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Razavi-Shearer D, Child H, Razavi-Shearer K, Voeller A, Razavi H, Buti M, Tacke F, Terrault N, Zeuzem S, Abbas Z, Aghemo A, Akarca U, Al Masri N, Alalwan A, Blomé MA, Jerkeman A, Aleman S, Kamal H, Alghamdi A, Alghamdi M, Alghamdi S, Al-Hamoudi W, Ali E, Aljumah A, Altraif I, Amarsanaa J, Asselah T, Baatarkhuu O, Babameto A, Ben-Ari Z, Berg T, Biondi M, Braga W, Brandão-Mello C, Brown R, Brunetto M, Cabezas J, Cardoso M, Martins A, Chan H, Cheinquer H, Chen CJ, Yang HI, Chen PJ, Chien CH, Chuang WL, Garza LC, Coco B, Coffin C, Coppola N, Cornberg M, Craxi A, Crespo J, Cuko L, De Ledinghen V, Duberg AS, Etzion O, Ferraz M, Ferreira P, Forns X, Foster G, Fung J, Gaeta G, García-Samaniego J, Genov J, Gheorghe L, Gholam P, Gish R, Glenn J, Hamid S, Hercun J, Hsu YC, Hu CC, Huang JF, Idilman R, Jafri W, Janjua N, Jelev D, Jia J, Kåberg M, Kaita K, Kao JH, Khan A, Kim D, Kondili L, Lagging M, Lampertico P, Lázaro P, Lazarus J, Lee MH, Yang HI, Lim YS, Lobato C, Macedo G, Marinho R, Marotta P, Mendes-Correa M, Méndez-Sánchez N, Navas MC, Ning Q, Örmeci N, Orrego M, Osiowy C, Pan C, Pessoa M, Piracha Z, Pop C, Qureshi H, Raimondo G, Ramji A, Ribeiro S, Ríos-Hincapié C, Rodríguez M, Rosenberg W, Roulot D, Ryder S, Saeed U, Safadi R, Shouval D, Sanai F, Sanchez-Avila J, Santantonio T, Sarrazin C, Seto WK, Seto WK, Simonova M, Tanaka J, Tergast T, Tsendsuren O, Valente C, Villalobos-Salcedo J, Waheed Y, Wong G, Wong V, Yip T, Wong V, Wu JC, Yang HI, Yu ML, Yuen MF, Yurdaydin C, Zuckerman E. Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories. J Hepatol 2024; 80:232-242. [PMID: 38030035 DOI: 10.1016/j.jhep.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND & AIMS Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.
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Hartmann J, Keller A, Enk A, Gholam P. Hemodynamic changes during conventional and daylight photodynamic therapy of actinic keratoses - a randomized controlled trial. J DERMATOL TREAT 2022; 33:3022-3027. [PMID: 35775704 DOI: 10.1080/09546634.2022.2097160] [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] [Indexed: 10/17/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK). However, pain and hypertension are important side effects of conventional PDT (c-PDT). Several studies have demonstrated that daylight PDT (dl-PDT) is less painful while being as effective as c-PDT. OBJECTIVE To observe the effect of c-PDT and dl-PDT on different hemodynamic parameters (systolic blood pressure and diastolic blood pressure, pulse rate, and peripheral oxygen saturation). METHODS Fifty patients with AK on the head were enrolled into this prospective, randomized, controlled study and treated with c-PDT or dl-PDT in a 1:1 ratio. Hemodynamic parameters were measured at four different time points during treatment. Pain was quantified using a visual analog scale. AK was counted before treatment and after one month. RESULTS C-PDT is associated with significantly more pain, a significant increase in blood pressure and a higher rate of patients with grade 3 hypertension. Whereas dl-PDT is almost painless and does not lead to any changes in hemodynamic parameters. For both treatments, a similar lesion response rate was found after one month. CONCLUSIONS dl-PDT has a better tolerability while being as effective as c-PDT and therefore may be the more favorable treatment option in certain patient groups.
