is common in mitochondrial disease. Neuromuscul Disord 2020; 30:413-419. [PMID: 32334903 PMCID: PMC7306151 DOI: 10.1016/j.nmd.2020.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
Chronic pain is common in patients with mitochondrial disease. Pain due to mitochondrial disease is primarily of neuropathic nature. Distribution, intensity and type of pain are genetically determined.
In the absence of cure, the main objectives in the management of patients with mitochondrial disease are symptom control and prevention of complications. While pain is a complicating symptom in many chronic diseases and is known to have a clear impact on quality of life, its prevalence and severity in people with mitochondrial disease is unknown. We conducted a survey of pain symptoms in patients with genetically confirmed mitochondrial disease from two UK mitochondrial disease specialist centres. The majority (66.7%) of patients had chronic pain which was primarily of neuropathic nature. Presence of pain did not significantly impact overall quality of life. The m.3243A>G MTTL1 mutation was associated with higher pain severity and increased the likelihood of neuropathic pain compared to other causative nuclear and mitochondrial gene mutations. Although previously not considered a core symptom in people with mitochondrial disease, pain is a common clinical manifestation, frequently of neuropathic nature, and influenced by genotype. Therefore, pain-related symptoms should be carefully characterised and actively managed in this patient population.
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Affiliation(s)
- Jelle van den Ameele
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; WT/CRUK Gurdon Institute, Tennis Court Road, Cambridge CB2 1QN, UK.
| | - Joshua Fuge
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Sarah Berry
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Zoe McIntyre
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Michael Lee
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Patrick F Chinnery
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge CB2 0XY, UK.
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Dettmer S, Suhling H, Klingenberg I, Otten O, Kaireit T, Fuge J, Kuhnigk JM, Gottlieb J, Haverich A, Welte T, Wacker F, Vogel-Claussen J, Shin HO. Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome. Eur J Radiol 2018; 106:137-144. [PMID: 30150035 DOI: 10.1016/j.ejrad.2018.07.016] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/04/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate quantitative computed tomography (CT) measurements of the lung parenchyma in lung transplant (LTx) patients for early detection of the bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS 359 CT scans of 122 lung transplant patients were evaluated. Measurements of lung volume and density were performed for the whole lung and separately for each lobe. For longitudinal analysis the difference between the baseline at 6 months after LTx and follow-up examinations was calculated. Patients with and without BOS (matched 1:2) were compared at two different time points, the last examination before the BOS onset and the first examination within one year after BOS onset. RESULTS 30 patients developed BOS during the follow-up period. Longitudinal changes in the lung volume and lung density measured on CT differed significantly between those patients with and without early BOS, in particular the difference of the inspiratory and expiratory lung volume (p < 0.001), the ratio of the expiratory and inspiratory lung volume (p < 0.001-p = 0.001) and MLD (p < 0.001-p = 0.001), the volume on expiration (p < 0.001-p = 0.007), the MLD on expiration (p < 0.001-p = 0.007), and the percentiles on expiration (p < 0.001-p = 0.002) with an increase of lung volume and a decrease of lung density. Changes were pronounced in the lower lobes. Before BOS onset, patients with and without future development of BOS showed no significant differences. CONCLUSION Longitudinal changes of lung volume and lung density measured on CT start markedly at BOS onset with increased lung volume and decreased lung density indicating increased inflation levels. Even though this method may help to diagnose BOS at onset it is not useful as a predictor for BOS before disease onset.
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Affiliation(s)
- S Dettmer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - H Suhling
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - I Klingenberg
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - O Otten
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - T Kaireit
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - J Fuge
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany.
| | - J M Kuhnigk
- Fraunhofer Institute for Medical Image Computing MEVIS, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - J Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany.
| | - A Haverich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - T Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany.
