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Lorenz R, Paasch C, Stechemesser B, Reinpold W, Niebuhr H, Fortelny RH, Mayer F, Köckerling F, Mantke R. Long-term evaluation of the Hernia Compact course of the German Hernia School. Hernia 2024; 28:621-628. [PMID: 38393496 DOI: 10.1007/s10029-024-02966-5] [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] [Received: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 years of experience, a survey was conducted to evaluate the long term effect of this training. METHOD Using an anonymous online-questionnaire, we contacted from September 2023 to October 2023 the Hernia Compact course participants via the congress organizer "Weitmeer" and the German Hernia Society. This online questionnaire contains 18 multiple choice questions regarding participants' age, gender, professional experience, participation in other modules of the German Hernia School, the effect of the course on their daily practice and their specific interest in hernia and abdominal wall surgery. RESULTS A total of 146 participants responded to the anonymous online questionnaire. A majority of 132 of 146 participants (90.42%) responded that this course improved the quality of surgical and hernia training (n = 146, no missing data). 141 of 146 individuals (96.58%) recommended the course to surgical colleagues (n = 146, no missing data). There were 89.73% of participants, (n = 146, no missing data) that developed a specific interest in hernia and abdominal wall surgery after the course. For 78.08% (n = 146, no missing data) of participants hernia and abdominal wall surgery was one of the most important activities in their daily surgical practice. CONCLUSION The standardized Hernia Compact basic course of the German Hernia School appears to have a huge impact on the quality of hernia surgery training in Germany and Austria. It might also help generate a specific interest in hernia surgery among participants.
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Affiliation(s)
- R Lorenz
- 3+CHIRURGEN Hernia Center, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
| | - C Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - B Stechemesser
- Hernia Center Cologne, PAN-Klinik, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - W Reinpold
- Hamburger Hernien Centrum, Harburg (an der Helios Mariahilf Klinik), Stader Str. 203c, 21075, Hamburg, Germany
| | - H Niebuhr
- Hamburger Hernien Centrum, Eppendorf, Eppendorfer Baum 8, 20249, Hamburg, Germany
| | - R H Fortelny
- Department of General Surgery, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, University Hospital, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - F Köckerling
- Vivantes Humboldt Hospital Berlin, Academic Teaching Hospital of Charite' University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - R Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Paasch C, Kobelt E, Lünse S, Heisler S, Lorenz R, Hunger R, Mantke R. How often is prophylactic parastomal mesh placement performed after rectal resection without sphincter preservation? An analysis of German nationwide hospital discharge data among 41,697 patients. Hernia 2024; 28:9-15. [PMID: 37843603 PMCID: PMC10891180 DOI: 10.1007/s10029-023-02887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The European Hernia Society guidelines of parastomal hernias, published in 2017, strongly recommend prophylactic synthetic non-absorbable mesh upon the construction of a permanent end colostomy to reduce the incidence of parastomal hernias. This study aims to evaluate the implementation of the guidelines in Germany. METHODS This is a retrospective multicentric analysis conducted in December 2022 at the University Hospital Brandenburg an der Havel. Anonymous data on rectal resection without sphincter preservation in the period 2010-2020 were extracted from the German nationwide hospital discharge data set. Individuals with a hernia and < 18 years old were excluded. Another exclusion criterion was a performed colectomy or proctocolectomy with an ileoanal pouch and placement of an absorbable mesh. The primary endpoint was the annual rate of prophylactic parastomal mesh placement following rectal resection without sphincter preservation in Germany. Cases reporting both non-absorbable mesh placement and rectal resection without sphincter preservation were considered prophylactic mesh insertions. RESULTS A total of 41,697 patients received a rectal resection without sphincter preservation and without non-absorbable mesh placement. Among these individuals, 27,089 were male and 14,608 were female. The rate of reoperations (3.1%) and the length of hospital stay (25.3 days ± 19.32) remained almost constant during these 10 years. The rate of prophylactic mesh placement was increasing from 0.2% (n = 8) in 2010 to 6.4% (n = 198) in 2020. CONCLUSIONS Currently, only the minority of patients who have undergone rectal resection without sphincter preservation receive prophylactic mesh insertion.
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Affiliation(s)
- C Paasch
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany.
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - E Kobelt
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - S Lünse
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - S Heisler
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - R Lorenz
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
- Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - R Hunger
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - R Mantke
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
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Kopp EL, Deussen DN, Cuomo R, Lorenz R, Roth DM, Mahata SK, Patel HH. Modeling and Phenotyping Acute and Chronic Type 2 Diabetes Mellitus In Vitro in Rodent Heart and Skeletal Muscle Cells. Cells 2023; 12:2786. [PMID: 38132105 PMCID: PMC10741513 DOI: 10.3390/cells12242786] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Type 2 diabetes (T2D) has a complex pathophysiology which makes modeling the disease difficult. We aimed to develop a novel model for simulating T2D in vitro, including hyperglycemia, hyperlipidemia, and variably elevated insulin levels targeting muscle cells. We investigated insulin resistance (IR), cellular respiration, mitochondrial morphometry, and the associated function in different T2D-mimicking conditions in rodent skeletal (C2C12) and cardiac (H9C2) myotubes. The physiological controls included 5 mM of glucose with 20 mM of mannitol as osmotic controls. To mimic hyperglycemia, cells were exposed to 25 mM of glucose. Further treatments included insulin, palmitate, or both. After short-term (24 h) or long-term (96 h) exposure, we performed radioactive glucose uptake and mitochondrial function assays. The mitochondrial size and relative frequencies were assessed with morphometric analyses using electron micrographs. C2C12 and H9C2 cells that were treated short- or long-term with insulin and/or palmitate and HG showed IR. C2C12 myotubes exposed to T2D-mimicking conditions showed significantly decreased ATP-linked respiration and spare respiratory capacity and less cytoplasmic area occupied by mitochondria, implying mitochondrial dysfunction. In contrast, the H9C2 myotubes showed elevated ATP-linked and maximal respiration and increased cytoplasmic area occupied by mitochondria, indicating a better adaptation to stress and compensatory lipid oxidation in a T2D environment. Both cell lines displayed elevated fractions of swollen/vacuolated mitochondria after T2D-mimicking treatments. Our stable and reproducible in vitro model of T2D rapidly induced IR, changes in the ATP-linked respiration, shifts in energetic phenotypes, and mitochondrial morphology, which are comparable to the muscles of patients suffering from T2D. Thus, our model should allow for the study of disease mechanisms and potential new targets and allow for the screening of candidate therapeutic compounds.
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Affiliation(s)
- Elena L. Kopp
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92161, USA
- Faculty of Medicine, University of Munich (LMU Munich), 80539 Munich, Germany
| | - Daniel N. Deussen
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92161, USA
- Faculty of Medicine, University of Munich (LMU Munich), 80539 Munich, Germany
| | - Raphael Cuomo
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92161, USA
| | - Reinhard Lorenz
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, 80539 Munich, Germany
| | - David M. Roth
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92161, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Sushil K. Mahata
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Hemal H. Patel
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92161, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
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Harbeck N, Fasching PA, Würstlein R, Degenhardt T, Lüftner D, Kates RE, Schumacher J, Räth P, Hoffmann O, Lorenz R, Decker T, Reinisch M, Göhler T, Staib P, Gluz O, Schinköthe T, Schmidt M. Significantly longer time to deterioration of quality of life due to CANKADO PRO-React eHealth support in HR+ HER2- metastatic breast cancer patients receiving palbociclib and endocrine therapy: Primary outcome analysis of the multicenter randomized AGO-B WSG PreCycle trial. Ann Oncol 2023:S0923-7534(23)00684-1. [PMID: 37201751 DOI: 10.1016/j.annonc.2023.05.003] [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: 04/21/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The multicenter, randomized phase IV intergroup AGO-B WSG PreCycle trial (NCT03220178) evaluated the impact of CANKADO-based ePRO (electronic patient-reported outcomes) assessment on quality of life (QoL) in HR+ HER2- locally advanced or metastatic breast cancer (MBC) patients receiving palbociclib (P) and an aromatase inhibitor or P+fulvestrant. CANKADO PRO-React, an EU-registered medical device, is an interactive autonomous application reacting to patient self-reported observations. PATIENTS AND METHODS Between 2017 and 2021, 499 patients (median age 59 years) from 71 centers were randomized (2:1, stratified by therapy line) between an active version of CANKADO PRO-React (CANKADO-active arm) or a version with limited functionality (CANKADO-inform arm). 412 patients (271 CANKADO-active; 141 CANKADO-inform) were available for analysis of the primary endpoint, time to deterioration (TTD) of QoL (10-point drop on FACT-G), using an Aalen-Johansen estimator for cumulative incidence function of TTD DQoL with 95% pointwise confidence intervals (CI). Secondary endpoints included PFS, OS, and DQoL (QoL deterioration). RESULTS In all pts (ITT-ePRO), cumulative incidence of DQoL was significantly more favorable (lower) in the CANKADO-active arm (HR=0.698, 95%CI [0.506 - 0.963]). Among 1stL patients (n=295), the corresponding HR was 0.716 (0.484-1.060; p=0.09), and in 2ndL patients (n=117) it was 0.661 (0.374-1.168; p=0.2). Absolute patient numbers declined in later visits; FACT-G completion rates were 80% and higher until about visit 30; mean FACT-G scores showed steady decline from baseline and an offset in favor of CANKADO-active. No significant differences in clinical outcome were observed between arms: Median PFS (ITT population) was 21.4 (95%CI 19.4-23.7) (CANKADO-active) and 18.7 (15.1-23.5) months (CANKADO-inform); median OS was not reached (CANKADO-active) and 42.6 months (CANKADO-inform). CONCLUSIONS PreCycle is the first multicenter randomized eHealth trial demonstrating a significant benefit for MBC patients receiving oral tumor therapy when using an interactive autonomous patient empowerment application.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany.
| | - P A Fasching
- University Hospital Erlangen, Obstetrics and Gynecology, Erlangen, Germany
| | - R Würstlein
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Degenhardt
- Breast Center, Department of Obstetrics and Gynecology and CCC Munich LMU, University Hospital, Munich, Germany; Hausarztpraxis Wolfratshausen, Wolfratshausen, Germany
| | - D Lüftner
- Immanuel Hospital Märkische Schweiz Buckow, Germany; Immanuel Hospital Rüdersdorf and Medical University of Brandenburg Theodor Fontane, Germany
| | - R E Kates
- West German Study Group, Statistics, Moenchengladbach, Germany
| | | | - P Räth
- palleos healthcare GmbH, Wiesbaden, Germany
| | - O Hoffmann
- University Hospital Essen, Breast Center, Essen, Germany
| | - R Lorenz
- Studien GbR Braunschweig, Braunschweig, Germany
| | - T Decker
- Hematology / Oncology, Ravensburg, Germany
| | - M Reinisch
- Breast Center, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - T Göhler
- Oncocenter Dresden, Dresden, Germany
| | - P Staib
- St.-Antonius Hospital gGmbH, Clinic for Hematology and Oncology, Eschweiler, Germany
| | - O Gluz
- West German Study Group, Statistics, Moenchengladbach, Germany
| | - T Schinköthe
- CANKADO Service GmbH, Kirchheim, Germany; Research Center Smart Digital Health, University of the Bundeswehr, Neubiberg, Germany
| | - M Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Niebuhr H, Köckerling F, Fortelny R, Hoffmann H, Conze J, Holzheimer RG, Koch A, Köhler G, Krones C, Kukleta J, Kuthe A, Lammers B, Lorenz R, Mayer F, Pöllath M, Reinpold W, Schwab R, Stechemesser B, Weyhe D, Wiese M, Zarras K, Meyer HJ. [Inguinal hernia operations-Always outpatient?]. Chirurgie (Heidelb) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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Affiliation(s)
- H Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
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Posiolova LV, Lognonné P, Banerdt WB, Clinton J, Collins GS, Kawamura T, Ceylan S, Daubar IJ, Fernando B, Froment M, Giardini D, Malin MC, Miljković K, Stähler SC, Xu Z, Banks ME, Beucler É, Cantor BA, Charalambous C, Dahmen N, Davis P, Drilleau M, Dundas CM, Durán C, Euchner F, Garcia RF, Golombek M, Horleston A, Keegan C, Khan A, Kim D, Larmat C, Lorenz R, Margerin L, Menina S, Panning M, Pardo C, Perrin C, Pike WT, Plasman M, Rajšić A, Rolland L, Rougier E, Speth G, Spiga A, Stott A, Susko D, Teanby NA, Valeh A, Werynski A, Wójcicka N, Zenhäusern G. Largest recent impact craters on Mars: Orbital imaging and surface seismic co-investigation. Science 2022; 378:412-417. [DOI: 10.1126/science.abq7704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Two >130-meter-diameter impact craters formed on Mars during the later half of 2021. These are the two largest fresh impact craters discovered by the Mars Reconnaissance Orbiter since operations started 16 years ago. The impacts created two of the largest seismic events (magnitudes greater than 4) recorded by InSight during its 3-year mission. The combination of orbital imagery and seismic ground motion enables the investigation of subsurface and atmospheric energy partitioning of the impact process on a planet with a thin atmosphere and the first direct test of martian deep-interior seismic models with known event distances. The impact at 35°N excavated blocks of water ice, which is the lowest latitude at which ice has been directly observed on Mars.
