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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Hewer E, Panitz G, Elsner J, Swamy von Zastrow F, Quint K, Eschbacher J, Sadeghi D, Ikeliani IU, Brunner M, Maragkou T, Abramov I, Xu Y, Belykh E, Mignucci-Jimenez G, Preul MC, Schlegel J. P13.05.A Image annotation guideline for invivo confocal laser endomicroscopy, interrater reliability and how to learn from medical consensus for machine learning algorithms. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.285] [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
Intraoperative confocal laser endomicroscopy (CLE) is an in vivo imaging technique increasingly studied in neurosurgery and neuropathology. It can be affected by artifacts introduced by the CLE device or related to the intraoperative setting. We developed and evaluated an image annotation guideline (AGL) to detect and eliminate images bearing no valuable information as a result of such artifacts. Images ware classified into good and bad quality, based on defined technical criteria, which are also considered relevant by clinical experts.
Material and Methods
Datasets were created from intraoperative CLE in vivo specimens of patients resected for brain tumors. The process from data collection to development of the ML algorithm followed 7 steps: data quality specification, image and metadata collection, AGL development, annotation, data allocation for clinical validation, clinical validation, and, optionally, algorithm development. Final diagnoses were obtained by pathological analysis. Artifacts were grouped into three categories: diminished signal-to-noise-ratio (dSNR), optical distortions (movement/perturbations), and contrast/brightness artifacts. Images were annotated by 4 medical data annotators (T4). For clinical validation, 500 images were excluded from the training data and additionally annotated by 3 board certified neuropathologists (NPs 1-3) with experience in CLE imaging, to determine the medical consensus on good and bad images. All raters (NPs) were compared against each other and against T4; T4 was also compared against the medical consensus. Cohen’s Kappa and overall percentage agreement (OPA) were used to evaluate inter-rater reliability. Positive percent agreement (PPA) and negative percentage agreement (NPA) were also used to evaluate agreement between medical consensus and T4.
Results
21,616 CLE images and corresponding clinical metadata were collected from 94 patients and annotated. For each case between 27 and 815 CLE images were acquired over the course of the surgery (mean=175 images per case, SD=170.6). 11% and 13% of images were labeled as dSNR and distortion, respectively, and 34% as class contrast. 42% of the images represented the good quality images. Interrater agreement between the 3 NPs ranged between 0.30 and 0.59. Agreement between T4 and the medical consensus was substantial (Cohen’s Kappa >=0.61). OPA between T4 and the medical consensus was 80.60%, PPA 72.34% and NPA 87.92%.
Conclusion
Annotations according to a well-structured and expertly curated AGL show higher values for Cohen’s Kappa and Overall Percent Agreement (OPA) with the medical consensus, than that of individual experts among one another. Such an AGL can be considered appropriate and produces on par results with annotations by a group of experts in the field and can be further employed for training machine learning (ML) algorithms.
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Affiliation(s)
- E Hewer
- Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - G Panitz
- Carl Zeiss Meditec AG , Oberkochen , Germany
| | - J Elsner
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | | | - K Quint
- Quint Healthcare , Fürth , Germany
| | - J Eschbacher
- Barrow Neurological Institute , Phoenix, AZ , United States
| | - D Sadeghi
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - I U Ikeliani
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - M Brunner
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - T Maragkou
- Institute of Pathology, Inselspital Bern , Bern , Switzerland
| | - I Abramov
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - Y Xu
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - E Belykh
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - G Mignucci-Jimenez
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - M C Preul
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - J Schlegel
- Institute of Neuropathology, TUM School of Medicine , Munich , Germany
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Schmit P, Winkler L, Brunner M. Renewable, Synthetic Natural Gas as Seasonal Energy Storage in Industrial Application at Stadtwerke Trier. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255369] [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: 11/10/2022]
Affiliation(s)
- P. Schmit
- FITT Saaruferstr. 16 66117 Saarbruecken Germany
| | - L. Winkler
- Universitaet des Saarlandes Chair of Automation and Energy Systems 66123 Saarbruecken Germany
| | - M. Brunner
- FITT Saaruferstr. 16 66117 Saarbruecken Germany
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Lauer D, Schniering J, Gabrys H, Maciukiewicz M, Brunner M, Distler O, Frauenfelder T, Tanadini-Lang S, Maurer B. OP0199 RADIOMIC SIGNATURES REFLECT TREATMENT RESPONSE TO NINTEDANIB IN PRECLINICAL LUNG FIBROSIS MODEL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundResponses to anti-fibrotic drugs in preclinical disease models are difficult to quantify by histological analysis of single tissue sections. Quantitative in-depth analysis of imaging data, termed “radiomics”, may represent a more reliable and accurate measure of treatment response since the pathology of the whole organ is captured.ObjectivesTo study the potential of µCT-derived radiomic features to reflect response to Nintedanib in the bleomycin (BLM)-induced murine model of fibrosing interstitial lung disease.MethodsAll C57BL/6J mice from both study groups were intratracheally instilled with 2 U/kg BLM on day 0 to induce lung fibrosis. Nintedanib was administered daily by gavage at 60 mg/kg for two weeks starting from day 7 (n=15). Controls received equivalent treatment with vehicle-only (n=19). Whole lung µCT scans (SkyScan 1176, Bruker) of each animal were acquired at baseline (day 0), pre-treatment (day 7), and post-treatment (day 21). The Ashcroft score was assessed on Sirius Red stained lung sections post-treatment. Lung volumes in µCTs were defined semi-automatically in MIM Software (6.9.2), followed by extraction of radiomic features with our in-house developed software Z-Rad (7.3.1). Each data set contained 1’386 features, describing image characteristics with histogram, texture, and wavelet functions. Data pre-processing involved removal of features sensitive to intra- and interobserver delineation variability (ICC<0.75), highly correlated features (Pearson’s r>0.95), and features not significantly changing between days 0 and 7 (p>0.05). Agglomerative clustering of radiomic temporal trajectories was performed on the Nintedanib group to identify distinct feature clusters. The identified feature sets were then used to plot average feature value trajectories for both study groups in each cluster. To identify features significantly different between a) Nintedanib vs. control, and b) pre- vs. post-treatment, Mann-Whitney U and Wilcoxon signed-rank tests were used, respectively. Samples were pooled from two independent experiments.ResultsEvaluation of tissue sections did not show a significant treatment-induced reduction of fibrosis with average Ashcroft scores of 3.7 (±1.2 s.d.) and 3.4 (±1.6 s.d.) in Nintedanib and control samples, respectively (p>0.05). Radiomics data analysis revealed two feature clusters in Nintedanib samples, composed of 52 features (cluster 1) and 96 features (cluster 2), the trajectories of which were then plotted for both study groups. In cluster 1, feature value trajectories significantly decreased in both Nintedanib and control group between pre-and post-treatment (p<0.001), whereas feature values in cluster 2 remained flat (p>0.05). Importantly, Nintedanib-treated mice displayed a much more pronounced feature value decrease post-treatment in cluster 1 compared to the control group (p<0.05). Here, feature values post-treatment resembled pre-disease baseline conditions in the Nintedanib group (p>0.05), whereas the control group remained significantly different from baseline (p<0.01). Cluster 1 was composed of 6 histogram, 11 texture, and 35 wavelet features, emphasizing the role of high-dimensional metrics for the detection of differences.ConclusionHistological quantification of lung fibrosis accounts only for a small fraction of the whole pathology in a spatially heterogeneous disease. We demonstrated that µCT-derived radiomic features identified significant differences on imaging level following Nintedanib treatment, which we could not reliably detect on tissue level using Ashcroft scoring. These findings hold great potential for the development of novel readouts for improved stratification of anti-fibrotic treatment effects in preclinical models.AcknowledgementsThis study received funding support from the Swiss Lung Association.Disclosure of InterestsDavid Lauer Shareholder of: Roche (no relation to project), Employee of: Former employee of Roche (no relation to project), Janine Schniering: None declared, Hubert Gabrys: None declared, Malgorzata Maciukiewicz: None declared, Matthias Brunner: None declared, Oliver Distler Speakers bureau: Speaker fees in the area of systemic sclerosis and related complications from Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Consultancies in the area of systemic sclerosis and its complications with Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Grant/research support from Kymera, Mitsubishi Tanabe, Boehringer Ingelheim, Thomas Frauenfelder: None declared, Stephanie Tanadini-Lang: None declared, Britta Maurer Speakers bureau: Received speaker fees from Boehringer-Ingelheim as well as congress support from Medtalk, Pfizer, Roche, Actelion, Mepha, and MSD, Consultant of: Consultancies with Novartis, Boehringer Ingelheim, Janssen-Cilag. Has a patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143), Grant/research support from: Had grant/research support from AbbVie, Protagen, Novartis Biomedical Research.
