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Müller S, Fink M, Hense J, Comino MRS, Schuler M, Teufel M, Tewes M. Palliative care outpatients in a German comprehensive cancer center-identifying indicators for early and late referral. BMC Palliat Care 2022; 21:221. [PMID: 36503625 PMCID: PMC9743520 DOI: 10.1186/s12904-022-01114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center. METHODS Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3-12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal-Wallis test was used to determine symptom severity and laboratory parameter in each referral category. RESULTS LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER. CONCLUSION A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.
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Affiliation(s)
- S. Müller
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Fink
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - J. Hense
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. R. Salvador Comino
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
| | - M. Schuler
- grid.410718.b0000 0001 0262 7331Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany ,grid.410718.b0000 0001 0262 7331German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - M. Teufel
- grid.5718.b0000 0001 2187 5445Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147 Essen, Germany
| | - M. Tewes
- grid.410718.b0000 0001 0262 7331Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147 Essen, Germany
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Gordan L, Diaz M, Patel A, Fink M, Wenk D, Roos A, Jiang J, Tam J, Sathyan P, Febbo P. 1162P Tissue and liquid biopsy utilization in advanced NSCLC in a large community US practice. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1285] [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: 11/27/2022] Open
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Fink M, Kades K, Bischoff A, Moll M, Heußel PC, Kauczor UH, Maier-Hein K, Weber T, Kleesiek J. Evaluation eines auf strukturierten Befunden trainierten Deep Learning-Algorithmus zur Klassifikation des Tumoransprechens in onkologischen Freitextbefunden. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749878] [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: 11/07/2022]
Affiliation(s)
- M Fink
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - K Kades
- Division of Medical Image Computing (E230), Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - A Bischoff
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - M Moll
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - P C Heußel
- Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik Heidelberg, Heidelberg
| | - U H Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - K Maier-Hein
- Medical Imaging Computing, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - T Weber
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - J Kleesiek
- Institut für Künstliche Intelligenz in der Medizin (IKIM), Universitätsklinikum Essen, Essen
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Fink M, Seibold C, Kauczor UH, Stiefelhagen R, Kleesiek J. Deep Learning-basierte Synthese virtueller monoenergetischer Bilder zur Optimierung einer automatisierten Detektion von Lungenarterienembolien in konventionellen CT-Scans. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749762] [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: 11/05/2022]
Affiliation(s)
- M Fink
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg
| | - C Seibold
- Institut für Anthropomatik und Robotik (IAR), Karlsruher Institut für Technologie (KIT), Karlsruhe
| | - U H Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg
| | - R Stiefelhagen
- Institut für Anthropomatik und Robotik (IAR), Karlsruher Institut für Technologie (KIT), Karlsruhe
| | - J Kleesiek
- Institut für Künstliche Intelligenz in der Medizin (IKIM), Universitätsklinikum Essen, Essen
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Krajden Haratz K, Oliveira Szejnfeld P, Govindaswamy M, Leibovitz Z, Gindes L, Severino M, Rossi A, Paladini D, Garcia Rodriguez R, Ben-Sira L, Borkowski Tillman T, Gupta R, Lotem G, Raz N, Hamamoto TENK, Kidron D, Arad A, Birnbaum R, Brussilov M, Pomar L, Vial Y, Leventer RJ, McGillivray G, Fink M, Krzeszowski W, Fernandes Moron A, Lev D, Tamarkin M, Shalev J, Har Toov J, Lerman-Sagie T, Malinger G. Prenatal diagnosis of rhombencephalosynapsis: neuroimaging features and severity of vermian anomaly. Ultrasound Obstet Gynecol 2021; 58:864-874. [PMID: 33942916 DOI: 10.1002/uog.23660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe the prenatal neuroimaging spectrum of rhombencephalosynapsis (RES) and criteria for its classification according to the severity of vermian anomaly. METHODS In this multicenter retrospective study of fetuses with RES between 2002 and 2020, the medical records and brain ultrasound and magnetic resonance images were evaluated comprehensively to determine the severity of the vermian anomaly and the presence of associated brain findings. RES was classified, according to the pattern of vermian agenesis and the extent of the fusion of the hemispheres, as complete RES (complete absence of the vermis) or partial RES (further classified according to the part of the vermis that was missing and, consequently, the region of hemispheric fusion, as anterior, posterior, severe or mixed RES). Findings were compared between cases with complete and those with partial RES. RESULTS Included in the study were 62 fetuses with a gestational age ranging between 12 and 37 weeks. Most had complete absence of the vermis (complete RES, 77.4% of cases), a 'round-shaped' cerebellum on axial views (72.6%) and a transverse cerebellar diameter (TCD) < 3rd centile (87.1%). Among the 22.6% of cases with partial RES, 6.5% were classified as severe partial, 6.5% as partial anterior, 8.1% as partial mixed and 1.6% as partial posterior. Half of these cases presented with normal or nearly normal cerebellar morphology and 28.5% had a TCD within the normal limits. Infratentorially, the fourth ventricle was abnormal in 88.7% of cases overall, and anomalies of the midbrain and pons were frequent (93.5% and 77.4%, respectively). Ventriculomegaly was observed in 80.6% of all cases, being more severe in cases with complete RES than in those with partial RES, with high rates of parenchymal and septal disruption. CONCLUSIONS This study provides prenatal neuroimaging criteria for the diagnosis and classification of RES, and identification of related features, using ultrasound and magnetic resonance imaging. According to our findings, a diagnosis of RES should be considered in fetuses with a small TCD (severe cerebellar hypoplasia) and/or a round-shaped cerebellum on axial views, during the second or third trimester, especially when associated with ventriculomegaly. Partial RES is more common than previously thought, but presents an extreme diagnostic challenge, especially in cases with normal or nearly-normal cerebellar morphobiometric features. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Krajden Haratz
