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Daunhawer I, Schumacher K, Badura A, Vogt JE, Michel H, Wellmann S. Validating the early phototherapy prediction tool across cohorts. Front Pediatr 2023; 11:1229462. [PMID: 37876524 PMCID: PMC10593448 DOI: 10.3389/fped.2023.1229462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
Background Hyperbilirubinemia of the newborn infant is a common disease worldwide. However, recognized early and treated appropriately, it typically remains innocuous. We recently developed an early phototherapy prediction tool (EPPT) by means of machine learning (ML) utilizing just one bilirubin measurement and few clinical variables. The aim of this study is to test applicability and performance of the EPPT on a new patient cohort from a different population. Materials and methods This work is a retrospective study of prospectively recorded neonatal data from infants born in 2018 in an academic hospital, Regensburg, Germany, meeting the following inclusion criteria: born with 34 completed weeks of gestation or more, at least two total serum bilirubin (TSB) measurement prior to phototherapy. First, the original EPPT-an ensemble of a logistic regression and a random forest-was used in its freely accessible version and evaluated in terms of the area under the receiver operating characteristic curve (AUROC). Second, a new version of the EPPT model was re-trained on the data from the new cohort. Third, the predictive performance, variable importance, sensitivity and specificity were analyzed and compared across the original and re-trained models. Results In total, 1,109 neonates were included with a median (IQR) gestational age of 38.4 (36.6-39.9) and a total of 3,940 bilirubin measurements prior to any phototherapy treatment, which was required in 154 neonates (13.9%). For the phototherapy treatment prediction, the original EPPT achieved a predictive performance of 84.6% AUROC on the new cohort. After re-training the model on a subset of the new dataset, 88.8% AUROC was achieved as evaluated by cross validation. The same five variables as for the original model were found to be most important for the prediction on the new cohort, namely gestational age at birth, birth weight, bilirubin to weight ratio, hours since birth, bilirubin value. Discussion The individual risk for treatment requirement in neonatal hyperbilirubinemia is robustly predictable in different patient cohorts with a previously developed ML tool (EPPT) demanding just one TSB value and only four clinical parameters. Further prospective validation studies are needed to develop an effective and safe clinical decision support system.
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Affiliation(s)
- Imant Daunhawer
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Kai Schumacher
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Anna Badura
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Julia E. Vogt
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Holger Michel
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
| | - Sven Wellmann
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John, University Children’s Hospital Regensburg (KUNO), Regensburg, Germany
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Schumacher K, Aridgides PD, Gossett J, Kang G, Huang A, Merchant TE, Mazewski C. Outcomes Following Radiation Therapy (RT) for Very Young Age CNS Embryonal Tumors on COG ACNS0334 According to Molecular-Confirmed Diagnosis. Int J Radiat Oncol Biol Phys 2023; 117:S76. [PMID: 37784570 DOI: 10.1016/j.ijrobp.2023.06.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The outcomes of upfront or relapse radiation therapy (RT) for the Children's Oncology Group ACNS0334 protocol based on molecular diagnosis were assessed. Therapy included maximal safe surgery, high-dose chemotherapy with stem cell rescue, randomization for inclusion of high dose methotrexate (MTX) and optional RT. MATERIALS/METHODS There were 24 patients that received RT on COG ACNS0334 of 77 evaluable patients with a diagnosis of either high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (SPNET). RT was a recommendation (M0: Focal, M+: CSI 18 Gy) given young patient age <36 months at enrollment. Seven RT patients were excluded for ineligible pathology (1 ATRT, 1 HGG) or insufficient tissue. The aim of this report is to review outcomes of 17 patients on ACNS0334 receiving RT (8 Upfront, 9 at relapse) with a molecular diagnosis that included MB, Pineoblastoma (PB), or Embryonal tumor with multilayered rosettes (ETMR). RESULTS In the MB group, there were 9 patients irradiated with MB (Group 3 = 8, SHH = 1). 5-year OS for MB Group 3 receiving RT (median primary dose 54 Gy) was 62.5% with no difference observed comparing 6 patients treated with upfront RT versus 2 treated at relapse (p = 0.27). All upfront RT for MB Group 3 had initial partial response (PR) to 0334 chemotherapy. RT delivery for upfront RT MB Group 3 included craniospinal radiation (CSI) in 5 patients and 1 patient who received focal RT to the primary (50 Gy) and metastatic site (44 Gy). Eighty percent of CSI for upfront RT in Group 3 was 18 Gy or 23.4 Gy. Relapse RT for MB Group 3 (2 patients) utilized full dose CSI (36 Gy, 39.6 Gy) and both patients are survivors with 5+ years follow-up. CSI dose for Group 3 MB was higher for relapse RT (mean 37.8 Gy) as compared to upfront RT (mean 19.8 Gy, p = 0.013). Use of MTX was 50% in both upfront RT and relapse RT Group 3 MB cohorts. One patient with MB SHH (classic histology) underwent upfront focal RT (54 Gy) after initial PR to systemic therapy (without MTX) and is surviving 5+ years. PB: Of 4 PB patients (median primary dose 48.8 Gy) 1 had RT upfront (CSI 18 Gy) and 3 had RT at relapse (1 patient received CSI, 21 Gy). All patients with PB expired within 2 years. MTX was given in 75% (including 1 upfront RT PB). Two of 3 patients treated at relapse had prior complete response (CR). ETMR: All 4 patients (median primary dose 54 Gy) with ETMR were treated at relapse, with CSI given in 1 patient (23.4 Gy). All patients with ETMR expired within 2 years, and 2 (50%) had received MTX. Two patients (50%) had initial CR. CONCLUSION The RT cohort for Group 3 MB on ACNS0334 exhibited long-term survival both for both upfront and relapse RT, however relapsed Group 3 MB received higher dose CSI. RT upfront for MB, including one surviving MB SHH patient receiving focal RT, was solely given for incomplete initial chemotherapy response. There were no survivors for either PB or ETMR when the majority (88%) were treated at relapse.