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Hornyik T, Bodi I, Michaelides K, Mettke L, Perez-Feliz S, El-Battrawy I, Brunner M, Bode C, Odening K. Metabolic treatment of an electrical disease? Beneficial APD/QT prolongation by L-Carnitine in transgenic SQT1 rabbit models. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Short-QT syndrome 1 (SQT1) is a genetic cardiac channelopathy caused by gain-of-function mutations (KCNH2-N588K) in HERG/IKr, that leads to shortened QT-interval, increased risk for arrhythmias and sudden cardiac death (SCD). An acquired form of SQTS has been described in patients with primary (genetic) carnitine-deficiency, indicating that carnitine might affect cardiac repolarization.
Purpose
We aimed to investigate potential beneficial (APD/QT-prolonging) effect of L-Carnitine in (genetic) SQTS using transgenic SQT1 rabbits that mimic the human disease phenotype.
Methods
Effects of L-carnitine on cardiac repolarisation were assessed in adult wildtype (WT) and transgenic SQT1 rabbits (KCNH2-N588K) using in vivo ECG and ex vivo Langendorff-perfused whole-heart or isolated ventricular cardiomyocyte action potential (AP) recordings. Effects on ion currents were assessed by whole-cell patch-clamping.
Results
In vivo, the heart-rate corrected QT index (QTi) was prolonged significantly by L-carnitine both in WT (QTi, baseline 102.7%±4.9 vs. L-carnitine 106.9%±6.2, p<0.05, n=12) and SQT1 (QTi, baseline 94.8%±7.4 vs. L-carnitine 99.5%±8.2, p<0.05, n=13), leading to normalisation of QTi in SQT1. Ex vivo, whole-heart monophasic and cellular APs were also significantly prolonged by L-carnitine in WT and SQT1 (change in monophasic APD75, ms, WT +13.9±4.4, SQT1 +9.9±7.0; change in cellular APD90, %, WT +10.4%, SQT1 +10.4%, all p<0.05). As underlying mechanisms, we identified acute effects on the main repolarizing ion currents IKr and IKs: IKr-steady, which is significantly increased in SQT1 contributing to accelerated repolarization, was reduced by L-carnitine (WT: −23%, SQT1: −16%). Moreover, L-carnitine accelerated the deactivation kinetics of IKr - while no change was observed in IKr-tail. In addition, IKs-steady was decreased by L-carnitine in SQT1 and WT cardiomyocytes.
Conclusion
L-carnitine prolongs/normalizes QT and APD in transgenic SQT1 rabbits by decreasing the pathologically increased IKr-steady and also IKs-steady and may therefore serve as potential future anti-arrhythmic therapy in SQTS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG)
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Affiliation(s)
- T Hornyik
- University of Bern, Translational Cardiology, Department of Cardiology and Department of Physiology, Bern, Switzerland
| | - I Bodi
- University of Bern, Translational Cardiology, Department of Cardiology and Department of Physiology, Bern, Switzerland
| | - K Michaelides
- Heart Center University of Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - L Mettke
- Heart Center University of Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - S Perez-Feliz
- Heart Center University of Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, First Department of Medicine, Mannheim, Germany
| | - M Brunner
- Heart Center University of Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - C Bode
- Heart Center University of Freiburg, Department of Cardiology and Angiology I, Freiburg, Germany
| | - K Odening
- University of Bern, Translational Cardiology, Department of Cardiology and Department of Physiology, Bern, Switzerland
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Nimani S, Hornyik T, Alerni N, Lewetag R, Giammarino L, Perez-Feliz S, Matas L, Moss KR, Zehender M, Brunner M, Seemann G, Odening KE. Differences in extent of mechano-induced QT-changes in SQTS, WT and LQTS rabbit models. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Electro-mechanical (EMC) and mechano-electrical coupling (MEC) are essential for normal cardiac function. Alterations in these can result in increased arrhythmia formation. In “electrical” cardiac diseases, long-QT and short-QT syndrome, regional mechanical function is altered via EMC.
Purpose
In this study, we aimed to investigate how acute changes in mechanics may impact on electrical function (MEC) in these diseases.
Methods
To determine how acute changes in preload impact on QT duration, adult rabbits of both sexes were given a 6ml/kg BW bolus of 0.9% NaCl IV and 12-lead-ECGs were assessed first in wildtype (WT) and acquired drug-induced (E4031 to block IKr) LQT2 (“aLQT2”) rabbits, and in a second step in transgenic short-QT type 1 (“SQT1”, KCNH2-N588K) and WT littermate control rabbits (“WT-LMC”).
Results
At baseline, aLQT2 rabbits demonstrated a markedly prolonged heart-rate corrected QTc duration compared to WT (p<0.0001; n=13), with increased QT-dispersion (QTMax-Min [ms], WT 21.4±5.7 vs. aLQT2 25.8±5.8; p=0.003; n=13) and increased short-term variability of QT (STVQT [ms], WT 3.5±1.0 vs. aLQT2 5.3±1.7; p=0.02; n=13), markers for regional and temporal heterogeneity of repolarization, respectively. SQT1 rabbits (n=8) demonstrated a shorter QTc duration compared to WT-LMC (n=10; p=0.04), with no differences in QT-dispersion and STVQT between the two groups.
Increased preload acutely prolonged QT and heart-rate corrected QTc in all groups (despite a slight increase in heart-rate by an average of 25 beats/min): in WT [ms] 171.6±11.6 to 213.3±20.3 (p<0.0001) vs. aLQT2 208.9±19.6 to 271.0±37.5 (p<0.0001; n=13 each), and in WT-LMC 171.3±4.8 to 199.2±5.4 (p<0.0001; n=10) vs. SQT1 156.0±4.7 to 177.3±3.5 (p=0.0004; n=8). Importantly, the extent of mechano-induced electrical changes differed among genotypes, with less pronounced QTc prolongation in SQT1 compared to WT-LMC (delta QTc [ms], SQT1 21.2±3.4 (n=8) vs. WT-LMC 27.9±2.8 (n=10; p=0.15)), and a more pronounced QTc prolongation in aLQT2 compared to WT (delta QTc [ms], WT 41.6±14.9 vs. aLQT2 62.1±32.1; p=0.006; n=13 each). Moreover, QT-dispersion was increased significantly upon global mechanical change only in aLQTS (QTMax-Min [ms], 25.8±5.5 to 32.7±12.3; p=0.03; n=13).
Conclusion
Acute changes in mechanical function result in electrical changes via MEC in SQT1, WT and aLQT2 rabbits. The extent of these changes, however, depends on the underlying QTc duration, with the least pronounced QTc prolongation in SQT1 rabbits, with the shortest QTc, and the most pronounced QTc prolongation in aLQT2 rabbits, with the longest QTc. The most pronounced MEC effects on global QT duration as well as on regional QT dispersion in aLQT2 indicate that acute MEC effects may play an additional role in LQTS-related arrhythmogenesis.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Research Foundation (DFG) andSwiss National Science Foundation (SNF)
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Affiliation(s)
- S Nimani
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
| | - T Hornyik
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
| | - N Alerni
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
| | - R Lewetag
- University of Freiburg, Dep. of Cardiology and Angiology I, Freiburg, Germany
| | - L Giammarino
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
| | - S Perez-Feliz
- University of Freiburg, Dep. of Cardiology and Angiology I, Freiburg, Germany
| | - L Matas
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
| | - K R Moss
- University of Freiburg, Inst. for Experimental Cardiovascular Medicine, Freiburg, Germany
| | - M Zehender
- University of Freiburg, Dep. of Cardiology and Angiology I, Freiburg, Germany
| | - M Brunner
- University of Freiburg, Dep. of Cardiology and Angiology I, Freiburg, Germany
| | - G Seemann
- University of Freiburg, Inst. for Experimental Cardiovascular Medicine, Freiburg, Germany
| | - K E Odening
- University of Bern, Translational Cardiology, Dep. of Cardiology and Dep. of Physiology, Bern, Switzerland
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Almer G, Brunner M, Schwarz A, Diwoky C, Lechleitner M, Sommer G, Kolb D, Wolinski H, Oswald W, Opriessnig P, Hörl G, Groselj-Strele A, Höfler G, Rechberger G, Frank S, Holzapfel G, Kratky D, Mangge H, Tehlivets O. Elevated homocysteine induces atherosclerosis-related changes in aortic rabbit walls in the absence of hypercholesterolemia. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.639] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maciukiewicz M, Schniering J, Gabrys H, Brunner M, Blüthgen C, Meier C, Guckenberger M, Fretheim H, Hoffmann-Vold AM, Distler O, Frauenfelder T, Tanadini-Lang S, Maurer B. OP0150 MACHINE LEARNING APPROACHES FOR RISK MODELLING IN INTERSTITIAL LUNG DISEASE ASSOCIATED WITH SYSTEMIC SCLEROSIS USING HIGH DIMENSIONAL IMAGE ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The interstitial lung disease (ILD) associated with connective tissue diseases including systemic sclerosis (SSc) is heterogenous disease characterized by reduced survival of approximately 3 years (1). “Radiomics’’ is a field of research which describes the in-depth analysis of tissues by computational retrieval of high-dimensional quantitative features from medical images (2). Our previous study suggested capacity of radiomics features to differentiate between “high” and “low” risk groups for lung function decline in two independent cohorts (3).Objectives: •bTo develop robust, machine learning (ML) workflow for “radiomics” data in SSc-ILD to select optimal methods for prediction. •oTo predict the time to individual lung function decline defined as defined by the time to a relative decline of ≥ 15% in Forced Vital Capacity (FVC)% as previously (3), using workflow.Methods:We investigated two cohorts of SSc-ILD: 90 patients (76.7% female, median age 57.5 years) from the University Hospital Zurich and 66 patients (75.8% female, median age 61.0 years) from Oslo University Hospital’s. Patients were retrospectively selected if (3): a) diagnosed with early/mild SSc according to the Very Early Diagnosis of Systemic Sclerosis (VEDOSS) criteria, b) presence of ILD on HRCT as determined by a senior radiologist. For every subject, we defined 1,355 robust radiomic features from HRCT images. The follow-up period was defined as the time interval between baseline