| | - F Wacker
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - J Vogel-Claussen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - H O Shin
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Germany; Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Küppers L, Holz O, Schuchardt S, Gottlieb J, Fuge J, Greer M, Hohlfeld JM. Breath volatile organic compounds of lung transplant recipients with and without chronic lung allograft dysfunction. J Breath Res 2018; 12:036023. [PMID: 29771243 DOI: 10.1088/1752-7163/aac5af] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chronic lung allograft dysfunction with its clinical correlative of bronchiolitis obliterans syndrome (BOS) remains the major limiting factor for long-term graft survival. Currently there are no established methods for the early diagnosis or prediction of BOS. To assess the feasibility of breath collection as a non-invasive tool and the potential of breath volatile organic compounds (VOC) for the early detection of BOS, we compared the breath VOC composition between transplant patients without and different stages of BOS. METHODS 75 outpatients (25 BOS stage 0, 25 BOS stage 1 + 2, 25 BOS stage 3) after bilateral lung transplantation were included. Exclusion criteria were active smoking, oxygen therapy and acute infection. Patients inhaled room air through a VOC and sterile filter and exhaled into an aluminum reservoir tube. Breath was loaded directly onto Tenax® TA adsorption tubes and was subsequently analyzed by gas-chromatography/mass-spectrometry. RESULTS The three groups were age and gender matched, but differed with respect to time since transplantation, the spectrum of underlying disease, and treatment regimes. Relative to patients without BOS, BOS stage 3 patients showed a larger number of different VOCs, and more pronounced differences in the level of VOCs as compared to BOS stage 1 + 2 patients. Logistic regression analysis found no differences between controls and BOS 1 + 2, but four VOCs (heptane, isopropyl-myristate, ethyl-acetate, ionone) with a significant contribution to the discrimination between controls and BOS stage 3. A combination of these four VOCs separated these groups with an area under the curve of 0.87. CONCLUSION Breath sample collection using our reservoir sampler in the clinical environment was feasible. Our results suggest that breath VOCs can discriminate severe BOS. However, convincing evidence for VOCs with a potential to detect early onset BOS is lacking.
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Affiliation(s)
- L Küppers
- Fraunhofer ITEM, Clinical Airway Research-Hannover, Germany
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Drick N, Welte T, Fuge J, Suhling H. Mepolizumab – Wirksamkeit und Prädiktoren für ein Therapieansprechen im klinischen Alltag. Pneumologie 2018. [DOI: 10.1055/s-0037-1619159] [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)
- N Drick
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - J Fuge
- Klinik für Pneumologie, Medizinische Hochschule Hannover
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Rademacher J, Buck A, Schwerk N, Price M, Fuge J, Welte T, Ringshausen F. Nasal Nitric Oxide Measurement and a Modified PICADAR Score for the Screening of Primary Ciliary Dyskinesia in Adults with Bronchiectasis. Pneumologie 2017; 71:543-548. [DOI: 10.1055/s-0043-111909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Determining the underlying diagnosis is essential for the targeted and specific treatment of bronchiectasis. Primary ciliary dyskinesia (PCD) is a rare genetic disease, which is characterized by abnormalities in ciliary structure and/or function and which may result in bronchiectasis. The disease is probably underestimated among adults with bronchiectasis due to the fact that extensive diagnostic testing is required and that the recognition of PCD is low.
Objective To evaluate a feasible screening algorithm for PCD among adults with bronchiectasis.
Methods Data from all patients who presented to our bronchiectasis outpatient clinic from June 2010 until July 2016 were retrospectively analysed from our database. Nasal NO (nNO) and a modified PICADAR score (PrImary CiliAry DyskinesiA Rule) were measured and compared in the two groups of PCD-bronchiectasis and non-PCD-bronchiectasis.
Results 185 of 365 patients (75 males, 110 females) had a sufficient measurement of nNO concentration and complete clinical data and were eligible for analysis. The mean (SD) nNO concentration in nL/ml was significant lower in the PCD group compared to the non-PCD group (25 [31] and 227 [112] nL/min, respectively; p < 0.001). A nNO level of 77 nL/min had the best discriminative value to differentiate between the two groups. Patients with PCD had a significant higher modified PIDACAR score than patients without PCD (5 2 and 1 1, respectively [p < 0.001]). Using ROC curve analysis, the modified PICADAR score of 2 had the best discriminative value with a sensitivity of 1.00 and a specificity of 0.89.
Conclusions Low nNO concentration and the modified PICADAR score are suitable and cheap screening tests for PCD in adults with bronchiectasis.