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Affiliation(s)
| | | | - J Gossett
- St Jude Childrens Research Hospital, Memphis, TN
| | - G Kang
- St. Jude Children's Research Hospital, Memphis, TN
| | - A Huang
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - T E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - C Mazewski
- Emory University School of Medicine, Atlanta, GA
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McCormick A, Jarosz A, Lim H, Peng D, Schumacher K, Frame D, Cusick M. Daratumumab for Chronic Antibody Mediated Rejection and Subsequent Successful Pediatric Heart-Kidney Retransplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [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: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abhilash Jain
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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Koch G, Wilbaux M, Kasser S, Schumacher K, Steffens B, Wellmann S, Pfister M. Leveraging Predictive Pharmacometrics-Based Algorithms to Enhance Perinatal Care—Application to Neonatal Jaundice. Front Pharmacol 2022; 13:842548. [PMID: 36034866 PMCID: PMC9402995 DOI: 10.3389/fphar.2022.842548] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
The field of medicine is undergoing a fundamental change, transforming towards a modern data-driven patient-oriented approach. This paradigm shift also affects perinatal medicine as predictive algorithms and artificial intelligence are applied to enhance and individualize maternal, neonatal and perinatal care. Here, we introduce a pharmacometrics-based mathematical-statistical computer program (PMX-based algorithm) focusing on hyperbilirubinemia, a medical condition affecting half of all newborns. Independent datasets from two different centers consisting of total serum bilirubin measurements were utilized for model development (342 neonates, 1,478 bilirubin measurements) and validation (1,101 neonates, 3,081 bilirubin measurements), respectively. The mathematical-statistical structure of the PMX-based algorithm is a differential equation in the context of non-linear mixed effects modeling, together with Empirical Bayesian Estimation to predict bilirubin kinetics for a new patient. Several clinically relevant prediction scenarios were validated, i.e., prediction up to 24 h based on one bilirubin measurement, and prediction up to 48 h based on two bilirubin measurements. The PMX-based algorithm can be applied in two different clinical scenarios. First, bilirubin kinetics can be predicted up to 24 h based on one single bilirubin measurement with a median relative (absolute) prediction difference of 8.5% (median absolute prediction difference 17.4 μmol/l), and sensitivity and specificity of 95.7 and 96.3%, respectively. Second, bilirubin kinetics can be predicted up to 48 h based on two bilirubin measurements with a median relative (absolute) prediction difference of 9.2% (median absolute prediction difference 21.5 μmol/l), and sensitivity and specificity of 93.0 and 92.1%, respectively. In contrast to currently available nomogram-based static bilirubin stratification, the PMX-based algorithm presented here is a dynamic approach predicting individual bilirubin kinetics up to 48 h, an intelligent, predictive algorithm that can be incorporated in a clinical decision support tool. Such clinical decision support tools have the potential to benefit perinatal medicine facilitating personalized care of mothers and their born and unborn infants.
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Affiliation(s)
- Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- NeoPrediX AG, Basel, Switzerland
- *Correspondence: Gilbert Koch,
| | - Melanie Wilbaux
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Severin Kasser
- Division of Neonatology, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Kai Schumacher
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John of God, University Children’s Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
| | - Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- NeoPrediX AG, Basel, Switzerland
| | - Sven Wellmann
- NeoPrediX AG, Basel, Switzerland
- Division of Neonatology, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Department of Neonatology, Hospital St. Hedwig of the Order of St. John of God, University Children’s Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- NeoPrediX AG, Basel, Switzerland
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Vollroth M, Misfeld M, Meier S, Krögh G, Schumacher K, Wagner R, Dähnert I, Borger MA, Kostelka M. Die Ross-Operation bei Kindern: Aspekte der chirurgischen Technik. Z Herz- Thorax- Gefäßchir 2022. [DOI: 10.1007/s00398-022-00495-w] [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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7
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Cousino M, Blume E, Smith C, Lim H, Yu S, Lowery R, Viers S, Uzark K, Fredericks E, Miller V, Schumacher K. Palliative and End of Life Care Preferences in Adolescents and Young Adults with Heart Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.385] [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: 11/16/2022] Open
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8
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Kemna M, Shaw D, Ameduri R, Azeka E, Bradford T, Jorgensen N, Lin K, Menteer J, Moller T, Reardon L, Schumacher K, Shih R, Stendahl G, West S, Wisotzkey B, Zangwill S. Posterior Reversible Encephalopathy Syndrome (PRES) after Pediatric Heart Transplantation: A Multicenter Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1270] [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] Open
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9
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Griffiths E, Schumacher K, DiPaola F, Chen S, Gerrish H, West S, Nandi D, McCulloch M, O'Connor M, Zangwill S, Lee T, Friedland-Little J, Carlo W, Alejos J, Lambert L, Rezvani M, Shaaban A, Ou Z, Molina K. The Fontan Liver after Cardiac Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1271] [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] Open
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10
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Scholtz AW, Hahn A, Stefflova B, Medzhidieva D, Ryazantsev SV, Paschinin A, Kunelskaya N, Schumacher K, Weisshaar G. Efficacy and Safety of a Fixed Combination of Cinnarizine 20 mg and Dimenhydrinate 40 mg vs Betahistine Dihydrochloride 16 mg in Patients with Peripheral Vestibular Vertigo: A Prospective, Multinational, Multicenter, Double-Blind, Randomized, Non-inferiority Clinical Trial. Clin Drug Investig 2020; 39:1045-1056. [PMID: 31571128 PMCID: PMC6800407 DOI: 10.1007/s40261-019-00858-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/25/2022]
Abstract