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Affiliation(s)
| | - P. Lognonné
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - W. B. Banerdt
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - J. Clinton
- Swiss Seismological Service, ETH Zurich, Zurich, Switzerland
| | - G. S. Collins
- Department of Earth Science and Engineering, Imperial College London, London, UK
| | - T. Kawamura
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - S. Ceylan
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - I. J. Daubar
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI, USA
| | - B. Fernando
- Department of Earth Sciences, University of Oxford, Oxford, UK
| | - M. Froment
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - D. Giardini
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - M. C. Malin
- Malin Space Science Systems, San Diego, CA, USA
| | - K. Miljković
- Space Science and Technology Centre, School of Earth and Planetary Sciences, Curtin University, Perth, WA, Australia
| | - S. C. Stähler
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - Z. Xu
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - M. E. Banks
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - É. Beucler
- Nantes Université, Université Angers, Le Mans Université, CNRS, UMR 6112, Laboratoire de Planétologie et Géosciences, Nantes, France
| | | | - C. Charalambous
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - N. Dahmen
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - P. Davis
- Department of Earth, Planetary, and Space Sciences, University of California, Los Angeles, CA, USA
| | - M. Drilleau
- Institut Supérieur de l’Aéronautique et de l’Espace ISAE-SUPAERO, Toulouse, France
| | - C. M. Dundas
- U.S. Geological Survey, Astrogeology Science Center, Flagstaff, AZ, USA
| | - C. Durán
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - F. Euchner
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
| | - R. F. Garcia
- Institut Supérieur de l’Aéronautique et de l’Espace ISAE-SUPAERO, Toulouse, France
| | - M. Golombek
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - A. Horleston
- School of Earth Sciences, University of Bristol, Bristol, UK
| | - C. Keegan
- Malin Space Science Systems, San Diego, CA, USA
| | - A. Khan
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
- Physik-Institut, University of Zurich, Zurich, Switzerland
| | - D. Kim
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
- Department of Geology, University of Maryland, College Park, MD, USA
| | - C. Larmat
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - R. Lorenz
- Johns Hopkins Applied Physics Laboratory, Laurel, MD, USA
| | - L. Margerin
- Institut de Recherche en Astrophysique et Planétologie, Université Toulouse III Paul Sabatier, CNRS, CNES, Toulouse, France
| | - S. Menina
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - M. Panning
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - C. Pardo
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - C. Perrin
- Nantes Université, Université Angers, Le Mans Université, CNRS, UMR 6112, Laboratoire de Planétologie et Géosciences, Nantes, France
| | - W. T. Pike
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - M. Plasman
- Université Paris Cité, Institut de Physique du Globe de Paris, CNRS, Paris, France
| | - A. Rajšić
- Space Science and Technology Centre, School of Earth and Planetary Sciences, Curtin University, Perth, WA, Australia
| | - L. Rolland
- Université Côte d’Azur, Observatoire de la Côte d’Azur, CNRS, IRD, Géoazur, Valbonne, France
| | - E. Rougier
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - G. Speth
- Malin Space Science Systems, San Diego, CA, USA
| | - A. Spiga
- Laboratoire de Météorologie Dynamique/IPSL, Sorbonne Université, CNRS, Ecole Normale Supérieure, PSL Research University, Ecole Polytechnique, Paris, France
| | - A. Stott
- Institut Supérieur de l’Aéronautique et de l’Espace ISAE-SUPAERO, Toulouse, France
| | - D. Susko
- Malin Space Science Systems, San Diego, CA, USA
| | - N. A. Teanby
- School of Earth Sciences, University of Bristol, Bristol, UK
| | - A. Valeh
- Malin Space Science Systems, San Diego, CA, USA
| | - A. Werynski
- Malin Space Science Systems, San Diego, CA, USA
| | - N. Wójcicka
- Department of Earth Science and Engineering, Imperial College London, London, UK
| | - G. Zenhäusern
- Institute of Geophysics, ETH Zurich, Zurich, Switzerland
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Sehouli J, Oskay-Öczelik G, Zocholl D, Klemt AS, Bangemann N, Albrecht O, Strittmatter HJ, Wimberger P, Kaczerowsky A, Lorenz R, Ruhwedel W, Fehm T, Zahn A, Tome O, Markert M, Hager D, Zorr A, Keller M, Rittmeister H, Grabowski J. 1573P Developing a patient-related predictive model for the occurrence of CINV (NOGGO-EMRISK trial): Prospective, multicentre study in Germany. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1666] [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: 11/01/2022] Open
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Aster HC, Romanos M, Walitza S, Gerlach M, Mühlberger A, Rizzo A, Andreatta M, Hasenauer N, Hartrampf PE, Nerlich K, Reiners C, Lorenz R, Buck AK, Deserno L. Responsivity of the Striatal Dopamine System to Methylphenidate-A Within-Subject I-123-β-CIT-SPECT Study in Male Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2022; 13:804730. [PMID: 35492708 PMCID: PMC9046584 DOI: 10.3389/fpsyt.2022.804730] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/15/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Methylphenidate (MPH) is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). MPH binds to the dopamine (DA) transporter (DAT), which has high density in the striatum. Assessments of the striatal dopamine transporter by single positron emission computed tomography (SPECT) in childhood and adolescent patients are rare but can provide insight on how the effects of MPH affect DAT availability. The aim of our within-subject study was to investigate the effect of MPH on DAT availability and how responsivity to MPH in DAT availability is linked to clinical symptoms and cognitive functioning. METHODS Thirteen adolescent male patients (9-16 years) with a diagnosis of ADHD according to the DSM-IV and long-term stimulant medication (for at least 6 months) with MPH were assessed twice within 7 days using SPECT after application of I-123-β-CIT to examine DAT binding potential (DAT BP). SPECT measures took place in an on- and off-MPH status balanced for order across participants. A virtual reality continuous performance test was performed at each time point. Further clinical symptoms were assessed for baseline off-MPH. RESULTS On-MPH status was associated with a highly significant change (-29.9%) of striatal DAT BP as compared to off-MPH (t = -4.12, p = 0.002). A more pronounced change in striatal DAT BP was associated with higher off-MPH attentional and externalizing symptom ratings (Pearson r = 0.68, p = 0.01). Striatal DAT BP off-MPH, but not on-MPH, was associated with higher symptom ratings (Pearson r = 0.56, p = 0.04). CONCLUSION Our findings corroborate previous reports from mainly adult samples that MPH changes striatal DAT BP availability and suggest higher off-MPH DAT BP, likely reflecting low baseline DA levels, as a marker of symptom severity.
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Affiliation(s)
- Hans-Christoph Aster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Würzburg, Würzburg, Germany.,Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Würzburg, Würzburg, Germany
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Manfred Gerlach
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Würzburg, Würzburg, Germany
| | - Andreas Mühlberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Albert Rizzo
- Department of Psychiatry and Behavioral Sciences, University of Southern California (USC) Davis School of Gerontology and USC Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Marta Andreatta
- Clinical Psychology, Erasmus School of Social and Behavioural Sciences, Rotterdam, Netherlands
| | - Natalie Hasenauer
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | | | - Kai Nerlich
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Christoph Reiners
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Reinhard Lorenz
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Lorenz Deserno
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Würzburg, Würzburg, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Matthias K, Lorenz R, De Santis KK. The application of AMSTAR 2 in overviews of systematic reviews shows a need for improvement. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.647] [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
Overviews of systematic reviews (SR) summarise and appraise the quality of research relevant for evidence-based decision-making. ‘A Measurement Tool to Assess Systematic Reviews' (AMSTAR 2) is a valid and moderately reliable appraisal instrument with 16 items that can be used to derive the overall confidence rating (OCR). OCR (high, moderate, low or critically low) can be derived based on the original algorithm with 7/9 critical/non-critical items. We aimed to assess the methods for deriving OCR in overviews of SRs of clinical interventions.
Methods
Our cross-sectional study was conducted using 45 overviews of SRs with at least 20 AMSTAR 2 appraisals selected by two authors from a title/abstract search for ‘AMSTAR 2' in Medline, Epistemonikos and CINAHL in 09/2020. One author coded the data. OCR methods and outcomes were compared using descriptive and univariate statistics.
Results
The 45 overviews were published in 2018-2020 by 2-16 authors. The overviews appraised on average 44 SRs (range: 20-158). OCRs of 1.412 SRs were derived in 41 overviews (91%). OCR were derived according to the original algorithm (22; 54%), own algorithm (9; 22%), unspecified algorithm (9; 22%) or AMSTAR 2 website (1; 2%). The OCR were high (190; 13%), moderate (182; 13%), low (267, 19%) or critically low (773; 55%). The original algorithm was more likely to generate the critically low+low ratings than either own algorithms (OR = 2.28, 95% CI [1.66-3.13]) or unclear algorithms (OR = 3.78 [2.81-5.09]).
Conclusions
High quality SRs are needed for making public health decisions. AMSTAR 2 assigns mostly low and critically low OCR to SRs in various clinical areas. These SRs should not be relied on as a source of accurate evidence. Furthermore, our results show that SR reporting guidelines need to be better followed and that AMSTAR 2 users should explicitly report their OCR methods.
Key messages
The methodological quality of the majority of systematic reviews (SRs) in various clinical fields is disappointing, highlighting the requirement for better adherence to reporting guidelines. There is a need for improvement on reporting how AMSTAR 2 is applied in overviews of SRs.