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Affiliation(s)
- J. Rademacher
- Department of Respiratory Medicine, Hannover Medical School
| | - A. Buck
- Department of Respiratory Medicine, Hannover Medical School
| | - N. Schwerk
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School
| | - M. Price
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School
| | - J. Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - T. Welte
- Department of Respiratory Medicine, Hannover Medical School
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - F. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Strueber M, Warnecke G, Fuge J, Simon AR, Zhang R, Welte T, Haverich A, Gottlieb J. Everolimus Versus Mycophenolate Mofetil De Novo After Lung Transplantation: A Prospective, Randomized, Open-Label Trial. Am J Transplant 2016; 16:3171-3180. [PMID: 27104933 DOI: 10.1111/ajt.13835] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 03/27/2016] [Accepted: 04/16/2016] [Indexed: 01/25/2023]
Abstract
The role of mammalian target of rapamycin (mTOR) inhibitors in de novo immunosuppression after lung transplantation is not well defined. We compared Everolimus versus mycophenolate mofetil in an investigator-initiated single-center trial in Hannover, Germany. A total of 190 patients were randomly assigned 1:1 on day 28 posttransplantation to mycophenolate mofetil (MMF) or Everolimus combined with cyclosporine A (CsA) and steroids. Patients were followed up for 2 years. The primary endpoint was freedom from bronchiolitis obliterans syndrome (BOS). The secondary endpoints were incidence of acute rejections, infections, treatment failure and kidney function. BOS-free survival in intention-to-treat (ITT) analysis was similar in both groups (p = 0.174). The study protocol was completed by 51% of enrolled patients. The per-protocol analysis shows incidence of bronchiolitis obliterans syndrome (BOS): 1/43 in the Everolimus group and 8/54 in the MMF group (p = 0.041). Less biopsy-proven acute rejection (AR) (p = 0.005), cytomegalovirus (CMV) antigenemia (p = 0.005) and lower respiratory tract infection (p = 0.003) and no leucopenia were seen in the Everolimus group. The glomerular filtration rate (GFR) decreased in both groups about 50% within 6 months. Due to a high withdrawal rate, the study was underpowered to prove a difference in BOS-free survival. The dropout rate was more pronounced in the Everolimus group. Secondary endpoints indicate potential advantages of Everolimus-based protocols but also a potentially higher rate of drug-related serious adverse events.
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Affiliation(s)
- M Strueber
- Richard DeVos Heart & Lung Transplant Program, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI.
| | - G Warnecke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - J Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A R Simon
- Department of Heart and Lung Transplantation/VAD, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - R Zhang
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T Welte
- German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - J Gottlieb
- German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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9
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Hadem J, Gottlieb J, Seifert D, Fegbeutel C, Sommer W, Greer M, Wiesner O, Kielstein JT, Schneider AS, Ius F, Fuge J, Kühn C, Tudorache I, Haverich A, Welte T, Warnecke G, Hoeper MM. Prolonged Mechanical Ventilation After Lung Transplantation-A Single-Center Study. Am J Transplant 2016; 16:1579-87. [PMID: 26607844 DOI: 10.1111/ajt.13632] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 11/10/2015] [Accepted: 11/14/2015] [Indexed: 01/25/2023]
Abstract
This single-center study examines the incidence, etiology, and outcomes associated with prolonged mechanical ventilation (PMV), defined as time to definite spontaneous ventilation >21 days after double lung transplantation (LTx). A total of 690 LTx recipients between January 2005 and December 2012 were analyzed. PMV was necessary in 95 (13.8%) patients with decreasing incidence during the observation period (p < 0.001). Independent predictors of PMV were renal replacement therapy (odds ratio [OR] 11.13 [95% CI, 5.82-21.29], p < 0.001), anastomotic dehiscence (OR 8.74 [95% CI 2.42-31.58], p = 0.001), autoimmune comorbidity (OR 5.52 [95% CI 1.86-16.41], p = 0.002), and postoperative neurologic complications (OR 5.03 [95% CI 1.98-12.81], p = 0.001), among others. Overall 1-year survival was 86.0% (90.4% for LTx between 2010 and 2012); it was 60.7% after PMV and 90.0% in controls (p < 0.001). Conditional long-term outcome among hospital survivors, however, did not differ between the groups (p = 0.78). Multivariate analysis identified renal replacement therapy (hazard ratio [HR] 3.55 [95% CI 2.40-5.25], p < 0.001), post-LTx extracorporeal membrane oxygenation (HR 3.47 [95% CI 2.06-5.83], p < 0.001), and prolonged inotropic support (HR 1.95 [95% CI 1.39-2.75], p < 0.001), among others, as independent predictors of mortality. In conclusion, PMV complicated 14% of LTx procedures and, although associated with increased in-hospital mortality, outcomes among patients surviving to hospital discharge were unaffected.