Background and Objective Vertigo derived from peripheral vestibular disorders is quite frequently encountered in daily clinical practice and can be a severely disabling symptom associated with substantial impairment of health-related quality of life for the affected patients. Betahistine, a structural analogue of histamine and presumably the most widely prescribed anti-vertigo drug worldwide, has previously been shown to be an effective and safe treatment for these patients. The objective of the present study was to evaluate whether the fixed combination of cinnarizine and dimenhydrinate (Arlevert®) is non-inferior and thus a potentially useful alternative to betahistine dihydrochloride in the treatment of patients suffering from peripheral vestibular vertigo. Methods In this prospective, multicenter, double-blind, randomized, non-inferiority clinical trial, outpatients from 8 ENT clinics in Austria, Bulgaria, the Czech Republic and Russia were randomly assigned to receive three times daily one tablet of either the fixed combination cinnarizine 20 mg/dimenhydrinate 40 mg or betahistine dihydrochloride 16 mg for 4 weeks. Primary endpoint was the reduction of the mean vertigo score (MVS), a validated 12-item composite score defined as the mean of 6 vertigo symptoms (dystasia and walking unsteadiness, staggering, rotary sensation, tendency to fall, lift sensation, blackout) and 6 trigger factors for vertigo (change of position, bowing, getting up, driving by car/train, head movements, eye movement), after 4 weeks of therapy, as judged by the patient on a 5-point visual analogue scale (VAS). The non-inferiority margin was set to 0.3. Secondary outcomes included the patient’s and investigator’s judgment of global efficacy, the patient’s rating of impairment of daily activities, and safety/tolerability of the treatments. Results Three hundred and six patients (mean age 53.5 years, approximately 60% female) were enrolled and randomized to the fixed combination cinnarizine/dimenhydrinate (n = 152) or betahistine (n = 154) groups; 297 patients completed the study and 294 (146 and 148, respectively) were valid for the per-protocol analysis, which was used for the non-inferiority analysis. Treatment with cinnarizine/dimenhydrinate led to a stronger reduction of the MVS [least squares mean (LSM)] after 4-week therapy (primary endpoint) in comparison to betahistine (0.395 vs 0.488; difference: − 0.093, 95% CI − 0.180; − 0.007, p = 0.035); since the upper limit of the two-sided 95% confidence interval was not only below the non-inferiority margin of 0.3, but also entirely below 0, superiority of the fixed combination could be demonstrated. The combination preparation was also more effective after 1 week of therapy and received more favorable patient’s ratings on overall efficacy and impairment of daily activities. Both treatments were very well tolerated. Only 12 patients (3.92%) reported 13 non-serious adverse events; 2 cinnarizine/dimenhydrinate-treated patients discontinued the study prematurely due to adverse events as compared to 5 betahistine-treated patients. Conclusion The fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg was found to be not only non-inferior, but superior to betahistine 16 mg in the improvement of peripheral vestibular vertigo. Furthermore, taking into account a good and slightly favorable safety profile, the present study provides evidence that the fixed-combination preparation is a potent and even superior alternative to betahistine in the treatment of vertigo related to peripheral vestibular disorders. Study Registration EudraCT No. 2011-004025-27.
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Affiliation(s)
- Arne W Scholtz
- ENT Clinic, Medical University of Innsbruck, and ENT Center for Vertigo, Innsbruck, Austria
| | - Ales Hahn
- ENT Clinic, 3rd Medical Faculty, Charles University of Prague, Prague, Czech Republic
| | | | - Daniela Medzhidieva
- ENT Clinic, Medical University of Sofia-St. Ivan Rilski Hospital, Sofia, Bulgaria
| | - Sergey V Ryazantsev
- Federal State Institution St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - Alexander Paschinin
- North West State Medical University n. a. I.I. Mechnikov of Ministry of Health and Social Development, St. Petersburg, Russia
| | - Natalia Kunelskaya
- Moscow Research-Practical Center of Otolaryngology n. a. L. I. Sverzhevsky, Moscow, Russia
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Seewoester T, Buettner P, Dagres N, Schumacher K, Dinov B, Nedios S, Bollmann A, Hilbert S, Jahnke C, Paetsch I, Hindricks G, Kornej J. P3692Association between different cardiac MRI parameters with electro-anatomical substrate and NT-proANP levels in atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Seewoester
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - P Buettner
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - N Dagres
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - K Schumacher
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - B Dinov
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Nedios
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - A Bollmann
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Hilbert
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - C Jahnke
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - I Paetsch
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - G Hindricks
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - J Kornej
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
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12
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Schumacher K, Kornej J, Bollmann A, Sommer P, Arya A, Husser D, Potpara T, Lip G, Hindricks G. 367Prediction of very late arrhythmia recurrence after catheter ablation in patients with atrial fibrillation using APPLE and MB-LATER scores: the Leipzig AF ablation registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Schumacher
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Kornej
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - A Bollmann
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - P Sommer
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - A Arya
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - D Husser
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - T Potpara
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - G Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - G Hindricks
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
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13
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Schneider W, Schumacher K, Thiede B, Gross R. Chromatographic Isolation of the LDH-Isoenzymes of Human Blood Platelets and an Investigation of Their Enzyme Kinetics. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651273] [Citation(s) in RCA: 1] [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: 10/28/2022]
Abstract
SummaryThe LDH-isoenzymes of human blood platelets show a distinct predominance of the isoenzymes 2 and 3 upon chromatography on DEAE-cellulose. Small amounts of LDH-1 are also present, while only traces of LDH-4 and -5 can be detected.Enzyme kinetic investigations of the principal isoenzymes LDH-1, -2 and -3 clearly show that the differences in inhibition constants with pyruvate as substrate which are demonstrable at 25° largely disappear at 37°. On the other hand, the differences among the isoenzymes in their affinity for pyruvate and lactate as substrate as well as in with respect to the optimal substrate concentrations of pyruvate are more marked at 37° than at 25°. Also, the type of inhibition found with lactate as substrate is increasingly the expression of a higher order reaction in going from LDH-1 to LDH-3. A dependence of the LDH distribution pattern upon the metabolism of the cell is discussed. A comparison of our results with thrombocytes with those of other workers with erythrocytes and leucocytes makes it unlikely that the LDH pattern is directly dependent upon the existence of an oxidative metabolism. Rather, the redox potential of the cell could be of importance for the nature of the pattern of isoenzymes and for their differing kinetic properties.