visit and the last available follow-up visit.We have developed a systematic computational workflow to build predictive ML models. To reduce the number of redundant radiomic features, we applied correlation thresholds. We applied distinct methods including 1) Lasso Penalized Regression for feature selection, and 2) Random Forest (RF) for modeling using the R package ‘caret’. To select the optimal ML model, we randomly divided derivation cohort into Training (70%) and Holdout (30%) sets and applied fivefold cross-validation (5kCV) for feature and classifier selection on Training set only.Results:We have investigated various methods to select the optimal set of predictive radiomic features. Since the ML model performance is affected by both, feature, and classifier selection, we assessed these factors first.Results from feature filtering and selection, suggested that the combination of correlation threshold of 0.9 with Lasso regression proved best. As we perform feature selection in 5k CV workflow, features present in at least 2 sets entered model optimization step.During model selection, we selected RF classifier. We detected positive correlation between actual and predicted values with Spearman’s rho = 0.313, p = 0.167 and Spearman’s rho = 0.341, p = 0.015 in Oslo and Holdout sets respectively, as shown on Figure 1. The percentage of variance remained modest for both Holdout (Rsq = 0.104) and Oslo (Rsq = 0.126) datasets.Figure 1.Performance of the best, RF classifier shown as scatterplot between actual and predicted values of individual time to lung decline.Conclusion:In summary, we: (1) developed ML workflow that allowed to select o optimal methodology for modeling (i.e., feature and classifier selection), and (2) provide models that predicted time to individual lung function decline, characterized by significant correlation between predicted and actual values.References:[1]Hansell DM, Goldin JG, King TE, Jr., Lynch DA, Richeldi L, Wells AU. CT staging and monitoring of fibrotic interstitial lung diseases in clinical practice and treatment trials: a position paper from the Fleischner Society. Lancet Respir Med. 2015;3(6):483-96.[2]Lambin, P. et al. Radiomics: extracting more information from medical images using advanced feature analysis. Eur. J. Cancer 48, 441–446 (2012).[3]Schniering J. et al. Resolving phenotypic and prognostic differences in interstitial lung disease related to systemic sclerosis by computed tomography-based radiomics. https://www.medrxiv.org/content/10.1101/2020.06.09.20124800v1Disclosure of Interests:None declared
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Meier C, Maciukiewicz M, Brunner M, Schniering J, Gabrys H, Kühnis A, Distler O, Frauenfelder T, Tanadini-Lang S, Maurer B. POS0866 TWO-DIMENSIONAL HRCT-BASED RADIOMIC FEATURES IN SSC-ILD DISTINGUISH DRUG RESPONDERS FROM NON-RESPONDERS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Management of patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) is complicated by high inter-patient variability. To date, no validated predictors of treatment response are available for routine use. High resolution computed tomography (HRCT)-based radiomics, i.e. the high-dimensional, quantitative analysis of imaging metadata, have previously been shown to be successful in discriminating (SSc-)ILD phenotypes in preclinical and clinical studies1. Since HRCT is an integral part of the routine work-up in SSc, HRCT-based radiomic features may hold potential as non-invasive biomarkers.Objectives:To predict treatment response using two-dimensional (2D) HRCT-based radiomics in SSc-ILD patients from a prospectively followed cohort.Methods:Inclusion criteria were diagnosis of SSc-ILD in HRCT, availability of a suitable chest HRCT scan within 12 months prior to initiation of a new treatment, and availability of clinical baseline and follow-up information. Treatment response was defined as the absence of all of the following over a follow-up period of 12-24 months: relative decrease in forced vital capacity (FVC) ≥5%, increase of ILD in HRCT as assessed by a radiologist, change in treatment regimen due to insufficient response, ILD-related death or lung transplantation. Of each pre-treatment HRCT, 6 slices (15±5 mm apart, starting from the basal lung margin) were manually segmented and 1513 2D radiomic features were extracted using the in-house software Z-Rad (Python 2.7). Features were Z-score transformed and pre-filtered for inter- and intra-reader robustness (intraclass correlation coefficient >0.85) and inter-feature correlation (Spearman’s rho <0.9). A categorical linear regression model was created using 3-fold cross-validated elastic nets for feature selection. Features were then summarized and divided by their number. For generation of a score cut-off, Youden’s score was used. For two-group analyses of continuous variables, Wilcoxon’s test was performed, whereas categorical data was assessed using Fisher’s exact test.Results:A total of 64 pre-treatment HRCTs from 54 patients were analyzed. In 9 patients, >1 asynchronous treatments were assessed, while 45 patients had only 1 eligible treatment approach. The response rate within the assessed follow-up period was 45.3% (n=29). For score generation, 13 radiomic features were selected and an optimal cut-off value of -0.1589 was determined. Univariate linear regression showed significant association between our categorical radiomics-based score and treatment response (p=0.007, area under the curve = 0.65 (0.51-0.79), sensitivity=0.90, specificity=0.43), whereby a high score was predictive for treatment response.No differences between patients with high (n=46) or low (n=18) scores were detected for baseline age (mean±SD=55.5±12.0 and 55.5±13.6 years, p=0.84), duration of SSc (mean±SD=6.2±8.4 and 4.7±4.4 years, p=0.79), time since ILD diagnosis (2.7±2.9 and 2.4±3.1 years, p=0.59), FVC (77.6±20.6 and 80.1±17.9, p=0.41) or DLco (54.4±21.0 and 57.6±18.9, p=0.40). Distribution of anti-Scl-70 positivity (45.7% vs. 55.6%, p=0.58) and diffuse cutaneous disease (47.7% vs. 61.1%, p=0.41) was not significantly different between patients with high and low scores, respectively, although a trend towards higher percentages in the high score group was observed.Conclusion:Our results indicate that, following validation in external cohorts, radiomics may be a promising tool for future pre-treatment patient stratification. Moreover, our radiomics-based score seems not to be associated with commonly studied clinical predictors such as anti-Scl-70 positivity or lung function, underlining a possible additive value to ‘traditional’ clinical parameters.References:[1]Schniering, J., et al. Resolving phenotypic and prognostic differences in interstitial lung disease related to systemic sclerosis by computed tomography-based radiomics. medRxiv [Preprint] doi:10.1101/2020.06.09.20124800 (2020).Disclosure of Interests:Chantal Meier: None declared, Malgorzata Maciukiewicz: None declared, Matthias Brunner: None declared, Janine Schniering: None declared, Hubert Gabrys: None declared, Anja Kühnis: None declared, Oliver Distler Speakers bureau: Speaker fee on Scleroderma and related complications: Bayer, Boehringer Ingelheim, Medscape, Novartis, Roche. Speaker fee on rheumatology topic other than Scleroderma: MSD, iQone, Novartis, Pfizer, Roche, Consultant of: Consultancy fee for Scleroderma and its complications: Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Bayer, Baecon Discovery, Boehringer, CSL Behring, ChemomAb, Corbus Pharmaceuticals, Horizon Pharmaceuticals, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, Kymera, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Roivant Sciences, Sanofi, UCB. Consultancy fee for rheumatology topic other than Scleroderma: Abbvie, Amgen, Lilly, Pfizer, Grant/research support from: Research Grants to investigate the pathophysiology and potential treatment of Scleroderma and its complications: Kymera Therapeutics, Mitsubishi Tanabe, Thomas Frauenfelder: None declared, Stephanie Tanadini-Lang: None declared, Britta Maurer Speakers bureau: Speaker fees from Boehringer-Ingelheim, Grant/research support from: Grant/research support from AbbVie, Protagen, Novartis Biomedical Research, congress support from Pfizer, Roche, Actelion, mepha, and MSD
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Ong K, Bordeianou L, Brunner M, Buntzen S, Collie MHS, Hanly A, Hunt CW, Matzel KE, O'Connell PR, Rydningen M, Savitt L, Totaro A, Vaizey CJ, Maeda Y. Changing paradigm of sacral neuromodulation and external anal sphincter repair for faecal incontinence in specialist centres. Colorectal Dis 2021; 23:710-715. [PMID: 32894636 DOI: 10.1111/codi.15349] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to determine whether the paradigm of surgical intervention for faecal incontinence (FI) has changed between 2000 and 2013. METHOD This was a multi-centre retrospective study of patients who had undergone either sacral neuromodulation (SNM) or delayed sphincter repair or sphincteroplasty (SR) as a primary surgical intervention for FI in five centres in Europe and one in the United States. The flow of patients according to the intervention, sustainability of the treatment at a minimum follow-up of 5 years, complications and requirement for further interventions were recorded. RESULTS A total of 461 patients (median age 56 years, range 24-90 years, 41 men) had either SNM or SR as an index operation during the study period [SNM 284 (61.6%), SR 177 (38.4%)]. Among SNM patients, there were 169 revisional operations (change of battery and/or lead, re-siting or removal). At the time of last follow-up 203 patients (71.4%) continued to use SNM. Among SR patients, 30 (16.9%) had complications, most notably wound infection (22, 12.4%). During follow-up 32 patients (18.1%) crossed over to SNM. Comparing two 4-year periods (2000-2003 and 2007-2010), the proportion of patients operated on who had a circumferential sphincter defect of less than 90° was 48 (68%) and 45 (46%), respectively (P = 0.03), while those who had SNM as the primary intervention increased from 29% to 89% (P < 0.05). CONCLUSION The paradigm of surgical intervention for FI has changed with increasing use of SNM.