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Affiliation(s)
- K Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Sciences Stralsund, Stralsund, Germany
| | - R Lorenz
- Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - KK De Santis
- Prevention and Evaluation Department, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
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10
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Köckerling F, Lorenz R, Stechemesser B, Conze J, Kuthe A, Reinpold W, Niebuhr H, Lammers B, Zarras K, Fortelny R, Mayer F, Hoffmann H, Kukleta JF, Weyhe D. Comparison of outcomes in rectus abdominis diastasis repair-which data do we need in a hernia registry? Hernia 2021; 25:891-903. [PMID: 34319466 DOI: 10.1007/s10029-021-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. Therefore, "RAD ± concomitant hernia" will be documented as a separate hernia entity in the Herniamed Registry in the future. For this purpose, an appropriate case report form will be developed on the basis of the existing literature. METHODS A systematic search of the available literature was performed in March 2021 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library. 93 publications were identified as relevant for this topic. RESULTS In total 45 different surgical techniques for the repair of RAD ± concomitant hernia were identified in the surgical literature. RAD ± concomitant hernia is predominantly repaired by plastic but also by general surgeons. Classification of RAD ± concomitant hernia is based on a proposal of the German Hernia Society and the International Endohernia Society. Surgical techniques are summarized as groups subject to certain aspects: Techniques with abdominoplasty, open techniques, mini-less-open and endoscopic sublay techniques, mini-less-open and endoscopic subcutaneous/preaponeurotic techniques and laparoscopic techniques. Additional data impacting the outcome are also recorded as is the case for other hernia entities. Despite the complexity of this topic, documentation of RAD ± concomitant hernia has not proved to be any more cumbersome than for any of the other hernia entities when using this classification. CONCLUSION Using the case report form described here, the complex hernia entity RAD ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - J Conze
- UM Hernia Center, Arabellastr. 17, 81925, München, Germany
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - W Reinpold
- Hernia Center Hamburg, Helios Mariahilf Klinik, Stader Str. 203C, 21075, Hamburg, Germany
| | - H Niebuhr
- Hanse Hernia Center, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - R Fortelny
- Medical Faculty Austria, Private Hospital Confraternitaet, Sigmund Freud Private University Vienna, 1080, Vienna, Austria
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J F Kukleta
- Klinik Im Park Zurich (Hirslanden Group), Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
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11
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Köckerling F, Brunner W, Fortelny R, Mayer F, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia 2020; 25:605-617. [PMID: 33237505 DOI: 10.1007/s10029-020-02345-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 06/11/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the hernia defect of 3 cm. Suture repair should only be considered for small hernia defects of less than 1 cm. Hence, the use of a mesh in general is subject to controversial debate particularly for small (< 2 cm) umbilical hernias. This analysis of data from the Herniamed Registry now presents data on the treatment of small (< 2 cm) umbilical hernias over the past 10 years. METHODS Herniamed is an Internet-based hernia registry in which hospitals and surgical centers in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia operations. Between 2010 and 2019, data were entered into the Herniamed Registry by 737 hospitals/surgery centers on a total of 111,765 patients with primary elective umbilical hernia repair. The prospective data were analyzed retrospectively for each year and statistically compared. Due to a higher number of cases, the years 2013 and 2019 were compared for the perioperative outcome and the years 2013 and 2018 for 1-year follow-up. Fisher's exact test was applied for unadjusted analyses between the years, using a significance level of alpha = 5%. For post hoc tests of single categories, a Bonferroni adjustment for multiple testing was implemented. RESULTS A mesh technique was used to treat 45.4% of all umbilical hernias. The proportion of small (< 2 cm) umbilical hernias in the total collective of umbilical hernias was 55.6%. Suture repair was used consistently over the 10-year period to treat around 75% of all small (< 2 cm) umbilical hernias. Preperitoneal mesh placement as recommended in the guidelines was used only in 1.8% of cases. Between 2013 and 2019, stable values of 2 and 0.7% were observed for the postoperative complications and complication-related reoperations, respectively, with no relevant effect identified for the surgical technique. At 1-year follow-up, significantly higher rates of pain at rest (2.6 vs. 3.3), pain on exertion (5.7 vs. 6.6), and recurrences (1.3 vs. 1.8) (all p < 0.05) were identified for 2018 compared with 2013. CONCLUSIONS A suture technique is still used to treat 75% of patients with small (< 2 cm) umbilical hernias. The pain and recurrence rates are significantly less favorable for 2018 compared with 2013.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of Surgery, Kantonspital St. Gallen, Rorschacher Str. 95, CH-9007, St. Gallen, Switzerland
| | - R Fortelny
- Department of General Surgery, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- University Hospital of Visceral Surgery, Pius Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
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12
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Wiessner R, Lorenz R, Gehring A, Kleber T, Benz C, Sander M, Richter DU, Philipp M. Alterations in the mechanical, chemical and biocompatibility properties of low-cost polyethylene and polyester meshes after steam sterilization. Hernia 2020; 24:1345-1359. [PMID: 32975699 PMCID: PMC7701087 DOI: 10.1007/s10029-020-02272-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/14/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
Introduction In Africa and other Low Resource Settings (LRS), the guideline-based and thus in most cases mesh-based treatment of inguinal hernias is only feasible to a very limited extent. This has led to an increased use of low cost meshes (LCMs, mostly mosquito meshes) for patients in LRS. Most of the LCMs used are made of polyethylene or polyester, which must be sterilized before use. The aim of our investigations was to determine changes in the biocompatibility of fibroblasts as well as mechanical and chemical properties of LCMs after steam sterilization. Material and methods Two large-pored LCMs made of polyester and polyethylene in a size of 11 x 6 cm were cut and steam sterilized at 100, 121 and 134 °C. These probes and non-sterile meshes were then subjected to mechanical tensile tests in vertical and horizontal tension, chemical analyses and biocompatibility tests with human fibroblasts. All meshes were examined by stereomicroscopy, scanning electron microscopy (SEM), LDH (cytotoxicity) measurement, viability testing, pH, lactate and glycolysis determination. Results Even macroscopically, polyethylene LCMs showed massive shrinkage after steam sterilization, especially at 121 and 134 °C. While polyester meshes showed no significant changes after sterilization with regard to deformation and damage as well as tensile force and stiffness, only the unsterile polyethylene mesh and the mesh sterilized at 100 °C could be tested mechanically due to the shrinkage of the other specimen. For these meshes the tensile forces were about four times higher than for polyester LCMs. Chemical analysis showed that the typical melting point of polyester LCMs was between 254 and 269 °C. Contrary to the specifications, the polyethylene LCM did not consist of low-density polyethylene, but rather high-density polyethylene and therefore had a melting point of 137 °C, so that the marked shrinkage described above occurred. Stereomicroscopy confirmed the shrinkage of polyethylene LCMs already after sterilization at 100 °C in contrast to polyester LCMs. Surprisingly, cytotoxicity (LDH measurement) was lowest for both non-sterile LCMs, while polyethylene LCMs sterilized at 100 and 121 °C in particular showed a significant increase in cytotoxicity 48 hours after incubation with fibroblasts. Glucose metabolism showed no significant changes between sterile and non-sterile polyethylene and polyester LCMs. Conclusion The process of steam sterilization significantly alters mechanical and structural properties of synthetic hernia mesh implants. Our findings do not support a use of low-cost meshes because of their unpredictable properties after steam sterilization.
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Affiliation(s)
- Reiko Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany.
| | - R Lorenz
- 3+ Chirurgen, Berlin-Spandau, Germany
| | - A Gehring
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany
| | - T Kleber
- Department of Vascular Surgery, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - C Benz
- Institute of Structural Mechanics (StM), University of Rostock, Albert-Einstein-Str. 2, 18059, Rostock, Germany
| | - M Sander
- Institute of Structural Mechanics (StM), University of Rostock, Albert-Einstein-Str. 2, 18059, Rostock, Germany
| | - D-U Richter
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
| | - M Philipp
- Department of General, Visceral, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
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Petersen K, Morrison J, Oprea V, Grischkan D, Koch A, Lorenz R, Bendavid R, Iakovlev V. Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants. Hernia 2020; 25:1239-1251. [PMID: 32960368 DOI: 10.1007/s10029-020-02297-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. METHODS Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. Patterns of percentage growth and time lapses at 50th and 95th percentiles were used to compare groups of different hernia type, age, gender and reason for excision. RESULTS The 50th and 95th case percentiles in the dataset were at 3.75 and 15.0 years between mesh implantation and excision. For hernia types, the longest time lapses were for groin hernias (4.0 and 16.11 years at 50th and 95th percentiles). The shortest were for umbilical hernias (2.16 and 9.68 years). Males had later excisions than females (4.11 and 16.1 vs. 2.47 and 9.79 years). Younger patients (< 45 y.o.) had later excisions than older patients (4.12 and 17.68 vs. 3.37 and 10.0 years). Out of all subgroups, the longest time lapses were for groin hernias in younger males (4.77 and 18.89 years) and for mesh erosion into organs (4.67 and 17.0 years). CONCLUSIONS Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. We propose to use cumulative incidence for standardized risk reporting (y% risk at x years). This will show time-dependent patterns and allow comparisons between different techniques and studies of variable duration. Standardization will also help to predict long-term risks beyond shorter (practical) follow-ups and facilitate real-time monitoring during surveillance.
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Affiliation(s)
| | - J Morrison
- Chatham Kent Health Alliance, Chatham, Ontario, Canada
| | - V Oprea
- Military Hospital of Cluj, Cluj-Napoca, Romania, Romania
| | | | - A Koch
- Day Surgery and Hernia Center, Cottbus, Germany
| | - R Lorenz
- , Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - R Bendavid
- Department of Surgery, Shouldice Hospital, Thornhill, University of Toronto, Toronto, ON, Canada
| | - V Iakovlev
- Department of Laboratory Medicine, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
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Köckerling F, Brunner W, Mayer F, Fortelny R, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Assessment of potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair: a registry-based multivariable analysis of 31,965 patients. Hernia 2020; 25:587-603. [PMID: 32951104 DOI: 10.1007/s10029-020-02305-4] [Citation(s) in RCA: 9] [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: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION How best to treat a small (< 2 cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1 cm. Since the quality of evidence is limited for hernias with defect sizes smaller than 1 cm, suture repair can be considered. To date, little is known about the potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair. This multivariable analysis of data from the Herniamed Registry now aims to assess these factors. METHODS The data of patients with primary elective umbilical hernia repair and defect size < 2 cm entered into the Herniamed Registry from September 1, 2009 to December 31, 2018 were analyzed to assess through multivariable analysis all confirmatory pre-defined potential influencing factors on the primary outcome criteria intraoperative and postoperative complications, general complications, complication-related reoperations, recurrence rate and rates of pain at rest, pain on exertion and chronic pain requiring treatment at 1-year follow-up. RESULTS 31,965 patients (60%) met the inclusion criteria. The proportion of suture repairs was 78.6% (n = 25,119), of open mesh repairs 15.2% (n = 4853), and of laparoscopic mesh repairs 6.2% (n = 1993). Compared with open mesh repair, suture repair had a highly significantly unfavorable association with the recurrence rate (OR = 1.956 [1.463; 2.614]; p < 0.001). Female gender also had an unfavorable relation to the recurrence rate (OR = 1.644 [1.385; 1.952]; p < 0.001). Compared with open mesh repair, open suture repair had a highly significantly favorable association with the rate of postoperative complications (OR = 0.583 [0.484; 0.702]; p < 0.001) and complication-related reoperations (OR = 0.567 [0.397; 0.810]; p = 0.002).While laparoscopic IPOM showed a favorable relationship with the postoperative complications and complication-related reoperations, it demonstrated an unfavorable association with the intraoperative complications, general complications, recurrence rate and pain rates. CONCLUSION Suture repair continues to be used for 78% of umbilical hernias with a defect < 2 cm. While suture repair has a favorable influence on the rates of postoperative complications and complication-related reoperations, it has a higher risk of recurrence. Female gender also has an unfavorable influence on the recurrence rate. Laparoscopic IPOM appears to be indicated only in settings of obesity (BMI ≥ 30).