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Affiliation(s)
- J Hartmann
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - A Keller
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - P Gholam
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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Shavlokhova V, Vollmer M, Gholam P, Saravi B, Vollmer A, Hoffmann J, Engel M, Freudlsperger C. Deep Learning on Basal Cell Carcinoma In Vivo Reflectance Confocal Microscopy Data. J Pers Med 2022; 12:jpm12091471. [PMID: 36143256 PMCID: PMC9506260 DOI: 10.3390/jpm12091471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Extended skin malignancies of the head and neck region are among the most common cancer types and are associated with numerous diagnostic and therapeutical problems. The radical resection of skin cancer in the facial area often leads to severe functional and aesthetic impairment, and precise margin assessments can avoid the extensive safety margins. On the other hand, the complete removal of the cancer is essential to minimize the risk of recurrence. Reliable intraoperative assessments of the wound margins could overcome this discrepancy between minimal invasiveness and safety distance in the head and neck region. With the help of reflectance confocal laser microscopy (RCM), cells can be visualized in high resolution intraoperatively. The combination with deep learning and automated algorithms allows an investigator independent and objective interpretation of specific confocal imaging data. Therefore, we aimed to apply a deep learning algorithm to detect malignant areas in images obtained via in vivo confocal microscopy. We investigated basal cell carcinoma (BCC), as one of the most common entities with well-described in vivo RCM diagnostic criteria, within a preliminary feasibility study. Patients and Methods: We included 62 patients with histologically confirmed BCC in the head and neck region. All patients underwent in vivo confocal laser microscope scanning. Approximately 382 images with BCC structures could be obtained, annotated, and proceeded for further deep learning model training. Results: A sensitivity of 46% and a specificity of 85% in detecting BCC regions could be achieved using a convolutional neural network model (“MobileNet”). Conclusion: The preliminary results reveal the potential and limitations of the automated detection of BCC with in vivo RCM. Further studies with a larger number of cases are required to obtain better predictability.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre—Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Keller A, Hartmann J, Enk A, Gholam P. Pulse rate and blood pressure changes during low-irradiance PDT compared with conventional PDT in the treatment of facial actinic keratoses: A retrospective study. Photodermatol Photoimmunol Photomed 2022; 38:435-441. [PMID: 34967470 DOI: 10.1111/phpp.12764] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Conventional photodynamic therapy (c-PDT) is a highly effective treatment for actinic keratoses. Besides pain as the main side effect, blood pressure (BP) increases and hypertensive crises may occur during treatment. Reducing the irradiation intensity while keeping the total dose constant (low-irradiance PDT) can achieve a clinically relevant reduction in pain. This study aimed to evaluate the influence of li-PDT on the BP and pulse (PR) during therapy and the incidence of post-interventional hypertension compared with c-PDT. METHODS We retrospectively analyzed the treatment data of 79 patients (39 c-PDT and 40 li-PDT). BP and PR measurements were performed in all patients before PDT, at mid-exposure, and immediately after PDT. In addition, the pain was assessed by using the visual analog scale. RESULTS Patients treated with li-PDT reported significantly lower pain than those receiving c-PDT (p < .0005). Additionally, they showed less systolic (SBP) and diastolic (DBP) BP increase (∆SBP: p < .0005, ∆DBP: p = .015) and overall lower absolute BP values (SBP: p < .0005, DBP: p = .008) compared with c-PDT. They were also significantly less likely to develop post-interventional hypertension (p = .037) or higher stages of arterial hypertension. Regarding PR, there was no difference in absolute values between both groups, but the increase from onset to half irradiation duration was significantly higher in c-PDT (p = .013). CONCLUSIONS Li-PDT is an excellent option to reduce the elevation of arterial BP and decrease the incidence of post-interventional hypertension and hypertensive crisis. This finding has considerable relevance, especially with the risk profile of many PDT patients in mind (advanced age and cardiovascular history).
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Affiliation(s)
- Aric Keller
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Hartmann
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Lonsdorf AS, Keller A, Hartmann J, Enk AH, Gholam P. Ablative Fractional Laser-assisted Low-irradiance Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients: A Prospective, Randomized, Intraindividual Controlled Trial. Acta Derm Venereol 2022; 102:adv00694. [PMID: 35356991 PMCID: PMC9558342 DOI: 10.2340/actadv.v102.1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain and inferior efficacy are major limiting factors of conventional photodynamic therapy for the field treatment of actinic keratoses in immunosuppressed organ transplant recipients. This prospective randomized controlled study evaluates the efficacy and tolerability of ablative fractional laser system pretreatment combined with low-irradiance photodynamic therapy (18.5 mW/cm2) compared with conventional photodynamic therapy (61.67 mW/cm2) in the treatment of actinic keratoses on the face and scalp in organ transplant recipients, using a red light-emitting diode lamp at a total light dose of 37 J/cm2. Low-irradiance photodynamic therapy combined with Er:YAG pretreatment achieved a significantly superior lesion response rate (mean ± standard deviation 77.3 ± 23.6%) compared with conventional photodynamic therapy (61.8 ± 21.4%; p = 0.025) in intra-individual fields at 3 months without negatively impacting pain (p = 0.777) or cosmetic outcome (p = 0.157).
