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Schulz T, Cattaneo A, Löhr M, Dufner V, Monoranu C, Keßler A. P11.34.A Pseudoprogression in cases of brain metastases and its neurooncological pitfalls under PD-1 inhibitor therapy in the era of personalized medicine. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.223] [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: 11/14/2022] Open
Abstract
Abstract
Background
Immunotherapy plays an increasing role in combating malignant cancers. Recently, there has been a noticeable uptick of pseudoprogression mimicking true tumor growth or even intracranial abscess. PD-1 inhibitors especially have come under scrutiny for imitating progressive diseases. Here, we summarize our departmental findings to this regard.
Material and Methods
We analyzed the clinical, intraoperative and neuropathological findings as well as perioperative radiological imaging in four cases.
Results
Four patients (three males and one female, ranged 52-74 years) underwent resection for brain metastases and were subsequently treated with radiotherapy and with PD-1 inhibitors. Within one-year post-surgery, cranial MRI-imaging showed space-occupying, contrast enhanced lesions in all four patients. In two cases FET-PETs were performed pre-operatively. They showed a significant increase in aminoacid uptake. In two cases, 5-aminolevulineacid (5-ALA) was applied pre-operatively. In one case, there was considerable 5-ALA uptake. The fourth patient presented radiological signs of an abscess and underwent emergency surgery. The neuropathological workup of all tissues in question depicted highly increased activity of lymphocytes and microglia, accompanied by necrosis. All cases were classified as pseudoprogression, which, on top, had developed supramarginally in previously healthy tissue.
Conclusion
Neurooncologists face crescent challenges in the increasing cases of pseudoprogression under/after immunotherapy. Radiological imaging doesn’t seem to be able to clearly differentiate between true and pseudoprogression. Even FET-PETs, in general a valid diagnostic tool, seem to be fooled by checkpoint inhibitors. Furthermore, pseudoprogressive tissue after PD-1 inhibitor therapy might mimic tumor tissue intra-operatively by increased 5-ALA uptake. All these characteristics increase the risk of overly aggressive resection of the suspected cancerous or infectious, but in the end pseudo-progressive tissue. Brain edema and clinical symptoms spurred by pseudoprogression may be an indication for surgery, but the risk of performing possibly unnecessary surgery based on radiological findings fooled by PD-1 inhibitors should be taken into consideration. At this point, there does not seem to be a foolproof diagnostic method to differentiate pseudo- from true progression. And there is the possibility that the pseudoprogression is happening in tissue adjacent to the previously resected lesion. Neurooncologists need to acknowledge that pseudoprogression under/after immunotherapy will become only more prevalent in the future and take this message to their patients.
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Affiliation(s)
- T Schulz
- Universitätsklinikum Würzburg , Würzburg , Germany
| | - A Cattaneo
- Universitätsklinikum Würzburg , Würzburg , Germany
| | - M Löhr
- Universitätsklinikum Würzburg , Würzburg , Germany
| | - V Dufner
- Universitätsklinikum Würzburg , Würzburg , Germany
| | - C Monoranu
- Universitätsklinikum Würzburg , Würzburg , Germany
| | - A Keßler
- Universitätsklinikum Würzburg , Würzburg , Germany
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2
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Salvador E, Kessler AF, Köppl T, Schönhärl S, Burek M, Tempel Brami C, Voloshin T, Giladi M, Ernestus R, Löhr M, Förster C, Hagemann C. P10.01.A Reversible blood-brain barrier (BBB) disruption by Tumor Treating Fields (TTFields) in a human 3D in vitro model. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.166] [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: 11/13/2022] Open
Abstract
Abstract
Background
Drug delivery to the central nervous system (CNS) is often impeded by the restrictive nature of the blood brain barrier (BBB). Since many therapeutic molecules are not able to traverse this barrier, the development of new methods to disrupt the BBB is of paramount importance. Tumor Treating Fields (TTFields) are alternating electric fields of low intensity (1-3 V/cm) and intermediate frequency (100-300 kHz), which are approved and effective for the treatment of glioblastoma at a frequency of 200 kHz. We recently demonstrated that TTFields at lower frequencies are able to transiently induce BBB permeability in in vitro and in vivo murine models. Here, we explored whether the transient opening of the BBB by TTFields in our murine systems also translates to a human cell-based 3D model.
Material and Methods
A three-dimensional BBB model was established by co-culturing primary human brain microvascular endothelial cells (HBMVEC) on a transwell insert together with human pericytes on the bottom of a well-plate. The model was treated with TTFields at 100-300 kHz for 2496 h using the inovitro™ TTFields Lab Bench System (Novocure®). Afterwards, the cells recovered for 24-96 h. In order to analyze the effects of TTFields on barrier integrity and compromise, transendothelial electrical resistance (TEER) of the HBMVEC monolayer was measured before the start of TTFields treatment, immediately after TTFields cessation, as well as 24-96 h after TTFields treatment. Permeability of the barrier was assessed by visualizing the movement of FITC-dextran through the HBMVEC monolayer. In addition, changes in expression and localization of the tight junction protein (TJP) claudin-5 (Cl-5) after application of TTFields were analyzed by fractionated Western-blotting and immunofluorescence (IF) staining, respectively.
Results
Application of TTFields at all investigated frequencies significantly decreased TEER across the HBMVEC monolayer after as early as 24 h, with the strongest effects seen after 72 h at a TTFields frequency of 100 kHz. TTFields treatment delocalized TJP Cl5 from the cell boundaries to the cytoplasm as evidenced by Western-blots and IF stainings. Restoration of the cell barrier was already measurable as early as 24 h after TTFields cessation and a complete recovery was evident after 48 h.
Conclusion
These results in a human 3D in vitro model confirm our previous observations from mouse models that TTFields could transiently open the BBB. These fundamental pre-clinical data demonstrate the feasibility of facilitating drug delivery to the CNS via concomitant application of TTFields. This method opens up the prospect of improved drug-based treatment of devastating CNS diseases such as GBM if these results could be translated to the clinical setting in the future.
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Affiliation(s)
- E Salvador
- University Hospital Wuerzburg , Würzburg , Germany
| | - A F Kessler
- University Hospital Wuerzburg , Würzburg , Germany
| | - T Köppl
- University Hospital Wuerzburg , Würzburg , Germany
| | - S Schönhärl
- University Hospital Wuerzburg , Würzburg , Germany
| | - M Burek
- University Hospital Wuerzburg , Würzburg , Germany
| | | | | | | | - R Ernestus
- University Hospital Wuerzburg , Würzburg , Germany
| | - M Löhr
- University Hospital Wuerzburg , Würzburg , Germany
| | - C Förster
- University Hospital Wuerzburg , Würzburg , Germany
| | - C Hagemann
- University Hospital Wuerzburg , Würzburg , Germany
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Diener L, Goedert N, Schulz T, Monoranu C, Ernestus R, Hagemann C, Löhr M, Nerreter T, Dufner V. P06.04.B Efficacy of Podoplanin-CAR-T Cells in ex vivo Patient Derived Glioblastoma Organoids. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.128] [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: 11/12/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is the most prevalent malignant brain tumor in adults. Recent immunotherapeutic approaches led to promising effects both in vitro and in preclinical animal models. However, tumor heterogeneity, antigen escape mechanisms and complex interactions with the tumor microenvironment (TME) hinder their clinical breakthrough. Thus, patient derived ex vivo models are needed to test new therapeutical approaches. Genetically modified T cells expressing a chimeric antigen receptor (CAR) hold enhanced affinity for tumor associated antigens. As Podoplanin (PDPN) shows stable and increased expression in GBM, it is a suitable target antigen. When activated, CAR-T cells initiate the triad of cytokine release, T cell proliferation and target cell apoptosis. We evaluated the performance of PDPN-CAR-T cells in GBM patient derived organoids (PDO).
Material and Methods
PDOs were generated from freshly resected GBM tissue and could be cultured successfully up to several months. We assessed PDPN expression of PDOs via immunohistochemistry (IHC) prior to treatment. PDPN-CAR T cells were generated from peripheral blood mononuclear cells of healthy donors via lentiviral transduction and expansion. The transduction rate was assessed by flow cytometry prior to application. PDOs treated with untransduced T cells served as controls. PDOs were incubated with a preset number of PDPN-CAR T cells at a E:T ratio of 1:4 and were examined microscopically to register morphological disintegration after 48h. Immunofluorescence staining was conducted to detect proliferating CD4+ CART cells (CD4+/ Ki67+) after 72h and cytokine release of IFN-γ was determined via ELISA after 20h.
Results
In total, PDOs from three patients were treated with PDPN-CART cells. All of them expressed the antigen according to IHC staining. All incubated PDOs presented clear disintegration of the circular organoid shape up to total dissolving, whereas control PDOs stayed intact. CD4+ CART cells showed extensive proliferation at a mean rate of 79.8% ± 6,59% which was significant for two PDOs in comparison to control PDOs (p = 0.48, p < 0.01). PDPNCART cells exhibited significantly elevated IFN-γ release in all PDOs (p < 0.01).
Conclusion
We here describe PDPN as a promising target and proved effectiveness of PDPN-CAR-T cells in an ex vivo 3D model. Additional ex vivo models like tumor slice cultures might be crucial to evaluate effectiveness of CAR-T cell therapy. PDPN-CAR-T cells should be tested in these ex vivo as well as in vivo GBM models alone and in a combined approach with CARs targeting additional antigens in order to overcome tumor heterogeneity.
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Affiliation(s)
- L Diener
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - N Goedert
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - T Schulz
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - C Monoranu
- Pathologisches Institut, Abteilung für Neuropathologie, Universität Würzburg , Würzburg , Germany
| | - R Ernestus
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - C Hagemann
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - M Löhr
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
| | - T Nerreter
- Medizinische Klinik II, Universitätsklinikum Würzburg , Würzburg , Germany
| | - V Dufner
- Neurochirurgische Klinik und Poliklinik, Sektion Experimentelle Neurochirurgie, Universitätsklinikum Würzburg , Würzburg , Germany
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Rosato V, Gómez-Rubio P, Molina-Montes E, Márquez M, Löhr M, O'Rorke M, Michalski CW, Molero X, Farré A, Perea J, Kleeff J, Crnogorac-Jurcevic T, Greenhalf W, Ilzarbe L, Tardón A, Gress T, Barberá VM, Domínguez-Muñoz E, Muñoz-Bellvís L, Balsells J, Costello E, Iglesias M, Kong B, Mora J, O'Driscoll D, Poves I, Scarpa A, Ye W, Hidalgo M, Sharp L, Carrato A, Real FX, La Vecchia C, Malats N. Gallbladder disease and pancreatic cancer risk: a multicentric case-control European study. Eur J Cancer Prev 2021; 30:423-430. [PMID: 34545020 DOI: 10.1097/cej.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection). METHODS Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders. RESULTS Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33-2.16). The ORs were 4.84 (95% CI 2.96-7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79-1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15-2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87-1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13-2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62-1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14-2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88-1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity. CONCLUSION Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.