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14
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Schumacher K, Schneider W, Gross R. Untersuchungen über das Verteilungsmuster der Laktatdehydrogenase-Isoenzyme menschlicher Blutplättchen. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651221] [Citation(s) in RCA: 1] [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: 10/28/2022]
Abstract
ZusammenfassungMit Hilfe der Polyacrylamid-Disc-Elektrophorese wurde das LDH-Isoenzymver-teilungsmuster normaler menschlicher Blutplättchen untersucht und eine Verteilung mit starkem Überwiegen der Banden 2 und 3 bei deutlich geringerem Anteil der LDH-1 gefunden. LDH-4 konnte nur in Spuren, LDH-5 in diesem System nicht nachgewiesen werden. Folgende Anteile wurden für die einzelnen Isoenzyme bestimmt (x ± s, n = 16): LDH-1 = 9,8 ± 7,3, LDH-2 =50,7 ± 7,7, LDH-3 = 38,3 ± 7,5, LDH-4 = 1,2 ± 1,2 rel. %.
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16
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Gambetta K, Wittlieb-Weber C, Bock M, Villa C, Johnson J, Lal A, Schumacher K, Law S, Deshpande S, West S, Friedland-Little J, Lytrivi I, Butts R, Cunningham C, Knecht K, McCullough M. Impact of Genotype on Boys with Duchenne Muscular Dystrophy. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.290] [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: 10/17/2022] Open
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17
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Pahl E, Nandi D, Vo J, Schumacher K, Fenton M, Singh R, Lin K, Conway J, Pruitt E, Dahl S, Lamour J, Kirklin J, Chin C. Practice Variation in Detection of Coronary Allograft Vasculopathy (CAV) in Children: A Pediatric Heart Transplant Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1012] [Citation(s) in RCA: 1] [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: 11/25/2022] Open
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18
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Seewoester T, Buettner P, Nedios S, Schumacher K, Dinov B, Hilbert S, Hindricks G, Bollmann A, Jahnke C, Paetsch I, Kornej J. 203Association between different cardiac MRI parameters with electro-anatomical substrate and NT-proANP levels in atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Seewoester
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - P Buettner
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Nedios
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - K Schumacher
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - B Dinov
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Hilbert
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - G Hindricks
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - A Bollmann
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - C Jahnke
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - I Paetsch
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - J Kornej
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
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Kornej J, Schumacher K, Buettner P, Zeynalova S, Dinov B, Bollmann A, Hindricks G. P374AF type and low voltage areas: biomarkers distinguish AF progression phenotypes. Europace 2018. [DOI: 10.1093/europace/euy015.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Kornej
- University of Leipzig, Heart Center, Leipzig, Germany
| | - K Schumacher
- University of Leipzig, Heart Center, Leipzig, Germany
| | - P Buettner
- University of Leipzig, Heart Center, Leipzig, Germany
| | - S Zeynalova
- University of Leipzig, Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig, Germany
| | - B Dinov
- University of Leipzig, Heart Center, Leipzig, Germany
| | - A Bollmann
- University of Leipzig, Heart Center, Leipzig, Germany
| | - G Hindricks
- University of Leipzig, Heart Center, Leipzig, Germany
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20
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Schumacher K, Lange J. Die Versuchsplanung bei der therapeutischen Forschung im Bereich der Leukämien. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Die therapeutische Versuchsplanung bei Leukämien bietet in Anbetracht der sehr variablen Spontanabläufe besondere Probleme. Einem individuellen Vergleich sind vorzugsweise die chronischen Formen zugänglich. Er bietet bei der Vielzahl objektiver Kriterien relativ geringe Schwierigkeiten, wenn genügend lange Therapie-Perioden geplant und durchgeführt wurden. Die Kriterien für die Herstellung homogener Kollektive als Basis des sehr viel schwierigeren Gruppenvergleichs werden besprochen. Mangels einer Stadieneinteilung kann die Anamnesendauer als Ersatz-Kriterium herangezogen werden. Inhomogenität in dieser Beziehung führt — wie ein praktisches Beispiel zeigt — zu falschen Resultaten. Wichtig ist auch die Beachtung therapeutischer und nicht-therapeutischer Mitursachen, die bereits in der Planung zu berücksichtigen sind. Die Befunddokumentation sollte in einem speziellen Formular erfolgen; ein eigener Entwurf wird zur Diskussion gestellt, Abschließend werden die Notwendigkeit der Zusammenarbeit mehrerer Kliniken auf therapeutischem Sektor und die spezielle Problematik eines solchen Vorhabens erörtert.
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21
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Tack J, Schumacher K, Tonini G, Scartoni S, Capriati A, Maggi CA. The neurokinin-2 receptor antagonist ibodutant improves overall symptoms, abdominal pain and stool pattern in female patients in a phase II study of diarrhoea-predominant IBS. Gut 2017; 66:1403-1413. [PMID: 27196574 DOI: 10.1136/gutjnl-2015-310683] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/01/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tachykinins have been implicated in the pathophysiology of IBS with diarrhoea (IBS-D). Our aim was to study the efficacy and safety of ibodutant, a selective neurokinin-2 (NK2) receptor antagonist, in patients with IBS-D. METHODS This multinational double-blind, placebo-controlled study recruited 559 patients with IBS-D according to Rome III criteria. After a 2-week treatment-free run-in, patients were randomised to ibodutant 1 mg, 3 mg, 10 mg or placebo once daily for eight consecutive weeks. Responders were those with a combined response of satisfactory relief (weekly binary question yes/no) of overall IBS symptoms and abdominal pain/discomfort on ≥75% weeks (primary end point). Secondary end points included abdominal pain and stool pattern. Data were also analysed according to US Food and Drug Administration (FDA)-approved interim end points (improvement of pain and stool consistency). Safety was assessed by monitoring adverse events and laboratory tests. Prespecified statistical analysis involved the whole group as well as gender subgroups. RESULTS Demographics and baseline characteristics were comparable for all treatment arms. In the overall population, responsiveness tended to increase with escalating ibodutant doses. In the prespecified analysis by gender, ibodutant 10 mg demonstrated significant superiority over placebo in females (p=0.003), while no significant effect occurred in males. This was confirmed for secondary end points and for the responder analysis according to FDA-approved end points. The tolerability and safety of ibodutant was excellent at all doses. CONCLUSIONS Ibodutant showed dose-dependent efficacy response in IBS-D, reaching statistical significance at the 10 mg dose in female patients. The safety and tolerability profile of ibodutant was similar to placebo. TRIAL REGISTRATION NUMBER NCT01303224.