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Affiliation(s)
- Anke S Lonsdorf
- Department of Dermatology, University Hospital Heidelberg, Germany.
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Hartmann K, Gholam P, Dietrich C, Fink C. Efficacy and safety of endovenous laser ablation with the 1470 nm diode laser using a novel optical probe. Int J Med Sci 2022; 19:695-700. [PMID: 35582422 PMCID: PMC9108407 DOI: 10.7150/ijms.70916] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: Outcome assessment of a novel optical fiber probe for the 1470 nm diode laser under real-world conditions. Methods: Prospective clinical pilot study in 10 patients undergoing endovenous laser ablation with a follow-up period of 1 year. Primary endpoints were efficacy and safety. Secondary endpoints include, inter alia, quality of life and patient satisfaction. Results: After a follow-up period of 1 year all treated vein segments were still occluded. Only mild and short-term side effects (hematoma, ecchymosis and hyperpigmentation) were observed. No intake of pain medication was needed and a quick return to normal activity was documented (0.9 days). Clinical hallmarks of the venous disease (VCSS) improved significantly (p= .003). All patients were very satisfied with the treatment and quality of life (AVVQ) was significantly improved after the procedure (p=.008). Conclusions: The study demonstrates that the endoluminal treatment with the novel fiber probe is highly effective and safe.
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Affiliation(s)
- Karsten Hartmann
- Venenzentrum Freiburg, Zähringer Str. 14, 79108, Freiburg, Germany
| | - Patrick Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Carmen Dietrich
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Dick J, Kröhl V, Enk A, Hartschuh W, Gholam P. Improvement in Quality of Life and Pain in Patients With Hidradenitis Suppurativa After Wide Local Excision: A Prospective Study. Dermatol Surg 2021; 47:1556-1561. [PMID: 34537785 DOI: 10.1097/dss.0000000000003235] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects patients' quality of life (QoL). OBJECTIVE To investigate changes in QoL in patients with HS after wide local excision (WLE) and to examine the level of pain, rate of postoperative complications, recurrences, and the time to complete wound closure. METHODS Fifty-five patients were enrolled in this prospective study. All patients underwent WLE of HS, followed by secondary wound healing. Dermatologic Life Quality Questionnaire, pain, and wound size were measured 1 day, 3 weeks, 3 months, and 6 months after surgery. RESULTS Dermatologic Life Quality Questionnaire and pain scores (mean ± SD) improved significantly (both p < .001) from 14.5 ± 7.3 and 3.7 ± 2.8 at baseline to 5.8 ± 6.9 and 0.8 ± 1.7, 6 months postoperatively, respectively. Wounds were closed completely by secondary intention after 4.4 ± 2.8 months. Sixteen patients (29.1%) experienced postoperative complications, local recurrences in the treated sites were observed in 11 patients (20%), and new lesions in untreated sites were observed in 5 cases (9.1%). CONCLUSION Wide local excision significantly improves patients' QoL and pain, and, given its low rate of recurrence and complications, should be considered as a first-line therapy, especially in patients with higher Hurley stages.