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Oliveira Szejnfeld
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
- DDI UNIFESP, São Paulo, Brazil
- Fundação Instituto de Pesquisa e Estudo de Diagnostico por Imagem, São Paulo, Brazil
| | - M Govindaswamy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Z Leibovitz
- Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - L Gindes
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - M Severino
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - D Paladini
- Fetal Medicine Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - R Garcia Rodriguez
- Complejo Hospitalario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - L Ben-Sira
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Radiology Unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Borkowski Tillman
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Gupta
- Sunehri Devi Hospital, Sonepat India, Indraprastha Apollo Hospital, New Delhi, India
| | - G Lotem
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - N Raz
- Technion Faculty of Medicine, Haifa, Israel
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hedera, Israel
| | - T E N K Hamamoto
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Kidron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - A Arad
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Bnai Zion Medical Center, Haifa, Israel
| | - R Birnbaum
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Brussilov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pomar
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Y Vial
- Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - R J Leventer
- Department of Neurology, The Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia
| | - G McGillivray
- Royal Women's Hospital, Mercy Hospital for Women and Murdoch Children's Research Institute, Melbourne, Australia
| | - M Fink
- Department of Medical Imaging, The Royal Children's Hospital and Perinatal Unit, The Mercy Hospital for Women, Melbourne, Australia
| | | | - A Fernandes Moron
- Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - D Lev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - M Tamarkin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - J Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Institute of Genetics, Wolfson Medical Center, Holon, Israel
| | - J Har Toov
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel
| | - G Malinger
- Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Syeda S, Mohammed M, Foley A, Donkervoort S, Saade D, Neuhaus S, Mohassel P, Bharucha-Goebel D, Leach M, Fink M, Dastgir J, Bönnemann C. COLLAGEN RELATED MUSCLE DISEASES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mack P, Klein M, Ayers K, Uzilov A, Zhou X, Corrigan D, Dietz M, Fink M, Guin S, Kip N, Rossi M, Oh W, Hantash F, Newman S, Schadt E, Chen R, Hirsch F. 1271P Molecular driver mutations in never-smokers with lung adenocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kriegisch V, Kuhn B, Dierks ML, Achenbach J, Briest J, Fink M, Dusch M, Amelung V, Karst M. [Evaluation of outpatient medical pain management in Germany : Results of an internet-based cross-sectional survey among pain specialists in outpatient departments]. Schmerz 2021; 35:103-113. [PMID: 32804299 PMCID: PMC7997815 DOI: 10.1007/s00482-020-00492-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hintergrund Nach den Kriterien der Qualitätssicherungsvereinbarung Schmerztherapie (QSV) nahmen zum Stichtag 31.12.2016 1206 Ärztinnen und Ärzte an der ambulanten Versorgung chronischer Schmerzpatienten teil. Bei in weiten Teilen bestehender Unterversorgung chronischer Schmerzpatienten fehlen Daten zur Einschätzung der ambulanten Schmerztherapie durch die Schmerztherapeuten selbst. Methoden In einem Hybrid-Delphi-Verfahren wurde ein Fragebogen zur inhaltlichen, strukturellen und persönlichen Bewertung der ambulanten Schmerztherapie in Deutschland entwickelt. Mit diesem Instrument wurde eine internetbasierte Querschnittsbefragung von 281 QSV-Schmerzmedizinern aus vier Bundesländern (Berlin, Niedersachsen, Sachsen, Baden-Württemberg) und aller universitären Schmerzambulanzleiter (n = 36) in Deutschland durchgeführt. Ergebnisse Die Befragung erzielte eine bereinigte Rücklaufquote von insgesamt 35,9 %. Bei den Schmerzambulanzleitern antworteten 66,7 %. Bei 91 % der Befragten lag der Anteil an chronisch Schmerzkranken in der Praxis bei über 70 %. 67,3 % geben an, mit ihrer Praxissituation zufrieden zu sein, auf der anderen Seite äußern 63,4 % ihre Unzufriedenheit mit der aktuellen Organisation der Schmerzmedizin in Deutschland insgesamt. Diese Unzufriedenheit zeigt sich vor allem in Bezug auf die Budgetregelungen (69,3 %), die Kooperation mit Psychotherapeuten (69,3 %) und die interdisziplinäre Vernetzung (50,5 %). Als gute Vorbereitung für den späteren Beruf werden die einjährige Weiterbildung bei einem Weiterbildungsbefugten (87,1 %) und die Teilnahme an dem Kurs „Psychosomatische Grundversorgung“ (90,1 %) bewertet. Vielfältige Freitextkommentare weisen darauf hin, dass die Ausbildung zu kurz und nicht ausreichend sei. Die Mehrheit der Befragten hält es sowohl aus Arztsicht (61,4 %) wie auch aus Patientensicht (54,5 %) für sinnvoll, einen Facharzt für Schmerzmedizin als Versorgungsmodell zu etablieren. 70,8 % der Schmerzambulanzleiter sprechen sich für eigenständige Strukturen mit eigenem Budget aus, 75,0 % geben an, dass ihre Ambulanz unter den aktuellen Bedingungen nicht kostendeckend arbeitet. In Bezug auf die aktuelle Ausbildungssituation berichten nur 39,7 % der QSV-Schmerztherapeuten in der Niederlassung, dass sie auch Ärzte ausbilden, 57,6 % von ihnen planen zudem, ihre Tätigkeit innerhalb der nächsten 10 Jahre aufzugeben. Schlussfolgerungen Die mangelnde Eigenständigkeit der Schmerzmedizin und die unzureichend ausgebauten ambulanten Versorgungsnetzwerke tragen dazu bei, dass Schmerztherapeuten mit vielen Aspekten ihrer Tätigkeit unzufrieden sind. Die Etablierung eines Facharztes für Schmerztherapie wird als eine gute Lösung für eine bessere schmerzmedizinische Versorgung und für die Nachwuchsproblematik gesehen.