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Affiliation(s)
- K Ong
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - L Bordeianou
- Colorectal Surgery Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M Brunner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - S Buntzen
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsoe, Norway
| | - M H S Collie
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - A Hanly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - C W Hunt
- Colorectal Surgery Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K E Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - M Rydningen
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsoe, Norway
| | - L Savitt
- Colorectal Surgery Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Totaro
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - Y Maeda
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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Vassos N, Brunner M, Perrakis A, Göhl J, Grützmann R, Hohenberger W, Croner RS. Oncological outcome after hyperthermic isolated limb perfusion for primarily unresectable versus locally recurrent soft tissue sarcoma of extremities. Surg Oncol 2020; 35:162-168. [PMID: 32882523 DOI: 10.1016/j.suronc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The management of locally advanced extremity soft tissue sarcomas, particularly in terms of a limb salvage strategy, represents a challenge, especially in recurrent tumors. In the context of a patient-tailored multimodal therapy, hyperthermic isolated limb perfusion (ILP) is a promising limb-saving treatment option. We report the outcome of patients with primarily irresectable and locally recurrent soft tissue sarcoma (STS) treated by ILP. PATIENTS AND METHODS Data about patient demographics, clinical und histopathological characteristics, tumor response, morbidity and oncological outcome of all patients with STS, who underwent an ILP at our institution in a 10-year period, were retrospectively detected and analyzed. RESULTS The cohort comprised 30 patients. Two patients were treated with ILP for palliative tumor control, 13 patients because of a local recurrent soft tissue sarcoma (rSTS) and 15 patients because of primarily unresectable soft tissue sarcoma (puSTS). 25 of the 28 patients with curative intention received surgery after ILP (11 pts with rSTS and 14 pts with puSTS). Histopathologically we observed complete response in 6 patients (24%) and partial responses in 19 patients (76%) with a significant better remission in patients with puSTS (p = 0,043). Limb salvage rate was 75%. Mean follow-up was 69 months [range 13-142 months]. Seven (7/11; 64%) patients with rSTS and one (1/14; 7%) patient with puSTS developed local recurrence after ILP and surgery, whereas eight (8/13; 62%) rSTS patients and seven (7/15; 47%) puSTS patients developed distant metastasis. During follow-up, eight patients (28.5%) died of disease (5/13; 38%) rSTS and 3/15 (20%) puSTS. ILP in the group of previously irradiated sarcoma patients (n = 13) resulted in a limb salvage rate of 69% and was not associated in an increased risk for adverse events. DISCUSSION ILP for advanced extremity STS is a treatment option for both puSTS and rSTS resulting in good local control and should be considered in multimodal management. ILP is also a good option for patients after radiation history.
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Affiliation(s)
- N Vassos
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany; Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
| | - M Brunner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - A Perrakis
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - J Göhl
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - W Hohenberger
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
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Schmit P, Brunner M, Kraume M. Biotechnologische Synthese von Methan aus Wasserstoff und Kohlendioxid. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- P. Schmit
- htwsaar DefiTechno Goebenstr. 40 66117 Saarbrücken Deutschland
| | - M. Brunner
- htwsaar DefiTechno Goebenstr. 40 66117 Saarbrücken Deutschland
| | - M. Kraume
- TU Berlin Institut für Prozess- und Verfahrenstechnik Straße des 17. Juni 135 10623 Berlin Deutschland
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Schniering J, Maciukiewicz M, Gabrys H, Brunner M, Blüthgen C, Distler O, Guckenberger M, Frauenfelder T, Tanadini-Lang S, Maurer B. SAT0569 “IMAGES ARE MORE THAN PICTURES, THEY ARE DATA” [1] – EXPLORATION OF RADIOMICS ANALYSIS FOR SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interstitial lung disease (ILD) affects 60% of patients with systemic sclerosis (SSc) and is the primary cause of death. Medical imaging is an integral part of the routine work-up for diagnosis and monitoring of SSc-ILD and includes high-resolution computed tomography (HRCT). Radiomics is a novel research area that describes the in-depth analysis of tissue phenotypes in medical images with computational retrieval of quantitative, mineable metadata appropriate for statistical analyses.Objectives:To explore the performance of HRCT-derived radiomic features for the assessment of SSc-associated ILD (i.e. diagnosis, staging, and lung function).Methods:Radiomics analysis was performed on HRCT scans from 98 SSc patients, including n=33 SSc patients without ILD, n=33 with limited and n=32 with extensive ILD as defined by 0%, <20% and ≥20% visual extent of fibrosis on HRCT, respectively. Following semi-automated segmentation of lung tissue on 3D reconstructed HRCT scans, 1386 radiomic features, including 17 intensity, 137 texture, and 1232 wavelet features were extracted using the in-house developed software Z-Rad (Python 2.7). In order to identify robust features, we conducted intra- and inter-reader correlation analysis (ICC) in a subgroup of patients. Only features with good reproducibility (ICC ≥ 0.75) entered subsequent analyses. We applied the Wilcoxon test, followed by Receiver Operating Characteristic ROC) curve analyses, to identify features significantly different between a) ILD and non-ILD and b) limited vs. extensive ILD patients. Spearman rank correlation was performed to reveal significant associations of radiomic features from a) and b) with lung function as measured by percentage of predicted forced vital capacity (FVC% predicted).Results:In total, 1355/1386 radiomic features passed the test of robustness and were eligible for further, exploratory analyses. Radiomic features with good performance (area under the ROC curve (AUC) ≥ 0.7 and p-value ≤ 0.05) were considered as potential candidate discriminators. Under this criterion, we identified 288/1355 (21.3%) radiomic features that were significantly different between ILD and non-ILD patients and 409/1355 (30.2%) features that significantly discriminated between limited and extensive ILD (Fig. 1). For diagnosis, the texture featuredependence count entropywas the top parameter to distinguish ILD patients from healthy controls (AUC = 0.89, p = 1.83x10-10), whereas for staging the wavelet featureHHH long run high grey level emphasisproved to be best suited to separate limited from extensive ILD (AUC = 0.88, p = 7.76x10-9).Fig 1.Correlation analysis of the most significant (best performing) discriminative radiomic features with lung function revealed a significant negative correlation ofdependence count entropy(rho = -0.51, p = 9.89x10-8) andHHH long run high grey level emphasis(rho = -0.51, p = 1.73x10-5) with FVC% predicted.Conclusion:Our study adds novelty to the field of SSc-ILD showing that radiomic features have great potential as quantitative imaging biomarkers for diagnosis and staging of SSc-ILD and that they may reflect lung function. As the next step, we are planning to build predictive models, using machine learning, for diagnosis, staging, and lung function and validate them in external patient cohorts. If validated such models will pave the way for computer-aided management in SSc-ILD and thus improve patients’ outcome.References:[1]Gillies, R. J., Kinahan, P. E. & Hricak, H. Radiomics: Images Are More than Pictures, They Are Data. Radiology 278, 563-577, doi:10.1148/radiol.2015151169 (2016).Disclosure of Interests:Janine Schniering: None declared, Malgorzata Maciukiewicz: None declared, Hubert Gabrys: None declared, Matthias Brunner: None declared, Christian Blüthgen: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Matthias Guckenberger: None declared, Thomas Frauenfelder: None declared, Stephanie Tanadini-Lang: None declared, Britta Maurer Grant/research support from: AbbVie, Protagen, Novartis, congress support from Pfizer, Roche, Actelion, and MSD, Speakers bureau: Novartis