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Rorschacher Kantonsspital St. Gallen, Str. 95, 9007, St. Gallen, Switzerland
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - R Fortelny
- Department of General Surgery, Hospital Ottakring, Montleartstrasse 37, 1160, Vienna, Austria.,Sigmund Freud University Vienna, Medical Faculty, Schnirchgasse 9a, 1030, Vienna, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3 + CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital Oldenburg, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
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Affiliation(s)
- Wolfgang Siess
- Institute for Prevention of Cardiovascular Diseases, Ludwig-Maximilians University (LMU) , Munich, Germany
| | - Philipp Von Hundelshausen
- Institute for Prevention of Cardiovascular Diseases, Ludwig-Maximilians University (LMU) , Munich, Germany
| | - Reinhard Lorenz
- Institute for Prevention of Cardiovascular Diseases, Ludwig-Maximilians University (LMU) , Munich, Germany
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Stuck M, Krenz I, Schulze Kökelsum B, Boye S, Voit B, Lorenz R. Improving glass transition temperature of unsaturated polyester thermosets: Conventional unsaturated polyester resins. J Appl Polym Sci 2020. [DOI: 10.1002/app.49825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Moritz Stuck
- Department of Chemical Engineering University of Applied Science Münster Münster Germany
- Institut für Makromolekulare Chemie Leibniz‐Institut für Polymerforschung Dresden Dresden Germany
- Organische Chemie der Polymere Technische Universität Dresden Dresden Germany
| | - Irina Krenz
- Department of Chemical Engineering University of Applied Science Münster Münster Germany
| | | | - Susanne Boye
- Institut für Makromolekulare Chemie Leibniz‐Institut für Polymerforschung Dresden Dresden Germany
| | - Brigitte Voit
- Institut für Makromolekulare Chemie Leibniz‐Institut für Polymerforschung Dresden Dresden Germany
- Organische Chemie der Polymere Technische Universität Dresden Dresden Germany
| | - Reinhard Lorenz
- Department of Chemical Engineering University of Applied Science Münster Münster Germany
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Köckerling F, Hantel E, Adolf D, Kuthe A, Lorenz R, Niebuhr H, Stechemesser B, Marusch F. Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data. Hernia 2020; 25:1169-1181. [PMID: 32748006 DOI: 10.1007/s10029-020-02281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry compared the outcome of scrotal vs. lateral vs. medial inguinal hernias and explored the relationship between hernia localization and outcomes. METHODS Included in the analysis were all primary elective unilateral inguinal hernias in men with scrotal, lateral or medial defect localization whose details had been entered into the Herniamed Registry by 712 participating institutions (status February 1, 2019). The relation of the hernia localization with the outcome parameters adjusted for pre-defined confounding patient- and procedure-related variables was analyzed via multivariable binary logistic models. RESULTS Details of 98,321 patients were thus available for multivariable analysis. These related to 65,932 (67.1%) lateral, 29,697 (30.2%) medial and 2,710 (2.7%) scrotal inguinal hernias. Scrotal hernias were associated with higher patient age, higher BMI, higher ASA score, larger defect, more risk factors and more frequent use of Lichtenstein repair. On the other hand, scrotal hernias were associated less commonly with preoperative pain. Multivariable analysis revealed that scrotal hernias had a highly significantly unfavorable association with postoperative complications, complication-related reoperations and general complications. But scrotal hernias had a highly significantly favorable relation with the pain rates at 1-year follow-up. Medial hernias were the hernia type most often related with recurrence and also had an unfavorable association with the pain rates at 1-year follow-up. CONCLUSION Scrotal inguinal hernias demonstrated a very unfavorable relation with the postoperative complication rate, the rate of complication-related reoperations and the rate of general complications. But a very favorable association with chronic pain rates was identified at 1-year follow-up. Medial inguinal hernia had an unfavorable relation with the recurrence and pain rates.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching, Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - E Hantel
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - A Kuthe
- Department of General and Visceral Surgery, DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - R Lorenz
- 3+Chirurgen, Klosterstrasse 34/35 Spandau, 13581, Berlin, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki and Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Stechemesser
- Hernia Center, Pan Hospital, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - F Marusch
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
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Köckerling F, Hantel E, Adolf D, Stechemesser B, Niebuhr H, Lorenz R, Zarras K, Marusch F. Do drains have an impact on the outcome after primary elective unilateral inguinal hernia repair in men? Hernia 2020; 24:1083-1091. [PMID: 32566993 DOI: 10.1007/s10029-020-02254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of drains continues to be a controversial topic in surgery. In a review of that topic for incisional hernia it was not possible to find sufficient evidence of the need for a drain. Likewise, for inguinal hernia surgery the data available are insufficient. METHODS In a multivariable analysis of data from the Herniamed Registry for 98,321 patients with primary elective unilateral inguinal hernia repair in men, the role of a drain was investigated. RESULTS A drain was used in 24.7% (n = 24,287/98,321) of patients. These patients were on average older, had higher BMI, longer operating time and received a smaller mesh. Drains were also used more often for patients with higher ASA score, risk factors, larger defects and scrotal hernia localization as well as for Lichtenstein, TEP and suture repair. The use of drains was highly significantly associated with intra- and postoperative complications as well as with complication-related reoperations. Hence, drains are used selectively in inguinal hernia repair for patients at higher risk of perioperative complications. Despite the use of drains, the outcome in this risk group is less favorable. It remains unclear if drains prevent further complications in high-risk patients. CONCLUSION Drains are used selectively in high-risk men with primary elective unilateral inguinal hernia repair. Drains are associated with intra- and postoperative complications rates and complication-related reoperation rate. Drains can serve as an indicator for early detection of complications.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - E Hantel
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - B Stechemesser
- Hernia Center, Pan Hospital, Zeppelinstraße 1, 50667, Köln, Germany
| | - H Niebuhr
- Hanse-Hernienzentrum, Eppendorfer Baum 8, 20249, Hamburg, Germany
| | - R Lorenz
- 3+Chirurgen, Klosterstraße 34/35, 13581, Berlin-Spandau, Germany
| | - K Zarras
- Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - F Marusch
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
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Zhang D, Ebrahim M, Adler K, Blanchet X, Jamasbi J, Megens RTA, Uhland K, Ungerer M, Münch G, Deckmyn H, Weber C, Elia N, Lorenz R, Siess W. Glycoprotein VI is not a Functional Platelet Receptor for Fibrin Formed in Plasma or Blood. Thromb Haemost 2020; 120:977-993. [DOI: 10.1055/s-0040-1710012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractGlycoprotein VI (GPVI), a platelet collagen receptor, is crucial in mediating atherothrombosis. Besides collagen, injured plaques expose tissue factor (TF) that triggers fibrin formation. Previous studies reported that GPVI also is a platelet receptor for fibrinogen and fibrin. We studied the effect of anti-GPVI antibodies and inhibitors of GPVI signaling kinases (Syk and Btk) on platelet adhesion and aggregate formation onto immobilized fibrinogen and different types of fibrin under arterial flow conditions. Fibrin was prepared from isolated fibrinogen (“pure fibrin”), recombinant fibrinogen (“recombinant fibrin”), or generated more physiologically from endogenous fibrinogen in plasma (“plasma fibrin”) or by exposing TF-coated surfaces to flowing blood (“blood fibrin”). Inhibition of GPVI and Syk did not inhibit platelet adhesion and aggregate formation onto fibrinogen. In contrast anti-GPVI antibodies, inhibitors of Syk and Btk and the anti-GPIb antibody 6B4 inhibited platelet aggregate formation onto pure and recombinant fibrin. However, inhibition of GPVI and GPVI signaling did not significantly reduce platelet coverage of plasma fibrin and blood fibrin. Plasma fibrin contained many proteins incorporated during clot formation. Advanced optical imaging revealed plasma fibrin as a spongiform cushion with thicker, knotty, and long fibers and little activation of adhering platelets. Albumin intercalated in plasma fibrin fibers left only little space for platelet attachment. Pure fibrin was different showing a dense mesh of thin fibers with strongly activated platelets. We conclude that fibrin formed in plasma and blood contains plasma proteins shielding GPVI-activating epitopes. Our findings do not support a role of GPVI for platelet activation by physiologic fibrin.
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Affiliation(s)
- Danmei Zhang
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | - Mariam Ebrahim
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | | | - Xavier Blanchet
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | - Janina Jamasbi
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | - Remco T. A. Megens
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | | | | | | | - Hans Deckmyn
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Christian Weber
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Natalie Elia
- Department of Life Sciences, BGU (Ben Gurion University), Beer-Sheva, Israel
| | - Reinhard Lorenz
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
| | - Wolfgang Siess
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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McGuire K, Lorenz R. 0229 Exploring the Relationships Between Sleep, Stress, and Performance in Simulation-Based Learning. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep deprivation and stress may affect performance among students. Simulation-based learning (SBL) in undergraduate nursing programs provides the opportunity for students to practice critical decision-making without fear of patient harm; however, students still report experiencing stress during SBL. Current research is unclear on the effect of sleep deprivation combined with stress on performance in SBL. The purpose of this study was to explore the association between stress, functional outcomes of sleep, and performance in SBL.
Methods
Elements of the Theory of Stress, Appraisal, and Coping and the National League for Nursing Jeffries Nursing Education Simulation Framework guided this study. Baccalaureate nursing students consented to participate in a 1-hour SBL experience that included the collection of one hair and 4 saliva samples for cortisol concentration. Participants completed the Functional Outcomes of Sleep- Short Form and the Perceived Stress Questionnaire. An experienced faculty member evaluated student performance using the Creighton Competency Evaluation Inventory.
Results
Participants (N=35) were mainly female (n=32, 91.4%), white (n=29, 82.9%), with ages ranging between 18–22 years (n=32, 91.4%), and employed outside of nursing school (n=32, 91.4%). Other ethnicities represented include Asian and African American. Kendall’s Tau correlations revealed a significant relationship between functional outcomes of sleep and perceived stress (r=-.281, p=.020). Although not significant, a small relationship was observed between functional outcomes of sleep and performance (r=.145, p=.236). No significant relationship between performance and perceived stress (r=-.099, p=.423) was identified.
Conclusion
This study suggests that daytime dysfunction related to sleep is related to perceived stress and performance in undergraduate nursing students during participation in SBL. Due likely to small sample size, the relationship between sleep and performance was unable to achieve significance. These findings support the need for future research exploring the effects of sleep on stress and performance with larger more heterogeneous samples of students.
Support
This researcher would like to acknowledge and thank the following funding sources for their generous support of this work: Marion Bender Scholarship (Saint Louis University School of Nursing), Dissertation Award from Sigma Theta Tau International-Epsilon Eta Chapter, and Southern Illinois University Edwardsville School of Nursing Faculty Scholar Award.
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Affiliation(s)
- K McGuire
- Southern Illinois University Edwardsville, Edwardsville, IL
| | - R Lorenz
- State University of New York at Buffalo, Buffalo, NY
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Lorenz R, Oppong C, Frunder A, Lechner M, Sedgwick DM, Tasi A, Wiessner R. Improving surgical education in East Africa with a standardized hernia training program. Hernia 2020; 25:183-192. [PMID: 32157505 DOI: 10.1007/s10029-020-02157-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/01/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Inguinal hernias are among the most common surgical diseases in Africa. The current International HerniaSurge Guidelines recommend mesh-based surgical techniques in Low Resource Settings (LRS). This recommendation is currently unachievable in large parts of Africa due to the unaffordability of mesh and lack of appropriate training of the few available surgeons. There is, therefore, a need for formal training in mesh surgery. There is an experience in Hernia Repair for the Underserved in Central and South America, however, inadequate evidence of structured training in Africa. MATERIAL AND METHODS Since 2016, the aid Organizations, Surgeons for Africa and Operation Hernia have developed and employed a structured hernia surgical training program for postgraduate surgical trainees and medical doctors in Rwanda. This course consists of lectures on relevant aspects of hernia surgery and hands-on training in operating theatres. The lectures emphasize anatomy and surgical technique. All parts of the training were evaluated. Formal pre-course evaluation was conducted to assess the personal surgical experience of the trainees. RESULTS Over a 3-year period, a structured hernia training programme was employed to train a total of 36 surgical trainees in both mesh and also non mesh hernia surgery. The key principle in this course is the continuous competence assessment and feedback. Evidence is provided to demonstrate improvement in surgical skills as well as knowledge of surgical anatomy which is essential to acquiring surgical competency. With self-assessment, expressed on a Likert scale, the participants could improve the theoretical knowledge about hernias from median 4.4 (on a scale of 1-10) before training to 8.4 after the training. The specific knowledge about anatomy could be improved in the same assessment from 4.8 before training to 8.1. after the training. After training course 12 of the 36 participants (33.33%) were able to carry out both suture- and mesh-based operations of simple inguinal hernias completely and independently. 20 of the 36 participants (55.55%) required only minimal supervision and only four participants (11.11%) required surgical supervision even after the completion of the course. CONCLUSION We have demonstrated that, medical personnel in Africa can be trained in mesh and non-mesh hernia surgery using a structured training programme.
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Affiliation(s)
- R Lorenz
- 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
| | - C Oppong
- University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, PL6 8DH, UK
| | - A Frunder
- Lorettoklinik Tübingen, Katharinenstraße 10, 72072, Tübingen, Germany
| | - M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | | | - A Tasi
- Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany
| | - R Wiessner
- Department of General and Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, deGregorio deGregorio A, Tzschaschel M, Bekes I, Scholz C, Rack B, Janni W, Friedl TWP. Abstract P4-01-01: Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognostic relevance of circulating tumor cells (CTCs) during adjuvant breast cancer treatment and follow up has been well established. However, little information is available regarding CTC-detection and its association to site of first metastatic disease. Methods: The adjuvant phase III SUCCESS A trial, an open label, randomized, multicenter study, compared chemotherapy with three cycles of epirubicin, fluorouracil and cyclophosphamide followed by either three cycles of docetaxel or three cycles of docetaxel plus gemcitabine in patients with early high-risk breast cancer. Following chemotherapy, patients were randomized to two or five years of zoledronate treatment. CTC status was assessed before and after chemotherapy using the FDA-approved CellSearch® System (Menarini Silicon Biosystems; Bologna, Italy). The association between the presence of CTCs and the site of first distant disease was assessed using Chi Square tests. Findings: Of 3754 SUCCESS A patients, 373 developed metastatic disease. 206 of these patients participated in the translational research program of the trial so the CTC status at baseline was assessed. These patients were included into the analysis. At least one CTC before chemotherapy was detected in 70 (34.0%) of patients (median 2 CTCs, range 1 - 827 CTCs). For 159 patients, CTC status after chemotherapy could also be evaluated. Disease progression in terms of first distant disease occurred in 44 patients (21.4 %) in the bones, in 60 (29.1 %) in visceral sites (lung, liver), in 23 (11.2 %) in the brain or neural system, and in 51 patients (24.7 %) in other sites. In 28 patients (13.6 %), more than one site of metastatic disease was overt at the time of first distant recurrence. The median time to metastatic disease (measured from date of randomization) was 33.0 months (range 0.7 - 92.4 months). Overall, patients with bone-only first distant disease were numerically most likely to be CTC positive before chemotherapy (40.9 %); however, there was no significant association between site of first metastatic disease (bones, visceral, other) and the presence of CTCs before chemotherapy (p.224). Adding CTC status after chemotherapy did not change the results. However, patients with persistently positive CTCs were significantly more likely to show first distant disease at multiple sites than patients with a negative CTC status before and/or after chemotherapy. Interpretation: Although the presence of CTCs predicts poor prognosis in early breast cancer, no association of positive CTC status before and after chemotherapy with the site of metastatic disease was found. Therefore, a positive CTC status should trigger routine diagnostic intervention depending on clinical evaluation.