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Affiliation(s)
- V Kriegisch
- Klinik für Anästhesiologie und Intensivmedizin, Schmerzambulanz, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Kuhn
- Kassenärztliche Bundesvereinigung, Herbert-Lewin-Platz 2, 10623, Berlin, Deutschland
| | - M-L Dierks
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - J Achenbach
- Klinik für Anästhesiologie und Intensivmedizin, Schmerzambulanz, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - J Briest
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Fink
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Dusch
- Klinik für Anästhesiologie und Intensivmedizin, Schmerzambulanz, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - V Amelung
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Karst
- Klinik für Anästhesiologie und Intensivmedizin, Schmerzambulanz, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Klein M, Mack P, Guin S, Gong Y, O'Connell T, Ayers K, Li Z, Li Y, Mullaney T, Jappe W, Redfern A, Prentice T, Schadt E, Fink M, Zhou X, Newman S, Chen R, Hirsch F. P35.09 Oncogenetic Differences in Never-Smokers versus Smokers with NSCLC Adenocarcinoma Treated at the Mt Sinai Tisch Cancer Institute. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.710] [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: 10/21/2022]
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Foley A, Leach M, Averion G, Hu Y, Yun P, Neuhaus S, Saade D, Arévalo C, Fink M, DeCoster J, Mendoza C, Mayer O, Hausmann R, Petraki D, Cheung K, Bönnemann C. CONGENITAL MUSCULAR DYSTROPHY: LAMA2. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.443] [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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Ourir A, Fink M. Active Control of the Spoof Plasmon Propagation in Time Varying and Non-reciprocal Metamaterial. Sci Rep 2019; 9:2368. [PMID: 30787310 PMCID: PMC6382830 DOI: 10.1038/s41598-018-36948-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/16/2018] [Accepted: 11/23/2018] [Indexed: 11/28/2022] Open
Abstract
We present an efficient concept based on time varying and non reciprocal metamaterials to achieve an active control of the spoof plasmon (SP) propagation at sub-wavelength scale. An experimental demonstration of non-reciprocal guiding device based on split ring resonator is proposed as an application of this concept in the microwave regime. We show that this device is able to blue-shift the propagated SP waves and to achieve an active steering of these SPs at sub-wavelength scale by controlling the modulation frequency of the time varying metamaterial. This approach could be extended plainly to infrared and optical regimes by considering suitable technologies.
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Affiliation(s)
- A Ourir
- Institut Langevin, ESPCI Paris, CNRS, PSL University, 1 rue Jussieu, 75005, Paris, France.
| | - M Fink
- Institut Langevin, ESPCI Paris, CNRS, PSL University, 1 rue Jussieu, 75005, Paris, France
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Foley A, Leach M, Averion G, Hu Y, Yun P, Neuhaus S, Saade D, Arevalo C, Fink M, DeCoster J, Mendoza C, Mayer O, Hausmann R, Petraki D, Cheung K, Bönnemann C. CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.377] [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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Saade D, Bharucha-Goebel D, Norato G, Foley A, Waite M, Jain M, Debs S, Vasavada R, Nichols C, Kaur R, Donkervoort S, Neuhaus S, Hu Y, Lehky T, Gray S, Fink M. CMT AND NEUROGENIC DISEASE. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.385] [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: 11/28/2022]
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Fink M, Vazulka S, Jarmer J, Cserjan M, Striedner G. Production of antibody-fragments with plasmid-based and genome-integrated T7 E. coli expression systems – evaluation of systems performance in microtiter fed-batch-like cultivations. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Puyo L, Paques M, Fink M, Sahel JA, Atlan M. In vivo laser Doppler holography of the human retina. Biomed Opt Express 2018; 9:4113-4129. [PMID: 30615709 PMCID: PMC6157768 DOI: 10.1364/boe.9.004113] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 05/20/2023]
Abstract
The eye offers a unique opportunity for the non-invasive exploration of cardiovascular diseases. Optical angiography in the retina requires sensitive measurements, which hinders conventional full-field laser Doppler imaging schemes. To overcome this limitation, we used digital holography to perform laser Doppler perfusion imaging of human retina with near-infrared light. Two imaging channels with a slow and a fast CMOS camera were used simultaneously for real-time narrowband measurements, and offline wideband measurements, respectively. The beat frequency spectrum of optical interferograms recorded with the fast (up to 75 kHz) CMOS camera was analyzed by short-time Fourier transformation. Power Doppler images drawn from the Doppler power spectrum density qualitatively revealed blood flow in retinal vessels over 512 × 512 pixels covering 2.4 × 2.4 mm2 on the retina with a temporal resolution down to 1.6 ms. The sensitivity to lateral motion as well as the requirements in terms of sampling frequency are discussed.
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Affiliation(s)
- L. Puyo
- Institut Langevin, Centre National de la Recherche Scientifique (CNRS), Paris Sciences & Lettres (PSL Research University), École Supérieure de Physique et de Chimie Industrielles (ESPCI Paris) - 1 rue Jussieu, 75005 Paris,
France
| | - M. Paques
- Institut de la Vision, INSERM UMR-S 968, CNRS UMR 7210, UPMC, 17 rue Moreau, 75012 Paris,
France
- Centre d’Investigation Clinique (CIC) Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, INSERM, 28 rue de Charenton, 75012 Paris,
France
| | - M. Fink
- Institut Langevin, Centre National de la Recherche Scientifique (CNRS), Paris Sciences & Lettres (PSL Research University), École Supérieure de Physique et de Chimie Industrielles (ESPCI Paris) - 1 rue Jussieu, 75005 Paris,
France
| | - J.-A. Sahel
- Institut de la Vision, INSERM UMR-S 968, CNRS UMR 7210, UPMC, 17 rue Moreau, 75012 Paris,
France
- Centre d’Investigation Clinique (CIC) Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, INSERM, 28 rue de Charenton, 75012 Paris,
France
| | - M. Atlan
- Institut Langevin, Centre National de la Recherche Scientifique (CNRS), Paris Sciences & Lettres (PSL Research University), École Supérieure de Physique et de Chimie Industrielles (ESPCI Paris) - 1 rue Jussieu, 75005 Paris,
France
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Abstract
OBJECTIVE To examine the psychological substrate of catatonia. METHOD Reviewing the historical descriptions and explanations of catatonic behaviours by clinicians from its delineation in the 19th century to the present. RESULTS Patients with catatonia are often haunted by fears and terrors; this has not been widely appreciated, and certainly was lost from view in the days when catatonia was considered a subtype of schizophrenia. The report contributes to resolving a major question in catatonia: is the mind in stupor inactive, as the blank state that we picture in anesthetized patients, or is the mind active, so preoccupied as to exclude all other influences. THE MAIN FINDING Persistent fear occupies the mind of catatonic patients. CONCLUSION The signs of catatonia are adaptations to persistent fear, akin to tonic immobilization. The relief afforded by sedation supports this interpretation.
