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More TH, Mozafari B, Märtens A, Herr C, Lepper PM, Danziger G, Volk T, Hoersch S, Krawczyk M, Guenther K, Hiller K, Bals R. Plasma Metabolome Alterations Discriminate between COVID-19 and Non-COVID-19 Pneumonia. Metabolites 2022; 12:1058. [PMID: 36355140 PMCID: PMC9693035 DOI: 10.3390/metabo12111058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 03/10/2024] Open
Abstract
Pneumonia is a common cause of morbidity and mortality and is most often caused by bacterial pathogens. COVID-19 is characterized by lung infection with potential progressive organ failure. The systemic consequences of both disease on the systemic blood metabolome are not fully understood. The aim of this study was to compare the blood metabolome of both diseases and we hypothesize that plasma metabolomics may help to identify the systemic effects of these diseases. Therefore, we profiled the plasma metabolome of 43 cases of COVID-19 pneumonia, 23 cases of non-COVID-19 pneumonia, and 26 controls using a non-targeted approach. Metabolic alterations differentiating the three groups were detected, with specific metabolic changes distinguishing the two types of pneumonia groups. A comparison of venous and arterial blood plasma samples from the same subjects revealed the distinct metabolic effects of pulmonary pneumonia. In addition, a machine learning signature of four metabolites was predictive of the disease outcome of COVID-19 subjects with an area under the curve (AUC) of 86 ± 10 %. Overall, the results of this study uncover systemic metabolic changes that could be linked to the etiology of COVID-19 pneumonia and non-COVID-19 pneumonia.
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Affiliation(s)
- Tushar H. More
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Bahareh Mozafari
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Andre Märtens
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Christian Herr
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Guy Danziger
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, 66421 Homburg, Germany
| | - Sabrina Hoersch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, 66421 Homburg, Germany
| | - Marcin Krawczyk
- Department of Internal Medicine II-Gastroenterology, Saarland University, 66421 Homburg, Germany
| | - Katharina Guenther
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
| | - Karsten Hiller
- Department of Bioinformatics and Biochemistry, Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, 66421 Homburg, Germany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, 66123 Saarbrücken, Germany
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Herr C, Mang S, Mozafari B, Guenther K, Speer T, Seibert M, Srikakulam SK, Beisswenger C, Ritzmann F, Keller A, Mueller R, Smola S, Eisinger D, Zemlin M, Danziger G, Volk T, Hoersch S, Krawczyk M, Lammert F, Adams T, Wagenpfeil G, Kindermann M, Marcu C, Ataya ZWD, Mittag M, Schwarzkopf K, Custodis F, Grandt D, Schaefer H, Eltges K, Lepper PM, Bals R. Distinct Patterns of Blood Cytokines Beyond a Cytokine Storm Predict Mortality in COVID-19. J Inflamm Res 2021; 14:4651-4667. [PMID: 34552347 PMCID: PMC8451220 DOI: 10.2147/jir.s320685] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/18/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background COVID-19 comprises several severity stages ranging from oligosymptomatic disease to multi-organ failure and fatal outcomes. The mechanisms why COVID-19 is a mild disease in some patients and progresses to a severe multi-organ and often fatal disease with respiratory failure are not known. Biomarkers that predict the course of disease are urgently needed. The aim of this study was to evaluate a large spectrum of established laboratory measurements. Patients and Methods Patients from the prospective PULMPOHOM and CORSAAR studies were recruited and comprised 35 patients with COVID-19, 23 with conventional pneumonia, and 28 control patients undergoing elective non-pulmonary surgery. Venous blood was used to measure the serum concentrations of 79 proteins by Luminex multiplex immunoassay technology. Distribution of biomarkers between groups and association with disease severity and outcomes were analyzed. Results The biomarker profiles between the three groups differed significantly with elevation of specific proteins specific for the respective conditions. Several biomarkers correlated significantly with disease severity and death. Uniform manifold approximation and projection (UMAP) analysis revealed a significant separation of the three disease groups and separated between survivors and deceased patients. Different models were developed to predict mortality based on the baseline measurements of several protein markers. A score combining IL-1ra, IL-8, IL-10, MCP-1, SCF and CA-9 was associated with significantly higher mortality (AUC 0.929). Discussion Several newly identified blood markers were significantly increased in patients with severe COVID-19 (AAT, EN-RAGE, myoglobin, SAP, TIMP-1, vWF, decorin) or in patients that died (IL-1ra, IL-8, IL-10, MCP-1, SCF, CA-9). The use of established assay technologies allows for rapid translation into clinical practice.