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Affiliation(s)
- Julika Dick
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Haut-und Laserzentrum Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Shavlokhova V, Vollmer M, Vollmer A, Gholam P, Saravi B, Hoffmann J, Engel M, Elsner J, Neumeier F, Freudlsperger C. In vivo reflectance confocal microscopy of wounds: feasibility of intraoperative basal cell carcinoma margin assessment. Ann Transl Med 2021; 9:1716. [PMID: 35071410 PMCID: PMC8743714 DOI: 10.21037/atm-21-3462] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Background In vivo reflectance confocal microscopy (RCM) is well established in non-melanoma skin cancer detection and screening. However, there is no sufficient validation regarding intraoperatively obtained images of wound margins. A reliable and fast resection margin detection is of high clinical relevance. Hence, we aimed to investigate feasibility and validity of in vivo RCM imaging for wound margins assessment compared with standard skin surface imaging and the gold standard histopathology. Methods A surgical incision through the center of a large basal cell carcinoma (BCC) affected area in the head and face region was performed. After removing half of the tumor, the wound margins of the remaining half as well as the corresponding skin surface were scanned with an in vivo RCM. A total of 50 wound margin images with BCC, 50 images of BCC-free margins and the corresponding skin surface images from 50 patients were compared with each other and with histopathological findings. Presence of confocal diagnostic criteria for BCC in images was analyzed. Results An overall sensitivity and specificity in detection of BCC in wound margins was 88.5%, and 91.7% compared to skin surface imaging and 97.8% and 90.7%, respectively, compared to histopathology. We identified all known confocal patterns of healthy skin and BCC in wound margin scans: damage of the epidermal layer above the lesion and cellular pleomorphism, elongated and monomorphic basaloid nuclei, nuclear polarization, an increased number of dilated blood vessels with high leukocyte traffic, inflammatory cells. Conclusions The accuracy of in vivo RCM imaging of wound margins is comparable with a standard skin surface imaging. The intraoperative detection of BCC areas in wound margins is as precise as the standard skin imaging and may be supportive for surgical interventions.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Ramcke T, Enk A, Gholam P. Folliculotropic Mycosis Fungoides in the Tumour Stage Mimics Venous Leg Ulcers. Acta Derm Venereol 2021; 101:adv00537. [PMID: 34427315 PMCID: PMC9425599 DOI: 10.2340/00015555-3903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Torben Ramcke
- Department of Dermatology, University Hospital Heidelberg, DE-69120 Heidelberg, Germany. E-mail:
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Brinker TJ, Kiehl L, Schmitt M, Jutzi TB, Krieghoff-Henning EI, Krahl D, Kutzner H, Gholam P, Haferkamp S, Klode J, Schadendorf D, Hekler A, Fröhling S, Kather JN, Haggenmüller S, von Kalle C, Heppt M, Hilke F, Ghoreschi K, Tiemann M, Wehkamp U, Hauschild A, Weichenthal M, Utikal JS. Deep learning approach to predict sentinel lymph node status directly from routine histology of primary melanoma tumours. Eur J Cancer 2021; 154:227-234. [PMID: 34298373 DOI: 10.1016/j.ejca.2021.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
AIM Sentinel lymph node status is a central prognostic factor for melanomas. However, the surgical excision involves some risks for affected patients. In this study, we therefore aimed to develop a digital biomarker that can predict lymph node metastasis non-invasively from digitised H&E slides of primary melanoma tumours. METHODS A total of 415 H&E slides from primary melanoma tumours with known sentinel node (SN) status from three German university hospitals and one private pathological practice were digitised (150 SN positive/265 SN negative). Two hundred ninety-one slides were used to train artificial neural networks (ANNs). The remaining 124 slides were used to test the ability of the ANNs to predict sentinel status. ANNs were trained and/or tested on data sets that were matched or not matched between SN-positive and SN-negative cases for patient age, ulceration, and tumour thickness, factors that are known to correlate with lymph node status. RESULTS The best accuracy was achieved by an ANN that was trained and tested on unmatched cases (61.8% ± 0.2%) area under the receiver operating characteristic (AUROC). In contrast, ANNs that were trained and/or tested on matched cases achieved (55.0% ± 3.5%) AUROC or less. CONCLUSION Our results indicate that the image classifier can predict lymph node status to some, albeit so far not clinically relevant, extent. It may do so by mostly detecting equivalents of factors on histological slides that are already known to correlate with lymph node status. Our results provide a basis for future research with larger data cohorts.
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Affiliation(s)
- Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.