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Affiliation(s)
- V Rosato
- Unit of Medical Statistics and Biometry, National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - P Gómez-Rubio
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - E Molina-Montes
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - M Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
| | - M Löhr
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M O'Rorke
- Centre for Public Health, Belfast, Queen's University Belfast, Belfast, UK
| | - C W Michalski
- Department of Surgery, Technical University of Munich, Munich
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - X Molero
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Universitat Autònoma de Barcelona, Barcelona
- CIBEREHD
| | - A Farré
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - J Perea
- Department of Surgery, University Hospital 12 de Octubre
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - J Kleeff
- Department of Surgery, Technical University of Munich, Munich
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - T Crnogorac-Jurcevic
- Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, John Vane Science Centre, London
| | - W Greenhalf
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool, UK
| | - L Ilzarbe
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - A Tardón
- Department of Medicine, Instituto Universitario de Oncología del Principado de Asturias, Oviedo
- CIBERESP, Spain
| | - T Gress
- Department of Gastroenterology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - V M Barberá
- Molecular Genetics Laboratory, General University Hospital of Elche
| | - E Domínguez-Muñoz
- Department of Gastroenterology, University Clinical Hospital of Santiago de Compostela
| | - L Muñoz-Bellvís
- General and Digestive Surgery Department, Salamanca University Hospital, Elche, Santiago de Compostela, and Salamanca, Spain
| | - J Balsells
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Universitat Autònoma de Barcelona, Barcelona
- CIBEREHD
| | - E Costello
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool, UK
| | - M Iglesias
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - Bo Kong
- Department of Surgery, Technical University of Munich, Munich
| | - J Mora
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - D O'Driscoll
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - I Poves
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Hospital del Mar-Parc de Salut Mar, Barcelona
| | - A Scarpa
- ARC-Net centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - W Ye
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Hidalgo
- Madrid-Norte-Sanchinarro Hospital, Madrid, Spain
| | - L Sharp
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Newcastle University, Institute of Health & Society, Newcastle, UK
| | - A Carrato
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Department of Oncology, Ramón y Cajal University Hospital, IRYCIS, Alcala University
| | - F X Real
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- Epithelial Carcinogenesis Group
- Spanish National Cancer Research Centre (CNIO), Madrid
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid
- CIBERONC, Spain
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Dufner V, Schulz E, Monoranu C, Hudecek M, Ernestus R, Hagemann C, Löhr M, Nerreter T. P04.17 Antigen heterogeneity in glioblastoma cell lines, patient-derived cells, and patients’ glioblastoma tissue is an obstacle for CAR-T cell therapy development. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.071] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Immunotherapy targeting surface antigens, e.g. CAR-T-cell therapy has become a promising therapeutic approach for glioblastoma (GBM) treatment. Antigen heterogeneity constitutes a major obstacle not only for preclinical in vitro studies but also for clinical translation. Here, we provide information about the surface expression of the eight in GBM CAR-T-cell therapy most targeted antigens (GD2, CSPG4, CD133, CD70, HER2, Il13Rα2, EGFRvIII and EphA2) by analyzing GBM cell lines (GCL), patient-derived cells (PDCL) and patients’ tumor tissue (PT) and comparing the expression profiles.
MATERIAL AND METHODS
We measured expression of the above-mentioned antigens in 7 GCL (GaMG, U87, U373, U343, U251, U138, DKMG), 7 PDCL and PT of 9 patients by flow cytometry (FACSCanto II). After evaluation with FlowJo software (TreeStar), we scored antigen expression (0–1.0: low expression, 1.1–2.0: medium expression, 2.1–3.0: high expression) and calculated the mean expression and range.
RESULTS
GD2 showed a medium expression in GCL (x̅=1.3) but was highly expressed in PDCL (x̅=2.6) and PT (x̅=2.4). In contrast, CSPG4 displayed low expression in GCL (x̅=0.3) and PT (x̅=0.4), but medium expression in PDCL (x̅=1.9). CD133, a stem cell marker, showed low expression in GCL (x̅=0.8) and PDCL (x̅=0.4), whereas the expression in PT was medium (x̅=1.4). Both CD70 and Il13Rα2 were weakly expressed in GCL, PDCL and PT (x̅=0.2, 0.4, 0.0 and 0.5, 0.6, 0.4, respectively). HER2 displayed medium expression in GCL (x̅=1.4) and PDCL (x̅=1.4) and low expression in PT (x̅=0.6). For EGFRvIII medium expression was detectable in all three entities (x̅=1.4, 1.1 and 1.1). EphA2 was mildly expressed in GCL (x̅=0.1), medium expressed in PT (x̅=2.0) and highly expressed in PDCL (x̅=2.6). Overall, there was high variability of antigen surface expression even within each of the groups.
CONCLUSION
GCL, PDCL and PT display heterogenic antigen surface expression with high variability within each group, thereby complicating clinical translation of in vitro results obtained using cell lines. This aspect should be taken into account in GBM target antigen research.
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Affiliation(s)
- V Dufner
- Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany
| | - E Schulz
- Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany
| | - C Monoranu
- Neuropathology, University of Wuerzburg, Wuerzburg, Germany
| | - M Hudecek
- AG Hudecek, Med II, University of Wuerzburg, Wuerzburg, Germany
| | - R Ernestus
- Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany
| | - C Hagemann
- Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany
| | - M Löhr
- Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany
| | - T Nerreter
- AG Hudecek, Med II, University of Wuerzburg, Wuerzburg, Germany
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Deister A, Brückner-Bozetti P, Heuft G, Kölch M, Klein M, Löhr M, Richert A, Hauth I. [Personnel assessment in psychiatry and psychotherapy : Results of a feasibility study on the platform model]. Nervenarzt 2021; 92:457-467. [PMID: 32880658 DOI: 10.1007/s00115-020-00995-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The topic of personnel assessment in psychiatry, psychotherapy and psychosomatics is currently of great importance in terms of health policy. Sufficient empirical evidence for the development of a comprehensive system for staffing is not yet available. The platform model developed by the psychiatric psychosomatic societies and associations pursues a combined empirical normative approach for a future-oriented assessment instrument for the various professional groups. The concept presented has been proven in the health policy discussion as a sensible system of comprehensive personnel assessment; however, an empirically sound control is still lacking as to whether this system can be used practically for the task described and thus can withstand the task of a resilient and future-proof measurement instrument for the necessary personnel. The task of the present study was to examine the extent to which the assumptions of the platform model are confirmed, whether methodological indications can be identified and whether there are limitations of the study that can be used in the validation and foundation of the model. The study confirmed the feasibility of the model and refers to a number of methodological findings and limitations that can be used for the further development of the model. The developed model allows the necessary staffing to be derived and justified, regardless of diagnoses and settings. It is future-oriented and dynamic.
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Affiliation(s)
- A Deister
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Deutschland.
| | | | - G Heuft
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - M Kölch
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock, Deutschland
| | - M Klein
- Zentrum für Psychiatrie, Klinikum Schloß Winnenden, Winnenden, Deutschland
| | - M Löhr
- LWL-Klinikum Gütersloh, Gütersloh, Deutschland
| | - A Richert
- Alexianer St. Hedwig Kliniken, Berlin, Deutschland
| | - I Hauth
- Alexianer St. Joseph-Krankenhaus, Berlin, Deutschland
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Braicu EI, Mustea A, Laib AM, Kaduthanam S, Hartmann R, Jackson D, Meisel C, Löhr M, Sehouli J. Progress of evidence-based treatment decision support utilizing Molecular Health Guide in patients with gynecological solid tumors over three to six years. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718252] [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: 10/23/2022] Open
Affiliation(s)
- EI Braicu
- Charite University Medicine of Berlin, Department of Gynecology, Charite Campus Virchow-Klinikum
| | - A Mustea
- University Hospital Bonn, Department of Gynecology and Gynecological Oncology
| | | | | | | | | | | | - M Löhr
- Karolinska University Hospital, CLINTEC, Center for Digestive Diseases
| | - J Sehouli
- Charite University Medicine of Berlin, Department of Gynecology, Charite Campus Virchow-Klinikum
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8
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Keßler AF, Weiland J, Linsenmann T, Ernestus R, Hagemann C, Löhr M. P14.60 FET PET response upon radiochemotherapy followed by Tumor Treating Fields (TTFields) in a patient with progressive high-grade glioma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.295] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The addition of Tumor Treating Fields (TTFields) to the first-line therapy in glioblastoma (GBM) demonstrated significantly improved progression free survival, overall survival and longterm survival rates in the EF-14 phase 3 trial. However, responder analysis of patients with recurrent GBM (rGBM) treated with TTFields monotherapy (in the EF-11 trial) revealed delayed response monitored by MRI analysis. More recent data suggests that O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET may add valuable information for monitoring therapy response of glioblastoma patients treated with TTFields. Here, we report on FET PET response in a patient with progressive anaplastic astrocytoma WHO grade III (AA) treated with TTFields in combination with temozolomide (TMZ) chemotherapy.
METHODS
We present a 38-year old patient with an initial diagnosis of a diffuse astrocytoma WHO grade II in 2011, and malignisation to an AA on progression. The treatment regimen included initially radio-chemotherapy (RCT) with TMZ. On further progression of the AA in 2017, TTFields were added to another 6 cycles of TMZ. Several FET PET scans for differentiation of tumor progression from treatment-related changes were performed over time. The definitive diagnosis (tumor progression and grading) was confirmed by histopathology after stereotactic biopsy (SB).
RESULTS
In 2012, the patient was first diagnosed with a low grade astrocytoma WHO grade II of the right frontal, temporal and parietal lobe including infiltration of thalamus and corpus was confirmed by SB, followed by irradiation. On progression in 2015, a FET PET Scan showed FET avidity in all tumor affected regions of the brain. SB confirmed an AA, while FET PET scans showed only a mild response in the temporoparietal region after 6 cycles of TMZ. In 2017, the next progression without further malignisation was confirmed by SB and treated RCT with 41.4 Gy and TMZ chemotherapy, followed by application of TTFields with an average usage rate of 85.7 % over 6 months. Thus, the TTFields adherence was well above the independent prognostic threshold of 75 %. No additional adverse events due to the combined therapy of TTFields and TMZ were observed. Due to a new contrast enhancing lesion in the right frontal lobe (10x7mm), another FET PET scan was performed 1.5 years later. In this scan, obtained after combined TTFields and RCT therapy a strong response regarding FET avidity was observed.
CONCLUSION
In summary, FET PET is able to add important additional information for evaluation of treatment response in high grade glioma patients, in particular for TTFields treated patients, while adding TTFields to radiochemotherapy might even enhance treatment response of high grade glioma. Further studies might elucidate the role of FET PET imaging for therapy monitoring in high grade glioma patients treated with TTFields.
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Affiliation(s)
- A F Keßler
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - J Weiland
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - T Linsenmann
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - R Ernestus
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - C Hagemann
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - M Löhr
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
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9
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Schulz E, Mawamba V, Sturm V, Ernestus R, Schatzschneider U, Löhr M, Hagemann C. P11.44 Conception of a promising future therapy: Drug loaded-microbubbles against glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.190] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Major obstacles for an effective chemotherapy of glioblastomas (GBM) are the blood-brain-barrier (BBB) and serious systemic side effects of the cytotoxic drugs. A new promising strategy could be the delivery of microbubbles, encapsulating the chemotherapeutics, across the BBB to the tumor site. This will shield the drug from detrimental systemic effects. Low intensity focused ultrasound (LIFU) is able to open the BBB and triggers targeted release of the drugs within the tumor. First data on the synthesis of microbubbles, specifically designed new drugs and the targeted rupture of microbubbles by LIFU are presented.