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Affiliation(s)
- J Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - K Schumacher
- Menarini Research & Business Service GmbH, Berlin, Germany
| | - G Tonini
- Menarini Ricerche S.p.A, Florence, Italy
| | - S Scartoni
- Menarini Ricerche S.p.A, Florence, Italy
| | - A Capriati
- Menarini Ricerche S.p.A, Florence, Italy
| | - C A Maggi
- Menarini Ricerche S.p.A, Florence, Italy
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22
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Cousino M, Rea K, Zamberlan M, Jordan J, Eder S, Fredericks E, Schumacher K. Psychosocial Screening in Pediatric Heart Transplant Recipients and Their Families. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Cousino M, Rea K, Zamberlan M, Jordan J, Lim H, Peng D, Schumacher K. Variability in Tacrolimus Levels Is Associated with Biopsy Proven Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Bragard I, Farhat N, Seghaye MC, Schumacher K. [High fidelity simulation : a new tool for learning and research in pediatrics]. Rev Med Liege 2016; 71:455-459. [PMID: 28383854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Caring for a sick child represents a high risk activity that requires technical and non-technical skills related to several factors such as the rarity of certain events or the stress of caring for a child. As regard these conditions, medi¬cal simulation provides a learning environment without risk, the control of variables, the reproducibility of situations, and the confrontation with rare events. In this article, we des¬cribe the steps of a simulation session and outline the current knowledge of the use of simulation in paediatrics. A session of simulation includes seven phases following the model of Peter Dieckmann, particularly the scenario and the debriefing that form the heart of the learning experience. Several studies have shown the advantages of simulation for paediatric trai¬ning in terms of changes in attitudes, skills and knowledge. Some studies have demonstrated a beneficial transfer to prac¬tice. In conclusion, simulation provides great potential for training and research in paediatrics. The establishment of a collaborative research program by the whole simulation com¬munity would help ensure that this type of training improves the quality of care.
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Affiliation(s)
- I Bragard
- Département de Pédiatrie, CHU de Liège, site ND des Bruyères
- Unité de Psychologie de la Santé, Université de Liège, Belgique
| | - N Farhat
- Département de Pédiatrie, CHU de Liège, site ND des Bruyères, Liège, Belgique
| | - M-C Seghaye
- Département de Pédiatrie, CHU de Liège, site ND des Bruyères, Liège, Belgique
| | - K Schumacher
- Département de Pédiatrie, CHU de Liège, site ND des Bruyères, Liège, Belgique
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25
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Kornej J, Schumacher K, Büttner P, Husser D, Hindricks G, Bollmann A. 16-04: Association between biomarkers of fibrotic turnover, PR interval and electro-anatomical substrate in AF patients undergoing radiofrequency catheter ablation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i1c] [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] Open
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26
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Necchi A, Miceli R, Bregni M, Bokemeyer C, Berger LA, Oechsle K, Schumacher K, Kanfer E, Bourhis JH, Massard C, Laszlo D, Montoro J, Flechon A, Arpaci F, Secondino S, Wuchter P, Dreger P, Crysandt M, Worel N, Kruger W, Ringhoffer M, Unal A, Nagler A, Campos A, Wahlin A, Michieli M, Sucak G, Donnini I, Schots R, Ifrah N, Badoglio M, Martino M, Raggi D, Giannatempo P, Rosti G, Pedrazzoli P, Lanza F. Prognostic impact of progression to induction chemotherapy and prior paclitaxel therapy in patients with germ cell tumors receiving salvage high-dose chemotherapy in the last 10 years: a study of the European Society for Blood and Marrow Transplantation Solid Tumors Working Party. Bone Marrow Transplant 2015; 51:384-90. [DOI: 10.1038/bmt.2015.300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/21/2015] [Accepted: 10/24/2015] [Indexed: 11/09/2022]
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27
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Giannatempo P, Lo Vullo S, Mariani L, Raggi D, Schumacher K, Massard C, Kanfer E, Oechsle K, Laszlo D, Michieli M, Ifrah N, Crysandt M, Wuchter P, Nagler A, Wahlin A, Badoglio M, Pedrazzoli P, Lanza F, Necchi A. Conventional-dose (CDCT) versus high-dose chemotherapy (HDCT) in the salvage management of relapsed pure seminoma: results from an international database. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.04] [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: 11/14/2022] Open
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28
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Schulze T, Morsi M, Brüning D, Schumacher K, Rustenbeck I. Differences in the oxygen consumption pattern suggest that nutrient-induced insulin secretion is differentially regulated in primary mouse islets and MIN6 pseudo-islets. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549763] [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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29
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Görgler N, Willenborg M, Schumacher K, Welling A, Rustenbeck I. Modification of the Ca2+ influx pattern of the pancreatic beta cell by high extracellular potassium. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549762] [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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30
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Brüning D, Schumacher K, Matz M, Baumann K, Rustenbeck I. Granule mobility, fusion frequency and stimulated insulin secretion are differentially affected by insulinotropic stimuli. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549765] [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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31
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De Ferrari GM, Maier LS, Mont L, Schwartz PJ, Simonis G, Leschke M, Gronda E, Boriani G, Darius H, Guillamón Torán L, Savelieva I, Dusi V, Marchionni N, Quintana Rendón M, Schumacher K, Tonini G, Melani L, Giannelli S, Alberto Maggi C, Camm AJ. Ranolazine in the treatment of atrial fibrillation: Results of the dose-ranging RAFFAELLO (Ranolazine in Atrial Fibrillation Following An ELectricaL CardiOversion) study. Heart Rhythm 2015; 12:872-8. [PMID: 25602175 DOI: 10.1016/j.hrthm.2015.01.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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: 09/01/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Currently available antiarrhythmic agents for the treatment of atrial fibrillation (AF) have important limitations, leaving an unmet need for safe and effective therapy. Ranolazine is an approved antianginal agent with a favorable safety profile and electrophysiologic properties suggesting a potential role in the treatment of AF. OBJECTIVE The purpose of this study was to assess the safety and efficacy of ranolazine in the prevention of AF recurrence after successful electrical cardioversion and to ascertain the most appropriate dose of this agent. METHODS This prospective, multicenter, randomized, double-blind, placebo-control parallel group phase II dose-ranging trial randomized patients with persistent AF (7 days to 6 months) 2 hours after successful electrical cardioversion to placebo, or ranolazine 375 mg, 500 mg, or 750 mg bid. Patients were monitored daily by transtelephonic ECG. The primary end-point was the time to first AF recurrence. RESULTS Of 241 patients randomized, 238 took at least 1 drug dose. Ranolazine proved to be safe and tolerable. No dose of the drug significantly prolonged time to AF recurrence. AF recurred in 56.4%, 56.9%, 41.7%, and 39.7% of patients in the placebo, ranolazine 375 mg, ranolazine 500 mg, and ranolazine 750 mg groups, respectively. The reduction in overall AF recurrence in the combined 500-mg and 750-mg groups was of borderline significance compared to the placebo group (P = .053) and significant compared to 375-mg group (P = .035). CONCLUSION No dose of ranolazine significantly prolonged time to AF recurrence. However, the 500-mg and 750 mg-groups combined reduced AF recurrences, suggesting a possible role for this agent in the treatment of AF.