| | - Lennard Kiehl
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Tanja B Jutzi
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Eva I Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dieter Krahl
- Private Laboratory of Dermatohistopathology, Mönchhofstraße 52, 69120, Heidelberg, Germany
| | - Heinz Kutzner
- Dermatopathology Laboratory, Friedrichshafen, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg. Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Joachim Klode
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Stefan Fröhling
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany
| | - Jakob N Kather
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany; Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Haggenmüller
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Charité University Medicine and Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus Heppt
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Franz Hilke
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Ulrike Wehkamp
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Hauschild
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Department of Dermatology, University Hospital (UKSH), Kiel, Germany
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Hartmann J, Enk AH, Gholam P. Sensitization following occupational exposure to methyl aminolevulinate: Report of two cases. Contact Dermatitis 2020; 83:50-52. [DOI: 10.1111/cod.13513] [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] [Received: 12/27/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Hartmann
- Department of Dermatology, Venerology and AllergologyUniversity Medical Center, Ruprecht‐Karls‐University Heidelberg Germany
| | - Alexander H. Enk
- Department of Dermatology, Venerology and AllergologyUniversity Medical Center, Ruprecht‐Karls‐University Heidelberg Germany
| | - Patrick Gholam
- Department of Dermatology, Venerology and AllergologyUniversity Medical Center, Ruprecht‐Karls‐University Heidelberg Germany
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Gholam P, Bosselmann I, Enk A, Fink C. Impact of red versus blue light on tolerability and efficacy of PDT: a randomized controlled trial. J Dtsch Dermatol Ges 2019; 16:711-717. [PMID: 29873905 DOI: 10.1111/ddg.13545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 01/02/2023]
Abstract
Various light sources may be used for photodynamic therapy of actinic keratosis since photosensitizing agents are activated by different wavelengths. However, the relative impact of red and blue light irradiation on the efficacy and tolerability of therapy is controversial. OBJECTIVE The aim of this study is to compare the efficacy and tolerability of therapy with red versus blue light sources, as well as the patients' evaluation of cosmetic results, clinical response, painfulness and preferred light source for future photodynamic treatments. METHODS This is a prospective, single-center, randomized, controlled, open-label study with 28 patients undergoing elective photodynamic therapy. RESULTS Red and blue light sources both showed very good results with a complete response rate of 84 % and 85 % respectively. Pain during photodynamic therapy was 6.1 vs. 5.4 (and 2.1 vs. 1.5 eight hours after therapy) on the visual analogue scale. Although these differences were statistically significant, the clinical relevance is low, since the number of therapy interruptions were equally distributed in both groups, and patients' subjective evaluation of the treatment showed no personal preference towards the light sources. CONCLUSION Both light sources showed very good clinical results and satisfactory tolerability in this study.
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Affiliation(s)
- Patrick Gholam
- Department of Dermatology, University of Heidelberg, Germany
| | - Ina Bosselmann
- Department of Dermatology, University of Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
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Streit E, Gholam P. Condyloma in the Nose. Dtsch Arztebl Int 2018; 114:857. [PMID: 29271344 DOI: 10.3238/arztebl.2017.0857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gholam P, Bosselmann I, Enk AH, Dick J. Low irradiance compared with conventional photodynamic therapy in the treatment of actinic keratoses. Photodermatol Photoimmunol Photomed 2018; 35:110-115. [DOI: 10.1111/phpp.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/27/2018] [Accepted: 09/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Patrick Gholam
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - Ina Bosselmann
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - Alexander H. Enk
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - Julika Dick
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
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Gholam P, Bosselmann I, Enk A, Fink C. Einfluss von Rot- versus Blaulicht auf Verträglichkeit und Wirksamkeit der PDT: eine randomisierte kontrollierte Studie. J Dtsch Dermatol Ges 2018; 16:711-718. [DOI: 10.1111/ddg.13545_g] [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] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
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Alahmadi A, Lee R, Siegel C, Gholam P. Utility of multidisciplinary tumor board (MTB) in the management of hepatocellular cancer (HCC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fink C, Toberer F, Enk A, Gholam P. Effective treatment of cutaneous leishmaniasis caused by Leishmania tropica with topical photodynamic therapy. J Dtsch Dermatol Ges 2016; 14:836-8. [PMID: 27509427 DOI: 10.1111/ddg.13082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
| | | | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University of Heidelberg, Germany
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Fink C, Toberer F, Enk A, Gholam P. Effektive Behandlung einer durch Leishmania tropica