MATERIAL AND METHODS
Thin-film hydration of lipids was utilized to prepare microbubbles, which were tested for toxicity on the GBM cell lines GaMG, U87, U138 and U343. In addition these cells were treated with 6 platinum(II) and palladium(II) complexes conjugated to lipophilic side chains of different length (C1, C8, C10) for 72h. To evaluate cell viability and calculate EC50 values MTT assays and a real-time proliferation assay using the impedance-based xCELLigence DP-System were executed.
RESULTS
Microbubbles ≤ 2µm in diameter were synthesized and could be disintegrated by applying LIFU. Neither the intact bubbles nor the lipids alone had any toxic effects on the GBM cells. In contrast, all six drugs were highly effective with EC50 values far below those of Temozolomide (67µM) and in the range of the reference drug cisplatin (3µM). Especially the palladium(II) compound with the C1-chain displayed a very low EC50 value (<10µM), while the longer chains and the platinum(II) compounds were less effective (EC50 10–40µM). An early and concentration-dependent onset of the cytotoxic effect of drugs with C1 and C8 side chains was revealed in the real time proliferation assay.
CONCLUSION
All components for a new microbubble-based therapeutic strategy are in place. Microbubbles were synthesized without having toxic effects in cell culture. New highly potent palladium(II) and platinum(II) compounds with low EC50 values were developed. The next step will be their encapsulation into the microbubbles via their lipophilic side chains to develop an effective drug-delivery system for the treatment of GBM in combination with LIFU. This will allow increasing the local concentration of chemotherapeutic agents at the tumor site, irrespectively of their molecular size and BBB penetration capacity.
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Affiliation(s)
- E Schulz
- Tumorbiology Laboratory, Würzburg, Germany
| | - V Mawamba
- Institute of Inorganic Chemistry, Würzburg, Germany
| | - V Sturm
- Tumorbiology Laboratory, Würzburg, Germany
| | - R Ernestus
- Tumorbiology Laboratory, Würzburg, Germany
| | | | - M Löhr
- Tumorbiology Laboratory, Würzburg, Germany
| | - C Hagemann
- Tumorbiology Laboratory, Würzburg, Germany
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10
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Keßler AF, Weiland J, Linsenmann T, Ernestus R, Hagemann C, Löhr M. P14.28 First report on the combination of axitinib and Tumor Treating Fields (TTFields) in three patients with recurrent glioblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.263] [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: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Adding Tumor Treating Fields (TTFields) to first-line therapy in glioblastoma (GBM) demonstrated significantly improved survival in the EF-14 trial. Furthermore, in a post-hoc analysis of the EF-14 trial, median overall survival increased significantly upon recurrence (rGBM) for patients treated with bevacizumab (Bev) and TTFields compared to Bev monotherapy. Axitinib (Axi) is an orally available tyrosine kinase inhibitor which is approved for the treatment of metastatic renal cell carcinoma. It has a high affinity and specificity for vascular endothelial growth factor receptors, thereby acting similar to Bev. In phase 2 trials, Axi improved response rate and progression free survival in rGBM patients compared to historical controls with a manageable toxicity profile. We report on three rGBM patients treated with TTFields and Axi (AxiTTFields).
METHODS
A 53-year-old male patient (#1) presented with a multifocal and consistently progressing GBM after initial surgery, radiochemotherapy (RCT) and after 4 cycles of temozolomide (TMZ), combined with TTFields. To meet the urgent need of an alternative treatment, Axi (5mg twice a day) was added to the treatment regimen. In a 46-year-old male patient (#2), an early progress occurred after surgery, RCT and 3 cycles of TMZ combined with TTFields. Similarly to #1, Axi was added to the treatment regimen. In a 61-year-old male patient (#3) with a rGBM after surgery and RCT at the time of the 6th cycle of TMZ, TTFields therapy was initiated at recurrence and treatment regimen was adapted to AxiTTFields.
RESULTS
In these three patients, AxiTTFields was safe and feasible. #1 and #2 were on AxiTTFields therapy for more than 8 months, presenting an improved neurological status with a partial response in the MRI 3 months initiating the combined treatment of AxiTTFields. #3 declined in his neurological status without any change in the MRI monitoring and died 2.4 months after initiating AxiTTFields. Although, Axi as well as TTFields may cause skin irritations, none were observed in this case series. With an average of 77 % in these three patients, the TTFields usage rate was above the independent prognostic threshold of 75 %, underlining the feasibility of this approach. There were no additional adverse events due to the combined therapy of AxiTTFields.
CONCLUSION
In summary, AxiTTFields was feasible and safe in three rGBM patients. As the addition of Axi to TTFields therapy is a promising approach, we plan to investigate the safety and feasibility of this combination in a pilot trial. Further studies might explore effects on outcome and survival of AxiTTFields in rGBM.
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Affiliation(s)
- A F Keßler
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - J Weiland
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - T Linsenmann
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - R Ernestus
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - C Hagemann
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - M Löhr
- University Hospital Würzburg, Department of Neurosurgery, Würzburg, Germany
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11
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Keßler AF, Salvador E, Domröse D, Burek M, Tempel Brami C, Voloshin Sela T, Giladi M, Ernestus R, Löhr M, Förster C, Hagemann C. P11.28 Alteration of blood brain barrier (BBB) permeability by Tumor Treating Fields (TTFields) in vivo. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.174] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Alternating electric fields with intermediate frequency (100 - 300 kHz) and low intensity (1 - 3 V/cm), known as Tumor Treating Fields (TTFields), have been established as a novel adjuvant therapy for glioblastoma (GBM) patients. The blood brain barrier (BBB) tightly controls the influx of the majority of compounds from blood to brain. Due to this regulation, the BBB may block delivery of drugs for treatment of brain tumors, in particular GBM. In this study, we investigated the influence of TTFields on BBB permeability in vivo.
MATERIAL AND METHODS
For determination of BBB permeability, rats were treated with 100 kHz TTFields for 72 h. At the end of treatment, rats were i.v. injected with Evan′s Blue (EB), which binds Albumin (~70 kDa) upon injection to the blood. EB was extracted after brain homogenization and quantified at 610 nm. In addition, cryosections of rat brains were prepared following TTFields application at 100 kHz for 72 h, and sections were stained for Claudin 5, Occludin and immunoglobulin G (IgG) to assess vessel structure. Moreover, serial dynamic contrast-enhanced DCE-MRI with Gadolinium contrast agent (Gd) was performed before and after TTFields application.
RESULTS
In vivo, the EB accumulation in the brain was significantly increased by application of TTFields to the rat head. Claudin 5 and Occludin staining was visible in vessel endothelial cells and localized at the cells’ edges in control cryosections of rat brains. In TTFields-treated rats, the vessel structure became diffuse; Claudin 5 and Occludin were delocalized and IgG was found throughout the brain tissue and not solely inside the vessels, as it is normally the case. Serial DCE-MRI demonstrated significantly increased accumulation of Gd in the brain, detected directly after 72 h of TTFields application. 96 h after end of TTFields treatment the effect on the BBB disappeared and no difference in contrast enhancement between controls and TTFields treated animals was observable.
CONCLUSION
Application of TTFields at 100 kHz could have the potential to deliver drugs to the brain, which normally are unable to cross the BBB by altering BBB integrity and permeability. Utilizing TTFields to open the BBB and its subsequent recovery, as demonstrated by the data presented herein, could lead to a clinical approach of drug delivery for treatment of malignant brain tumors and other diseases of the central nervous system. These results will be further validated in clinical trials.
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Affiliation(s)
- A F Keßler
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - E Salvador
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - D Domröse
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Burek
- University of Würzburg, Department of Anesthesia and Critical Care, Division Molecular Medicine, Würzburg, Germany
| | | | | | | | - R Ernestus
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Löhr
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - C Förster
- University of Würzburg, Department of Anesthesia and Critical Care, Division Molecular Medicine, Würzburg, Germany
| | - C Hagemann
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
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12
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Kessler A, Weiland J, Breun M, Linsenmann T, Ernestus R, Hagemann C, Löhr M. P01.045 Adherence to Tumor Treating Fields in patients with high-grade glioma - a single center experience. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.087] [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)
- A Kessler
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - J Weiland
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - M Breun
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - T Linsenmann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - R Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - C Hagemann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - M Löhr
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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13
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Kessler A, Jentschke E, Weiland J, Dufner V, Lilla N, Linsenmann T, Westermaier T, Hagemann C, Ernestus R, Löhr M. P01.047 Improving quality of life in glioma patients: platform for exchange of patients’ expertise in TTFields practice. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.089] [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)
- A Kessler
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - E Jentschke
- Department of Neurosurgery and Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
| | - J Weiland
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - V Dufner
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - N Lilla
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - T Linsenmann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - T Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - C Hagemann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - R Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - M Löhr
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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14
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Herold-Mende CC, Rapp C, Jungk C, Sahm F, Lamszus K, Ketter R, Löhr M, Senft C, Westphal M, von Deimling A, Unterberg A, Simon M. P04.79 Cytotoxic T cells and their activation status are independent prognostic markers in meningiomas. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.313] [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: 11/14/2022] Open
Affiliation(s)
- C C Herold-Mende
- Department of Neurosurgery, University of Heidelberg, Germany, Heidelberg, Germany
| | - C Rapp
- Department of Neurosurgery, University of Heidelberg, Germany, Heidelberg, Germany
| | - C Jungk
- Department of Neurosurgery, University of Heidelberg, Germany, Heidelberg, Germany
| | - F Sahm
- Department of Neuropathology, University of Heidelberg, Germany, Heidelberg, Germany
| | - K Lamszus
- Department of Neurosurgery, University of Hamburg, Germany, Hamburg, Germany
| | - R Ketter
- Department of Neurosurgery, University of Homburg, Germany, Homburg, Germany
| | - M Löhr
- Department of Neurosurgery, University of Würzburg, Germany, Würzburg, Germany
| | - C Senft
- Department of Neurosurgery, University of Frankfurt, Germany, Frankfurt, Germany
| | - M Westphal
- Department of Neurosurgery, University of Hamburg, Germany, Hamburg, Germany
| | - A von Deimling
- Department of Neuropathology, University of Heidelberg, Germany, Heidelberg, Germany
| | - A Unterberg
- Department of Neurosurgery, University of Heidelberg, Germany, Heidelberg, Germany
| | - M Simon
- Department of Neurosurgery, Bielefeld, Germany, Bielefeld, Germany
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15
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Hagemann C, Neuhaus N, Dahlmann M, Kessler AF, Kobelt D, Herrmann P, Eyrich M, Freitag B, Freitag B, Linsenmann T, Monoranu CM, Ernestus R, Löhr M, Stein U. P01.050 Circulating MACC1 transcript plasma levels in glioblastoma patients segregate together with prognostic markers and treatment response. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.092] [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)
- C Hagemann
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - N Neuhaus
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Dahlmann
- Experimental and Clinical Research Center, Charite Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine in the Helmholtz-Association, Berlin, Germany
| | - A F Kessler