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Affiliation(s)
- J Hadem
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - J Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - D Seifert
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - C Fegbeutel
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - W Sommer
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - M Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - O Wiesner
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - J T Kielstein
- Department of Nephrology and Hypertensiology, Hannover Medical School, Hannover, Germany
| | - A S Schneider
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - F Ius
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - C Kühn
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - I Tudorache
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - T Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - G Warnecke
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - M M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
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Rademacher J, Suhling H, Fuge J, Welte T, Gottlieb J, Ringshausen FC. Lungentransplantion bei Non-CF-Bronchiektasen: Eine retrospektive Analyse von 34 Patienten. Pneumologie 2015. [DOI: 10.1055/s-0035-1548646] [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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11
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Pugliatti M, Eskic D, Mikolcić T, Pitschnau-Michel D, Myhr KM, Sastre-Garriga J, Otero S, Wieczynska L, Torje C, Holloway E, Rienhoff O, Friede T, Buckow K, Ellenberger D, Hillert J, Glaser A, Flachenecker P, Fuge J, Schyns-Liharska T, Kasilingam E, Moretti A, Thalheim C. Assess, compare and enhance the status of Persons with Multiple Sclerosis (MS) in Europe: a European Register for MS. Acta Neurol Scand 2013:24-30. [PMID: 23278653 DOI: 10.1111/ane.12024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Persons with multiple sclerosis (PwMS) experience health-related quality of life (HRQoL) problems greatly differing across Europe, and the European Union (EU) faces deep inequalities in MS management from country to country. Through the establishment of a European MS Register (EUReMS), an effective action is proposed to improve the overall knowledge on MS and support effective intervention programmes at EU and national political level. EUReMS aims to achieve consensus on its mission and vision, to define existing data providers, to develop models driving future MS health policies and research, to develop an information technology (IT) infrastructure for a data set, to develop a European shared governance and to secure providers' data provision into EUReMS. MATERIALS AND METHODS EUReMS is meant to build on a minimum set of core data from existing national and regional population-based MS registries and from PwMS' perspectives. EUReMS' main partner is the European MS Platform (EMSP) acting in collaboration with associated and collaborating European partners. RESULTS EUReMS was launched in July 2011. A Consensus Statement on purposes, vision, mission and strategies was produced in December 2011, and a comprehensive survey on existing MS data collections in Europe has been performed, and the EUReMS data mask is currently being discussed. CONCLUSIONS EUReMS will represent a tool to provide up to date, comparable and sustainable MS data through an effective and credible register, which will encourage extensive knowledge building of MS, more equitable policies and higher standards in MS treatment and services.
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Affiliation(s)
- M. Pugliatti
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari; Italy
| | - D. Eskic
- Association of Multiple Sclerosis Societies of Croatia; Zagreb; Croatia
| | - T. Mikolcić
- Association of Multiple Sclerosis Societies of Croatia; Zagreb; Croatia
| | | | | | | | - S. Otero
- Multiple Sclerosis Centre of Catalonia (Cemcat); Barcelona; Spain
| | - L. Wieczynska
- Polskie Towarzystwo Stwardnienia Rozsianego; Warsaw; Poland
| | - C. Torje
- Societatea de Scleroza Multipla din Romania; Oradea; Bihor; Romania
| | - E. Holloway
- The Multiple Sclerosis Society of Great Britain and Northern Ireland; London; UK
| | - O. Rienhoff
- Universitätsmedizin Göttingen - Georg-August-Universität Göttingen; Germany
| | - T. Friede
- Universitätsmedizin Göttingen - Georg-August-Universität Göttingen; Germany
| | - K. Buckow
- Universitätsmedizin Göttingen - Georg-August-Universität Göttingen; Germany
| | - D. Ellenberger
- Universitätsmedizin Göttingen - Georg-August-Universität Göttingen; Germany
| | | | - A. Glaser
- Karolinska Institute; Stockholm; Sweden
| | - P. Flachenecker
- Neurological Rehabilitation Center Quellenhof; Bad Wildbad; Germany
| | - J. Fuge
- Deutsche Multiple Sklerose Gesellschaft; Bundesverband e.V.; Hannover; Germany
| | | | - E. Kasilingam
- European Multiple Sclerosis Platform; Brussels; Belgium
| | - A. Moretti
- European Multiple Sclerosis Platform; Brussels; Belgium
| | - C. Thalheim
- European Multiple Sclerosis Platform; Brussels; Belgium
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