verursachten kutanen Leishmaniose mit topischer, photodynamischer Therapie. J Dtsch Dermatol Ges 2016; 14:835-8. [DOI: 10.1111/ddg.13082_g] [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: 11/28/2022]
Affiliation(s)
- Christine Fink
- Hautklinik; Universität Heidelberg; Heidelberg Deutschland
| | | | - Alexander Enk
- Hautklinik; Universität Heidelberg; Heidelberg Deutschland
| | - Patrick Gholam
- Hautklinik; Universität Heidelberg; Heidelberg Deutschland
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Fink C, Uhlmann L, Enk A, Gholam P. Pain management in photodynamic therapy using a nitrous oxide/oxygen mixture: a prospective, within-patient, controlled clinical trial. J Eur Acad Dermatol Venereol 2016; 31:70-74. [PMID: 27393707 DOI: 10.1111/jdv.13788] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Photodynamic therapy is an effective treatment for actinic keratoses. Nevertheless, severe pain during the procedure is a serious adverse effect, which leads to interruption or even termination. Complete pain relief remains a difficult challenge. OBJECTIVE To evaluate the effect of a nitrous oxide/oxygen mixture on pain intensity during photodynamic therapy. METHODS This clinical trial has been designed as a prospective, single-centre, explorative, controlled, observational study. RESULTS We were able to detect a significant overall pain reduction of 55.2% after application of a nitrous oxide/oxygen mixture by means of an intra-individual comparison. Furthermore, the total number of therapy interruption significantly decreased by 82% after the inhalation analgesia. Additionally, treatment satisfaction ranged from 'extremely to very satisfied'. CONCLUSIONS This study shows that analgesia by means of a nitrous oxide/oxygen mixture is a very effective and well-tolerated method for achieving significant pain reduction during photodynamic therapy.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - P Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Gholam P, Fink C, Bosselmann I, Enk A. Retrospective analysis evaluating the effect of a keratolytic and physical pretreatment with salicylic acid, urea and curettage on the efficacy and safety of photodynamic therapy of actinic keratoses with methylaminolaevulinate. J Eur Acad Dermatol Venereol 2015; 30:619-23. [DOI: 10.1111/jdv.13449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Gholam
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - C. Fink
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - I. Bosselmann
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - A.H. Enk
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
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Abstract
Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy.
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Gholam P, Fink C, Uhlmann L, Enk A. Pain reduction in patients after applying a nitrous oxide/oxygen mixture (Livopan) during photodynamic therapy: study protocol for an observational study (Livopan study). BMJ Open 2015; 5:e006412. [PMID: 25823443 PMCID: PMC4386268 DOI: 10.1136/bmjopen-2014-006412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Photodynamic therapy (PDT) is an effective treatment option for extensively photodamaged skin with multiple actinic kerastosis. However, the main drawback of PDT is the intensive pain experienced during its application, which makes it frequently necessary to interrupt or even terminate the process resulting in incomplete treatment. Several strategies for controlling pain during PDT have been studied but few effective methods are currently available. Alternative options are urgently needed. Livopan, a nitrous oxide/oxygen mixture, is indicated for the treatment of short-term pain conditions when rapid analgesic onset and offset effects are wanted. But so far, there are no studies evaluating the effect of Livopan on pain intensity during PDT. Therefore, it remains unclear whether patients benefit from this inhalation analgesia. Within the Livopan study, this issue will be evaluated for the first time. METHODS AND ANALYSIS The Livopan study is a prospective, single-centre, explorative, controlled, observational study to investigate the pain reduction in patients after applying a nitrous oxide/oxygen mixture (Livopan) during PDT according to the visual analogue scale in 60 patients. ETHICS AND DISSEMINATION Ethics approval was provided by the ethics committee of the medical faculty of the University of Heidelberg. Ethics approval number S-169/2014. TRIAL REGISTRATION NUMBER German Clinical Trial Register (DRKS): DRKS00006054.
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Affiliation(s)
- Patrick Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Fink C, Enk A, Gholam P. Aspekte der Schmerztherapie bei der photodynamischen Therapie. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12546_suppl] [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: 11/28/2022]
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Kast K, Ansley K, Skillman M, Hanje J, Gholam P, Popp G, Schiltz N, Sanchez E, Woodside K. Social Support and Liver Transplant Outcomes. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02814] [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: 11/25/2022]
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Affiliation(s)
- E Streit
- Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Gholam P, Kroehl V, Enk AH. Dermatology Life Quality Index and Side Effects after Topical Photodynamic Therapy of Actinic Keratosis. Dermatology 2013; 226:253-9. [DOI: 10.1159/000349992] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022] Open