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Affiliation(s)
- Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, and Department of Molecular Medicine, University of Pavia, Pavia, Italy.
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lluís Mont
- Department of Cardiology, Thorax Institute Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Matthias Leschke
- Klinikum Esslingen GmbH, Abteilung Kardiologie, Esslingen, Germany
| | | | - Giuseppe Boriani
- Ospedale S. Orsola-Malpighi, Dipartimento di Cardiologia, Bologna, Italy
| | | | | | | | - Veronica Dusi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Italy
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Miguel Quintana Rendón
- The Karolinska Institute at Hospital de Torrevieja, Servicio de Cardiología, Alicante, Spain
| | - Kai Schumacher
- Menarini Research & Business Service GmbH, Berlin, Germany
| | | | - Lorenzo Melani
- Menarini Industrie Farmaceutiche Riunite s.r.l, Florence, Italy
| | | | | | - A John Camm
- St. George's University, London, United Kingdom
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32
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Necchi A, Miceli R, Berger L, Schumacher K, Bourhis J, Laszlo D, Nicolas-Virelizier E, Arpaci F, Secondino S, Dreger P, Kruger W, Ringhoffer M, Unal A, Nagler A, Campos A, Wahlin A, Donnini I, Badoglio M, Pedrazzoli P, Lanza F. Impact of Response to Induction Chemotherapy in Patients with Germ Cell Tumors (Gct) Receiving Salvage High-Dose Chemotherapy (Hdct): a Study of the Ebmt Solid Tumors Working Party (Stwp). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.53] [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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33
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Görgler N, Belz M, Willenborg M, Schumacher K, Rustenbeck I. Insulinotropic effect of high potassium concentration beyond plasma membrane depolarization. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374922] [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: 10/25/2022]
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34
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Schumacher K, Matz M, Baumann K, Rustenbeck I. Temperature-dependent effects of glucose and potassium depolarization on granule number and mobility in the submembrane space of insulin-secreting MIN6 cells. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375040] [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: 10/25/2022]
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35
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Magdo H, Yu S, Donohue J, Zamberlan M, Schumacher K, Gajarski R, Friedland-Little J. Clinical Significance of Anti-HLA Antibodies Associated With Ventricular Assist Device Use in Pediatric Patients: A United Network for Organ Sharing Database Analysis. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.814] [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: 11/26/2022] Open
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36
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Belz M, Willenborg M, Görgler N, Hamada A, Schumacher K, Rustenbeck I. Insulinotropic effect of high potassium concentration beyond plasma membrane depolarization. Am J Physiol Endocrinol Metab 2014; 306:E697-706. [PMID: 24452455 DOI: 10.1152/ajpendo.00362.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The question whether K⁺ depolarization is an appropriate experimental substitute for the physiological nutrient-induced depolarization of the β-cell plasma membrane was investigated using primary mouse β-cells and islets. At basal glucose 40 mM K⁺ induced a massive monophasic response, whereas 15 mM K⁺ had only a minimal insulinotropic effect, even though the increase in the cytosolic Ca²⁺ concentration ([Ca²⁺]i) was not inferior to that by 20 mM glucose. In voltage-clamp experiments, Ca²⁺ influx appeared as nifedipine-inhibitable inward action currents in the presence of sulfonylurea plus TEA to block compensatory outward K⁺ currents. Under these conditions, 15 mM K⁺ induced prolonged action currents and 40 mM K⁺ transformed the action current pattern into a continuous inward current. Correspondingly, 15 mM K⁺ led to an oscillatory increase and 40 mM K⁺ to a plateau of [Ca²⁺]i superimposed on the [Ca²⁺]i elevated by sulfonylurea plus TEA. Raising K⁺ to 15 or 40 mM in the presence of sulfonylurea (±TEA) led to a fast further increase of insulin secretion. This was reduced to basal levels by nifedipine or CoCl₂. The effects of 15 mM K⁺ on depolarization, action currents, and insulin secretion were mimicked by adding 35 mM Cs⁺ and those of 40 mM K⁺ by adding 35 mM Rb⁺, in parallel with their ability to substitute for K⁺ as permeant cation. In conclusion, the alkali metals K⁺, Rb⁺, or Cs⁺ concentration-dependently transform the pattern of Ca²⁺ influx into the β-cell and may thus generate stimuli of supraphysiological strength for insulin secretion.