Citation Format: Elisabeth Katharina Trapp, Peter A Fasching, Tanja Fehm, Andreas Schneeweiss, Volkmar Mueller, Nadia Harbeck, R. Lorenz, Claudia Schumacher, Georg Heinrich, Amelie deGregorio deGregorio, Marie Tzschaschel, Inga Bekes, Christoph Scholz, Brigitte Rack, Wolfgang Janni, Thomas WP Friedl. Presence of circulating tumor cells in high-risk early breast cancer do not predict site of metastatic lesions - Results of the SUCCESS A trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
| | - Peter A Fasching
- 2Department of Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- 3Department of Gynecology and Obstetrics, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Andreas Schneeweiss
- 4National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Volkmar Mueller
- 5Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nadia Harbeck
- 6Department of Gynecology and Obstetrics, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - R. Lorenz
- 7Private Practice for Gynaecology Casparistreet, Braunschweig, Germany
| | - Claudia Schumacher
- 8Department of Obstetrics and Gynecology St. Elisabeth's Hospital of Cologne, Cologne, Germany
| | - Georg Heinrich
- 9Private Practice for Gynaecology, Fürstenwalde, Germany
| | | | - Marie Tzschaschel
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Inga Bekes
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Christoph Scholz
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Brigitte Rack
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Thomas WP Friedl
- 10Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Busygina K, Denzinger V, Bernlochner I, Weber C, Lorenz R, Siess W. Btk Inhibitors as First Oral Atherothrombosis-Selective Antiplatelet Drugs? Thromb Haemost 2019; 119:1212-1221. [PMID: 31087308 DOI: 10.1055/s-0039-1687877] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bruton's tyrosine kinase (Btk) is essential for B cell differentiation and proliferation, but also platelets express Btk. Patients with X-linked agammaglobulinemia due to hereditary Btk deficiency do not show bleeding, but a mild bleeding tendency is observed in high dose therapy of B-cell malignancies with ibrutinib and novel second-generation irreversible Btk inhibitors (acalabrutinib and ONO/GS-4059). This review discusses recent studies that may explain this apparent paradox and gives mechanistic insights that suggest a unique potential of low dose irreversible Btk inhibitors as atherothrombosis-focused antiplatelet drugs.
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Affiliation(s)
- Kristina Busygina
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University Munich), Munich, Germany
| | - Viola Denzinger
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University Munich), Munich, Germany
| | - Isabell Bernlochner
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Medizinische Fakultät, Technische Universität München, Munich, Germany
| | - Christian Weber
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University Munich), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Reinhard Lorenz
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University Munich), Munich, Germany
| | - Wolfgang Siess
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians University Munich), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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Wiessner R, Gehring A, Kleber T, Ekwelle N, Lorenz R, Richter DU. An in vitro study on the biocompatibility of fibroblasts in sterile and non-sterile low-cost and commercial meshes. Hernia 2019; 23:1163-1174. [PMID: 30949894 DOI: 10.1007/s10029-019-01932-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/06/2018] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite several successful studies with low-cost meshes (LCM) for the treatment of inguinal hernias in India and Africa, a nationwide application has not been possible for a variety of reasons. One problem is the special preparation and sterilization of these meshes-naturally, they should comply with international standards and demands, which is often difficult to achieve in Africa. Our primary approach was to determine whether there are differences in the biocompatibility of fibroblasts between non-sterile and sterile LCMs and commercial meshes (CM). MATERIALS AND METHODS Two polyester CMs with different pore size and a polyester LCM were examined as both sterile and non-sterile. LCM was plasma sterilized at 60 °C and steam sterilized at 134 °C. Sterile and non-sterile meshes were soaked with an antibiotic (penicillin/streptomycin) and antimycotic solution (amphotericin B). Human fibroblasts from healthy subcutaneous tissue were used. Various tests for evaluating the growth behavior and cell morphology of human fibroblasts were conducted. Semiquantitative (light microscopy) and qualitative (scanning electron microscopy) analyses were performed after 1 week and again after 12 weeks. The metabolism of fibroblasts was checked by pH measurements and glucose analyses. Biocompatibility of fibroblasts on sterile and non-sterile meshes was carried out by luminescence methods (cell viability and apoptosis) as well as calorimetric methods for proliferation determination (BrDU assay) and cytotoxicity (LDH assay). RESULTS Light and electron microscopy revealed a moderate growth of fibroblasts on all investigated mesh types. The results of glycolysis and the pH value were within the normal range for all sterile and non-sterile meshes. In biocompatibility studies, no elevated level of apoptosis was detected. The viability measurement of mitochondrial activity of fibroblasts showed a 50% inhibition of mitochondria in all nets, with the exception of non-sterile CM, whereas mitochondrial activity was increased in the non-sterile CM. A proliferation measurement (BrdU test) revealed different growth inhibition in the sterile and non-sterile meshes. This growth inhibition was significantly stronger, particularly for non-sterile CM light meshes, than it was for the non-sterile LCM. CONCLUSION Again, our studies show no significant differences in biocompatibility of fibroblasts between expensive and low-cost meshes. In addition, we detected fibroblast growth even in sterile meshes, independent of the mesh group. To our knowledge, the present study is the first of its kind in terms of qualitative equivalence of sterile and non-sterile in vitro mesh samples. We do not wish to create future patient studies with non-sterilized meshes saturated with antibiotics/antimycotics. However, perhaps we can prove in future studies that under semi-sterile conditions with certain LCMs, wound infection rates can be acceptable.
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Affiliation(s)
- R Wiessner
- Department of General an Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany.
| | - A Gehring
- Department of General an Visceral Surgery, Bodden-Kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - T Kleber
- Heart und Vascular Center, Albertinen Hospital, Hamburg, Germany
| | - N Ekwelle
- Department of General and Visceral Surgery, Hospital Märkisch Oberland, Wriezen, Germany
| | - R Lorenz
- 3+ Chirurgen, Berlin-Spandau, Germany
| | - D-U Richter
- Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
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Janni W, Rack BK, Friedl TW, Müller V, Lorenz R, Rezai M, Tesch H, Heinrich G, Andergassen U, Harbeck N, Schochter F, De Gregorio A, Tzschaschel M, Huober J, Hepp P, Fehm TN, Schneeweiss A, Lichtenegger W, Blohmer J, Hauner D, Beckmann MW, Häberle L, Fasching PA, Hauner H. Abstract GS5-03: Lifestyle Intervention and Effect on Disease-free Survival in Early Breast Cancer Pts: Interim Analysis from the Randomized SUCCESS C Study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs5-03] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Recent trials have provided evidence that obesity and a low level of physical activity are not only associated with a higher risk of developing breast cancer, but also with an increased risk for recurrence and reduced survival in breast cancer patients (pts). The SUCCESS C study is the first randomized Phase III trial to evaluate the effect of an intensive lifestyle intervention program, focusing on both physical activity and healthy diet following adjuvant chemotherapy on disease-free survival in women with early breast cancer.
Methods:
SUCCESS C is a German multicenter, 2×2 factorial design, randomized phase III study comparing disease-free survival (DFS) in pts with HER2-negative early breast cancer treated with either 3 cycles of epirubicine, fluorouracil, cyclophosphamide chemotherapy followed by 3 cycles of docetaxel (FEC-D) or 6 cycles of docetaxel-cyclophosphamide (DC). The second randomization compares DFS in pts with a body mass index (BMI) of 24—40 kg/m2 receiving either a telephone-based individualized lifestyle intervention (LI) program aiming at moderate weight loss for 2 years (LI arm) or general recommendations for a healthy lifestyle alone (non-LI arm). DFS according to lifestyle intervention was analyzed using both univariable cox regressions and multivariable cox regressions adjusted for age (years, continuous), BMI (kg/m2, continuous), menopausal status (premenopausal, postmenopausal), tumor size (pT1, pT2, pT3/pT4), nodal stage (pN0, pN1, pN2, pN3), hormone receptor status (positive, negative), grading (G1, G2, G3), histological type (ductal, lobular, other) and chemotherapy randomization (FEC-D, DC). Median follow-up was 64.2 months.
Results:
Overall, 2292 of the 3643 pts recruited for the SUCCESS C study were randomized for the lifestyle intervention program (1146 pts in both the non-LI arm and the LI arm). The Intention-to-treat analysis revealed no difference in DFS between the two treatment arms (LI vs. non-LI) in univariable analysis (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.76 — 1.28, p = 0.922) and in adjusted multivariable cox regression (HR 0.91, 95% CI 0.70 — 1.18, p = 0.48). At the 2-year follow up, pts in the LI arm lost on average 1.0 kg weight compared to the start of the LI program, while pts in the non-LI arm gained on average 0.95 kg (p < 0.001). Overall, 1477 pts completed the 2-year LI program (non-LI arm: 80.7%, 925 of 1146 pts; LI arm: 48.2%, 552 of 1146 pts; p < 0.001). Pts that completed the 2-year LI program had a significant better DFS than non-completers (HR 0.35, 95% CI 0.27 — 0.45, p < 0.001). Among completers, pts in the LI arm had a significantly better DFS than pts in the non-LI arm both in univariable analysis (HR 0.53, 95% CI 0.35 — 0.82, p = 0.004) and in adjusted multivariable cox regression (HR 0.51, 95% CI 0.33 — 0.78, p = 0.002).
Conclusions:
This explorative and non-planned interim analysis indicates that the completion of a systematic telephone life style intervention program may positively impact patient outcome in early breast cancer.
Citation Format: Janni W, Rack BK, Friedl TW, Müller V, Lorenz R, Rezai M, Tesch H, Heinrich G, Andergassen U, Harbeck N, Schochter F, De Gregorio A, Tzschaschel M, Huober J, Hepp P, Fehm TN, Schneeweiss A, Lichtenegger W, Blohmer J, Hauner D, Beckmann MW, Häberle L, Fasching PA, Hauner H. Lifestyle Intervention and Effect on Disease-free Survival in Early Breast Cancer Pts: Interim Analysis from the Randomized SUCCESS C Study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS5-03.
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Affiliation(s)
- W Janni
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - BK Rack
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - TW Friedl
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - V Müller
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - R Lorenz
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - M Rezai
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - H Tesch
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - G Heinrich
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - U Andergassen
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - N Harbeck
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - F Schochter
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - A De Gregorio
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - M Tzschaschel
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - J Huober
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - P Hepp
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - TN Fehm
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - A Schneeweiss
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - W Lichtenegger
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - J Blohmer
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - D Hauner
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - MW Beckmann
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - L Häberle
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - PA Fasching
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
| | - H Hauner
- University Hospital Ulm, Ulm, Germany; Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany; Gynecological Clinic Lorenz/Hecker/Wesche, Braunschweig, Germany; Breast Center of Düsseldorf, Luisenkrankenhaus, Düsseldorf, Germany; Onkologie Bethanien, Frankfurt, Germany; Schwerpunktpraxis für Gynäkologische Onkologie, Fürstenwalde, Germany; Ludwig-Maximilians-University Munich, München, Germany; HELIOS University Hospital Wuppertal, Wuppertal, Germany; University Hospital, Heinrich Heine University, Düsseldorf, Düsseldorf, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; Charité - Universitätsmedizin Berlin, Campus Mitte and Benjamin Franklin, Berlin, Germany; Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, München, Germany; University Hospit
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Denzinger V, Busygina K, Jamasbi J, Pekrul I, Spannagl M, Weber C, Lorenz R, Siess W. Optimizing Platelet GPVI Inhibition versus Haemostatic Impairment by the Btk Inhibitors Ibrutinib, Acalabrutinib, ONO/GS-4059, BGB-3111 and Evobrutinib. Thromb Haemost 2019; 119:397-406. [DOI: 10.1055/s-0039-1677744] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AbstractIbrutinib and acalabrutinib are approved for B cell malignancies and novel Bruton's tyrosine kinase (Btk) inhibitors undergo clinical testing also in B cell-driven autoimmune disorders. Btk in platelets mediates platelet activation via glycoprotein (GP) VI, which is crucial for atherosclerotic plaque-induced platelet thrombus formation. This can be selectively inhibited by Btk inhibitors. Since patients on second-generation Btk inhibitors apparently show less bleeding than patients on ibrutinib, we compared the effects of ibrutinib and four novel irreversible Btk inhibitors on GPVI-dependent platelet aggregation in blood and in vitro bleeding time. Low concentrations of collagen which induced the same low degree of GPVI-mediated platelet aggregation as atherosclerotic plaque material were applied. IC50 values for collagen (0.2–0.5 µg/mL)-induced platelet aggregation after 15-minute pre-incubation were: ibrutinib 0.12 µM, BGB-3111 0.51 µM, acalabrutinib 1.21 µM, ONO/GS-4059 1.20 µM and evobrutinib 5.84 µM. Peak venous plasma concentrations of ibrutinib (0.5 µM), acalabrutinib (2 µM) and ONO/GS-4059 (2 µM) measured after anti-proliferative dosage inhibited collagen-induced platelet aggregation, but did not increase PFA-200 closure time on collagen/epinephrine. Closure times were moderately increased by 2- to 2.5-fold higher concentrations of these inhibitors, but not by BGB-3111 (1 µM) and evobrutinib (10 µM). Prolonging platelet drug exposure to 60 minutes lowered IC50 values of any Btk inhibitor for GPVI-mediated aggregation by several fold, and 5- to 10-fold below anti-proliferative therapeutic drug plasma levels. In conclusion, low blood concentrations of ibrutinib and the novel Btk inhibitors suffice for GPVI selective platelet inhibition relevant for atherothrombosis but do not impair primary haemostasis.