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Payr S, Bergelin J, Beck J, Dragovich T, Azizian A, Brunner M, König U, Naraev B, Ellenrieder V, Gaedcke J, Schütz E, Kundranda M, König AO. Cell-free tumour-DNA (cfDNA) as a very early predictor of therapeutic outcome in pancreatic ductal adenocarcinoma (PDAC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kroon HM, Dudi-Venkata N, Bedrikovetski S, Thomas M, Kelly M, Aalbers A, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alberda W, Andric M, Antoniou A, Austin K, Baker R, Bali M, Baseckas G, Bednarski B, Beets G, Berg P, Beynon J, Biondo S, Bordeianou L, Brunner M, Buchwald P, Burger J, Burling D, Campain N, Chan K, Chang G, Chew M, C Chong P, Christensen H, Codd M, Colquhoun A, Corr A, Coscia M, Coyne P, Creavin B, Damjanovic L, Daniels I, Davies M, Davies R, de Wilt J, Denost Q, Dietz D, Dozois E, Duff M, Eglinton T, Enriquez-Navascues J, Evans M, Fearnhead N, Frizelle F, Garcia-Granero E, Garcia-Sabrido J, Gentilini L, George M, Glynn R, Golda T, Griffiths B, Harris D, Evans M, Hagemans J, Harji D, Heriot A, Hohenberger W, Holm T, Jenkins J, Kapur S, Kanemitsu Y, Kelley S, Keller D, Kim H, Koh C, Kok N, Kokelaar R, Kontovounisios C, Kusters M, Larson D, Law W, Laurberg S, Lee P, Lydrup M, Lynch A, Mantyh C, Mathis K, Martling A, Meijerink W, Merkel S, Mehta A, McDermott F, McGrath J, Mirnezami A, Morton J, Mullaney T, Mesquita-Neto J, Nielsen M, Nieuwenhuijzen G, Nilsson P, O'Connell P, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan R, Rasheed S, Rasmussen P, Regenbogen S, Rocha R, Rothbarth J, Roxburgh C, Rutten H, Ryan É, Sagar P, Saklani A, Schizas A, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart N, Smith J, Solomon M, Sørensen M, Steele S, Steffens D, Stocchi L, Stylianides N, Tekkis P, Taylor C, Tsarkov P, Tsukamoto S, Turner W, Tuynman J, van Ramshorst G, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Wasmuth H, Weiser M, Wheeler J, Wild J, Yip J, Winter D, Sammour T. Palliative pelvic exenteration: A systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45:1787-1795. [DOI: 10.1016/j.ejso.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
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Brunner M, Roth H, Günther K, Grützmann R, Matzel KE. Ventral rectopexy with biological mesh for recurrent disorders of the posterior pelvic organ compartment. Int J Colorectal Dis 2019; 34:1763-1769. [PMID: 31506799 DOI: 10.1007/s00384-019-03363-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Recurrent prolapse of the posterior pelvic organ compartment presents a management challenge, with the best surgical procedure remaining unclear. We present functional outcome and patient satisfaction after laparoscopic and robotic ventral mesh rectopexy (VMR) with biological mesh in patients with recurrence. METHODS We analyzed data from 30 patients with recurrent posterior pelvic organ prolapse who underwent VMR with biological mesh from August 2012 to January 2018. Data included patient demographics and intra- and postoperative findings; functional outcome as assessed by Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Score Longo (ODS), and Cleveland Clinic Incontinence Score (CCIS); and patient satisfaction. RESULTS CCCS, CCIS, and ODS were significantly improved at 6-12 months postoperatively and at last follow-up. Patient satisfaction (visual analog scale [VAS] 6.7 [0 to 10]), subjective symptoms (+ 3.4 [scale - 5 to + 5]), and quality of life improvement (+ 3.0 [scale from - 5 to + 5]) were high at last follow-up. The rates of morbidity and major complications were 13% and 3%, respectively. There were no mesh-related complications or deaths. Difference in type of previous surgery (abdominal or transanal/perineal) had no significant effect on results. CONCLUSIONS VMR with biological mesh is a safe and effective option for patients with recurrent posterior pelvic organ prolapse. It reduces functional symptoms, has a low complication rate, and promotes patient satisfaction.
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Affiliation(s)
- M Brunner
- Department of General and Visceral Surgery, Friedrich Alexander University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - H Roth
- Department of General and Visceral Surgery, Hospital Hallerwiese, St. Johannis Mühlgasse19, Nürnberg, Germany
- Department of General and Visceral Surgery, DRK Hospital, Bahnhofstraße36, Sömmerda, Germany
| | - K Günther
- Department of General and Visceral Surgery, Hospital Hallerwiese, St. Johannis Mühlgasse19, Nürnberg, Germany
| | - R Grützmann
- Department of General and Visceral Surgery, Friedrich Alexander University, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Klaus E Matzel
- Department of General and Visceral Surgery, Friedrich Alexander University, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Payr S, Beck J, König U, Brunner M, Gaedcke J, Azizian A, Ghadimi M, Ellenrieder V, Schütz E, König AO. Cell free tumor-DNA can predict treatment outcome in advanced PDAC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Brunner M, Grützmann R, Weber GF. [Palliative therapy concepts for pancreatic carcinoma]. Chirurg 2018; 89:737-750. [PMID: 30094706 DOI: 10.1007/s00104-018-0696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of patients with ductal pancreatic adenocarcinoma are already in a locally advanced or metastatic stage at the time of diagnosis and require palliative therapy. Interventional and operative measures are available for the restoration of biliary outflow in bile duct obstruction and the continuity of the upper intestinal lumen in duodenal or gastric outlet obstruction. In the presence of tumor-related pain, pain therapy according to the World Health Organization (WHO) scheme or a truncus coeliacus blockade, in cachexia a nutritional therapy and in thromboembolic events an anticoagulant therapy are used. An individualized palliative chemotherapy regimen should be selected for each patient, taking into account the patient's general condition and the side effects profile of the chemotherapeutic agents. Radiochemotherapy and local ablative therapies should currently only be used within the framework of studies. A palliative resection is not recommended according to current knowledge.
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Affiliation(s)
- M Brunner
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - R Grützmann
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - G F Weber
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum, Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
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22
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Castiglione A, Hornyik T, Franke G, Perez-Feliz S, Bosze Z, Koren G, Varro A, Zehender M, Brunner M, Bode C, Baczko I, Odening KE. P604Docosahexaenoic acid acts as QT-shortening agent with genotype-tspecific beneficial effects in transgenic LQT1, LQT2, LQT5 and LQT2-5 rabbit models. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Castiglione
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - T Hornyik
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - G Franke
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - S Perez-Feliz
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - Z Bosze
- Agricultural Biotechnology Institute, NARIC, Godollo, Hungary
| | - G Koren
- Brown University, Cardiovascular Research Center, Providence, United States of America
| | - A Varro
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - M Zehender
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - M Brunner
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - C Bode
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
| | - I Baczko
- University of Szeged, Department of Pharmacology and Pharmacotherapy, Szeged, Hungary
| | - K E Odening
- University Heart Center Freiburg, Cardiology and Angiology I, Freiburg, Germany
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Bauer A, Nimmo J, Newman R, Brunner M, Welle MM, Jagannathan V, Leeb T. A splice site variant in the SUV39H2 gene in Greyhounds with nasal parakeratosis. Anim Genet 2018; 49:137-140. [PMID: 29423952 DOI: 10.1111/age.12643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/27/2022]
Abstract
Hereditary nasal parakeratosis (HNPK), described in the Labrador Retriever breed, is a monogenic autosomal recessive disorder that causes crusts and fissures on the nasal planum of otherwise healthy dogs. Our group previously showed that this genodermatosis may be caused by a missense variant located in the SUV39H2 gene encoding a histone 3 lysine 9 methyltransferase, a chromatin modifying enzyme with a potential role in keratinocyte differentiation. In the present study, we investigated a litter of Greyhounds in which six out of eight puppies were affected with parakeratotic lesions restricted to the nasal planum. Clinically and histologically, the lesions were comparable to HNPK in Labrador Retrievers. Whole genome sequencing of one affected Greyhound revealed a 4-bp deletion at the 5'-end of intron 4 of the SUV39H2 gene that was absent in 188 control dog and three wolf genomes. The variant was predicted to disrupt the 5'-splice site with subsequent loss of SUV39H2 function. The six affected puppies were homozygous for the variant, whereas the two non-affected littermates were heterozygous. Genotyping of a larger cohort of Greyhounds revealed that the variant is segregating in the breed and that this breed might benefit from genetic testing to avoid carrier × carrier matings.