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Affiliation(s)
- M Fink
- Psychiatry and Neurology Emeritus, State University of New York at Stony Brook, St. James, NY, USA
| | - E Shorter
- History of Medicine, University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Mgaieth S, Kemp W, Gow P, Fink M, Lubel J, Nicoll A, Gazzola A, Hong T, Ryan M, Knight V, Dev AT, Sood S, Bell S, Paul E, Roberts SK. Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study. J Viral Hepat 2017; 24:982-989. [PMID: 28414893 DOI: 10.1111/jvh.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/27/2017] [Indexed: 12/15/2022]
Abstract
While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.
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Affiliation(s)
- S Mgaieth
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - P Gow
- Department of Gastroenterology, Austin Hospital, Heidelberg, Vic., Australia
| | - M Fink
- Department of Surgery, Austin Hospital, Heidelberg, Vic., Australia
| | - J Lubel
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia
| | - A Nicoll
- Department of Gastroenterology, Box Hill Hospital, Box Hill, Vic., Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - A Gazzola
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
| | - T Hong
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - M Ryan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - V Knight
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - A T Dev
- Department of Gastroenterology, Monash Medical Centre, Clayton, Vic., Australia
| | - S Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - S Bell
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Vic., Australia
| | - E Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Vic., Australia
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Fink M, Waldmann J, Schumm-Draeger PM. Diabetes and Periodontitis – can improvement of glycaemia also ameliorate periodontitis? DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1603543] [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: 10/19/2022]
Affiliation(s)
- M Fink
- Dental Clinic Munich North, Unterschleißheim, Germany
| | - J Waldmann
- Centre of Internal Medicine Fuenf Hoefe, Munich, Germany
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Mohan R, Gupta S, Sharma A, Anumanthan G, Sinha P, Fink M, Tripathi R, Raikwar S, Giuliano E, Rieger F, Hesemann N, Sinha N, Chaurasia S. Novel tissue-targeted localized gene therapy for corneal scarring and neovascularization. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0452] [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: 11/27/2022]
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Vorhagen S, Nafisi J, Tellkamp F, Fink M, Niessen C. 130 Polarity signaling in spindle orientation and regulation of epidermal stem cell fate. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.148] [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: 11/28/2022]
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Pellizzari M, Simonutti M, Degardin J, Sahel JA, Fink M, Paques M, Atlan M. High speed optical holography of retinal blood flow. Opt Lett 2016; 41:3503-6. [PMID: 27472604 DOI: 10.1364/ol.41.003503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We performed noninvasive video imaging of retinal blood flow in a pigmented rat by holographic interferometry of near-infrared laser light backscattered by retinal tissue, beating against an off-axis reference beam sampled at a frame rate of 39 kHz with a high throughput camera. Local Doppler contrasts emerged from the envelopes of short-time Fourier transforms and the phase of autocorrelation functions of holograms rendered by Fresnel transformation. This approach permitted imaging of blood flow in large retinal vessels (∼30 microns diameter) over 400×400 pixels with a spatial resolution of ∼8 microns and a temporal resolution of ∼6.5 ms.
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Weber M, Fink M, Fortov V, Lipaev A, Molotkov V, Morfill G, Petrov O, Pustylnik M, Thoma M, Thomas H, Usachev A, Raeth C. Assessing particle kinematics via template matching algorithms. Opt Express 2016; 24:7987-8012. [PMID: 27137240 DOI: 10.1364/oe.24.007987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Template matching algorithms represent a viable tool to locate particles in optical images. A crucial factor of the performance of these methods is the choice of the similarity measure. Recently, it was shown in [Gao and Helgeson, Opt. Express 22 (2014)] that the correlation coefficient (CC) leads to good results. Here, we introduce the mutual information (MI) as a nonlinear similarity measure and compare the performance of the MI and the CC for different noise scenarios. It turns out that the mutual information leads to superior results in the case of signal dependent noise. We propose a novel approach to estimate the velocity of particles which is applicable in imaging scenarios where the particles appear elongated due to their movement. By designing a bank of anisotropic templates supposed to fit the elongation of the particles we are able to reliably estimate their velocity and direction of motion out of a single image.
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Affiliation(s)
- M Fink
- Departments of Psychiatry and Neurology, Stony Brook University School of Medicine, St James, NY, USA.
| | - G Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - T Rummans
- Department of Psychiatry, Mayo Clinic, Rochester, MN, USA
| | - E Shorter
- Department of Psychiatry and History of Medicine Program, University of Toronto, Toronto, Canada
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Fink M. Seeing the king's frenzy as catatonia. Acta Psychiatr Scand 2015; 132:500-1. [PMID: 26696386 DOI: 10.1111/acps.12519] [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: 11/27/2022]
Affiliation(s)
- M Fink
- Departments of Psychiatry and Neurology, Stony Brook University School of Medicine, St James, NY, USA.
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Riviere JE, Gabrielsson J, Fink M, Mochel J. Mathematical modeling and simulation in animal health. Part I: Moving beyond pharmacokinetics. J Vet Pharmacol Ther 2015; 39:213-23. [PMID: 26592724 DOI: 10.1111/jvp.12278] [Citation(s) in RCA: 21] [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: 08/11/2015] [Revised: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 02/05/2023]
Abstract
The application of mathematical modeling to problems in animal health has a rich history in the form of pharmacokinetic modeling applied to problems in veterinary medicine. Advances in modeling and simulation beyond pharmacokinetics have the potential to streamline and speed-up drug research and development programs. To foster these goals, a series of manuscripts will be published with the following goals: (i) expand the application of modeling and simulation to issues in veterinary pharmacology; (ii) bridge the gap between the level of modeling and simulation practiced in human and veterinary pharmacology; (iii) explore how modeling and simulation concepts can be used to improve our understanding of common issues not readily addressed in human pharmacology (e.g. breed differences, tissue residue depletion, vast weight ranges among adults within a single species, interspecies differences, small animal species research where data collection is limited to sparse sampling, availability of different sampling matrices); and (iv) describe how quantitative pharmacology approaches could help understanding key pharmacokinetic and pharmacodynamic characteristics of a drug candidate, with the goal of providing explicit, reproducible, and predictive evidence for optimizing drug development plans, enabling critical decision making, and eventually bringing safe and effective medicines to patients. This study introduces these concepts and introduces new approaches to modeling and simulation as well as clearly articulate basic assumptions and good practices. The driving force behind these activities is to create predictive models that are based on solid physiological and pharmacological principles as well as adhering to the limitations that are fundamental to applying mathematical and statistical models to biological systems.