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Affiliation(s)
- Viola Denzinger
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
| | - Kristina Busygina
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
| | - Janina Jamasbi
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
| | - Isabell Pekrul
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Michael Spannagl
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Christian Weber
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Reinhard Lorenz
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
| | - Wolfgang Siess
- Institute for Prevention of Cardiovascular Diseases, LMU (Ludwig-Maximilians-University) Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Auerbach S, Lopez R, Gruss V, Lorenz R. DEMENTIA BIASES AMONG INTERNATIONAL HEALTHCARE PROVIDERS: A LITERATURE REVIEW. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - R Lopez
- MGH Institute of Health Professions
| | - V Gruss
- University of Illinois at Chicago
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Köckerling F, Koch A, Adolf D, Keller T, Lorenz R, Fortelny RH, Schug-Pass C. Has Shouldice Repair in a Selected Group of Patients with Inguinal Hernia Comparable Results to Lichtenstein, TEP and TAPP Techniques? World J Surg 2018; 42:2001-2010. [PMID: 29299648 PMCID: PMC5990577 DOI: 10.1007/s00268-017-4433-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Indexed: 01/22/2023]
Abstract
Background In the new international guidelines only the mesh-based Lichtenstein, TEP and TAPP techniques are recommended. This present analysis of data from the Herniamed Registry compares the outcome for Shouldice versus Lichtenstein, TEP and TAPP.
Methods Propensity score matching analyses were performed to obtain homogeneous comparison groups for Shouldice versus Lichtenstein (n = 2115/2608; 81.1%), Shouldice versus TEP (n = 2225/2608; 85.3%) and Shouldice versus TAPP (2400/2608; 92.0%). Results The most important characteristics of the Shouldice patient collective were younger patients with a mean age of 40 years, a large proportion of women of 30%, a mean BMI value of 24 and a proportion of defect sizes up to 3 cm of over 85%. For this selected patient collective, propensity score matched-pair analysis did not identify any difference in the perioperative and one-year follow-up outcome compared with TAPP, fewer intraoperative (0.5 vs. 1.3%; p = 0.009) but somewhat more postoperative complications (2.3 vs. 1.5%; p = 0.050) compared with TEP and advantages with regard to pain at rest (4.6 vs. 6.1%; p = 0.039) and on exertion (10.0 vs. 13.4%; p < 0.001) compared with the Lichtenstein technique. Conclusion For a selected group of patients the Shouldice technique can be used for primary unilateral inguinal hernia repair while achieving an outcome comparable to that of Lichtenstein, TEP and TAPP operations.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A Koch
- Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, 03044, Cottbus, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - T Keller
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - R Lorenz
- 3Surgeons, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - R H Fortelny
- Department of General Surgery Wilhelminenspital, Medical Faculty, Sigmund Freud University, Montleartstrasse 37, 1160, Vienna, Austria
| | - C Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
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Schochter F, Rack B, Fasching PA, Häberle L, Tesch H, Lorenz R, Tzschaschel M, De Gregorio A, Fehm T, Müller V, Schneeweiss A, Lichtenegger W, Beckmann MW, Scholz C, Pantel K, Janni W, Friedl TWP. Nachweis von zirkulierenden Tumorzellen bei Patientinnen mit frühem Brustkrebs fünf Jahre nach adjuvanter Chemotherapie und späte Rezidive – Ergebnisse der SUCCESS A Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Schochter
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - B Rack
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - PA Fasching
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - L Häberle
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - H Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Deutschland
| | - R Lorenz
- Gemeinschaftspraxis Dr. Lorenz, Hecker und Wesche, Braunschweig, Deutschland
| | | | | | - T Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - V Müller
- Universitätsklinikum Hamburg Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen Heidelberg, Heidelberg, Deutschland
| | - W Lichtenegger
- Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Deutschland
| | - C Scholz
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - K Pantel
- Universitätsklinikum Hamburg Eppendorf, Institut für Tumorbiologie, Hamburg, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - TWP Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
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Tzschaschel M, Westernhagen U, Rack B, Schneweiss A, Müller V, Fehm T, Gade J, Lorenz R, Rezai M, Tesch H, Söling U, Polasik A, Schochter F, De Gregorio A, Mahner S, Schindlbeck C, Beckmann M, Fasching P, Janni W, Friedl TW. Gibt es einen Zusammenhang zwischen BMI und dem Nachweis von CTCs bei Patientinnen mit frühem Hochrisiko Mammakarzinom? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | - B Rack
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - A Schneweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - V Müller
- Universitätsklinikum Hamburg Eppendorf, Klinik und Poliklinik für Gynäkologie, Hamburg, Deutschland
| | - T Fehm
- Klinikum der Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - J Gade
- Diakoniekrankenhaus Friederikenstift, Klinik für Gynäkologie, Hannover, Deutschland
| | - R Lorenz
- Gemeinschaftspraxis Dr. Lorenz, Hecker und Wesche, Braunschweig, Deutschland
| | - M Rezai
- Luisenkrankenhaus Düsseldorf, Klinik für Gynäkologie und Geburtshilfe, Düsseldorf, Deutschland
| | - H Tesch
- Onkologische Gemeinschaftspraxis, Frankfurt, Deutschland
| | - U Söling
- Gemeinschaftspraxis Siehl und Soeling, Kassel, Deutschland
| | - A Polasik
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - F Schochter
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | | | - S Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Schindlbeck
- Klinikum Traunstein, Frauenklinik, Traunstein, Deutschland
| | - M Beckmann
- Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - P Fasching
- Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - W Janni
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
| | - TW Friedl
- Universitätsfrauenklinik Ulm, Ulm, Deutschland
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Ignatiadis M, Litière S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Trastuzumab versus observation for HER2 nonamplified early breast cancer with circulating tumor cells (EORTC 90091-10093, BIG 1-12, Treat CTC): a randomized phase II trial. Ann Oncol 2018; 29:1777-1783. [DOI: 10.1093/annonc/mdy211] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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35
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Auerbach S, Lorenz R, Thomas FP. 1034 Discordance Between Subjective And Objective Measures Of Sleep Among Adults With Multiple Sclerosis. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1033] [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: 11/12/2022] Open
Affiliation(s)
| | - R Lorenz
- University at Buffalo, Buffalo, NY
| | - F P Thomas
- Seton Hall-Hackensack Meridian School of Medicine, South Orange, NJ
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36
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Hüwe C, Schmeichel J, Brodkorb F, Dohlen S, Kalbfleisch K, Kreyenschmidt M, Lorenz R, Kreyenschmidt J. Potential of antimicrobial treatment of linear low-density polyethylene with poly((tert-butyl-amino)-methyl-styrene) to reduce biofilm formation in the food industry. Biofouling 2018; 34:378-387. [PMID: 29663827 DOI: 10.1080/08927014.2018.1453926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Antimicrobial surfaces are one approach to prevent biofilms in the food industry. The aim of this study was to investigate the effect of poly((tert-butyl-amino)-methyl-styrene) (poly(TBAMS)) incorporated into linear low-density polyethylene (LLDPE) on the formation of mono- and mixed-species biofilms. The biofilm on untreated and treated LLDPE was determined after 48 and 168 h. The comparison of the results indicated that the ability of Listeria monocytogenes to form biofilms was completely suppressed by poly(TBAMS) (Δ168 h 3.2 log10 cfu cm-2) and colonization of Staphylococcus aureus and Escherichia coli was significantly delayed, but no effect on Pseudomonas fluorescens was observed. The results of dual-species biofilms showed complex interactions between the microorganisms, but comparable effects on the individual bacteria by poly(TBAMS) were identified. Antimicrobial treatment with poly(TBAMS) shows great potential to prevent biofilms on polymeric surfaces. However, a further development of the material is necessary to reduce the colonization of strong biofilm formers.
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Affiliation(s)
- Carina Hüwe
- a Faculty of Agriculture, Institute of Nutritional and Food Sciences, Food Processing Engineering , University of Bonn , Bonn , Germany
| | - Jennifer Schmeichel
- a Faculty of Agriculture, Institute of Nutritional and Food Sciences, Food Processing Engineering , University of Bonn , Bonn , Germany
| | - Florian Brodkorb
- b Department of Chemical Engineering , University of Applied Sciences Münster , Steinfurt , Germany
| | - Sophia Dohlen
- a Faculty of Agriculture, Institute of Nutritional and Food Sciences, Food Processing Engineering , University of Bonn , Bonn , Germany
| | - Katrin Kalbfleisch
- b Department of Chemical Engineering , University of Applied Sciences Münster , Steinfurt , Germany
| | - Martin Kreyenschmidt
- b Department of Chemical Engineering , University of Applied Sciences Münster , Steinfurt , Germany
| | - Reinhard Lorenz
- b Department of Chemical Engineering , University of Applied Sciences Münster , Steinfurt , Germany
| | - Judith Kreyenschmidt
- a Faculty of Agriculture, Institute of Nutritional and Food Sciences, Food Processing Engineering , University of Bonn , Bonn , Germany
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37
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Ignatiadis M, Litiere S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Abstract P1-13-09: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- M Ignatiadis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Litiere
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - F Rothe
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Riethdorf
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Proudhon
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - T Fehm
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Aalders
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - H Forstbauer
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Fasching
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Brain
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Vuylsteke
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Guardiola
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - R Lorenz
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Pantel
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Tryfonidis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - W Janni
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - M Piccart
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Sotiriou
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - B Rack
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - J-Y Pierga
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
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Möbus V, Mahlberg R, Janni W, Tomé O, Marmé F, Forstbauer H, Reimer T, von der Assen A, Reinisch M, Lorenz R, Schmatloch S, Schmidt M, Sinn B, Klutinus N, Stickeler E, Untch M, Seiler S, Burchardi N, von Minckwitz G, Loibl S. Abstract P5-20-09: Pharmacokinetic results of a subcutaneous injection of trastuzumab into the thigh versus into the abdominal wall in patients with HER2-positive primary breast cancer (BC) treated within the neo-/adjuvant GAIN-2 study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-09] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
A new subcutaneous (s.c.) formulation of trastuzumab became available in 2013 based on equivalent efficacy, pharmacokinetic (PK) profile and safety with the standard intravenous (i.v.) administration, where the s.c. trastuzumab was administered only into the thigh. As an s.c. injection into the abdominal wall (abdw) might be more convenient for patients (pts) and health care professionals, the PK profile of s.c. trastuzumab injected into the thigh vs the abdw in pts with HER2+ early BC needs to be evaluated.
Methods
GAIN-2 study compared two intense dose-dense (idd) anthracycline/taxane containing regimens. After completion of the anthracycline and i.v. trastuzumab given concurrently with taxanes, HER2+ BC pts were randomized in a 1:1 ratio to continue adjuvant s.c. trastuzumab 600mg fixed dose injected every 3 weeks either into the thigh or the abdw. Randomization was stratified according to CT arm [(iddEnPC) vs tailored dd CT (dtEC-dtD)] and age (≤50 vs >50). Pts in the EnPC arm received 14 and in the dtEC-dtD arm 15 cycles of s.c. trastuzumab.
For the PK profile of s.c. trastuzumab serum samples collected before cycle 7, on days 2, 4, 8, 15 and 21 of cycle 7 are evaluated. With a total sample size of 30 (15 per group), the simulated 90% two-sided CI for the area under the plasma concentration (AUC0-last) will be (0.79-1.27) and for the peak drug concentration (Cmax) will be (0.77-1.30). Allowing for a dropout rate of 15%, 18 pts per group will be included in the PK analysis.
The primary objective was to assess the PK profile of s.c. trastuzumab injected into the thigh vs the abdw. The secondary objectives included safety and tolerability.
Results
The per-protocol (pp) set consists of 30 pts (17 in the thigh group and 13 in the abdw group). Baseline characteristics were well balanced between the groups. The log-transformed Geometric Least Square Means (GLSM) for Cmax were 11.77 and 11.52 in the thigh and the abdw group, respectively. The geo-mean ratio (on the original scale) for Cmax was 1.29 (90% CI 1.05-1.58). The log-transformed GLSM for AUC0-last were 14.54 and 14.28 in the thigh and the abdw group, respectively. The geo-mean ratio for AUC0-last was 1.29 (90% CI 1.02-1.63).
Overall 29 pts (96.7%) reported any grade and 5 pts (16.7%) high grade adverse events (AEs). The incidence of any grade AEs was similar between the two groups. The most common AEs were anemia (70.6% for the thigh vs 61.5% for the abdw group, p=0.705), leukopenia (80.0% for both groups, p=1.000) and fatigue (47.1% for the thigh vs 76.9% for the abdw group, p=0.141). 6 serious AEs were reported (2 in the thigh vs 4 in the abdw group). The final PK results of s.c. trastuzumab will be presented at the meeting.