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Affiliation(s)
- A Bauer
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001, Bern, Switzerland.,DermFocus, University of Bern, 3001, Bern, Switzerland
| | - J Nimmo
- ASAP Laboratory, Mulgrave, Vic., 3170, Australia
| | - R Newman
- Mobile Vet Services and Supplies, Warwick, Qld, 4370, Australia
| | - M Brunner
- DermFocus, University of Bern, 3001, Bern, Switzerland.,Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, 3001, Bern, Switzerland
| | - M M Welle
- DermFocus, University of Bern, 3001, Bern, Switzerland.,Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, 3001, Bern, Switzerland
| | - V Jagannathan
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001, Bern, Switzerland.,DermFocus, University of Bern, 3001, Bern, Switzerland
| | - T Leeb
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001, Bern, Switzerland.,DermFocus, University of Bern, 3001, Bern, Switzerland
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Balitska V, Shpotyuk O, Brunner M, Hadzaman I. Stretched-to-compressed-exponential crossover observed in the electrical degradation kinetics of some spinel-metallic screen-printed structures. Chem Phys 2018. [DOI: 10.1016/j.chemphys.2017.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schiano di Visconte M, Santoro GA, Cracco N, Sarzo G, Bellio G, Brunner M, Cui Z, Matzel KE. Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up. Tech Coloproctol 2018; 22:97-105. [DOI: 10.1007/s10151-017-1745-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022]
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Hines M, Brunner M, Poon S, Lam M, Tran V, Yu D, Togher L, Shaw T, Power E. Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI). BMC Health Serv Res 2017; 17:757. [PMID: 29162086 PMCID: PMC5697081 DOI: 10.1186/s12913-017-2721-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals’ experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. Methods A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. Results Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. Conclusions Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.
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Affiliation(s)
- M Hines
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia.
| | - M Brunner
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia.,Faculty of Education and Arts, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - S Poon
- Faculty of Engineering and Information Technologies, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - M Lam
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - V Tran
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - D Yu
- Faculty of Engineering and Information Technologies, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - L Togher
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia.,Moving Ahead, NHMRC Centre of Research Excellence in Brain Recovery, School of Psychology, The University of New South Wales, Camperdown, NSW, 2052, Australia
| | - T Shaw
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - E Power
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
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Ramstedt S, Mohamed S, Vlemmings WHT, Danilovich T, Brunner M, De Beck E, Humphreys EML, Lindqvist M, Maercker M, Olofsson H, Kerschbaum F, Quintana-Lacaci G. The circumstellar envelope around the S-type AGB star W Aql. Effects of an eccentric binary orbit. Astron Astrophys 2017; 605:A126. [PMID: 29142327 PMCID: PMC5683349 DOI: 10.1051/0004-6361/201730934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT Recent observations at subarcsecond resolution, now possible also at submillimeter wavelengths, have shown intricate circumstellar structures around asymptotic giant branch (AGB) stars, mostly attributed to binary interaction. The results presented here are part of a larger project aimed at investigating the effects of a binary companion on the morphology of circumstellar envelopes (CSEs) of AGB stars. AIMS AGB stars are characterized by intense stellar winds that build CSEs around the stars. Here, the CO(J = 3→2) emission from the CSE of the binary S-type AGB star W Aql has been observed at subarcsecond resolution using ALMA. The aim of this paper is to investigate the wind properties of the AGB star and to analyse how the known companion has shaped the CSE. METHODS The average mass-loss rate during the creation of the detected CSE is estimated through modelling, using the ALMA brightness distribution and previously published single-dish measurements as observational constraints. The ALMA observations are presented and compared to the results from a 3D smoothed particle hydrodynamics (SPH) binary interaction model with the same properties as the W Aql system and with two different orbital eccentricities. Three-dimensional radiative transfer modelling is performed and the response of the interferometer is modelled and discussed. RESULTS The estimated average mass-loss rate of W Aql is Ṁ = 3.0×10-6 M⊙ yr-1 and agrees with previous results based on single-dish CO line emission observations. The size of the emitting region is consistent with photodissociation models. The inner 10″ of the CSE is asymmetric with arc-like structures at separations of 2-3″ scattered across the denser sections. Further out, weaker spiral structures at greater separations are found, but this is at the limit of the sensitivity and field of view of the ALMA observations. CONCLUSIONS The CO(J = 3→2) emission is dominated by a smooth component overlayed with two weak arc patterns with different separations. The larger pattern is predicted by the binary interaction model with separations of ~10″ and therefore likely due to the known companion. It is consistent with a binary orbit with low eccentricity. The smaller separation pattern is asymmetric and coincides with the dust distribution, but the separation timescale (200 yrs) is not consistent with any known process of the system. The separation of the known companions of the system is large enough to not have a very strong effect on the circumstellar morphology. The density contrast across the envelope of a binary with an even larger separation will not be easily detectable, even with ALMA, unless the orbit is strongly asymmetric or the AGB star has a much larger mass-loss rate.
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Affiliation(s)
- S Ramstedt
- Department of Physics and Astronomy, Uppsala University
| | - S Mohamed
- South African Astronomical Observatory, PO box 9, 7935 Observatory, South Africa
- Astronomy Department, University of Cape Town, University of Cape Town, 7701, Rondebosch, South Africa
- South Africa National Institute for Theoretical Physics, Private Bag X1, Matieland, 7602, South Africa
| | - W H T Vlemmings
- Dept. of Earth and Space Sciences, Chalmers University of Technology, Onsala Space Observatory, 439 92 Onsala Sweden
| | - T Danilovich
- Instituut voor Sterrenkunde, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
| | - M Brunner
- Dept. of Astrophysics, University of Vienna, Türkenschanzstr. 17, 1180 Vienna, Austria
| | - E De Beck
- Dept. of Earth and Space Sciences, Chalmers University of Technology, Onsala Space Observatory, 439 92 Onsala Sweden
| | - E M L Humphreys
- ESO, Karl-Schwarzschild-Str. 2, 85748 Garching bei München, Germany
| | - M Lindqvist
- Dept. of Earth and Space Sciences, Chalmers University of Technology, Onsala Space Observatory, 439 92 Onsala Sweden
| | - M Maercker
- Dept. of Earth and Space Sciences, Chalmers University of Technology, Onsala Space Observatory, 439 92 Onsala Sweden
| | - H Olofsson
- Dept. of Earth and Space Sciences, Chalmers University of Technology, Onsala Space Observatory, 439 92 Onsala Sweden
| | - F Kerschbaum
- Dept. of Astrophysics, University of Vienna, Türkenschanzstr. 17, 1180 Vienna, Austria
| | - G Quintana-Lacaci
- Instituto de Ciencia de Materiales de Madrid, CSIC, c/ Sor Juana Inés de la Cruz 3, 28049 Cantoblanco, Madrid, Spain
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Abstract
Due to improvements in imaging modalities the diagnosis of branch duct intraductal papillary mucinous neoplasms (BD-IPMN) has been significantly increased in recent years. A BD-IPMN is frequently diagnosed as an incidental finding in asymptomatic patients. The optimal management of BD-IPMN is the subject of controversial discussions. Numerous studies have shown that an individualized therapeutic strategy with a follow-up observation of most BD-IPMNs is feasible and safe, considering age, comorbidities and patient preference. An accurate evaluation of BD-IPMN with a detailed anamnesis, high-resolution imaging techniques and endoscopic ultrasound is necessary. Symptomatic patients as well as patients with so-called high-risk stigmata should undergo resection. Asymptomatic patients with so-called worrisome features can either undergo surveillance or surgical resection, taking age and comorbidities into account. For BD-IPMN patients without high-risk stigmata and worrisome features and showing no symptoms, surveillance of the pancreatic lesion is the preferred approach. The high prevalence of BD-IPMN, limitations in differential diagnostics, an overestimation of the risk of malignancy due to an overrepresentation of symptomatic and suspected BD-IPMN in resected cohorts, an overestimated role of BD-IPMN as precursor lesions for pancreatic carcinoma and evidence of the safety of follow-up surveillance, underline the enormous importance of surveillance. Based on this and considering the background of a notable mortality and morbidity of pancreatic surgery, aggressive management with prophylactic surgical resection is not justified for all BD-IPMN, in particular for low-risk lesions.
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Affiliation(s)
- M Brunner
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - G F Weber
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - S Kersting
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - Robert Grützmann
- Klink für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
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Abstract
Abstract. Although suffering is a central issue in pain, there is only little research on this topic. The aim of this study was to assess suffering in an experimental context using various stimulation methods and durations, and to examine which psychological or psychophysiological measures covary with pain-related suffering. Twenty-one healthy volunteers participated in two experiments in which we used tonic thermal and phasic electric stimuli with short and long stimulus durations. The participants rated pain intensity, unpleasantness, and pain-related suffering on separate visual analog scales (VAS) and completed the Pictorial Representation of Illness and Self Measure (PRISM), originally developed to assess suffering in chronic illness. We measured heart rate, skin conductance responses (SCRs), and the electromyogram (EMG) of the musculus corrugator supercilii. For both heat and electric pain, we obtained high ratings on the suffering scale confirming that suffering can be evoked in experimental pain conditions. Whereas pain intensity and unpleasantness were highly correlated, both scales were less highly related to suffering, indicating that suffering is distinct from pain intensity and unpleasantness. Higher suffering ratings were associated with more pronounced fear of pain and increased private self-consciousness. Pain-related suffering was also related to high resting heart rate, increased SCR, and decreased EMG during painful stimulation. These results offer an approach to the assessment of suffering in an experimental setting using thermal and electric pain stimulation and shed light on its psychological and psychophysiological correlates.