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Affiliation(s)
- J E Riviere
- Institute of Computational Comparative Medicine, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - J Gabrielsson
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Fink
- Novartis Pharma AG, Basel, Switzerland
| | - J Mochel
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
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Rettinger A, Broeckl S, Fink M, Prodinger WM, Blum H, Krebs S, Domogalla J, Just F, Gellert S, Straubinger RK, Büttner M. The Region of Difference Four is a Robust Genetic Marker for Subtyping Mycobacterium caprae Isolates and is Linked to Spatial Distribution of Three Subtypes. Transbound Emerg Dis 2015; 64:782-792. [PMID: 26518998 DOI: 10.1111/tbed.12438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Indexed: 12/22/2022]
Abstract
Alpine Mycobacterium caprae isolates found in cattle and red deer display at least three genetic variations in the region of difference four (RD4) that can be used for further differentiation of the isolates into the subtypes 'Allgäu', 'Karwendel' and 'Lechtal'. Each genomic subtype is thereby characterized by a specific nucleotide deletion pattern in the 12.7-kb RD4 region. Even though M. caprae infections are frequently documented in cattle and red deer, little is known about the transmission routes. Hence, robust markers for M. caprae subtyping are needed to gain insight into the molecular epidemiology. For this reason, a rapid and robust multiplex PCR was developed for the simultaneous detection of three M. caprae RD4 subtypes and was used to subtype a total number of 241 M. caprae isolates from animals (145 cattle, 95 red deer and one fox) from Bavaria and Austria. All three subtypes occur spatially distributed and are found in cattle and in red deer suggesting transmission between the two species. As subtypes are genetically stable in both species it is hypothesized that the described genetic variations developed within the host due to 'within-host replication'. The results of this study recommend the genomic RD4 region as a reliable diagnostic marker for M. caprae subtype differentiation.
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Affiliation(s)
- A Rettinger
- Institute for Infectious Diseases and Zoonoses, LMU Munich, Munich, Germany
| | - S Broeckl
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - M Fink
- Austrian Agency for Health and Food Safety, Institute for Veterinary Disease Control, Moedling, Austria
| | | | - H Blum
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - S Krebs
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, LMU Munich, Munich, Germany
| | - J Domogalla
- Bavarian Environment Agency, Wielenbach, Germany
| | - F Just
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - S Gellert
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - R K Straubinger
- Institute for Infectious Diseases and Zoonoses, LMU Munich, Munich, Germany
| | - M Büttner
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
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28
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Affiliation(s)
- M Fink
- Department of Psychiatry & Neurology, Stony Brook University, Long Island, NY, USA.
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Büttner M, Bröckl S, Krebs S, Blum H, Fink M, Straubinger R. Molekulare Typisierungsverfahren bei Mykobacterium caprae. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563041] [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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Abstract
OBJECTIVE To review the findings of the four-hospital collaborative studies of electroconvulsive therapy (ECT) in unipolar depressed patients known as CORE between 1997 and 2011. Unipolar depressed patients were treated with bilateral ECT, and on remission were randomly assigned to a fixed schedule continuation ECT or to combined lithium and nortriptyline for 6 months. A second study compared three electrode placements in unipolar and bipolar depressed patients. METHOD Nineteen published reports were reviewed. The findings are compared with those of a parallel multi-hospital study of ECT led by a Columbia University Collaboration (CUC) team that studied right unilateral ECT in a similar population with similar inclusion/exclusion and remission criteria. Successful ECT was followed by placebo, nortriptyline alone, or combined lithium, and nortriptyline. RESULTS Relapse rates after remission were similar with fixed schedule ECT as with medications. Predictors of outcome (psychosis, suicide risk, polarity, melancholia, atypical depression, age) and technical aspects (electrode placement, seizure threshold, speed of response) are discussed, CONCLUSION The findings offer criteria to optimize the selection of patients, the technique, and outcome of ECT for unipolar and bipolar depressed patients. Continuation ECT is an effective alternative to continuation treatment with lithium and nortriptyline. Bilateral electrode placement is more efficient than alternative placements. ECT relieves both bipolar and unipolar depression.
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Affiliation(s)
- M Fink
- Departments of Psychiatry and Neurology, Stony Brook University, Long Island, NY, USA
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Fink M, Medelnik J, Strobel K, Hirschfelder U, Hofmann E. Metric precision via soft-tissue landmarks in three-dimensional structured-light scans of human faces. J Orofac Orthop 2014; 75:133-43. [PMID: 24577017 DOI: 10.1007/s00056-013-0201-9] [Citation(s) in RCA: 8] [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] [Received: 01/17/2013] [Accepted: 05/13/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The goal of the current work was to investigate the suitability of ten facial soft-tissue landmarks (trichion, glabella, nasion, left and right orbital, subnasal, left and right porion, pogonion, gnathion) as reference points for metric facial analysis by analyzing their intra- and interserial precision in all three dimensions. METHODS The faces of 32 volunteers were scanned using a standardized protocol with a structured-light scanner (FaceSCAN(3D) Scientific Photolab 60 Hz; 3D Shape, Erlangen, Germany). Three examiners placed the landmarks twice within a 2-week interval. Image processing (Onyx Ceph(3); Image Instruments; Chemnitz, Germany) and statistical (SAS 9.2; SAS Institute, Cary, NC, USA) software was used for analysis. All measurements were corrected for mean values per patient and analyzed for intraserial and interserial error by model II ANOVA for a simple classification with random effects. RESULTS Median intraserial precision was 0.40 mm (range 0.05-1.01 mm) overall, including 0.40 mm (0.33-0.85 mm) on the x-axis, 0.64 mm (0.36-0.87 mm) on the y-axis, and 0.27 mm (0.05-1.01 mm) on the z-axis. Interserial precision was substantially lower at a median of 0.05 mm (0-0.22 mm), often not statistically assessable with intraserial precision. We observed no landmark-associated differences; in particular, the medians of the bilateral landmarks orbital (intraserial: 0.40 mm; interserial: 0.02 mm) and porion (intraserial: 0.36 mm; interserial: small and not assessable) were in the middle of the range of our results. Trichion (intraserial: 0.73 mm; interserial: 0.05 mm) and gnathion (intraserial: 0.87 mm; interserial: 0.20 mm) revealed the highest degrees of intraserial measurement imprecision. Outliers were identified in 1.2% (64 of 5400) of measurements. CONCLUSION All selected landmarks offer suitably high levels of intra- and interserial precision for the three-dimensional (3D) metric assessment of facial soft-tissue parameters. No difference between (bi)lateral and facial midline landmarks was noted.