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Affiliation(s)
- M Belz
- Institute of Pharmacology and Toxicology, University of Braunschweig, Braunschweig, Germany
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37
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Katzenmeier C, Keil M, Landwehr C, Schumacher K, Rothschild M. Rechtsfragen der vorsorglichen Asservierung postmortal entnommener Körpersubstanzen. Rechtsmedizin (Berl) 2013. [DOI: 10.1007/s00194-013-0928-z] [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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38
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Schumacher K, Matz M, Baumann K, Rustenbeck I. Different effects of glucose and potassium depolarization on the granule mobility in the submembrane space of insulin-secreting MIN6 cells. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schwarz A, Schumacher M, Pfaff D, Schumacher K, Jarius S, Balint B, Wiendl H, Haas J, Wildemann B. Fine-Tuning of Regulatory T Cell Function: The Role of Calcium Signals and Naive Regulatory T Cells for Regulatory T Cell Deficiency in Multiple Sclerosis. J I 2013; 190:4965-70. [DOI: 10.4049/jimmunol.1203224] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Willenborg M, Belz M, Schumacher K, Paufler A, Hatlapatka K, Rustenbeck I. Ca(2+)-dependent desensitization of insulin secretion by strong potassium depolarization. Am J Physiol Endocrinol Metab 2012; 303:E223-33. [PMID: 22550068 DOI: 10.1152/ajpendo.00010.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Depolarization by a high K(+) concentration is a widely used experimental tool to stimulate insulin secretion. The effects occurring after the initial rise in secretion were investigated here. After the initial peak a fast decline occurred, which was followed by a slowly progressive decrease in secretion when a strong K(+) depolarization was used. At 40 mM KCl, but not at lower concentrations, the decrease continued when the glucose concentration was raised from 5 to 10 mM, suggesting an inhibitory effect of the K(+) depolarization. When tolbutamide was added instead of the glucose concentration being raised, a complete inhibition down to prestimulatory values was observed. Equimolar reduction of the NaCl concentration to preserve isoosmolarity enabled an increase in secretion in response to glucose. Unexpectedly, the same was true when the Na(+)-reduced media were made hyperosmolar by choline chloride or mannitol. The insulinotropic effect of tolbutamide was not rescued by the compensatory reduction of NaCl, suggesting a requirement for activated energy metabolism. These inhibitory effects could not be explained by a lack of depolarizing strength or by a diminished free cytosolic Ca(2+) concentration ([Ca(2+)](i)). Rather, the complexation of extracellular Ca(2+) concomitant with the K(+) depolarization markedly diminished [Ca(2+)](i) and attenuated the inhibitory action of 40 mM KCl. This suggests that a strong but not a moderate depolarization by K(+) induces a [Ca(2+)](i)-dependent, slowly progressive desensitization of the secretory machinery. In contrast, the decline immediately following the initial peak of secretion may result from the inactivation of voltage-dependent Ca(2+) channels.
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Affiliation(s)
- M Willenborg
- Institute of Pharmacology and Toxicology, University of Braunschweig, Braunschweig, Germany
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Schumacher K, Hatlapatka K, Matz M, Baumann K, Rustenbeck I. Pre-exocytotic mobility of insulin granules in the submembrane space. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314452] [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: 10/28/2022]
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Willenborg M, Denicke S, Ghaly H, Schumacher K, Panten U, Rustenbeck I. Paradoxe Repolarisation pankreatischer Beta-Zellen während der Initiierung der Insulinsekretion. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314541] [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: 10/28/2022]
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Belz M, Hatlapatka K, Schumacher K, Willenborg M, Rustenbeck I. Ca2+-abhängige Desensitisierung der Depolarisations-induzierten Insulinsekretion. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314536] [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: 10/28/2022]
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Belz M, Hatlapatka K, Schumacher K, Willenborg M, Rustenbeck I. Stimulation und Hemmung der Insulinsekretion durch K+- Depolarisation. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fogari R, Taddei S, Holm-Bentzen M, Baszak J, Melani L, Schumacher K. Efficacy and safety of olmesartan medoxomil 40 mg/hydrochlorothiazide 12.5 mg combination therapy versus olmesartan medoxomil 40 mg monotherapy in patients with moderate to severe hypertension: a randomized, double-blind, parallel-group, multicentre, multinational, phase III study. Clin Drug Investig 2010; 30:581-97. [PMID: 20593911 DOI: 10.2165/11536710-000000000-00000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current hypertension guidelines recommend using two antihypertensive agents when blood pressure (BP) control is not achieved with one single agent. OBJECTIVE This study was designed to assess the antihypertensive benefit of the olmesartan medoxomil 40 mg/hydrochlorothiazide (HCTZ) 12.5 mg combination versus olmesartan medoxomil 40 mg monotherapy in patients with moderate to severe hypertension. METHODS This was a randomized, double-blind, parallel-group, up-titration, multicentre, multinational, phase III study. Following a 2-week single-blind placebo run-in phase, 846 hypertensive patients with mean seated systolic BP (SeSBP) of 160-200 mmHg and mean seated diastolic BP (SeDBP) of 100-120 mmHg were randomized (1 : 2 ratio) to receive double-blind treatment with olmesartan medoxomil 40 mg or olmesartan medoxomil 40 mg/HCTZ 12.5 mg for 8 weeks (phase A). At week 8, patients not reaching BP goal (<140/90 mmHg; <130/80 mmHg in patients with diabetes mellitus) were up-titrated from olmesartan medoxomil 40 mg to olmesartan medoxomil 40 mg/HCTZ 12.5 mg or from olmesartan medoxomil 40 mg/HCTZ 12.5 mg to olmesartan medoxomil 40 mg/HCTZ 25 mg for an additional 8 weeks (phase B). Patients on goal continued their initial treatment. The primary efficacy parameter was the change in mean SeDBP during phase A. RESULTS Olmesartan medoxomil 40 mg/HCTZ 12.5 mg reduced mean SeDBP significantly more (-18.9 mmHg) than olmesartan medoxomil 40 mg (-15.8 mmHg) after 8 weeks of double-blind treatment (difference: -3.1 mmHg, p < 0.0001). Olmesartan medoxomil 40 mg/HCTZ 12.5 mg also reduced mean SeSBP significantly more than olmesartan medoxomil 40 mg (-5.4 mmHg, p < 0.0001). As a result, BP goal rates at week 8 were significantly higher with olmesartan medoxomil 40 mg/HCTZ 12.5 mg than with olmesartan medoxomil 40 mg (58.5% vs 44.3%; odds ratio 1.88; 95% CI 1.32, 2.54). During phase B, mean BP reductions were greater in patients up-titrated from olmesartan medoxomil 40 mg to olmesartan medoxomil 40 mg/HCTZ 12.5 mg than in those continuing on olmesartan medoxomil 40 mg (SeDBP: -9.3 mmHg vs -0.5 mmHg; SeSBP: -12.4 mmHg vs -0.5 mmHg). Similarly, mean BP reductions were greater in patients up-titrated from olmesartan medoxomil 40 mg/HCTZ 12.5 mg to olmesartan medoxomil 40 mg/HCTZ 25 mg than in those continuing on olmesartan medoxomil 40 mg/HCTZ 12.5 mg (SeDBP: -8.0 mmHg vs -0.3 mmHg; SeSBP: -12.1 mmHg vs -0.4 mmHg). In patients not on goal at week 8, addition of HCTZ 12.5 mg to olmesartan medoxomil 40 mg or up-titration from olmesartan medoxomil 40 mg/HCTZ 12.5 mg to olmesartan medoxomil 40 mg/HCTZ 25 mg brought additional patients to goal at week 16 (38.8% vs 36.9%). All treatments were well tolerated. CONCLUSION The olmesartan medoxomil 40 mg/HCTZ 12.5 mg combination is superior to olmesartan medoxomil 40 mg monotherapy in reducing SeDBP and SeSBP and increasing BP goal rates after 8 weeks. Patients not on goal at week 8 with olmesartan medoxomil 40 mg or olmesartan medoxomil 40 mg/HCTZ 12.5 mg benefited from adding HCTZ 12.5 mg or up-titrating to olmesartan medoxomil 40 mg/HCTZ 25 mg, respectively, confirming that up-titration is a clinically meaningful way to improve BP control. [ TRIAL REGISTRATION NUMBER NCT00441350 (ClinicalTrials.gov Identifier)].