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Bidier M, Zschoche C, Gholam P, Enk AH, Hadaschik EN. Scleromyxoedema: clinical follow-up after successful treatment with high-dose immunoglobulins reveals different long-term outcomes. Acta Derm Venereol 2012; 92:408-9. [PMID: 22278389 DOI: 10.2340/00015555-1299] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mona Bidier
- Department of Dermatology, University of Heidelberg, Voßstreet 2, DE-69115 Heidelberg, Germany
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Taylor L, DeLong A, Maynard M, Chapman S, Gholam P, Blackard J, Rich J, Mayer K. Acute hepatitis C virus in an HIV clinic: a screening strategy, risk factors, and perception of risk. AIDS Patient Care STDS 2011; 25:571-7. [PMID: 21859307 DOI: 10.1089/apc.2011.0106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Acute hepatitis C virus (HCV) infection is being acquired undetected among HIV-infected individuals. A practical way to regularly screen HIV-infected patients for acute HCV irrespective of perceived risk or symptoms is needed. We piloted implementation of an acute HCV screening strategy using routine HIV clinical care schedules and the least costly blood tests, in a Rhode Island HIV care center. Study participants had ongoing HCV risk, completed questionnaires encompassing risk behaviors and perception of risk, and were screened with quarterly alanine aminotransferase (ALT). ALT rise triggered HCV RNA testing, with pooled rather than individual specimen HCV RNA testing for underinsured participants. Participants were primarily older, college-educated men who have sex with men (MSM) with history of sexually transmitted infection other than HIV. One of 58 participants developed acute HCV in 50 person-years of observation for an annual incidence of 2.0% per year (95% confidence interval [CI] 0.05-11.1%). The majority (54%) of MSM did not perceive that traumatic sexual and drug practices they were engaging in put them at risk for HCV. Unprotected sex often occurred under the influence of drugs or alcohol. Self-reported HCV risk and participation in several risk behaviors declined during the study. It was possible to collect frequent ALTs in a busy HIV clinic with 71% of total projected ALTs obtained and 88% of participants having at least one ALT during the 9-month follow-up period. All instances of ALT rise led to reflexive HCV RNA testing. Tracking quarterly ALT for elevation to systematically prompt HCV RNA testing before seroconversion is a promising approach to screen for acute HCV in a real-world HIV clinical setting.
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Affiliation(s)
- L.E. Taylor
- Department of Medicine, Division of Infectious Disease, Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
| | | | | | - S. Chapman
- The Miriam Hospital, Providence, Rhode Island
| | - P. Gholam
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - J.T. Blackard
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J. Rich
- Department of Medicine, Division of Infectious Disease, Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
| | - K.H. Mayer
- Department of Medicine, Division of Infectious Disease, Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
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Gholam P, Weberschock T, Denk K, Enk A. Treatment with 5-aminolaevulinic acid methylester is less painful than treatment with 5-aminolaevulinic acid nanoemulsion in topical photodynamic therapy for actinic keratosis. Dermatology 2011; 222:358-62. [PMID: 21757880 DOI: 10.1159/000329025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 04/16/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is an excellent treatment option for actinic keratosis (AK). Pain is one of the major adverse effects. OBJECTIVE To compare the pain intensity during the extensive treatment of cosmetic units using 5-aminolaevulinic acid methylester (MAL) or 5-aminolaevulinic acid nanoemulsion (BF-200-ALA). METHODS 173 patients with 965 treated areas were enrolled in this retrospective monocentric study. All patients had multiple AKs and received an extensive treatment of the photodamaged area. 424 areas were treated with MAL and 541 with BF-200-ALA. Pain was rated using a standardized visual analogue scale (VAS). The number of PDT treatment interruptions was documented. RESULTS PDT with MAL led to a lower mean VAS score (5.0 vs. 5.8), a lower number of treatment interruptions (13.2 vs. 19.9%) and a lower amount of patients experiencing severe pain (25.0 vs. 36.0%) compared to PDT with BF-200-ALA. CONCLUSION Our data shows that PDT using MAL is less painful than PDT using BF-200-ALA resulting in a significantly lower mean VAS score (p < 0.001), significantly fewer patients experiencing severe pain (p < 0.001) and a significantly (p < 0.05) lower number of treatment interruptions. Differences in selectivity for tumour cells and transport of ALA in peripheral neurons may play a role.
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Affiliation(s)
- Patrick Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Gholam P, Denk K, Sehr T, Enk A, Hartmann M. Factors influencing pain intensity during topical photodynamic therapy of complete cosmetic units for actinic keratoses. J Am Acad Dermatol 2010; 63:213-8. [DOI: 10.1016/j.jaad.2009.08.062] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 08/25/2009] [Accepted: 08/28/2009] [Indexed: 01/21/2023]
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Abstract
Epithelioma cuniculatum (EC) belongs to the category of verrucous carcinomas. Invasiveness and rate of metastasis are low, but there is a high risk of local recurrence. In cases of long-standing processes with formation of exophytic, malodorous tumors with jagged edges that do not respond to conventional therapy, consideration should already be given to EC upon visual inspection. The diagnosis is always established by histological examination. The standard treatment of EC is extensive excision of the tumor with micrographic margin control.