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Affiliation(s)
- M Fink
- Department of Orthodontics and Orofacial Orthopedics (Zahnklinik 3 - Kieferorthopädie), University of Erlangen-Nuremberg, Glückstr. 11, 91054, Erlangen, Germany,
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Abstract
HEX-programs extend logic programs under the answer set semantics with external computations through external atoms. As reasoning from ground Horn programs with nonmonotonic external atoms of polynomial complexity is already on the second level of the polynomial hierarchy, minimality checking of answer set candidates needs special attention. To this end, we present an approach based on unfounded sets as a generalization of related techniques for ASP programs. The unfounded set detection is expressed as a propositional SAT problem, for which we provide two different encodings and optimizations to them. We then integrate our approach into a previously developed evaluation framework for HEX-programs, which is enriched by additional learning techniques that aim at avoiding the reconstruction of the same or related unfounded sets. Furthermore, we provide a syntactic criterion that allows one to skip the minimality check in many cases. An experimental evaluation shows that the new approach significantly decreases runtime.
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Gautier A, Lowe P, Skerjanec A, McKernan P, Luttringer O, Fink M. P02-026 - Model-based characterization of the PKPD relationship for canakinumab in CAPS: a step towards personalized. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952738 DOI: 10.1186/1546-0096-11-s1-a133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Arnal B, Pinton G, Garapon P, Pernot M, Fink M, Tanter M. Global approach for transient shear wave inversion based on the adjoint method: a comprehensive 2D simulation study. Phys Med Biol 2013; 58:6765-78. [PMID: 24018867 DOI: 10.1088/0031-9155/58/19/6765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Shear wave imaging (SWI) maps soft tissue elasticity by measuring shear wave propagation with ultrafast ultrasound acquisitions (10 000 frames s(-1)). This spatiotemporal data can be used as an input for an inverse problem that determines a shear modulus map. Common inversion methods are local: the shear modulus at each point is calculated based on the values of its neighbour (e.g. time-of-flight, wave equation inversion). However, these approaches are sensitive to the information loss such as noise or the lack of the backscattered signal. In this paper, we evaluate the benefits of a global approach for elasticity inversion using a least-squares formulation, which is derived from full waveform inversion in geophysics known as the adjoint method. We simulate an acoustic waveform in a medium with a soft and a hard lesion. For this initial application, full elastic propagation and viscosity are ignored. We demonstrate that the reconstruction of the shear modulus map is robust with a non-uniform background or in the presence of noise with regularization. Compared to regular local inversions, the global approach leads to an increase of contrast (∼+3 dB) and a decrease of the quantification error (∼+2%). We demonstrate that the inversion is reliable in the case when there is no signal measured within the inclusions like hypoechoic lesions which could have an impact on medical diagnosis.
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Affiliation(s)
- B Arnal
- Institut Langevin, ESPCI ParisTech, CNRS UMR 7587, INSERM U979, Université Paris Diderot, France
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Mohindra P, Saeger K, Heath A, Burns A, Olson S, Smilowitz J, Fink M, Strutz J, Brandt K, Anderson B. Standardized Intensity Modulated Radiation Therapy (IMRT) Workflow to Allow Adequate Scheduling Notice for Patients Treated at a Busy Academic Radiation Oncology Center: Results of a Pilot Study. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1563] [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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Howell J, Sawhney R, Angus P, Fink M, Jones R, Wang BZ, Visvanathan K, Crowley P, Gow P. Identifying the superior measure of rapid fibrosis for predicting premature cirrhosis after liver transplantation for hepatitis C. Transpl Infect Dis 2013; 15:588-99. [PMID: 24028328 DOI: 10.1111/tid.12134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/24/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) recurrence post liver transplant is universal, with a subgroup of patients developing rapid hepatic fibrosis. Various clinical definitions of rapid fibrosis (RF) have been used to identify risks for rapid progression, but their comparability and efficacy at predicting adverse outcomes has not been determined. METHODS Retrospective data analysis was conducted on 100 adult patients with HCV who underwent liver transplantation at a single center. We measured year 1 fibrosis progression (RF defined as METAVIR F score ≥ 1 at 1-year liver biopsy), time to METAVIR F2-stage fibrosis, and fibrosis rate (calculated using liver biopsies graded by METAVIR scoring F0-4; fibrosis rate = fibrosis stage/year post transplant). RF was defined as ≥ 0.5 units/year. RESULTS Multivariate analysis revealed that donor age and peak HCV viral load were significant risks for RF, when fibrosis rate was used to define RF. Advanced donor age was a risk for rapid progression to F2-stage fibrosis, whereas genotype 2 or 3 HCV infection was protective. Fibrosis rate had the strongest correlation with time to cirrhosis development (P < 0.0001, r = -0.76) and was the most accurate predictor of rapid graft cirrhosis (P < 0.0001, area under the curve 0.979, sensitivity 100%, specificity 94%). CONCLUSION Different measures of RF progression identify different risks for RF and are not directly comparable. Fibrosis rate was the most accurate predictor of rapid graft cirrhosis.
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Affiliation(s)
- J Howell
- Victorian Liver Transplant Unit, Austin Hospital, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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38
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Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, Klauser AS, Sporea I, Calliada F, Cantisani V, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Fromageau J, Havre RF, Jenssen C, Ohlinger R, Săftoiu A, Schaefer F, Dietrich CF. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013; 34:238-53. [PMID: 23605169 DOI: 10.1055/s-0033-1335375] [Citation(s) in RCA: 461] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The clinical part of these Guidelines and Recommendations produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology EFSUMB assesses the clinically used applications of all forms of elastography, stressing the evidence from meta-analyses and giving practical advice for their uses and interpretation. Diffuse liver disease forms the largest section, reflecting the wide experience with transient and shear wave elastography . Then follow the breast, thyroid, gastro-intestinal tract, endoscopic elastography, the prostate and the musculo-skeletal system using strain and shear wave elastography as appropriate. The document is intended to form a reference and to guide clinical users in a practical way.