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Affiliation(s)
- Roberto Fogari
- Medical Clinic II-Policlinic San Matteo, University of Pavia, Pavia, Italy.
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O'Byrne KJ, Von Pawel J, Vynnychenko I, Zatloukal P, De Marinis F, Eberhardt WE, Paz-Ares LG, Schumacher K, Gatzemeier U, Pirker R. First-cycle rash as a clinical marker in patients with advanced non-small cell lung cancer (NSCLC) receiving first-line chemotherapy (CT) plus cetuximab: Efficacy by histology. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7556] [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: 11/20/2022] Open
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Aktas B, Mueller V, Schumacher K, Tewes M, Zeitz J, Kasimir-Bauer S, Rack B, Janni W, Solomayer E, Fehm T. ER and PR Expression Profile of Circulating Tumor Cells in Metastatic Breast Cancer Patients in Comparison to the Primary Tumor. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Introduktion: Several studies have indicated that the expression of predictive markers including ER and PR can change during course of disease. Therefoore, reassesment of of the prediktive markers at the time of disease progression might help to optimize treatment decisions. Metastatic tissue may be difficult to obtain for repeated analysis. In this context, characterization of circulating tumor cells (CTCs) could be of relevance. Therefore, the purpose of the present study was: (1) to reevaluate the ER/PR expression by circulating tumor cells and (2) to compare the hormone receptor status expression profile of CTC with the primary tumor. Materials and Methods: We ecaluated, 166 blood samples from metastatic breast cancer patients at the time of first diagnosis of first metastatic disease or disease progression. All samples underwent immunomagnetic enrichment using the AdnaTest BreastCancerSelect (AdnaGen AG, Germany) within 4 hours after blood withdrawal followed by RNA isolation and subsequent gene expression analysis by reverse transcription and Multiplex-PCR in separated tumor cells using the AdnaTest BreastCancerDetect. CTC were analyzed for the three breast cancer associated markers: GA733-2, Muc-1, Her-2 and β-actin as an internal PCR control. Expression of the estrogen (ER) and progesterone (PR) receptor was assessed in an additional RT-PCR. The analysis of PCR products was performed by capillary electrophoresis on the Agilent Bioanalyzer 2100. Results: The overall detection rate for CTC was 38% (63/166 patients) with the expression rates of 79% for EpCAM (50/63 patients), 77% for MUC1 (49/63 patients), 49% for HER2 (31/63 patients), 23% for ER (15/65 patients) and 11% for PR (7/65 patients), respectively. Comparisons with the primary tumor were only performed in CTC+ patients (n=65). In 41 of 65 (63%) patients with ER+ tumors, CTC were ER- and 38/65 (58%) patients with PR+ tumors did not express PR on CTC. Primary tumors and CTC displayed a concordant ER and PR status in only 34% and 61% of cases, respectively. Conclusion: Most of the CTC were ER/PR-negative despite the presence of an ER/PR-positive primary tumor. The predictive value of hormone receptor status expression profile of CTC for palliative endocrine therapy has to be prospectively evaluated.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3009.
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Affiliation(s)
- B. Aktas
- 1University Hospital Essen, University of Duisburg-Essen, Germany
| | | | | | - M. Tewes
- 4University Hospital Essen, University of Duisburg-Essen, Germany
| | - J. Zeitz
- 2University Hospital Hamburg, Germany
| | - S. Kasimir-Bauer
- 1University Hospital Essen, University of Duisburg-Essen, Germany
| | - B. Rack
- 6University Hospital Munich, Germany
| | - W. Janni
- 5University Hospital Duesseldorf, Germany
| | | | - T. Fehm
- 3University Hospital Tuebingen, Germany
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Schumacher K, Muscholl M, Zürn C, Grischke EM, Fehm T. Kardiotoxizität beim Mammakarzinom – Prävention und Therapie. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1240667] [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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Kisseler B, Schumacher K. Generalisierte osteoblastische Knochenmetastasierung bei einem Magenkarzinom*. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1226905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Heidemann E, Steinke B, Hartlapp J, Schumacher K, Possinger K, Kunz S, Neeser E, Ingersleben G, Hossfeld D, Caffier H, Souchon R, Waldmann R, Blümner E, Clark J. Prognostic Subgroups: The Key Factor for Treatment Outcome in Metastatic Breast Cancer. Oncol Res Treat 2009. [DOI: 10.1159/000218287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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