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Affiliation(s)
- M. Brunner
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M. Löffler
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S. Kamping
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - S. Bustan
- Institute for Health and Behavior, FLSHASE/INSIDE, University of Luxembourg, Luxembourg
| | - A. M. González-Roldán
- Institute for Health and Behavior, FLSHASE/INSIDE, University of Luxembourg, Luxembourg
| | - F. Anton
- Institute for Health and Behavior, FLSHASE/INSIDE, University of Luxembourg, Luxembourg
| | - H. Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Zouboulis C, Theodoridis A, Brunner M, Magro C. Benign atrophic papulosis (Köhlmeier-Degos disease): the wedge-shaped dermal necrosis can resolve with time. J Eur Acad Dermatol Venereol 2017; 31:1753-1756. [DOI: 10.1111/jdv.14355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
| | - A. Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
- Freiburg Veins Center; Freiburg Germany
| | - M. Brunner
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
| | - C.M. Magro
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
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Abstract
INTRODUCTION Sacral nerve stimulation (SNS) is a common and effective treatment for faecal incontinence (FI), but accessibility of the sacral nerves is mandatory. In some cases, electrode placement fails for unknown reasons. A frequent cause could be sacral malformations, which have a high incidence (up to 24.1%) and can be unsuspected. METHODS AND RESULTS We report two patients with FI consequent to congenital anorectal malformation and associated sacral malformation. Despite partial sacral agenesis, SNS was feasible in both. They benefitted greatly from SNS, with an improved ability to postpone the urge up to at least 15 min, reduced incontinence episodes (at least 50%), and significantly better quality of life. CONCLUSION SNS may be feasible in patients with FI, even in the presence of sacral malformation. However, clinicians should be aware of the attendant technical difficulties. Preoperative imaging, preferably with MRI of the sacrum, is advisable. If the sacral spinal nerves are inaccessible technically, pudendal nerve stimulation could be considered, if anatomy permits.
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Affiliation(s)
- M Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Z Cui
- Department of Gastrointestinal Surgery, Coloproctology Section, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Shandong Road, Shanghai, China
| | - K E Matzel
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Likar R, Jaksch W, Aigmüller T, Brunner M, Cohnert T, Dieber J, Eisner W, Geyrhofer S, Grögl G, Herbst F, Hetterle R, Javorsky F, Kress HG, Kwasny O, Madersbacher S, Mächler H, Mittermair R, Osterbrink J, Stöckl B, Sulzbacher M, Taxer B, Todoroff B, Tuchmann A, Wicker A, Sandner-Kiesling A. Interdisziplinäres Positionspapier „Perioperatives Schmerzmanagement“. Schmerz 2017; 31:463-482. [DOI: 10.1007/s00482-017-0217-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kadletz L, Kenner L, Poyntner L, Formanek M, Primosch T, Schartinger V, Brunner M. Postoperative radiotherapy versus surgery alone for T1N1 and T2N0 oropharygeal squamous cell carcinoma: a nationwide and retrospective study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shpotyuk O, Brunner M, Hadzaman I, Balitska V, Klym H. Analytical Description of Degradation-Relaxation Transformations in Nanoinhomogeneous Spinel Ceramics. Nanoscale Res Lett 2016; 11:499. [PMID: 27844462 PMCID: PMC5108734 DOI: 10.1186/s11671-016-1722-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/04/2016] [Indexed: 06/06/2023]
Abstract
Mathematical models of degradation-relaxation kinetics are considered for jammed thick-film systems composed of screen-printed spinel Cu0.1Ni0.1Co1.6Mn1.2O4 and conductive Ag or Ag-Pd alloys. Structurally intrinsic nanoinhomogeneous ceramics due to Ag and Ag-Pd diffusing agents embedded in a spinel phase environment are shown to define governing kinetics of thermally induced degradation under 170 °C obeying an obvious non-exponential behavior in a negative relative resistance drift. The characteristic stretched-to-compressed exponential crossover is detected for degradation-relaxation kinetics in thick-film systems with conductive contacts made of Ag-Pd and Ag alloys. Under essential migration of a conductive phase, Ag penetrates thick-film spinel ceramics via a considerable two-step diffusing process.
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Affiliation(s)
- O Shpotyuk
- Jan Dlugosz University in Czestochowa, 13/15, Armii Krajowej str., 42200, Czestochowa, Poland.
- Vlokh Institute of Physical Optics, 23, Dragomanov str., Lviv, 79005, Ukraine.
| | - M Brunner
- Technische Hochschule Köln/University of Technology, Arts, Sciences, 2, Betzdorfer Strasse, Köln, 50679, Germany
| | - I Hadzaman
- Drohobych Ivan Franko State Pedagogical University, 24, I. Franko str., Drohobych, 82100, Ukraine
| | - V Balitska
- Lviv State University of Life Safety, 35, Kleparivska str., Lviv, 79007, Ukraine
| | - H Klym
- Lviv Polytechnic National University, 12, Bandera str., Lviv, 79013, Ukraine
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Abstract
A 35-year-old man presented with two annular, reddish-brown, atrophic skin lesions in the navel and on the right lower abdomen. The lesions had persisted for more than 4 years and had remained unchanged and asymptomatic. Histology revealed annular atrophic lichen planus with a lichenoid lymphocytic infiltration and cystoid bodies. The patient was treated with local corticosteroids without improvement.
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Affiliation(s)
- I Karagiannidis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland.
| | - M Brunner
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - G Nikolakis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - C C Zouboulis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
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Schneider S, Thurnher D, Kadletz L, Seemann R, Brunner M, Kotowski U, Schmid R, Lill C, Heiduschka G. Effects of neratinib and combination with irradiation and chemotherapy in head and neck cancer cells. Oral Dis 2016; 22:797-804. [PMID: 27476950 DOI: 10.1111/odi.12552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Prognosis of patients with head and neck squamous cell carcinoma (HNSCC) is still poor. Novel therapeutic approaches are of great interest to improve the effects of radiochemotherapy. We evaluated the effects of tyrosine kinase inhibitor neratinib on HNSCC cell lines CAL27, SCC25 and FaDu as a single agent and in combination with irradiation and chemotherapy. METHODS Effects of neratinib were evaluated in HNSCC cell lines CAL27, SCC25 and FaDu. Effect on cell viability of neratinib and combination with cisplatin and irradiation was measured using CCK-8 assays and clonogenic assays. Western blot analysis was performed to distinguish the effect on epithelial growth factor receptor and HER2 expression. Apoptosis was evaluated by flow cytometry analysis. RESULTS Growth inhibition was achieved in all cell lines, whereas combination of cisplatin and neratinib showed greater inhibition than each agent alone. Apoptosis was induced in all cell lines. Combination of neratinib with irradiation or cisplatin showed significantly increased apoptosis. In clonogenic assays, significant growth inhibition was observed in all investigated cell lines. CONCLUSION Neratinib, as a single agent or in combination with chemo-irradiation, may be a promising treatment option for patients with head and neck cancer.
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Affiliation(s)
- S Schneider
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria
| | - D Thurnher
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Graz, Austria
| | - L Kadletz
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria
| | - R Seemann
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - M Brunner
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria
| | - U Kotowski
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria
| | - R Schmid
- Department of Radiotherapy, Medical University of Vienna, Austria
| | - C Lill
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria
| | - G Heiduschka
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Austria.
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Schallmoser K, Rosin C, Vormittag R, Brunner M, Dunkler D, Pabinger I, Panzer S. Specificities of Platelet Autoantibodies and Platelet Activation in Lupus Anticoagulant Patients: A Relation to their History of Thromboembolic Disease. Lupus 2016; 15:507-14. [PMID: 16942003 DOI: 10.1191/0961203306lu2341oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 11/05/2022]
Abstract
Lupus anticoagulants (LA) prolong in vitro phospholipid-dependent coagulation tests, but are associated with thromboembolic disease (TE). However, a subgroup of individuals with LA has no TE, and it is therefore desirable to distinguish those at risk for TE from those without. Whether platelets have a primary role in the development of TE is not clear yet. We determined platelet autoantibodies to identify a specific platelet target which is associated with platelet activation in 97 patients with a long history of detectable LA, 65 patients with TE (LA/TE+), and 32 individuals without TE (LA/TE+). Thrombocytopenia was more common in the LA/TE- than in the LA/TE+ group ( P < 0.05). Both groups had platelet antibodies, but the frequency of antibodies was lower in LA/TE+ than LA/TE- patients ( P < 0.01), who had higher antibody titres against glycoprotein IIb/IIIa and glycoprotein Ib/IX ( P < 0.05). Also, their platelets were more activated, as determined by PAC-1 binding ( P < 0.01). These differences were also noted if patients with arterial thrombosis were evaluated separately. These findings in LA/TE- individuals were similar to those in patients with chronic autoimmune thrombocytopenia. However, there was no autoantibody target identifiable to distinguish between LA/TE- from LA-TE+ individuals. We therefore conclude that the presence of platelet antibodies, even if associated with platelet activation, is not sufficient to dispose LA patients to thromboembolic disease.