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Affiliation(s)
- D Cosgrove
- Div. of Radiology, Imperial and Kings Colleges, London, UK.
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39
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Mochel JP, Gabrielsson J, Collard W, Fink M, Gehring R, Laffont C, Liu Y, Martin-Jimenez T, Pelligand L, Steimer JL, Toutain PL, Whittem T, Riviere J. Animal Health Modeling & Simulation Society: a new society promoting model-based approaches in veterinary pharmacology. J Vet Pharmacol Ther 2013; 36:417-419. [PMID: 23713757 DOI: 10.1111/jvp.12060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/05/2013] [Indexed: 11/28/2022]
Abstract
The Animal Health Modeling & Simulation Society (AHM&S) is a newly founded association (2012) that aims to promote the development, application, and dissemination of modeling and simulation techniques in the field of Veterinary Pharmacology and Toxicology. The association is co-chaired by Pr. Johan Gabrielsson (Europe), Pr. Jim Riviere (USA), and secretary Dr. Jonathan Mochel (Switzerland). This short communication aims at presenting the membership, rationale and objectives of this group.
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Affiliation(s)
- J P Mochel
- Department of Pharmacology, Leiden-Academic Centre for Drug Research, Leiden, The Netherlands; Department of Modeling and Simulation, Novartis Pharma AG, Basel, Switzerland
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40
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Abstract
Ultrasonography has been widely used for diagnosis since it was first introduced in clinical practice in the 1970's. Since then, new ultrasound modalities have been developed, such as Doppler imaging, which provides new information for diagnosis. Elastography was developed in the 1990's to map tissue stiffness, and reproduces/replaces the palpation performed by clinicians. In this paper, we introduce the principles of elastography and give a technical summary for the main elastography techniques: from quasi-static methods that require a static compression of the tissue to dynamic methods that uses the propagation of mechanical waves in the body. Several dynamic methods are discussed: vibro-acoustography, Acoustic Radiation Force Impulsion (ARFI), transient elastography, shear wave imaging, etc. This paper aims to help the reader at understanding the differences between the different methods of this promising imaging modality that may become a significant tool in medical imaging.
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Affiliation(s)
- J-L Gennisson
- Institut Langevin, ondes et images [Waves and Images], ESPCI ParisTech, CNRS UMR 7587, Inserm ERL U979, université Paris VII, 1, rue Jussieu, 75238 Paris cedex 05, France.
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41
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42
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Fink M, Zerlauth U, Kaulfersch C, Rab A, Alberer D, Preiss P, Sternad-Klobschauer K, Habernig E, Wandschneider W, Grimm G. A severe case of haemodynamic instability during anidulafungin administration. J Clin Pharm Ther 2013; 38:241-2. [DOI: 10.1111/jcpt.12046] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/03/2012] [Indexed: 01/22/2023]
Affiliation(s)
- M. Fink
- Department of Cardiothoracic and Vascular Surgery; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
- Department of Hospital Epidemiology and Infection Control; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - U. Zerlauth
- Department of Hospital Epidemiology and Infection Control; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - C. Kaulfersch
- Department of Internal Medicine; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - A. Rab
- Department of Internal Medicine; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - D. Alberer
- Department of Internal Medicine; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - P. Preiss
- Department of Cardiothoracic and Vascular Surgery; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | | | - E. Habernig
- Department of Hospital Pharmacy; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - W. Wandschneider
- Department of Cardiothoracic and Vascular Surgery; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
| | - G. Grimm
- Department of Internal Medicine; Klinikum Klagenfurt am Wörthersee; Klagenfurt Austria
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43
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Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013; 34:169-84. [PMID: 23558397 DOI: 10.1055/s-0033-1335205] [Citation(s) in RCA: 690] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The technical part of these Guidelines and Recommendations, produced under the auspices of EFSUMB, provides an introduction to the physical principles and technology on which all forms of current commercially available ultrasound elastography are based. A difference in shear modulus is the common underlying physical mechanism that provides tissue contrast in all elastograms. The relationship between the alternative technologies is considered in terms of the method used to take advantage of this. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided on optimisation of scanning technique, image display, image interpretation and some of the known image artefacts.
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Affiliation(s)
- J Bamber
- Ultrasound and Optics Team, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom.
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Abstract
In this paper, we investigate the problem of labeling point sites in focus regions of maps or diagrams. This problem occurs, for example, when the user of a mapping service wants to see the names of restaurants or other POIs in a crowded downtown area but keep the overview over a larger area. Our approach is to place the labels at the boundary of the focus region and connect each site with its label by a linear connection, which is called a leader. In this way, we move labels from the focus region to the less valuable context region surrounding it. In order to make the leader layout well readable, we present algorithms that rule out crossings between leaders and optimize other characteristics such as total leader length and distance between labels. This yields a new variant of the boundary labeling problem, which has been studied in the literature. Other than in traditional boundary labeling, where leaders are usually schematized polylines, we focus on leaders that are either straight-line segments or Bezier curves. Further, we present algorithms that, given the sites, find a position of the focus region that optimizes the above characteristics. We also consider a variant of the problem where we have more sites than space for labels. In this situation, we assume that the sites are prioritized by the user. Alternatively, we take a new facility-location perspective which yields a clustering of the sites. We label one representative of each cluster. If the user wishes, we apply our approach to the sites within a cluster, giving details on demand.