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - D Kobelt
- Experimental and Clinical Research Center, Charite Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine in the Helmholtz-Association, Berlin, Germany
| | - P Herrmann
- Experimental and Clinical Research Center, Charite Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine in the Helmholtz-Association, Berlin, Germany
| | - M Eyrich
- University of Würzburg, Department of Pediatric Hematology/Oncology, Würzburg, Germany
| | - B Freitag
- University of Würzburg, Department of Pediatric Hematology/Oncology, Würzburg, Germany
| | - B Freitag
- University of Würzburg, Department of Pediatric Hematology/Oncology, Würzburg, Germany
| | - T Linsenmann
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - C M Monoranu
- University of Würzburg, Department of Neuropathology, Würzburg, Germany
| | - R Ernestus
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Löhr
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - U Stein
- Experimental and Clinical Research Center, Charite Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine in the Helmholtz-Association, Berlin, Germany
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16
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Kessler A, Linsenmann T, Westermaier T, Wolber W, Hagemann C, Ernestus R, Löhr M. P01.046 Complete radiological response under treatment with Tumor Treating Fields following subtotal resection in a series of three Glioblastoma patients. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.088] [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)
- A Kessler
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - T Linsenmann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - T Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - W Wolber
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - C Hagemann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - R Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - M Löhr
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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17
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Kessler AF, Schaeffer C, Burek M, Ruschig U, Ernestus R, Löhr M, Förster C, Hagemann C. P04.33 Effects of Tumor Treating Fields (TTFields) on blood brain barrier (BBB) permeability. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.267] [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)
- A F Kessler
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - C Schaeffer
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Burek
- University of Würzburg, Department of Anesthesia and Critical Care, Division Molecular Medicine, Würzburg, Germany
| | - U Ruschig
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - R Ernestus
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - M Löhr
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
| | - C Förster
- University of Würzburg, Department of Anesthesia and Critical Care, Division Molecular Medicine, Würzburg, Germany
| | - C Hagemann
- University of Würzburg, Department of Neurosurgery, Tumorbiology Laboratory, Würzburg, Germany
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18
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Kessler AF, Krause K, Al-Shameri B, Weiland J, Linsenmann T, Ernestus R, Hagemann C, Löhr M, Jentschke E. OS4.3 The BReMen trial: Patients with benign meningioma - is rehabilitation really necessary? Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.028] [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)
- A F Kessler
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - K Krause
- University of Würzburg, Department of Neurosurgery, Neuropsychology, Würzburg, Germany
| | - B Al-Shameri
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - J Weiland
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - T Linsenmann
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - R Ernestus
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - C Hagemann
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - M Löhr
- University of Würzburg, Department of Neurosurgery, Laboratory of Tumorbiology, Würzburg, Germany
| | - E Jentschke
- University of Würzburg, Department of Neurosurgery, Neuropsychology, Würzburg, Germany
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19
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Kordes M, Löhr M, Malgerud L, Kaduthanam S, Frödin JE, Karimi M, Yachnin J, Fernadez Moro C, Ghazi S, Heuchel R, Wirta V, Hülsewig C, Stecker K, Del Chiaro M, Östman A, Engstrand L, Brock S, Gustafsson-Liljefors M. Molecular treatment stratification in second-line treatment of pancreatic adenocarcinoma: PePaCaKa-001. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.038] [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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20
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Firuzi O, Che P, Buijs M, Hassouni BE, Stefano C, Löhr M, Heuchel R, Saso L, Peters G, Giovannetti E. PO-278 Assessment of the influence of stellate cells on primary pancreatic cancer cell growth and drug resistance in a spheroid model: MET inhibitors to the rescue. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Molina-Montes E, Gomez-Rubio P, Márquez M, Rava M, Löhr M, Michalski CW, Molero X, Farré A, Perea J, Greenhalf W, Ilzarbe L, O'Rorke M, Tardón A, Gress T, Barberà VM, Crnogorac-Jurcevic T, Domínguez-Muñoz E, Muñoz-Bellvís L, Balsells J, Costello E, Huang J, Iglesias M, Kleeff J, Kong B, Mora J, Murray L, O'Driscoll D, Poves I, Scarpa A, Ye W, Hidalgo M, Sharp L, Carrato A, Real FX, Malats N. Risk of pancreatic cancer associated with family history of cancer and other medical conditions by accounting for smoking among relatives. Int J Epidemiol 2018; 47:473-483. [PMID: 29329392 DOI: 10.1093/ije/dyx269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background Family history (FH) of pancreatic cancer (PC) has been associated with an increased risk of PC, but little is known regarding the role of inherited/environmental factors or that of FH of other comorbidities in PC risk. We aimed to address these issues using multiple methodological approaches. Methods Case-control study including 1431 PC cases and 1090 controls and a reconstructed-cohort study (N = 16 747) made up of their first-degree relatives (FDR). Logistic regression was used to evaluate PC risk associated with FH of cancer, diabetes, allergies, asthma, cystic fibrosis and chronic pancreatitis by relative type and number of affected relatives, by smoking status and other potential effect modifiers, and by tumour stage and location. Familial aggregation of cancer was assessed within the cohort using Cox proportional hazard regression. Results FH of PC was associated with an increased PC risk [odds ratio (OR) = 2.68; 95% confidence interval (CI): 2.27-4.06] when compared with cancer-free FH, the risk being greater when ≥ 2 FDRs suffered PC (OR = 3.88; 95% CI: 2.96-9.73) and among current smokers (OR = 3.16; 95% CI: 2.56-5.78, interaction FHPC*smoking P-value = 0.04). PC cumulative risk by age 75 was 2.2% among FDRs of cases and 0.7% in those of controls [hazard ratio (HR) = 2.42; 95% CI: 2.16-2.71]. PC risk was significantly associated with FH of cancer (OR = 1.30; 95% CI: 1.13-1.54) and diabetes (OR = 1.24; 95% CI: 1.01-1.52), but not with FH of other diseases. Conclusions The concordant findings using both approaches strengthen the notion that FH of cancer, PC or diabetes confers a higher PC risk. Smoking notably increases PC risk associated with FH of PC. Further evaluation of these associations should be undertaken to guide PC prevention strategies.
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Affiliation(s)
- E Molina-Montes
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - P Gomez-Rubio
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Márquez
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Rava
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
| | - M Löhr
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - C W Michalski
- Technical University of Munich, Department of Surgery, Munich, Germany
- University of Heidelberg, Department of Surgery, Heidelberg, Germany
| | - X Molero
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, and CIBEREHD, Spain
| | - A Farré
- Hospital de la Santa Creu i Sant Pau, Department of Gastroenterology, Barcelona, Spain
| | - J Perea
- University Hospital 12 de Octubre, Department of Surgery, Madrid, Spain
| | - W Greenhalf
- Royal Liverpool University Hospital, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
| | - L Ilzarbe
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - M O'Rorke
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - A Tardón
- Instituto Universitario de Oncología del Principado de Asturias, Department of Medicine, Oviedo, and CIBERESP, Spain
| | - T Gress
- University Hospital of Giessen and Marburg, Department of Gastroenterology, Marburg, Germany
| | - V M Barberà
- General University Hospital of Elche, Molecular Genetics Laboratory, Elche, Spain
| | - T Crnogorac-Jurcevic
- Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK
| | - E Domínguez-Muñoz
- University Clinical Hospital of Santiago de Compostela, Department of Gastroenterology, Santiago de Compostela, Spain
| | - L Muñoz-Bellvís
- Salamanca University Hospital, General and Digestive Surgery Department, Salamanca, Spain
| | - J Balsells
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, and CIBEREHD, Spain
| | - E Costello
- Royal Liverpool University Hospital, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
| | - J Huang
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - M Iglesias
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - J Kleeff
- Technical University of Munich, Department of Surgery, Munich, Germany
- Martin-Luther-University Halle-Wittenberg, Department of Visceral, Vascular and Endocrine Surgery, Halle (Saale), Germany
| | - Bo Kong
- Technical University of Munich, Department of Surgery, Munich, Germany
| | - J Mora
- Hospital de la Santa Creu i Sant Pau, Department of Gastroenterology, Barcelona, Spain
| | - L Murray
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - D O'Driscoll
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | - I Poves
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - A Scarpa
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - W Ye
- Karolinska Institutet and University Hospital, Gastrocentrum, Stockholm, Sweden
| | - M Hidalgo
- Madrid-Norte-Sanchinarro Hospital, Madrid, Spain
| | - L Sharp
- National Cancer Registry Ireland and HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Carrato
- Ramón y Cajal University Hospital, Department of Oncology, IRYCIS, Alcala University, Madrid, and CIBERONC, Spain
| | - F X Real
- Spanish National Cancer Research Centre (CNIO), Epithelial Carcinogenesis Group, Madrid, Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, and CIBERONC, Spain
| | - N Malats
- Spanish National Cancer Research Center (CNIO), Genetic and Molecular Epidemiology Group, Madrid, and CIBERONC, Spain
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22
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Gomez-Rubio P, Rosato V, Márquez M, Bosetti C, Molina-Montes E, Rava M, Piñero J, Michalski CW, Farré A, Molero X, Löhr M, Ilzarbe L, Perea J, Greenhalf W, O'Rorke M, Tardón A, Gress T, Barberá VM, Crnogorac-Jurcevic T, Muñoz-Bellvís L, Domínguez-Muñoz E, Gutiérrez-Sacristán A, Balsells J, Costello E, Guillén-Ponce C, Huang J, Iglesias M, Kleeff J, Kong B, Mora J, Murray L, O'Driscoll D, Peláez P, Poves I, Lawlor RT, Carrato A, Hidalgo M, Scarpa A, Sharp L, Furlong LI, Real FX, La Vecchia C, Malats N. A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk. Ann Oncol 2017; 28:1618-1624. [PMID: 28383714 DOI: 10.1093/annonc/mdx167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed in late adulthood; therefore, many patients suffer or have suffered from other diseases. Identifying disease patterns associated with PDAC risk may enable a better characterization of high-risk patients. METHODS Multimorbidity patterns (MPs) were assessed from 17 self-reported conditions using hierarchical clustering, principal component, and factor analyses in 1705 PDAC cases and 1084 controls from a European population. Their association with PDAC was evaluated using adjusted logistic regression models. Time since diagnosis of morbidities to PDAC diagnosis/recruitment was stratified into recent (<3 years) and long term (≥3 years). The MPs and PDAC genetic networks were explored with DisGeNET bioinformatics-tool which focuses on gene-diseases associations available in curated databases. RESULTS Three MPs were observed: gastric (heartburn, acid regurgitation, Helicobacter pylori infection, and ulcer), metabolic syndrome (obesity, type-2 diabetes, hypercholesterolemia, and hypertension), and atopic (nasal allergies, skin allergies, and asthma). Strong associations with PDAC were observed for ≥2 recently diagnosed gastric conditions [odds ratio (OR), 6.13; 95% confidence interval CI 3.01-12.5)] and for ≥3 recently diagnosed metabolic syndrome conditions (OR, 1.61; 95% CI 1.11-2.35). Atopic conditions were negatively associated with PDAC (high adherence score OR for tertile III, 0.45; 95% CI, 0.36-0.55). Combining type-2 diabetes with gastric MP resulted in higher PDAC risk for recent (OR, 7.89; 95% CI 3.9-16.1) and long-term diagnosed conditions (OR, 1.86; 95% CI 1.29-2.67). A common genetic basis between MPs and PDAC was observed in the bioinformatics analysis. CONCLUSIONS Specific multimorbidities aggregate and associate with PDAC in a time-dependent manner. A better characterization of a high-risk population for PDAC may help in the early diagnosis of this cancer. The common genetic basis between MP and PDAC points to a mechanistic link between these conditions.