Conclusions
Bioavailability of s.c. trastuzumab as reflected by peak and total exposure measured in cycle 7 was approx. 30% higher if administered into the thigh than into the abdw in pts with HER2+ primary BC treated after dose-dense CT plus i.v. trastuzumab. However, no increased toxicity was observed. Study limitations were that no cross-over design was used and number of pts satisfying criteria for pp-set were different in the arms.
Citation Format: Möbus V, Mahlberg R, Janni W, Tomé O, Marmé F, Forstbauer H, Reimer T, von der Assen A, Reinisch M, Lorenz R, Schmatloch S, Schmidt M, Sinn B, Klutinus N, Stickeler E, Untch M, Seiler S, Burchardi N, von Minckwitz G, Loibl S. Pharmacokinetic results of a subcutaneous injection of trastuzumab into the thigh versus into the abdominal wall in patients with HER2-positive primary breast cancer (BC) treated within the neo-/adjuvant GAIN-2 study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-09.
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Affiliation(s)
- V Möbus
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - R Mahlberg
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - W Janni
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - O Tomé
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - F Marmé
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - H Forstbauer
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - T Reimer
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - A von der Assen
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Reinisch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - R Lorenz
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Schmatloch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Schmidt
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - B Sinn
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - N Klutinus
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - E Stickeler
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - M Untch
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Seiler
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - N Burchardi
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - G von Minckwitz
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
| | - S Loibl
- Klinikum Frankfurt; Klinikum Mutterhaus Mitte, Trier; Universitätsklinikum Ulm; St. Vincentius-Kliniken gAG, Karlsruhe; Universitätsklinikum Heidelberg; GOSPL - Gesellschaft für Onkologische Studien, Troisdorf; Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock; Franziskus-Hospital Harderberg; Kliniken Essen-Mitte; Frauenärztl. Gemeinschafts- u. Schwerpunktpraxis Onkologie, Braunschweig; Elisabeth Krankenhaus Kassel; Universitätsmedizin Mainz; Charité - Universitätsmedizin Berlin; HELIOS Klinikum Pforzheim GmbH Brustzentrum; Universitätsklinikum Freiburg; HELIOS Klinikum Berlin Buch; German Breast Group
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Lorenz R. Do we really need a renaissance of pure tissue repair? Invited comment to: Desarda's technique versus Lichtenstein technique for the treatment of primary inguinal hernia: a systematic review and meta-analysis of randomized controlled trials. Emile S, Elfeki H. Hernia 2018; 22:397-398. [PMID: 29392507 DOI: 10.1007/s10029-018-1742-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/20/2018] [Indexed: 12/21/2022]
Affiliation(s)
- R Lorenz
- 3+ Surgeons Herniacenter, Klosterstrasse 34/35, 13581, Berlin, Germany.
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Ebrahim M, Jamasbi J, Adler K, Megens R, M'Bengue Y, Blanchet X, Uhland K, Ungerer M, Brandl R, Weber C, Elia N, Lorenz R, Münch G, Siess W. Dimeric Glycoprotein VI Binds to Collagen but Not to Fibrin. Thromb Haemost 2018; 118:351-361. [DOI: 10.1160/th17-04-0302] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPlatelet glycoprotein VI (GPVI) acts as a decisive collagen receptor in atherothrombosis. Besides collagen, injured atherosclerotic plaques expose tissue factor (TF) that triggers fibrin formation. Two recent studies reported that platelet GPVI also functions as fibrin receptor, which would importantly widen the mode of action of GPVI-targeted antithrombotic drugs. We studied the binding of two GPVI fusion proteins to fibrin under static and arterial flow conditions. Fibrin was prepared from purified fibrinogen or generated more physiologically from endogenous fibrinogen by coagulating plasma with thrombin. Fibrin formation was also triggered by exposing TF-coated surfaces or human atherosclerotic plaque slices to arterially flowing blood. By binding studies and advanced optical imaging, we found that recombinant dimeric GPVI-Fc fusion proteins with Fc from either IgG1 (GPVI-Fc1) or IgG2 (GPVI-Fc2) bound to collagen fibres, but neither to fibrin prepared from purified fibrinogen obtained from three suppliers, nor to physiological fibrin formed by thrombin in plasma or triggered by exposing TF or atherosclerotic plaque slices to arterially flowing blood. Our findings do not support a role of dimeric platelet GPVI as receptor for fibrin. This is important for the understanding of plaque-triggered platelet thrombus formation and is clinically relevant for future GPVI-targeting therapies with recombinant GPVI-Fc and anti-GPVI antibodies.
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Dietlein M, Reiners C, Lorenz R. Nuclear medical inpatient treatment in Germany. Nuklearmedizin 2018; 49:49-57. [DOI: 10.3413/nukmed-0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 02/19/2010] [Indexed: 11/20/2022]
Abstract
SummaryAll public licensed hospitals of Germany are obligated since 2004 to establish and to publish a structured biennial quality report. The aim of this study was to analyse the quality reports from 2008 of clinics with nuclear-medicine therapy ward and to investigate developments for the inpatient nuclear-medicine therapy by comparing the results with the quality reports of the years 2004 and 2006. Methods: All available structured quality reports of clinics with a nuclear-medicine therapy ward of the years 2004, 2006 and 2008 were evaluated. Results: The total number of inpatient treatment cases in 2008 amounted to 54 190 (2006: 54 884; 2004: 57 366). This corresponds to a decrease of 5.5% in comparison to 2004. The number of the therapy wards decreased at the same time to currently 117 (2006: 120; 2004: 124). Remarkable changes were found in the spectrum of the main diagnosis. Thus, the most frequent diagnosis with the ICD-code E05 (hyperthyroidism) decreased continuously from 37 747 treatments in 2004 and 34 764 in 2006 to 31 756 in the year 2008. In contrast, the ICD-diagnoses for thyroid cancer (C73, Z08) with 14 761 cases in 2008 increased with time (2006: 13 426; 2004: 12 581). Conclusions: In analogy to the observations from Europe after introduction of an iodine prophylaxis the improved iodine supply in Germany has led to a decline of the radioiodine therapy due to hyperthyroidism.
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Buck A, Reiners C, Lorenz R. Stationäre nuklearmedizinische Therapie 2010 bis 2012 in Deutschland. Nuklearmedizin 2017; 54:61-8. [DOI: 10.3413/nukmed-0725-15-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 11/20/2022]
Abstract
ZusammenfassungDas Ziel dieser Analyse war es, deutschlandweite Daten über den Status und die Entwicklung der stationären nuklearmedizinischen Therapie zu ermitteln. Als Datenquelle wurden die gesetzlichen Qualitätsberichte der Krankenhäuser verwendet. Methodik: Die vom Gemeinsamen Bundesausschuss (G-BA) aus den maschinenverwertbaren XML-Daten der Qualitätsberichte erstellten Referenzberichte aller Kliniken Deutschlands mit nuklearmedizinischer Therapiestation wurden für die Jahre 2010 und 2012 analysiert. Für die Beurteilung der längerfristigen Entwicklung dienten Ergebnisse aus eigenen Voruntersuchungen der strukturierten Qualitätsberichte für die Jahre 2004, 2006 und 2008. Zur Ermittlung der deutschlandweiten Häufigkeit von Schilddrüsenoperationen und der Radioiodtherapie wurden öffentliche Datenbanken des Instituts für das Entgeltsystem im Krankenhaus (InEK) für die Jahre 2004 bis 2012 ausgewertet. Ergebnisse: Die Gesamtzahl der stationären nuklearmedizinischen Behandlungsfälle hat von 2010 mit 50 363 Patienten bis 2012 auf 47 314 Patienten gering abgenommen. Im längeren Verlauf von 2004 bis 2012 findet sich ein deutlicher Rückgang der Fälle von 17,5%. Der Rückgang ist vor allem durch eine Abnahme an Erkrankungen mit Hyperthyreose (ICD-Code E05) bedingt. Seit 2009 ist auch die Anzahl der Schilddrüsenoperationen rückläufig. Ein moderater Anstieg der Fallzahlen von 23,7% zeigt sich für die Diagnose Schilddrüsenkarzinom (ICD-Code C73) von 2004 bis 2012. Schlussfolgerungen: Vermutlich führt die verbesserte Iodversorgung in Deutschland zu einem Rückgang an stationären Patienten mit Hyperthyreose in der Nuklearmedizin und in der Folge zu einer Abnahme sowohl der Anzahl an Radioiodtherapien als auch der Schilddrüsenoperationen in der Chirurgie. Im Gegensatz hierzu ist die Anzahl der Patienten mit der Diagnose Schilddrüsenkarzinom auf nuklearmedizinischen Therapiestationen moderat ansteigend, dies korreliert mit der weltweit zu beobachtenden Steigerung der Inzidenz des Schilddrüsenkarzinoms.
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Mojica Muñoz AK, Jamasbi J, Uhland K, Degen H, Münch G, Ungerer M, Brandl R, Megens R, Weber C, Lorenz R, Siess W. Recombinant GPVI-Fc added to single or dual antiplatelet therapy in vitro prevents plaque-induced platelet thrombus formation. Thromb Haemost 2017; 117:1651-1659. [DOI: 10.1160/th16-11-0856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/04/2017] [Indexed: 11/05/2022]
Abstract
SummaryThe efficiency of current dual antiplatelet therapy might be further improved by its combination with a glycoprotein (GP) VI-targeting strategy without increasing bleeding. GPVI-Fc, a recombinant dimeric fusion protein binding to plaque collagen and concealing binding sites for platelet GPVI, acts as a lesion-focused antiplatelet drug, and does not increase bleeding in vivo. We investigated, whether GPVI-Fc added in vitro on top of acetylsalicylic acid (ASA), the P2Y12 antagonist ticagrelor, and the fibrinogen receptor antagonist abciximab alone or in combination would increase inhibition of platelet activation by atherosclerotic plaque. Under static conditions, GPVI-Fc inhibited plaque-induced platelet aggregation by 53%, and increased platelet inhibition by ASA (51%) and ticagrelor (64%) to 66% and 80%, respectively. Under arterial flow, GPVI-Fc inhibited plaque-induced platelet aggregation by 57%, and significantly increased platelet inhibition by ASA (28%) and ticagrelor (47%) to about 81% each. The triple combination of GPVI-Fc, ASA and ticagrelor achieved almost complete inhibition of plaque-induced platelet aggregation (93%). GPVI-Fc alone or in combination with ASA or ticagrelor did not increase closure time measured by the platelet function analyzer (PFA)-200. GPVI-Fc added on top of abciximab, a clinically used anti-fibrinogen receptor antibody which blocks platelet aggregation, strongly inhibited total (81%) and stable (89%) platelet adhesion. We conclude that GPVI-Fc added on top of single or dual antiplatelet therapy with ASA and/or a P2Y12 antagonist is likely to improve anti-atherothrombotic protection without increasing bleeding risk. In contrast, the strong inhibition of platelet adhesion by GPVI-Fc in combination with GPIIb/IIIa inhibitors could be harmful.Note: The review process for this manuscript was fully handled by Gregory Y. H. Lip, Editor in Chief.Supplementary Material to this article is available at www.thrombosis-online.com.
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Ross R, Koyfman S, Houston N, Reddy C, Joshi N, Woody N, Scharpf J, Prendes B, Lamarre E, Lorenz R, Chute D, Geiger J, Burkey B, Adelstein D, Ward M. A Matched Pair Analysis of Patients With HPV-Associated Carcinoma of Unknown Primary With T1-2 HPV-Associated Oropharynx Cancer: Implications for Clinical Trial Design. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dohlen S, Braun C, Brodkorb F, Fischer B, Ilg Y, Kalbfleisch K, Lorenz R, Kreyenschmidt M, Kreyenschmidt J. Effect of different packaging materials containing poly-[2-(tert-butylamino) methylstyrene] on the growth of spoilage and pathogenic bacteria on fresh meat. Int J Food Microbiol 2017. [DOI: 10.1016/j.ijfoodmicro.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Degen H, Borst O, Ziegler M, Mojica Munoz AK, Jamasbi J, Walker B, Göbel S, Fassbender J, Adler K, Brandl R, Münch G, Lorenz R, Siess W, Gawaz M, Ungerer M. ADPase CD39 Fused to Glycoprotein VI-Fc Boosts Local Antithrombotic Effects at Vascular Lesions. J Am Heart Assoc 2017; 6:JAHA.117.005991. [PMID: 28751543 PMCID: PMC5586441 DOI: 10.1161/jaha.117.005991] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND GPVI (Glycoprotein VI) is the essential platelet collagen receptor in atherothrombosis. Dimeric GPVI-Fc (Revacept) binds to GPVI binding sites on plaque collagen. As expected, it did not increase bleeding in clinical studies. GPVI-Fc is a potent inhibitor of atherosclerotic plaque-induced platelet aggregation at high shear flow, but its inhibition at low shear flow is limited. We sought to increase the platelet inhibitory potential by fusing GPVI-Fc to the ectonucleotidase CD39 (fusion protein GPVI-CD39), which inhibits local ADP accumulation at vascular plaques, and thus to create a lesion-directed dual antiplatelet therapy that is expected to lack systemic bleeding risks. METHODS AND RESULTS GPVI-CD39 effectively stimulated local ADP degradation and, compared with GPVI-Fc alone, led to significantly increased inhibition of ADP-, collagen-, and human plaque-induced platelet aggregation in Multiplate aggregometry and plaque-induced platelet thrombus formation under arterial flow conditions. GPVI-CD39 did not increase bleeding time in an in vitro assay simulating primary hemostasis. In a mouse model of ferric chloride-induced arterial thrombosis, GPVI-CD39 effectively delayed vascular thrombosis but did not increase tail bleeding time in vivo. CONCLUSIONS GPVI-CD39 is a novel approach to increase local antithrombotic activity at sites of atherosclerotic plaque rupture or injury. It enhances GPVI-Fc-mediated platelet inhibition and presents a potentially effective and safe molecule for the treatment of acute atherothrombotic events, with a favorable risk-benefit ratio.