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Affiliation(s)
- M Fink
- Lehrstuhl I, Institut f¨ur Informatik, Universitat Wurzburg
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45
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Mochel J, Fink M. Response to letter from Atkins et al
. Capturing the dynamics of systemic Renin-Angiotensin-Aldosterone System (RAAS) peptides heightens the understanding of the effect of benazepril in dogs. J Vet Pharmacol Ther 2012. [DOI: 10.1111/jvp.12017] [Citation(s) in RCA: 3] [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: 11/29/2022]
Affiliation(s)
- J. Mochel
- Modeling and Simulation; Novartis Campus St. Johann; Basel Switzerland
| | - M. Fink
- Modeling and Simulation; Novartis Campus St. Johann; Basel Switzerland
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Milberg P, Fink M, Pott C, Frommeyer G, Biertz J, Osada N, Stypmann J, Mönnig G, Koopmann M, Breithardt G, Eckardt L. Blockade of I(Ca) suppresses early afterdepolarizations and reduces transmural dispersion of repolarization in a whole heart model of chronic heart failure. Br J Pharmacol 2012; 166:557-68. [PMID: 22013922 DOI: 10.1111/j.1476-5381.2011.01721.x] [Citation(s) in RCA: 28] [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] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Chronic heart failure (CHF) is associated with action potential prolongation and Ca(2+) overload, increasing risk of ventricular tachyarrhythmias (VT). We therefore investigated whether I(Ca) blockade was anti-arrhythmic in an intact perfused heart model of CHF. EXPERIMENTAL APPROACH CHF was induced in rabbits after 4 weeks of rapid ventricular pacing. Hearts from CHF and sham-operated rabbits were isolated and perfused (Langendorff preparation), with ablation of the AV node. VT was induced by erythromycin and low [K(+) ] (1.5mM). Electrophysiology of cardiac myocytes, with block of cation currents, was simulated by a mathematical model. KEY RESULTS Repolarization was prolonged in CHF hearts compared with sham-operated hearts. Action potential duration (APD) and overall dispersion of repolarization were further increased by erythromycin (300 µM) to block I(Kr) in CHF hearts. After lowering [K(+) ] to 1.5mM, CHF and sham hearts showed spontaneous episodes of polymorphic non-sustained VT. Additional infusion of verapamil (0.75 µM) suppressed early afterdepolarizations (EAD) and VT in 75% of sham and CHF hearts. Verapamil shortened APD and dispersion of repolarization, mainly by reducing transmural dispersion of repolarization via shortening of endocardial action potentials. Mathematical simulations showed that EADs were more effectively reduced by verapamil assuming a state-dependent block than a simple block of I(Ca) . CONCLUSIONS AND IMPLICATIONS Blockade of I(Ca) was highly effective in suppressing VT via reduction of transmural dispersion of repolarization and suppression of EAD. Such blockade might represent a novel therapeutic option to reduce risk of VT in structurally normal hearts and also in heart failure. LINKED ARTICLE This article is commented on by Stams et al., pp. 554-556 of this issue. To view this commentary visit http://dx.doi.org/10.1111/j.1476-5381.2011.01818.x.
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Affiliation(s)
- P Milberg
- Division of Experimental and Clinical Electrophysiology, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany.
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Duran I, Mahmood A, Hoefeler H, Ghazal H, Lueftner D, Fink M, Bahl A, Hechmati G, Wei R, Atchison C. Burden of Skeletal-Related Events (SRES) in Patients (PTS) with Solid Tumors: Results of the Stars Observational Study in the US vs EU. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33973-9] [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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48
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Bulau AM, Fink M, Klingl V, Schwerd T, Kim S, Bufler P. P002 The antiinflammatory function and ATP dependent externalization of Interleukin-37 is dependent on caspase-1 processing. Cytokine 2012. [DOI: 10.1016/j.cyto.2012.06.085] [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: 12/01/2022]
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49
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Abstract
We present time reversal experiments demonstrating refocusing of gravity-capillary waves in a water tank cavity. Owing to the reverberating effect of the cavity, only a few channels are sufficient to reconstruct the surface wave at the point source, even if the absorption is not negligible. Space-time-resolved measurements of the waves during the refocusing allow us to quantitatively demonstrate that the quality of the refocusing increases linearly with the number of reemitting channels. Numerical simulations corresponding to water waves at larger scales, with negligible damping, indicate the possibility of very high quality refocusing.
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Affiliation(s)
- A Przadka
- Physique et Mécanique des Milieux Hétérogènes, PMMH, UMR CNRS 7636-ESPCI-UPMC Université Paris 6-UPD Université Paris 7, Paris, France
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50
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Marsac L, Chauvet D, Larrat B, Pernot M, Robert B, Fink M, Boch AL, Aubry JF, Tanter M. MR-guided adaptive focusing of therapeutic ultrasound beams in the human head. Med Phys 2012; 39:1141-9. [PMID: 22320825 DOI: 10.1118/1.3678988] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This study aims to demonstrate, using human cadavers the feasibility of energy-based adaptive focusing of ultrasonic waves using magnetic resonance acoustic radiation force imaging (MR-ARFI) in the framework of non-invasive transcranial high intensity focused ultrasound (HIFU) therapy. METHODS Energy-based adaptive focusing techniques were recently proposed in order to achieve aberration correction. The authors evaluate this method on a clinical brain HIFU system composed of 512 ultrasonic elements positioned inside a full body 1.5 T clinical magnetic resonance (MR) imaging system. Cadaver heads were mounted onto a clinical Leksell stereotactic frame. The ultrasonic wave intensity at the chosen location was indirectly estimated by the MR system measuring the local tissue displacement induced by the acoustic radiation force of the ultrasound (US) beams. For aberration correction, a set of spatially encoded ultrasonic waves was transmitted from the ultrasonic array and the resulting local displacements were estimated with the MR-ARFI sequence for each emitted beam. A noniterative inversion process was then performed in order to estimate the spatial phase aberrations induced by the cadaver skull. The procedure was first evaluated and optimized in a calf brain using a numerical aberrator mimicking human skull aberrations. The full method was then demonstrated using a fresh human cadaver head. RESULTS The corrected beam resulting from the direct inversion process was found to focus at the targeted location with an acoustic intensity 2.2 times higher than the conventional non corrected beam. In addition, this corrected beam was found to give an acoustic intensity 1.5 times higher than the focusing pattern obtained with an aberration correction using transcranial acoustic simulation-based on X-ray computed tomography (CT) scans. CONCLUSIONS The proposed technique achieved near optimal focusing in an intact human head for the first time. These findings confirm the strong potential of energy-based adaptive focusing of transcranial ultrasonic beams for clinical applications.
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Affiliation(s)
- L Marsac
- Université Paris 7, Paris, France.
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