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Affiliation(s)
- P Gomez-Rubio
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - V Rosato
- Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Department of Clinical Sciences and Community Health, University of Milan, Milan
- Unit of Medical Statistics, Biometry and Bioinformatics, National Cancer Institute, IRCCS Foundation, Milan
| | - M Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - C Bosetti
- Department of Epidemiology, Mario Negri Institute for Pharmacological Research-IRCCS, Milan, Italy
| | - E Molina-Montes
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - M Rava
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
| | - J Piñero
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - C W Michalski
- Department of Surgery, Technical University of Munich, Munich
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - A Farré
- Department of Gastroenterology, Santa Creu i Sant Pau Hospital, Barcelona
| | - X Molero
- Exocrine Pancreas Research Unit and Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
| | - M Löhr
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - L Ilzarbe
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - J Perea
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - W Greenhalf
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - M O'Rorke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Tardón
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
- Department of Medicine, University Institute of Oncology of Asturias, Oviedo, Spain
| | - T Gress
- Department of Gastroenterology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - V M Barberá
- Molecular Genetics Laboratory, General University Hospital of Elche, Elche, Spain
| | - T Crnogorac-Jurcevic
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Centre, London, UK
| | - L Muñoz-Bellvís
- General and Digestive Surgery Department, Salamanca University Hospital, Salamanca
| | - E Domínguez-Muñoz
- Department of Gastroenterology, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela
| | - A Gutiérrez-Sacristán
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - J Balsells
- Exocrine Pancreas Research Unit and Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona
- Network of Biomedical Research Centres (CIBER), Hepatic and Digestive Diseases and Epidemiology and Public Health, Madrid, Spain
| | - E Costello
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - C Guillén-Ponce
- Department of Oncology, Ramón y Cajal Hospital, Madrid, and CIBERONC, Spain
| | - J Huang
- Gastrocentrum, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Iglesias
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - J Kleeff
- Department of Surgery, Technical University of Munich, Munich
- Department of Molecular and Clinical Cancer Medicine, The Royal Liverpool University Hospital, Liverpool
| | - B Kong
- Department of Surgery, Technical University of Munich, Munich
| | - J Mora
- Department of Gastroenterology, Santa Creu i Sant Pau Hospital, Barcelona
| | - L Murray
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - D O'Driscoll
- Research Programme, National Cancer Registry Ireland
| | - P Peláez
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - I Poves
- Department of Gastroenterology, Parc de Salut Mar University Hospital, Barcelona
| | - R T Lawlor
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - A Carrato
- Department of Oncology, Ramón y Cajal Hospital, Madrid, and CIBERONC, Spain
| | - M Hidalgo
- Clara Campal Integrated Oncological Centre, Sanchinarro Hospital, Madrid, Spain
| | - A Scarpa
- ARC-Net Centre for Applied Research on Cancer and Department of Pathology and Diagnostics, University and Hospital trust of Verona, Verona, Italy
| | - L Sharp
- Research Programme, National Cancer Registry Ireland
- Institute of Health & Society, Newcastle University, UK
| | - L I Furlong
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Pompeu Fabra Univeristy (UPF), Barcelona, Spain
| | - F X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - C La Vecchia
- Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, and CIBERONC, Spain
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23
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Wolff-Menzler C, Gyßer S, Große C, Häfner S, Seemüller F, Godemann F, Wiegand H, Löhr M. Aufnahme- und Entlassentscheidungen in der Psychiatrie. Nervenarzt 2015; 87:753-9. [DOI: 10.1007/s00115-015-4385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Nienaber A, Wieskus-Friedemann E, Kliem S, Hoppmann J, Kemper U, Löhr M, Kronmüller KT, Wabnitz P. ['NischE - Nicht von schlechten Eltern' - Evaluation of a Multidisciplinary Teamwork Approach to Support Children in Families with Mentally Ill Parents]. Gesundheitswesen 2015; 79:89-95. [PMID: 26551852 DOI: 10.1055/s-0035-1564249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Evaluation of a project offering low-threshold anonymous counseling services jointly by mental health services and child and youth services to support children in families with mentally ill parents Methods: Evaluating performance data and completed questionnaires returned by parents included in the project. Results: Between 2011-2014, 150 families received up to 10 sessions of family-oriented counseling. The survey results indicate a high level of satisfaction with the services of the cooperation project. The vast majority of respondents said that they would recommend this service to others or would themselves take advantage of the services again. Conclusion: A collaboration of service providers from psychiatry and child and youth welfare department resulting in continuous availability of counseling with a common family medical perspective represents a forward-looking model for families with a mentally ill parent.
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Affiliation(s)
- A Nienaber
- LWL-Klinikum Gütersloh, Gütersloh, Gütersloh
| | | | - S Kliem
- AWO/Kinderschutz Zentrum, Gütersloh, Gütersloh
| | - J Hoppmann
- LWL-Klinikum Gütersloh, Gütersloh, Gütersloh
| | - U Kemper
- LWL-Klinikum Gütersloh, Gütersloh, Gütersloh
| | - M Löhr
- Fachhochschule der Diakonie, Bielefeld, Bielefeld
| | | | - P Wabnitz
- LWL-Klinikum Gütersloh, Gütersloh, Gütersloh
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25
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Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, Chari ST, Della-Torre E, Frulloni L, Goto H, Hart PA, Kamisawa T, Kawa S, Kawano M, Kim MH, Kodama Y, Kubota K, Lerch MM, Löhr M, Masaki Y, Matsui S, Mimori T, Nakamura S, Nakazawa T, Ohara H, Okazaki K, Ryu JH, Saeki T, Schleinitz N, Shimatsu A, Shimosegawa T, Takahashi H, Takahira M, Tanaka A, Topazian M, Umehara H, Webster GJ, Witzig TE, Yamamoto M, Zhang W, Chiba T, Stone JH. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol 2015; 67:1688-99. [PMID: 25809420 DOI: 10.1002/art.39132] [Citation(s) in RCA: 589] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
Affiliation(s)
- A Khosroshahi
- Emory University School of Medicine, Atlanta, Georgia
| | | | - J L Crowe
- University of Tennessee College of Medicine, Chattanooga
| | - T Akamizu
- Wakayama Medical University, Tokyo, Japan
| | - A Azumi
- Kobe Kaisei Hospital, Kobe, Japan
| | - M N Carruthers
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - H Goto
- Tokyo Medical University, Tokyo, Japan
| | - P A Hart
- The Ohio State University Medical College and The Ohio State University Wexner Medical Center, Columbus
| | - T Kamisawa
- Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - S Kawa
- Shinshu University, Matsumoto, Japan
| | - M Kawano
- Kanazawa University Graduate School of Medical Sciences and Kanazawa University Hospital, Kanazawa, Japan
| | - M H Kim
- University of Ulsan College of Medicine and Asan Medical Center, Ulsan, Republic of Korea
| | - Y Kodama
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Kubota
- Yokohama City University and Yokohama City University Hospital, Yokohama, Japan
| | - M M Lerch
- University of Greifswald Medical School, Greifswald, Germany
| | - M Löhr
- Karolinska Institutet, Stockholm, Sweden
| | - Y Masaki
- Kanazawa Medical University, Kanazawa, Japan
| | - S Matsui
- University of Toyama, Toyama, Japan
| | - T Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - S Nakamura
- Kyushu University and Kyushu University Dental Hospital, Fukuoka, Japan
| | - T Nakazawa
- Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - H Ohara
- Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - K Okazaki
- Kansai Medical University, Hirakata, Japan
| | - J H Ryu
- Mayo Clinic, Rochester, Minnesota
| | - T Saeki
- Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - N Schleinitz
- Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - A Shimatsu
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - H Takahashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M Takahira
- Kanazawa University Graduate School of Medical Sciences and Kanazawa University Hospital, Kanazawa, Japan
| | - A Tanaka
- Teikyo University School of Medicine, Tokyo, Japan
| | | | - H Umehara
- Kanazawa Medical University, Kanazawa, Japan
| | - G J Webster
- University College London and University College London Hospitals, London, UK
| | | | - M Yamamoto
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - W Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - T Chiba
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - J H Stone
- Massachusetts General Hospital, Boston
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- Japanese Ministry of Health, Labor, and Welfare, Amgen, and Genetech
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26
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Godemann F, Wolff-Menzler C, Löhr M, Nitschke R, Salize H, Seemüller F, Laengle G, Wolff J, Hauth I. Berechnung der Personalbemessung bei einer Umsetzung von 100 % Psych-PV. Nervenarzt 2015; 86:845-51. [DOI: 10.1007/s00115-015-4354-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Verbeke C, Löhr M, Karlsson JS, Del Chiaro M. Pathology reporting of pancreatic cancer following neoadjuvant therapy: challenges and uncertainties. Cancer Treat Rev 2015; 41:17-26. [PMID: 25434282 DOI: 10.1016/j.ctrv.2014.11.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [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: 09/03/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 12/22/2022]
Abstract
An increasing number of studies investigate the use of neoadjuvant treatment for ductal adenocarcinoma of the pancreas. While a strong rationale supports this approach, study results are difficult to interpret and compare due to marked variance in multiple aspects of study design and performance. Divergence in pathology examination and reporting as a cause for heterogeneity and incomparability of study results has not been brought into this discussion yet, despite the fact that several key outcome measures for neoadjuvant treatment are pathology-based. This article discusses areas of controversy and difficulty regarding the evaluation of the extent of residual tumour tissue, grading of tumour regression and assessment of the margins, and explains the important clinical implications of the present uncertainty and divergence in pathology practice.
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Affiliation(s)
- C Verbeke
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden; Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden.
| | - M Löhr
- Gastrocentrum, Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden.
| | - J Severin Karlsson
- Department of Pathology & Cytology, Karolinska University Hospital, Hälsovägen, 141 86 Stockholm, Sweden.
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Hälsovägen, 141 86 Stockholm, Sweden.