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Affiliation(s)
| | - Oliver Borst
- Medical Clinic III, University of Tübingen, Germany
| | | | | | - Janina Jamasbi
- IPEK - Institute for Prevention of Cardiovascular Diseases, University of Munich, Germany
| | | | | | | | | | - Richard Brandl
- St. Mary's Square Institute for Vascular Surgery and Phlebology, Munich, Germany
| | - Götz Münch
- advanceCOR - Procorde, Martinsried, Germany
| | - Reinhard Lorenz
- IPEK - Institute for Prevention of Cardiovascular Diseases, University of Munich, Germany
| | - Wolfgang Siess
- IPEK - Institute for Prevention of Cardiovascular Diseases, University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Munich Heart Alliance, Munich, Germany
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Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Abstract P2-05-02: Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
The prognosis of patients with early breast cancer is commonly estimated by prognostic factors obtained at the time of the initial diagnosis. However, patients and physicians alike are seeking for factors evaluating the prognosis years thereafter during follow-up. The identification of a patient group with an unfavourable prognosis could lead to secondary treatment intervention, potentially improving outcome. Aim of the study was to assess the added prognostic value of circulating tumor cells (CTCs) and CA27.29 beyond established predictors.
Materials and Methods
Patients of the phase III SUCCESS-A study were included into this analysis (n=1005). SUCCESS-A is a chemotherapy study for high risk patients with a comprehensive translational research program, which included the determination of CTCs and CA27.29 two years after the initial diagnosis. A Cox regression model with disease-free survival (DFS) as outcome and well-established predictors (age, BMI, pT, pN, histology, grading, ER, PR, Her2neu) was compared with an extended Cox model with the well-established predictors and additionally CTC (>0 versus 0) two years after randomization, and CA27.29 (in U/mL) measured after chemotherapy and again two years after randomization using a likelihood ratio test. In case of significance, the extended model was applied to predict for each patient the risk of disease recurrence within the next 12 months (0 to 100%). Cross-validated AUC, sensitivity and specificity values were determined to assess clinical usefulness of risk prediction.
Results
The markers CA27.29 and CTC were both significantly associated with subsequent prognosis (p < 0.000001). The detection of CTCs increased the risk of subsequent DFS events (HR=2.14, 95%CI: 1.31-3.48), while CA27.29 after two years increased the risk for DFS events with a HR of 1.12 per U/mL increase (95%CI: 1.09-1.15). The combination of the two markers significantly empowered the prognostic relevance, with a HR of 6.64 for patients with CTCs and an elevated CA27.29 by 10 U/mL compared to patients without CTCs and without CA27.29 elevation. The mean risk of disease recurrence in the third year after randomization was 2.38%. Discrimination of patients with and without disease recurrence based on risk prediction from the extended Cox model (AUC: 0.80) was better than discrimination based on the clinical model without the markers CTC and CA27.29 (AUC: 0.64). Sensitivity with regard to decision thresholds 1%, 2%, 3%, and 4% predicted risk was 0.89, 0.77, 0.65, and 0.55, respectively. The corresponding specificity was 0.42, 0.69, 0.81, and 0.88.
Discussion
Both CTCs and CA29.27 values determined 2 years after primary diagnosis are clinically relevant predictors of subsequent prognosis for those patients. This study extends evidence for active surveillance of breast cancer survivors. Identifying a group of women with a high recurrence risk after two years could be the basis for the development of secondary adjuvant treatment.
Citation Format: Janni W, Rack B, Häberle L, Friedl TWP, Tesch H, Lorenz R, Jäger B, Fehm T, Müller V, Schneeweiß A, Lichtenegger W, Blohmer J, Beckmann MW, Scholz C, Pantel K, Trapp E, Fasching PA. Active surveillance with a combination of tumor marker CA27.29 and detection of circulating tumor cells two year after primary diagnosis strongly predicts subsequent prognosis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-02.
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Affiliation(s)
- W Janni
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Rack
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - L Häberle
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - H Tesch
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - R Lorenz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - A Schneeweiß
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - W Lichtenegger
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - J Blohmer
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - MW Beckmann
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - C Scholz
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - K Pantel
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - E Trapp
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; University of Munich, Munich, Germany; University of Erlangen, Erlangen, Germany; Onkologische Praxisklinik, Frankfurt, Germany; Onkologische Praxisklinik, Braunschweig, Germany; Heinrich-Heine-University, Duesseldorf, Germany; Universitätsklinikum Eppendorf, Hamburg, Germany; University of Heidelberg, Heidelberg, Germany; Charite University Hospital, Berlin, Germany
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Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Abstract P1-01-03: Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The presence of circulating tumor cells (CTCs) before chemotherapy is known to be associated with reduced disease free survival (DFS) and overall survival (OS) in early breast cancer (EBC). In addition, recent findings suggest that CTCs persisting after adjuvant chemotherapy indicate poor prognosis. In an explorative analysis of the SUCCESS A trial, we evaluated the prognostic relevance of changes in CTC counts during the course of adjuvant chemotherapy across molecular subtypes to assess whether the prognostic role of persisting CTCs varies according to tumor biology.
Methods: The SUCCESS A trial is a phase III study, where patients with high-risk EBC (stage pN1-3 or pT2-4 or grade 3 or age ≤ 35 or hormone-receptor negative) were randomized to adjuvant chemotherapy with 3 cycles of epirubicin-fluorouracil-cyclophosphamide followed by either 3 cycles of docetaxel or 3 cycles of gemcitabine-docetaxel. CTC enumeration was performed before and after chemotherapy using the FDA-approved CellSearch® System (Janssen Diagnostics, LLC), and CTC positivity was defined as ≥ 1 CTC in 23 ml blood. Molecular subtypes were defined as luminal A like (hormone-receptor positive, grading 1 or 2), luminal B like (hormone-receptor positive, grading 3), triple-negative or HER2-positive. Patient outcome in terms of DFS and OS was analyzed using univariate log-rank tests and Cox regression models (median follow-up time 65.2 months).
Results: Data on both molecular subtypes and CTC status before and after chemotherapy were available for 1485 (39.6%) of 3754 patients randomized. This cohort contained 577 (38.9%) luminal A like, 236 (15.9%) luminal B like, 379 (25.5%) HER2-positive and 293 (19.7%) triple negative tumors. Overall, 917 (61.8%) patients were CTC negative before and after chemotherapy (neg/neg), 260 (17.5%) patients had a negative CTC status before and a positive CTC status after chemotherapy (neg/pos), 229 (15.4%) patients converted from positive to negative CTC status (pos/neg), and 79 (5.3%) patients were positive for CTCs at both time points (pos/pos). There were significant differences in DFS and OS among these four groups in patients with luminal A like tumors (log rank test, both p < 0.003) and patients with luminal B like tumors (log rank test, both p < 0.001). In both patients with luminal A like or luminal B like tumors, persistently CTC positive patients had the worst outcome (relative to persistently CTC-negative patients) in terms of DFS and OS. In contrast to luminal-like tumors, no significant differences with regard to DFS or OS were found among the four groups (neg/neg, neg/pos, pos/neg, pos/pos) in patients with HER2-positive or triple-negative tumors (log rank test, all p > 0.13).
Conclusion: The presence of CTCs both before and after adjuvant chemotherapy was associated with poor survival in luminal A like and luminal B like tumors, but not in HER2-positive or triple-negative tumors. Further research is needed to evaluate the effect of chemotherapy on CTC prevalence in different molecular subtypes of EBC.
Citation Format: Tzschaschel MLJ, Rack B, Andergassen U, Friedl TWP, Schneeweiss A, Mueller V, Tanja F, Pantel K, Gade J, Lorenz R, Rezai M, Tesch H, Soeling U, Polasik A, Alunni-Fabbroni M, Trapp EK, Mahner S, Schindlbeck C, Lichtenegger W, Beckmann MW, Fasching PA, Janni W. Dynamics of circulating tumor cells during the course of chemotherapy and prognostic relevance across molecular subtypes in high-risk early breast cancer patients – Results from the adjuvant SUCCESS A trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-03.
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Affiliation(s)
- MLJ Tzschaschel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - B Rack
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Andergassen
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - TWP Friedl
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Schneeweiss
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - V Mueller
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - F Tanja
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - K Pantel
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - J Gade
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - R Lorenz
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Rezai
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - H Tesch
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - U Soeling
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - A Polasik
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - M Alunni-Fabbroni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - EK Trapp
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - S Mahner
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - C Schindlbeck
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Lichtenegger
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - MW Beckmann
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - PA Fasching
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
| | - W Janni
- Ludwig Maximilians Universitaet Muenchen Klinik und Poliklinik fuer Frauenheilkunde und Gerburtshilfe, Munich, Germany; University Hospital Ulm, Ulm, Germany; National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany; Universitaetsklinikum Hamburg-Eppendorf, Hamburg, Germany; Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Diakoniekrankenhaus Friederikenstift, Hannover, Germany; Gemeinschaftspraxis Dr. Lorenz, Hecker, Wesche, Braunschweig, Germany; Luisenkrankenhaus Duesseldorf, Duesseldorf, Germany; Onkologische Gemeinschaftspraxis am Betahnien-Krankenhaus, Frankfurt, Germany; Gemeinschaftspraxis Siehl und Soeling, Cassel, Germany; Clinical Center Traunstein, Traunstein, Germany; Charité University Hospital Campus Virchow, Berlin, Germany; University Hospital Erlangen, Friedrich-Alexander, Erlangen, Germany
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Lorenz R, Stechemesser B, Reinpold W, Fortelny R, Mayer F, Schröder W, Köckerling F. Development of a standardized curriculum concept for continuing training in hernia surgery: German Hernia School. Hernia 2016; 21:153-162. [PMID: 28032227 DOI: 10.1007/s10029-016-1566-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/03/2016] [Accepted: 12/17/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The increasingly more complex nature of hernia surgery means that training programs for young surgeons must now meet ever more stringent requirements. There is a growing demand for improved structuring and standardization of education and training in hernia surgery. MATERIALS AND METHODS In 2011, the concept of a Hernia School was developed in Germany and has been gradually implemented ever since. That concept comprises the following series of interrelated, tiered course elements: Hernie kompakt (Hernia compact), Hernie konkret (Hernia concrete), and Hernie complex (Hernia complex). All three course elements make provision for structured clinical training based on guest visits to approved hernia centers. The Hernia compact basic course imparts knowledge of anatomy working with fresh cadavers. Hernia surgery procedures can also be conducted using unfixed specimens. Knowledge of abdominal wall ultrasound diagnostics is also imparted and hernia surgery procedures simulated on pelvic trainers. In all three course elements, lectures are delivered by experts across the entire field of hernia surgery using evidence-based practices from the literature. RESULTS To date, eight Hernie kompakt (Hernia compact) courses have been conducted, in each case with up to 55 participants, and with a total of 390 participants. On evaluating the course, over 95% of participants expressed the view that the Hernia compact course content improved hernia surgery training. Following that positive feedback, the more advanced Hernie konkret (Hernia concrete) and Hernie complex (Hernia complex) course elements were introduced in 2016. CONCLUSION The experiences gained to date since the introduction of a Hernia School-a standardized curriculum concept for continuing training in hernia surgery-has been evaluated by participants as an improvement on hitherto hernia surgery training.
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Affiliation(s)
- R Lorenz
- 3 + Surgeons, Klosterstrasse 34/35, 13581, Berlin, Germany.
| | - B Stechemesser
- Hernia Center Cologne, PAN-Hospital, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - W Reinpold
- Department of Surgery and Hernia Center, Wilhelmsburg Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R Fortelny
- Department of General-, Visceral- and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - W Schröder
- Professional Association of German Surgeons, BDC-Academy, Langenbeck-Virchow-Haus, Luisenstraße 58/59, 10117, Berlin, Germany
| | - F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
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