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Affiliation(s)
- T Weberschock
- Universitäts-Hautklinik Heidelberg, Vossstr. 2, 69115, Heidelberg.
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Gholam P, Sehr T, Enk A, Hartmann M. Successful treatment of systemic-sclerosis-related digital ulcers with a selective endothelin type A receptor antagonist (sitaxentan). Dermatology 2009; 219:171-3. [PMID: 19590168 DOI: 10.1159/000228318] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/31/2009] [Indexed: 11/19/2022] Open
Abstract
Digital ulcers represent a major vascular complication of systemic sclerosis (SSc) and can be difficult to treat with the common vasodilators. Herein, we report on a 39-year-old patient with recalcitrant SSc-related digital ulcers treated successfully with sitaxentan (100 mg q.d.), a selective endothelin type A receptor antagonist. During the 6 months of treatment, we noticed a remarkable decrease in pain, a nearly complete healing of the preexistent ulcers and no development of new ulcers. No side effects were noted.
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Affiliation(s)
- P Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Rothengatter S, Sehr T, Gholam P, Durani H, Hartmann M. Haut- und Geschlechtserkrankungen bei HIV-Patienten unter HAART im Vergleich zu einem nicht-infizierten Patientenkollektiv â Ergebnisse einer retrospektiven Studie. J Dtsch Dermatol Ges 2009. [DOI: 10.1111/j.1610-0387.2008.07001_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rothengatter S, Sehr T, Gholam P, Durani H, Hartmann M. Skin diseases and sexually transmitted diseases in HIV-infected patients on HAART compared to a non-infected population â results of a retrospective study. J Dtsch Dermatol Ges 2009; 7:527-32. [DOI: 10.1111/j.1610-0387.2008.07001.x] [Citation(s) in RCA: 3] [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: 11/30/2022]
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Gholam P, Enk A, Hartschuh W. Successful Surgical Management of Giant Condyloma Acuminatum (Buschke-Löwenstein Tumor) in the Genitoanal Region: A Case Report and Evaluation of Current Therapies. Dermatology 2009; 218:56-9. [DOI: 10.1159/000165359] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 06/06/2008] [Indexed: 11/19/2022] Open
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Gholam P, Autschbach F, Hartschuh W. Schistosomiasis in an HIV-positive patient presenting as an anal fissure and giant anal polyp. ACTA ACUST UNITED AC 2008; 144:950-2. [PMID: 18645157 DOI: 10.1001/archderm.144.7.950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kopp R, Classen S, Wolf H, Gholam P, Possinger K, Wilmanns W. Predictive relevance of soluble CD44v6 serum levels for the responsiveness to second line hormone- or chemotherapy in patients with metastatic breast cancer. Anticancer Res 2001; 21:2995-3000. [PMID: 11712800] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Concentrations of soluble CD44 standard (sCD44std) and CD44 variant 6 (sCD44v6) isoforms were determined in the sera of 59 patients with distant metastasis from breast cancer receiving second line hormone- or chemotherapy, in comparison to 46 breast cancer patients without detectable recurrent disease and 21 healthy blood donors. The sera of non-metastatic breast cancer, patients contained sCD44std and sCD44v6 concentrations similiar to those of healthy blood donors. In sera of patients with distant metastasis from recurrent breast cancer the median values of sCD44std and sCD44v6 were significantly higher (sCD44std: 502 ng/ml, p=0.03; sCD44v6: 193 ng/ml, p = 0.002) in comparison to healthy blood donors and patients with non-metastatic disease (p<0.001 for both parameters). A significant correlation was observed between sCD44v6 serum concentrations and the number of metastasized organs (p=0.0018), serum LDH concentrations (p<0.0001), tumor grading (p=0.025) and the presence of hepatic metastasis (p=0.028). Furthermore, sCD44v6 expression was associated with the patient's responsiveness to second line hormone- or chemotherapy. Non-responders had significantly higher sCD44v6 levels compared with the responder group (median: 447 ng/ml vs 171 ng/ml; p=0.0007). Logistic regression analysis indicated that sCD44v6 serum levels above 250 ng/ml (p =0.033) and the presence of hepatic metastasis (p=0.009) were independent factors predicting an unfavourable response to therapy.
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Affiliation(s)
- R Kopp
- GSF-National Research Center for Environment and Health, Munich, Germany
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