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28
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Godemann F, Löhr M, Wiegand H, Wolff-Menzler C, Nitschke R, Seemüller F. Das neue Entgeltsystem in der Psychiatrie – gehören ältere Patienten zu den Verlierern? Eine Analyse auf der Grundlage der VIPP-Datenbank. Fortschr Neurol Psychiatr 2014; 82:634-9. [DOI: 10.1055/s-0034-1385266] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Godemann
- Klinik für Psychiatrie und Psychotherapie, St. Joseph-Krankenhaus Berlin-Weißensee, Berlin
| | - M. Löhr
- Psychiatrie, Fachhochschule für Diakonie, Bielefeld
| | - H. Wiegand
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph-Krankenhaus, Berlin
| | - C. Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen
| | - R. Nitschke
- Medizincontrolling, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - F. Seemüller
- Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen
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29
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Nienaber A, Hemkendreis B, Löhr M, Schulz M. [Psychiatry with open doors]. Nervenarzt 2014; 85:1438-1439. [PMID: 23979359 DOI: 10.1007/s00115-013-3859-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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30
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Wolff-Menzler C, Maier B, Junne F, Löhr M, Große C, Falkai P, Pollmächer T, Salize HJ, Nitschke R, Hauth I, Deister A, Godemann F. Versorgungsindikatoren in der Psychiatrie und Psychosomatik (VIPP) – Ein Datenbank-Projekt. Fortschr Neurol Psychiatr 2014; 82:394-400. [PMID: 25014202 DOI: 10.1055/s-0034-1366577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C. Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen
| | - B. Maier
- BWL-Gesundheitsmanagement, Duale Hochschule Baden-Württemberg, Mannheim
| | - F. Junne
- Medizinische Klinik Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
| | - M. Löhr
- Psychiatrische Pflege, Fachhochschule der Diakonie, Bielefeld
| | - C. Große
- Professur für Finanzen und Controlling, Georg-August-Universität Göttingen
| | - P. Falkai
- Direktor der Klinik, Klinikum der Universität München
| | - T. Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt
| | - H.-J. Salize
- Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - R. Nitschke
- Medizincontrolling/Qualitätsmanagement, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - I. Hauth
- Geschäftsführung, Alexianer St. Joseph-Krankenhaus Berlin-Weißensee GmbH, Berlin
| | - A. Deister
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe
| | - F. Godemann
- Klinik für seelische Gesundheit im Alter und Verhaltensmedizin, Alexianer St. Joseph-Krankenhaus Berlin-Weißensee GmbH, Berlin
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Löhr M, Nitschke R, Schulz M, Wolter A, Hennings A, Wolff-Menzler C, Behrens J. [Management documentation of therapeutic units on inpatient treatment for people with dementia--does it allow conclusion to be drawn them about inpatient services? An exploratory analysis]. Gesundheitswesen 2014; 76:479-85. [PMID: 24493579 DOI: 10.1055/s-0033-1361112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Against the background of the continuously growing incidence rates of gerontopsychiatric disorders, their economic dimen-sions, and the effects on persons affected as well as their social environments, the present study focuses on an analysis of the services provided in acute psychiatric care settings for patients with dementia. RESULTS are based on secondary data. AIM OF THE STUDY We aim to compare therapeutic service units of different clusters of occupational groups (physicians/psychologists, nurses/special therapists) for the ICD-10 diagnostic groups F00-F03 and G30 in the years 2010 (starting with July) and 2011. Main research question is how many patients are mappable with 'therapeutic units' (Therapieeinheiten, TE) of the operation and procedures catalogue (OPS). METHODS The present study is based on an analysis of the §21 KHEntgG data record of 35 acute psychiatric facilities. Data collection took place within the project "Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)", "Supply indicators for psychiatric and psychosomatic settings". The data record implies statewide data of specialised hospitals, university hospitals and departments of psychiatry of the Federal Republic of Germany. RESULTS In total, 5 111 cases were included in the analysis. Nurses and special therapists carried out significantly more therapeutic units in the main diagnoses groups (F01, F03 and G30) and the care groups (regular vs. intensive) than physicians and psychologists (p<0.05). It was not possible to map all patients with the use of therapeutic units (G30 78.8%, F01 83.4%, F03 81.2%). Mapping of patients was significantly higher in the intensive care compared to regular care in both occupational clusters (p<0.05). CONCLUSIONS We demonstrated that the "therapeutic units" of the OPS codes are now used in the routine data (§21 KHEntgG), and that they are able to portray relevant aspects of non-medication therapeutic service. The present study provides a preliminary/exploratory overview on the services provided, mapped by therapeutic units. Future research should focus on the overlap between the category "therapeutic" units and the services actually provided.
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Affiliation(s)
- M Löhr
- Klinikentwicklung und Forschung, LWL-Klinikum Gütersloh, Gütersloh
| | - R Nitschke
- Zentralinstitut für Seelische Gesundheit, Medizincontrolling/Qualitäts-management, Mannheim
| | - M Schulz
- Fachhochschule der Diakonie Bielefeld
| | - A Wolter
- FGK Clinical Research GmbH, München
| | - A Hennings
- Klinikentwicklung und Forschung, LWL-Klinikum Gütersloh, Gütersloh
| | - C Wolff-Menzler
- Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - J Behrens
- Martin-Luther-Universität Halle/Wittenberg, Medizinische Fakultät, Institut für Pflege- und Gesundheitswissenschaft
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32
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Påhlsson HI, Groth K, Permert J, Swahn F, Löhr M, Enochsson L, Lundell L, Arnelo U. Telemedicine: an important aid to perform high-quality endoscopic retrograde cholangiopancreatography in low-volume centers. Endoscopy 2014; 45:357-61. [PMID: 23468194 DOI: 10.1055/s-0032-1326269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS The aim of this study was to investigate whether telemedicine can help to ensure high-quality endoscopic retrograde cholangiopancreatography (ERCP) in patients living in rural areas. The study was conducted by investigators from two centers: the Karolinska University Hospital, a high-volume center which provided the teleguided support, and the Visby District Hospital, a low-volume center. PATIENTS AND METHODS From September 2010 to August 2011, 26 ERCP procedures performed at a district hospital were teleguided by an experienced endoscopist at the Karolinska University Hospital. To ensure patient data protection, all communication went through a network (Sjunet) that was separate from the Internet and open only to accredited users. The indications for ERCP were common bile duct stones (n = 12), malignant strictures (n = 12), and benign biliary strictures (n = 2). In 15 cases, this was the patient's first ERCP procedure. RESULTS The common bile duct was successfully cannulated in all 26 teleguided procedures. The local endoscopist scored the teleguided support as crucial for the successful outcome in 8 /26 cases, as an important factor in 8, and as being of less importance in the remaining 10. In the eight cases where the teleguided support was judged to be crucial, six subsequent percutaneous transhepatic cholangiography procedures and two repeat ERCPs were avoided. The overall cannulation rate at the district hospital improved from 85 % to 99 % after teleguided support was introduced. No procedure-related complications occurred. CONCLUSION Distant guidance of advanced ERCP procedures in a low-volume center, through teleguided support from a high-volume center, has the potential to improve the quality of care, as reflected in high cannulation rates and the ability to complete the scheduled interventions.
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Affiliation(s)
- H I Påhlsson
- Karolinska Institutet, CLINTEC, Stockholm, Sweden.
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Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E. [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 2013; 51:1395-440. [PMID: 24338757 DOI: 10.1055/s-0033-1356220] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- T Seufferlein
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - M Porzner
- Klinik für Innere Medizin I, Universitätsklinikum Ulm
| | - T Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Kiel
| | - V Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin
| | - G Ceyhan
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Esposito
- Institut für Allgemeine Pathologie, Klinikum rechts der Isar, TU München
| | - R Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen
| | - M Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - H Friess
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - P Galle
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz
| | - M Geissler
- Klinik für Allgemeine Innere Medizin, Onkologie/Hämatologie, Gastroenterologie und Infektiologie, Klinikum Esslingen
| | - M Glanemann
- Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes Homburg/Saar
| | - T Gress
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - V Heinemann
- Medizinischen Klinik und Poliklinik III, Klinikum der Universität München LMU
| | | | - U Hopt
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg
| | - J Izbicki
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - E Klar
- Klinik für Allgemeine Chirurgie, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock
| | - J Kleeff
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - I Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg
| | | | - T Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e. V., Berlin
| | - J Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus Berlin
| | - M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - M Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm
| | - J Lüttges
- Institut für Pathologie, Marienkrankenhaus Hamburg
| | - M Lutz
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Endokrinologie, Infektiologie, Caritasklinikum Saarbrücken
| | - J Mayerle
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald
| | - P Michl
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Universitätsklinikum Gießen und Marburg
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm
| | - M Molls
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, TU München
| | - M Münter
- Klinik für Strahlentherapie und Radioonkologie, Klinikum Stuttgart
| | - M Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin
| | - H Oettle
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Universitätsmedizin Berlin
| | - S Post
- Chirurgische Klinik, Universitätsmedizin Mannheim
| | - A Reinacher-Schick
- Abt. für Hämatologie und Onkologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - C Röcken
- Institut für Pathologie, Universitätsklinikum Kiel
| | - E Roeb
- Medizinische Klinik II, SP Gastroenterologie, Universitätsklinikum Gießen und Marburg
| | - H Saeger
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Dresden
| | - R Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - W Schmiegel
- Medizinische Klinik, Klinikum der Ruhr-Universität Bochum
| | | | - J Siveke
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München
| | - M Stuschke
- Klinik für Strahlentherapie, Universitätsklinikum Essen
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum
| | - W Uhl
- Chirurgische Klinik, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum
| | - S Unverzagt
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg
| | - B van Oorschot
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg
| | - Y Vashist
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf
| | - J Werner
- Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universitätsklinikum Heidelberg
| | - E Yekebas
- Klinik für Allgemein-, Thorax- und Viszeralchirurgie, Klinikum Darmstadt
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Del Chiaro M, Verbeke C, Salvia R, Klöppel G, Werner J, McKay C, Friess H, Manfredi R, Van Cutsem E, Löhr M, Segersvärd R, Adham M, Albin N, Andren-Sandberg Å, Arnelo U, Bruno M, Cahen D, Cappelli C, Costamagna G, Del Chiaro M, Delle Fave G, Esposito I, Falconi M, Friess H, Ghaneh P, Gladhaug IP, Haas S, Hauge T, Izbicki JR, Klöppel G, Lerch M, Lundell L, Lüttges J, Löhr M, Manfredi R, Mayerle J, McKay C, Oppong K, Pukitis A, Rangelova E, Rosch T, Salvia R, Schulick R, Segersvärd R, Sufferlein T, Van Cutsem E, Van der Merwe SW, Verbeke C, Werner J, Zamboni G. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45:703-11. [PMID: 23415799 DOI: 10.1016/j.dld.2013.01.010] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [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: 11/06/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 12/11/2022]
Abstract
Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.
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Affiliation(s)
- Marco Del Chiaro
- Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
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Verburg FA, Sweeney R, Hänscheid H, Dießl S, Israel I, Löhr M, Vince GH, Flentje M, Reiners C, Samnick S. Patients with recurrent glioblastoma multiforme. Initial experience with p-[(131)I]iodo-L-phenylalanine and external beam radiation therapy. Nuklearmedizin 2013; 52:36-42. [PMID: 23303224 DOI: 10.3413/nukmed-0510-12-06] [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] [Received: 06/12/2012] [Accepted: 12/15/2012] [Indexed: 11/20/2022]
Abstract
AIM The objective of this study was to assess the feasibility, dosimetry, tolerability and efficacy of systemically administrated p-[(131)I]iodo-L-phenylalanine ((131)IPA) combined with hypo-fractionated external beam radiation therapy (EBRT) in patients with recurrent glioblastoma multiforme (GBM). PATIENTS, METHODS Five patients (2 women, 3 men, aged 27-69) with recurrent GBM and exhaustion of regular therapy options were included. All had a positive O-(2-[(18)F]Fluoroethyl)-L-tyrosine positron emission tomography (FET-PET) and pretherapeutic dosimetry was performed. Tumour targeting was verified by (131)IPA-SPECT up to six days after radiotracer administration. After (131)IPA therapy, patients were treated with hypo-fractionated EBRT in six fractions of 5 Gy (n = 4) or in eleven fractions of 2 Gy in one case. RESULTS Based on the individual dosimetry, the patients received a single intravenous administration of 2 to 7 GBq of (131)IPA, resulting in radiation absorbed doses to the blood of 0.80-1.47 Gy. The treatment was well tolerated; only minor complaints of nausea and vomiting that responded to ondansetron and pantoprazol were noticed in the first two patients. After preventive medication, the last three patients had no complaints during therapy. In none of the patients a decrease of leukocyte or thrombocyte counts below the baseline level or the lower normal limit was observed. Tumour doses from (131)IPA were low (≤ 1 Gy) and all patients died three to eight (median 5.5) months after therapy. CONCLUSION In this initial experience, treatment of GBM with (131)IPA in combination with EBRT was demonstrated to be safe and well tolerated, but less effective than suggested by the animal studies.