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Affiliation(s)
- K Schallmoser
- Clinic for Blood Group Serology, Medical University of Vienna, Austria
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Affiliation(s)
- I Karagiannidis
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland.
| | - T Kanaki
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
| | - M Brunner
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
| | - C C Zouboulis
- Klinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
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Niekusch U, Bissar A, Brunner M. Möglichkeiten und Grenzen einer Intraoralkamera bei zahnärztlichen Vorsorgeuntersuchung in Kitas und Schulen. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1578879] [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: 10/22/2022]
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Abstract
BACKGROUND The advantages of minimally invasive liver resections for selected patients are evident. Robots provide new innovations that will influence minimally invasive liver surgery in the future. This article presents our initial experience with this technology in our patient population. Material und Methods: In 14 patients with benign or malignant liver tumours, robotic-assisted liver surgery was performed. Selection criteria were compensated liver function and resection of ≤ 3 liver segments. Chronic liver disease or previous abdominal surgery were no exclusion criteria. RESULTS Malignant liver tumours were removed in 10 patients (71%) and benign symptomatic liver tumors in 3 patients (21%), respectively, with histopathologically negative margins (R0). One patient suffering from HCC underwent intraoperative ablation. In one case (7%) conversion was necessary. Mean operation time was 296 min (120-458 min); mean estimated blood loss was 319 ± 298 ml. The mean hospital stay of the patients was 8 days (3-17 days). Three patients (21%) suffered from postoperative complications, which were manageable by conservative treatment (Clavien-Dindo I) in 2 cases (14%). One patient (7%) needed endoscopic treatment for postoperative bile leak (Clavien-Dindo III a). No patient died intra- or perioperatively. CONCLUSION Robotic-assisted liver surgery is a safe procedure, which provides patients with all benefits of minimally invasive surgery. This highly advanced technology requires surgeons to strive for an increasing level of specialisation, in addition to being well-trained in liver surgery. Hence, a clear definition of the procedures and standardised teaching programs are necessary.
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Affiliation(s)
- R Croner
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - A Perrakis
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - R Grützmann
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - W Hohenberger
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - M Brunner
- Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
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Brunner-Ziegler S, Jilma B, Schörgenhofer C, Winkler F, Jilma-Stohlawetz P, Koppensteiner R, Quehenberger P, Seger C, Weigel G, Griesmacher A, Brunner M. Comparison between the impact of morning and evening doses of rivaroxaban on the circadian endogenous coagulation rhythm in healthy subjects. J Thromb Haemost 2016; 14:316-23. [PMID: 26644369 DOI: 10.1111/jth.13213] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED ESSENTIALS: It is unknown whether single rivaroxaban doses should best be administered in the morning or evening. Circadian rhythm of coagulation/fibrinolysis was measured after morning or evening intake of rivaroxaban. Evening intake of rivaroxaban leads to prolonged exposure to rivaroxaban concentrations. Evening intake of rivaroxaban better matches the morning hypofibrinolysis. BACKGROUND A circadian variation of the endogenous coagulation system exists with hypercoagulability and hypofibrinolysis and a corresponding peak of cardiovascular thromboembolic events in the morning. So far, no information is given as to whether single daily doses of the new oral anticoagulant drug rivaroxaban should best be administered in the morning or the evening. MATERIALS AND METHODS Sixteen healthy male or female volunteers with a mean age of 26 ± 7 years were included in this randomized, controlled, analyst-blinded cross-over clinical trial. All subjects were given three morning and three evening single doses of 10 mg rivaroxaban. Circadian rhythms of prothrombin fragment 1 + 2, plasminogen activator inhibitor, and plasmin-antiplasmin complex were measured before any medication intake, as well as after morning or evening medication intake. Rivaroxaban concentrations were determined by an anti-activated factor X assay and liquid chromatography-mass spectrometry. MAIN RESULTS Concentrations of rivaroxaban were higher 12 h after evening intake of rivaroxaban than 12 h after morning intake (53.3 ng mL(-1) [95% confidence interval 46.0-67.8] vs. 23.3 ng mL(-1) [19.4-29.1, respectively]). Rivaroxaban intake in the evening reduced morning F1+2 concentrations better at 8:00 AM than did administration on awakening (85 ± 25 nmol L(-1) vs. 106 ± 34 nmol L(-1) , CI: 9.4-32.1). In addition, this suppression effect was longer lasting after evening intake. CONCLUSIONS Evening intake of rivaroxaban leads to prolonged exposure to rivaroxaban concentrations and better matches the morning hypofibrinolysis. These results might help to further improve the efficacy and safety of rivaroxaban treatment.
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Affiliation(s)
- S Brunner-Ziegler
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - B Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - C Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - F Winkler
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - P Jilma-Stohlawetz
- Clinical Institute of Medical, Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - R Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - P Quehenberger
- Clinical Institute of Medical, Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - C Seger
- Central Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck, Austria
| | - G Weigel
- Central Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck, Austria
| | - A Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnostics, Innsbruck, Austria
| | - M Brunner
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Gehlen H, Brunner M. In-vitro allergy tests for diagnostic of summer eczema in the horse – Correlation of allergic hypersensitivity in functional in vitro test (FIT) and clinical manifestation under the influence of parasitic burdens. PFERDEHEILKUNDE 2016. [DOI: 10.21836/pem20160401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- C. Zouboulis
- Klinik für Dermatologie, Venerologie und Allergologie / Immunologisches Zentrum, Städtisches Klinikum Dessau
| | - M. Brunner
- Klinik für Dermatologie, Venerologie und Allergologie / Immunologisches Zentrum, Städtisches Klinikum Dessau
| | - U. Lippert
- Klinik für Dermatologie, Venerologie und Allergologie / Immunologisches Zentrum, Städtisches Klinikum Dessau
| | - P. Seele
- Klinik für Dermatologie, Venerologie und Allergologie / Immunologisches Zentrum, Städtisches Klinikum Dessau
| | - D. Trebing
- Klinik für Dermatologie, Venerologie und Allergologie / Immunologisches Zentrum, Städtisches Klinikum Dessau
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Bustan S, Gonzalez-Roldan A, Kamping S, Brunner M, Löffler M, Flor H, Anton F. Suffering as an independent component of the experience of pain. Eur J Pain 2015; 19:1035-48. [DOI: 10.1002/ejp.709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/06/2022]
Affiliation(s)
- S. Bustan
- Institute for Health and Behavior; FLSHASE/INSIDE; University of Luxembourg
| | | | - S. Kamping
- Center for Translational Research in Systems Neuroscience and Psychiatry; Department of Psychiatry and Psychotherapy; University Medical Center; Göttingen Germany
| | - M. Brunner
- Department of Cognitive and Clinical Neuroscience; Central Institute of Mental Health, Medical Faculty Mannheim; University of Heidelberg; Mannheim Germany
| | - M. Löffler
- Department of Cognitive and Clinical Neuroscience; Central Institute of Mental Health, Medical Faculty Mannheim; University of Heidelberg; Mannheim Germany
| | - H. Flor
- Department of Cognitive and Clinical Neuroscience; Central Institute of Mental Health, Medical Faculty Mannheim; University of Heidelberg; Mannheim Germany
| | - F. Anton
- Institute for Health and Behavior; FLSHASE/INSIDE; University of Luxembourg
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Nikolakis G, Zampeli VA, Brunner M, Zouboulis CC. Pigmentansammlungen im Wächterlymphknoten einer Patientin mit malignem Melanom. Hautarzt 2014; 66:137-9. [DOI: 10.1007/s00105-014-3544-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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El-Haj N, Micheli C, Brunner M, Zillikens D, Zouboulis CC. [Generalized inflammatory epidermolysis bullosa acquisita initially diagnosed as viral exanthem: a rare disease within the subepidermal blistering disorders]. Hautarzt 2014; 65:1062-5. [PMID: 25260302 DOI: 10.1007/s00105-014-3505-9] [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
A 67-year-old man presented with a maculopapular exanthem which started over the major joints. Within a few days, it spread to the entire skin surface and was accompanied by blisters as well as changes of the oral mucosa. The histological examination revealed subepidermal blistering. Targeted laboratory examinations detected serum antibodies against the epidermal basement membrane and autoantibodies against type VII collagen. The findings supported the diagnosis of a generalized inflammatory epidermolysis bullosa acquisita with mucosal involvement.
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Affiliation(s)
- N El-Haj
- Klinik für Dermatologie Venerologie und Allergologie Immunologisches Zentrum, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland,
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Löytved-Hardegg JJ, Brunner M, Ries JJ, Felten SV, Heugel C, Lapaire O, Voekt C, Hösli I. Replacement of oxytocin bolus administration by infusion: influences on adverse postpartum outcome. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Spengler M, Lüdtke O, Martin R, Brunner M. Childhood personality and teacher ratings of conscientiousness predict career success four decades later. Personality and Individual Differences 2014. [DOI: 10.1016/j.paid.2013.07.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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