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Affiliation(s)
- F A Verburg
- Department of Nuclear Medicine, University of Würzburg, Germany.
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Löhr M. Qualifizierungschancen für Nachwuchswissenschaftler in der Inneren Medizin – Positionspapier der DGIM. Dtsch Med Wochenschr 2012; 137:2038; discussion 2038. [DOI: 10.1055/s-0032-1327183] [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: 10/27/2022]
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37
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Michalski D, Heindl M, Kacza J, Laignel F, Küppers-Tiedt L, Schneider D, Grosche J, Boltze J, Löhr M, Hobohm C, Härtig W. Spatio-temporal course of macrophage-like cell accumulation after experimental embolic stroke depending on treatment with tissue plasminogen activator and its combination with hyperbaric oxygenation. Eur J Histochem 2012; 56:e14. [PMID: 22688295 PMCID: PMC3428963 DOI: 10.4081/ejh.2012.e14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inflammation following ischaemic stroke attracts high priority in current research, particularly using human-like models and long-term observation periods considering translational aspects. The present study aimed on the spatio-temporal course of macrophage-like cell accumulation after experimental thromboembolic stroke and addressed microglial and astroglial reactions in the ischaemic border zone. Further, effects of tissue plasminogen activator (tPA) as currently best treatment for stroke and the potentially neuroprotective co-administration of hyperbaric oxygen (HBO) were investigated. Rats underwent middle cerebral artery occlusion and were assigned to control, tPA or tPA+HBO. Twenty-four hours, 7, 14 and 28 days were determined as observation time points. The accumulation of macrophage-like cells was semiquantitatively assessed by CD68 staining in the ischaemic area and ischaemic border zone, and linked to the clinical course. CD11b, ionized calcium binding adaptor molecule 1 (Iba), glial fibrillary acidic protein (GFAP) and Neuronal Nuclei (NeuN) were applied to reveal delayed glial and neuronal alterations. In all groups, the accumulation of macrophage-like cells increased distinctly from 24 hours to 7 days post ischaemia. tPA+HBO tended to decrease macrophage-like cell accumulation at day 14 and 28. Overall, a trend towards an association of increased accumulation and pronounced reduction of the neurological deficit was found. Concerning delayed inflammatory reactions, an activation of microglia and astrocytes with co-occurring neuronal loss was observed on day 28. Thereby, astrogliosis was found circularly in contrast to microglial activation directly in the ischaemic area. This study supports previous data on long-lasting inflammatory processes following experimental stroke, and additionally provides region-specific details on glial reactions. The tendency towards a decreasing macrophage-like cell accumulation after tPA+HBO needs to be discussed critically since neuroprotective properties were recently ascribed to long-term inflammatory processes.
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Affiliation(s)
| | - M. Heindl
- Department of Neurology, University of Leipzig;,Paul Flechsig Institute for Brain Research, University of Leipzig
| | - J. Kacza
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Leipzig
| | - F. Laignel
- Department of Neurology, University of Leipzig;,Paul Flechsig Institute for Brain Research, University of Leipzig
| | | | | | - J. Grosche
- Paul Flechsig Institute for Brain Research, University of Leipzig
| | - J. Boltze
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig;,Translational Centre for Regenerative Medicine, University of Leipzig
| | - M. Löhr
- Department of Neurosurgery, University of Würzburg, Germany
| | - C. Hobohm
- Department of Neurology, University of Leipzig
| | - W. Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig
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38
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Michalski D, Heindl M, Kacza J, Laignel F, Küppers-Tiedt L, Schneider D, Grosche J, Boltze J, Löhr M, Hobohm C, Härtig W. Spatio-temporal course of macrophage-like cell accumulation after experimental embolic stroke depending on treatment with tissue plasminogen activator and its combination with hyperbaric oxygenation. Eur J Histochem 2012; 56:e14. [PMID: 22688295 DOI: 10.4081/ejh.2012.14] [Citation(s) in RCA: 10] [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: 12/11/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 01/01/2023] Open
Abstract
Inflammation following ischaemic stroke attracts high priority in current research, particularly using human-like models and long-term observation periods considering translational aspects. The present study aimed on the spatio-temporal course of macrophage-like cell accumulation after experimental thromboembolic stroke and addressed microglial and astroglial reactions in the ischaemic border zone. Further, effects of tissue plasminogen activator (tPA) as currently best treatment for stroke and the potentially neuroprotective co-administration of hyperbaric oxygen (HBO) were investigated. Rats underwent middle cerebral artery occlusion and were assigned to control, tPA or tPA+HBO. Twenty-four hours, 7, 14 and 28 days were determined as observation time points. The accumulation of macrophage-like cells was semiquantitatively assessed by CD68 staining in the ischaemic area and ischaemic border zone, and linked to the clinical course. CD11b, ionized calcium binding adaptor molecule 1 (Iba), glial fibrillary acidic protein (GFAP) and Neuronal Nuclei (NeuN) were applied to reveal delayed glial and neuronal alterations. In all groups, the accumulation of macrophage-like cells increased distinctly from 24 hours to 7 days post ischaemia. tPA+HBO tended to decrease macrophage-like cell accumulation at day 14 and 28. Overall, a trend towards an association of increased accumulation and pronounced reduction of the neurological deficit was found. Concerning delayed inflammatory reactions, an activation of microglia and astrocytes with co-occurring neuronal loss was observed on day 28. Thereby, astrogliosis was found circularly in contrast to microglial activation directly in the ischaemic area. This study supports previous data on long-lasting inflammatory processes following experimental stroke, and additionally provides region-specific details on glial reactions. The tendency towards a decreasing macrophage-like cell accumulation after tPA+HBO needs to be discussed critically since neuroprotective properties were recently ascribed to long-term inflammatory processes.
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Affiliation(s)
- D Michalski
- Department of Neurology, University of Leipzig, Germany.
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Driessen M, Wertz J, Steinert T, Borbé R, Vieten B, Diefenbacher A, Urban S, Kronmüller K, Löhr M, Richter D, Hohagen F. Das Erleben der Aufnahme in eine psychiatrische Klinik. Nervenarzt 2012; 84:45-54. [DOI: 10.1007/s00115-012-3485-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Wertz J, Hohagen F, Borbé R, Steinert T, Vieten B, Diefenbacher A, Kronmüller K, Löhr M, Richter D, Urban S, Driessen M. Das Erleben der Aufnahme in eine psychiatrische Klinik. Nervenarzt 2012; 84:38-44. [DOI: 10.1007/s00115-012-3484-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Swahn F, Arnelo U, Enochsson L, Löhr M, Agustsson T, Gustavsson K, D'Souza MA, Lundell L. Endoscopic closure of a perforated peptic ulcer. Endoscopy 2011; 43 Suppl 2 UCTN:E28-9. [PMID: 21271527 DOI: 10.1055/s-0030-1256002] [Citation(s) in RCA: 3] [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: 12/10/2022]
Affiliation(s)
- F Swahn
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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42
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Wallace MB, Meining A, Canto MI, Fockens P, Miehlke S, Roesch T, Lightdale CJ, Pohl H, Carr-Locke D, Löhr M, Coron E, Filoche B, Giovannini M, Moreau J, Schmidt C, Kiesslich R. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharmacol Ther 2010; 31:548-52. [PMID: 20002025 DOI: 10.1111/j.1365-2036.2009.04207.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) is rapidly emerging as a valuable tool for gastrointestinal endoscopic imaging. Fluorescent contrast agents are used to optimize imaging with CLE, and intravenous fluorescein is the most widely used contrast agent. Fluorescein is FDA-cleared for diagnostic angiography of the retina. For these indications, the safety profile of fluorescein has been well-documented; however, to date, fluorescein is not cleared for use with CLE. AIMS To estimate the rate of serious and total adverse events attributable to intravenous fluorescein when used for gastrointestinal CLE. METHODS We performed a cross sectional survey of 16 International Academic Medical Centres with active research protocols in CLE that involved intravenous fluorescein. Centres using i.v. fluorescein for CLE who were actively monitored for adverse events were included. RESULTS Sixteen centres performed 2272 gastrointestinal CLE procedures. The most common dose of contrast agent was 2.5-5 mL of 10% sodium fluorescein. No serious adverse events were reported. Mild adverse events occurred in 1.4% of individuals, including nausea/vomiting, transient hypotension without shock, injection site erythema, diffuse rash and mild epigastric pain. The limitation is that only immediate post procedure events were actively monitored. CONCLUSIONS Use of intravenous fluorescein for gastrointestinal CLE appears to be safe with few acute complications.
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Affiliation(s)
- M B Wallace
- Department of Medicine, Mayo Clinic, Jacksonville, FL, USA.
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Schulz M, Damkröger A, Heins C, Wehlitz L, Löhr M, Driessen M, Behrens J, Wingenfeld K. Effort-reward imbalance and burnout among German nurses in medical compared with psychiatric hospital settings. J Psychiatr Ment Health Nurs 2009; 16:225-33. [PMID: 19291150 DOI: 10.1111/j.1365-2850.2008.01355.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate whether nurses' efforts and rewards, as well as the effort-reward imbalance (ERI) and burnout, differ between subjects working in psychiatric vs. medical hospitals and between nurses under education and examined nurses respectively. Furthermore, the relationship between ERI and burnout was evaluated. Nursing is associated with high levels of emotional strain and heavy workloads. Burnout and a negative ERI can result in high absenteeism and turnover and have been identified as reasons why nurses leave their profession. In the last decade, working conditions of the nursing profession have changed in Germany, but somatic and psychiatric hospitals developed in different ways. This development may lead to different profiles. A sample of 389 nurses (78.8% female) in four German hospitals was investigated. A total of 147 nurses worked in psychiatric hospitals and 236 nurses worked in medical (somatic) hospitals. Fifty participants were still under education. The Effort-Reward Imbalance Inventory measures effort, reward and overcommitment at job and provides an imbalance score between effort and reward. The Maslach Burnout Inventory with the subscales, emotional exhaustion, lack of accomplishment and depersonalization, was also used. Nurses working in medical hospitals reported more burnout and had higher ERI scores. Subjects under education were comparable to examined nurses in terms of burnout but had lower ERI scores. Multiple regression analyses showed all ERI scales to be significant predictors for emotional exhaustion, while age, field of work and educational status further predict effort or ERI respectively. At present, the working situation of nurses in different settings appears to be characterized by a perceived imbalance of effort and reward and is associated with a high risk of developing burnout symptoms.
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Affiliation(s)
- M Schulz
- Department of Psychiatry and Psychotherapy Bethel, Remterweg 69-71, Bielefeld, Germany.
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Löhr M, Hiemke C, Grein HJ. Disturbed Vision under Treatment with Venlafaxine or Quetiapine in Association with Plasma Concentrations of the Drugs. Pharmacopsychiatry 2008. [DOI: 10.1055/s-0028-1088262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Hourfar MK, Walch LA, Geusendam G, Dengler T, Janetzko K, Gubbe K, Frank K, Karl A, Löhr M, Sireis W, Seifried E, Schmidt M. Sensitivity and specificity of Anti-HBc screening assays--which assay is best for blood donor screening? Int J Lab Hematol 2008; 31:649-56. [PMID: 18673399 DOI: 10.1111/j.1751-553x.2008.01092.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Compared to HIV and hepatitis C virus, the residual infectious risk of hepatitis B virus (HBV) posed by blood products is about 10 times higher. In addition to HBsAg testing, screening for anti-HBc was recommended by the German Advisory Committee Blood in March 2005. Prevalence of anti-HBc in German blood donors was investigated at five test sites located in different geographic regions. In total, 12,000 blood donors were screened for anti-HBc by PRISM HBcore, and a statistically representative number of these were tested with Abbott Murex anti-HBc total, bioMérieux Hepanostika anti-HBc uniform, Bio-Rad Monolisa anti-HBc PLUS and Dade Behring Enzygnost anti-HBc. Anti-HBc repeat reactive samples were tested for anti-HBs, anti-HBe and HBV DNA by individual donation NAT. The mean prevalence of anti-HBc was 1.75% in donors that had not been tested for anti-HBc in the past. The percentage of anti-HBs in anti-HBc repeat reactive donors was 93.7%. Samples that were additionally reactive for anti-HBe were anti-HBc reactive in all tested assays. The sample to cut-off (S/Co) values for anti-HBc were lower (competitive assays) in samples that were also positive for anti-HBe, when compared to samples that were only anti-HBc reactive. Most commercially available anti-HBc assays provide sufficient sensitivity for routine screening purposes, and lacking specificity is no longer a serious issue for most of them. Assay differences were recognized for samples that were anti-HBc only reactive. The overall loss of 1.75% of positive testing donors can be significantly reduced to 0.45% by implementation of re-entry procedures for donors with an anti-HBs titre of over 100 IU/l and negative by sensitive ID-NAT.
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Affiliation(s)
- M K Hourfar
- Institute of Transfusion Medicine and Immunohematology, German Red Cross, Johann Wolfgang Goethe University, Frankfurt, Germany
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Löhr M, Haas S, Bechstein W, Karrasch M, Mescheder A, Meyer I, Bodoky G, Pap A, Jäger D, Fölsch UR. First-line treatment of inoperable pancreatic adenocarcinoma with lipid complexed paclitaxel nanoparticles plus gemcitabine compared with gemcitabine monotherapy. A prospective RCT - phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4618] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
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Abstract
BACKGROUND Despite a recognized association between venous thromboembolic events (VTE) and cancer, little is known about the strength and the features of this association. We performed a meta-analysis in order to clarify this issue. METHODS We retrieved data from 40 reports published between 1982 and 2007: 12 contained cancer risk estimates for patients with either idiopathic or secondary VTE vs. subjects without VTE and 17 for patients with idiopathic vs. secondary VTE. We also pooled risk estimates from four cohort studies to assess the association between VTE and specific forms of cancer and conducted a proportional incidence study, based on the remaining 28 reports, which did not provide risk estimates. RESULTS The pooled relative risk (RR) of cancer was 3.2 [95% confidence interval (95% CI) 2.4-4.5] for patients with any form of VTE vs. no VTE, 2.7 (95% CI 1.9-3.9) for patients with idiopathic vs. no VTE and 3.8 (95% CI 2.6-5.4) for patients with idiopathic vs. secondary VTE. In the pooled cohort studies, RRs for VTE vs. no VTE were significantly elevated for cancers of the ovary (RR 7.0), pancreas (RR 6.1), liver (RR 5.6), blood (4.2), brain (RR 3.8), kidney (RR 3.4), lung (3.1), colon (2.9), and esophagus (2.1). In the proportional incidence study, cancers of the pancreas, colon, and blood were significantly more frequently observed than in the general population. CONCLUSIONS Overall we found a 3-fold excess risk of occult cancer in patients with VTE. The risk varies according to tumor site and is highest for cancers of the ovary, pancreas, and liver.
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Affiliation(s)
- S Iodice
- European Institute of Oncology, Milan, Italy
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Kayed H, Jiang X, Keleg S, Jesnowski R, Giese T, Berger MR, Esposito I, Löhr M, Friess H, Kleeff J. Regulation and functional role of the Runt-related transcription factor-2 in pancreatic cancer. Br J Cancer 2007; 97:1106-15. [PMID: 17876328 PMCID: PMC2360444 DOI: 10.1038/sj.bjc.6603984] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recent evidence suggests that Runt-related transcription factors play a role in different human tumours. In the present study, the localisation of the Runt-related transcription factor-2 (Runx2), its transcriptional activity, as well as its regulation of expression was analysed in human pancreatic ductal adenocarcinoma (PDAC). Quantitative real-time PCR and immunohistochemistry were used for Runx2 expression and localisation analysis. Runt-related transcription factor-2 expression was silenced using specific siRNA oligonucleotides in pancreatic cancer cells (Panc-1) and immortalised pancreatic stellate cells (IPSCs). Overexpression of Runx2 was achieved using a full-length expression vector. TGF-β1, BMP2, and other cytokines were assessed for their potential to regulate Runx2 expression. There was a 6.1-fold increase in median Runx2 mRNA levels in PDAC tissues compared to normal pancreatic tissues (P<0.0001). Runt-related transcription factor-2 was localised in pancreatic cancer cells, tubular complexes, and PanIN lesions of PDAC tissues as well as in tumour-associated fibroblasts/stellate cells. Coculture of IPSCs and Panc-1 cells, as well as treatment with TGF-β1 and BMP2, led to increased Runx2 expression in Panc-1 cells. Runt-related transcription factor-2 overexpression was associated with decreased MMP1 release as well as decreased growth and invasion of Panc-1 cells. These effects were reversed by Runx2 silencing. In conclusion, Runx2 is overexpressed in PDAC, where it is regulated by certain cytokines such as TGF-β1 and BMP2 in an auto- and paracrine manner. In addition, Runx2 has the potential to regulate the transcription of extracellular matrix modulators such as SPARC and MMP1, thereby influencing the tumour microenvironment.
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Affiliation(s)
- H Kayed
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - X Jiang
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - S Keleg
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - R Jesnowski
- Molecular Gastroenterology Unit, German Cancer Research Centre, Heidelberg, Germany
- Department of Medicine II, University of Heidelberg, Mannheim, Germany
| | - T Giese
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - M R Berger
- Unit of Toxicology and Chemotherapy, German Cancer Research Centre, Heidelberg, Germany
| | - I Esposito
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - M Löhr
- Molecular Gastroenterology Unit, German Cancer Research Centre, Heidelberg, Germany
- Department of Medicine II, University of Heidelberg, Mannheim, Germany
| | - H Friess
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - J Kleeff
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Surgery, Technical University of Munich, Ismaningerstrasse 22, Munich 81675, Germany. E-mail:
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Hahn C, Haussen RHV, Löhr M, Patsialas C, Rohde D. [Natural and artificial erections in spite of radical, non-nerve-sparing retropubic prostatectomy]. Aktuelle Urol 2007; 38:305-12. [PMID: 17647168 DOI: 10.1055/s-2006-944305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate sexual functions (SF) of patients after retropubic, non-nerve-sparing radical prostatectomy (NNS-RP). MATERIALS AND METHODS A self-assessment survey on 213 selected patients (multiple choice questionnaire, 18 questions and 80 choices with regard to pre- and postoperative SF and course of tumor disease) was performed. The analysed parameters were demographics, sexual desire, capacities for erections and intercourses, orgasm, use of potency-supporting drugs and devices, attending physicians, life quality (LQ), and S100 immunohistochemical staining on neurovasculare bundles (NVB). RESULTS The general response rate of the survey was 61.5 %. 123 data files were evaluable. 87 % of the patients reported on pre-operative erections (n = 107). Of these 12.1 % (n = 13) noticed residual nocturnal erections after NNS-RP. One patient had additional arbitrary full-erections that enabeled him to practice intercourse (< 50 % of attempts sufficient). Bilateral resections of NVB were confirmed on all histopathological specimens from erectile patients. Although 59.2 % of the patients reported on sexual desires (71/120) that persisted postoperatively, only 53.3 % (38/71) tested drugs or devices to induce or improve erections. 18 of these 38 patients (47.4 %) were finally capable of intercourses. 9 of 123 patients were sildenafil-responders, eight of them without any spontaneous erections. 23.8 % of the patients reported on a severe decrease in quality of life due to complete or partial loss of SF. However, only 62.6 % patients (77/123) asked for professional support regarding SF. For this purpose 88.3 % (68/77) consulted an urologist. CONCLUSIONS The existence of residual spontaneous erectile activities and responses on sildenafil after NNS-RP indicate some kind of functional accessory routes for innervations besides the NVB (or submaximal resections). However, the prevalence and quality of the observed erections were clinically insignificant.
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Affiliation(s)
- C Hahn
- Urologische Klinik, Klinikum Darmstadt, Germany
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Samel S, Löhr M. Targeted intraabdominal chemotherapy for peritoneal carcinomatosis. Cancer Treat Res 2007; 134:469-82. [PMID: 17633075 DOI: 10.1007/978-0-387-48993-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The prognosis of peritoneal spread from gastrointestinal cancer and subsequent malignant ascites is poor, and current medical treatments available are mostly ineffective. Targeted chemotherapy with intraperitoneal prodrug activation may be a beneficial new approach. L293 cells were genetically modified to express the cytochrome P450 enzyme 2B1 under the control of a cytomegalovirus immediate early promoter. This CYP2B 1 enzyme converts ifosfamide to its active cytotoxic compounds. The cells are encapsulated in a cellulose sulfate formulation (Capcell; Bavarian Nordic, Martinsried, Germany). Adult Balb/c mice were inoculated intraperitoneally (i.p.) with 1 x 10(6) colon cancer cells, previously transfected with GFP to emit a stable green fluorescence, by injection into the left lower abdominal quadrant. Two or five day's later animals were randomly subjected to either i.p. treatment with ifosfamide alone or ifosfamide combined with microencapsulated CYP2B1 expressing cells. Peritoneal tumour volume and tumour viability were assessed 10 days after tumour inoculation by means of fluorescence microscopy, spectroscopy and histology. Early i.p. treatment with ifosfamide and CYP2B1 cells resulted in a complete response. Treatment starting on day five and single-drug treatment with ifosfamide resulted in a partial response. These results suggest that targeted i.p. chemotherapy using a combination of a prodrug and its converting enzyme may be a successful treatment strategy for peritoneal spread from colorectal cancer. In summary, by using GFP-transfected colon 26 tumour cells in mice we established a well reproducible animal model of metastatic peritoneal cancer. Fluorescent imaging of GFP-transfected tumour was used to demonstrate tumour distribution in the peritoneal cavity and to estimate tumour growth and tumour response to treatment in this model. The application of Capcell and ifosfamide into the peritoneal cavity is a safe and well tolerated procedure in animal models and may help to target chemotherapeutic agents specifically at metastatic peritoneal cancer.
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Affiliation(s)
- S Samel
- University of Göttingen, Germany.
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