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Affiliation(s)
- Christian Herr
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Sebastian Mang
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Bahareh Mozafari
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Katharina Guenther
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV - Nephrology and Hypertension & Translational Cardio-Renal Medicine, Saarland University, Homburg, 66421, Germany
| | - Martina Seibert
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Sanjay Kumar Srikakulam
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Christoph Beisswenger
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Felix Ritzmann
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Andreas Keller
- Clinical Bioinformatics, Saarland University, Homburg, 66421, Germany
| | - Rolf Mueller
- Helmholtz-Institute for Pharmaceutical Science Saarland, Saarbrücken, 66123, Germany
| | - Sigrun Smola
- Institute for Virology, Saarland University, Homburg, 66421, Germany
| | | | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University, Homburg, 66421, Germany
| | - Guy Danziger
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, Homburg, 66421, Germany
| | - Sabrina Hoersch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Saarland University, Homburg, 66421, Germany
| | - Marcin Krawczyk
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Frank Lammert
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Thomas Adams
- Department of Internal Medicine II - Gastroenterology, Saarland University, Homburg, 66421, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, 66421, Germany
| | - Michael Kindermann
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Caritas Hospital St. Theresia Saarbrücken, Saarbrücken, 66113, Germany
| | - Constantin Marcu
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Caritas Hospital St. Theresia Saarbrücken, Saarbrücken, 66113, Germany
| | - Zuhair Wolf Dietrich Ataya
- Department of Gastroenterology, Internal and Intensive Care Medicine, Caritas Hospital St. Josef Saarbrücken, Saarbrücken, 66125, Germany
| | - Marc Mittag
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Konrad Schwarzkopf
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Florian Custodis
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Daniel Grandt
- Department of Anesthesiology, Gastroenterology and Intensive Care Medicine, Saarbrücken Hospital, Saarbrücken, 66119, Germany
| | - Harald Schaefer
- Department of Internal Medicine and Pulmonology, SHG-Hospital Völklingen, Saarbrücken, 66333, Germany
| | - Kai Eltges
- Department of Internal Medicine and Pulmonology, SHG-Hospital Völklingen, Saarbrücken, 66333, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, 66421, Germany
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Supady A, Lepper PM, Bracht H, Moerer O, Muellenbach RM, Michels G, Fiedler MO, Kalenka A, Kochanek M, Mutlak H, Danziger G, Muenz S, Lunz D, Hoersch S, Staudacher D, Wengenmayer T, Zotzmann V. Conservative management of COVID-19 associated hypoxaemia. ERJ Open Res 2021; 7:00204-2021. [PMID: 34159186 PMCID: PMC8054352 DOI: 10.1183/23120541.00204-2021] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
With great interest we read the article by Voshaaret al. [1] reporting data from a retrospective analysis of 78 coronavirus disease 2019 (COVID-19) patients treated with or without invasive mechanical ventilation. The authors conclude that avoiding invasive mechanical ventilation by allowing permissive hypoxaemia was superior to current treatment standards and guidelines. Overall mortality in this cohort was 7.7% (six out of 78), but 50% (four out of eight) of the patients supported with invasive mechanical ventilation eventually died [1]. This correspondence argues that data presented previously cannot justify a novel approach for treating hypoxic patients with severe #COVID19https://bit.ly/3dLaPlk
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Affiliation(s)
- Alexander Supady
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Freiburg im Breisgau, Germany
| | - Philipp M Lepper
- Dept of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Hendrik Bracht
- Dept of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Baden-Württemberg, Germany.,Dept of Emergency Medicine, University Hospital Ulm, Baden-Württemberg, Germany
| | - Onnen Moerer
- Dept of Anaesthesiology, University Medical Centre, Georg-August University Göttingen, Göttingen, Germany
| | - Ralf M Muellenbach
- Dept of Anaesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Guido Michels
- Dept of Acute and Emergency Care, St Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Mascha O Fiedler
- Dept of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Kalenka
- Dept of Anaesthesiology and Intensive Care Medicine, Kufstein District Hospital, Kufstein, Austria
| | - Matthias Kochanek
- First Dept of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), University of Cologne, Cologne, Germany
| | - Haitham Mutlak
- Dept of Anaesthesiology, Critical Care Medicine and Pain Medicine, SANA Klinikum Offenbach, Offenbach, Germany
| | - Guy Danziger
- Dept of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Sebastian Muenz
- Dept of Internal Medicine - Cardiology, Pneumology, Angiology and Intensive Care Medicine, SLK-Hospital Heilbronn, Baden-Württemberg, Germany
| | - Dirk Lunz
- Dept of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Sabrina Hoersch
- Dept of Anesthesiology, Intensive Care and Pain Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Dawid Staudacher
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tobias Wengenmayer
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Viviane Zotzmann
- Dept of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Dept of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany
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4
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Chen SC, Polhamus D, Riggs M, French J, Wang X, Smitt M, Hoersch S, Strasak A, Chernyukhin N, Quartino A, Jin J, Girish S, Li C. Abstract P4-21-26: Population pharmacokinetics (PK) and exposure-response (E-R) analysis of trastuzumab emtansine (T-DM1) in patients with HER2+ metastatic breast cancer (MBC) who have received at least two prior regimens of HER2-directed therapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-26] [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:
TH3RESA was a Phase III randomized study to evaluate the efficacy and safety of trastuzumab emtansine (T-DM1) compared to treatment of physician's choice (TPC) in patients with HER2+ MBC who have progression after at least two regimens of HER2-directed therapy. Population pharmacokinetic (PK) and exposure-response (E-R) analyses were performed to characterize T-DM1 PK as well as E-R relationship for key efficacy and safety endpoints in the population.
Methods:
Post-hoc analysis based on historical T-DM1 population PK models was performed to assess whether PK is consistent with historical data. E-R analyses with OS and PFS were conducted using Cox proportional hazard (CPH) models with exposure metrics (model-predicted Cycle 1 Cmin and AUCss) included in the model. Logistic regression models were used for binary endpoints of overall response rate (ORR) and key safety endpoints with exposure metrics included as continuous variable only. To supplement the E-R analysis for OS and PFS, case matching analyses were conducted to compare OS and PFS in the lowest exposure quartile (Q1) vs. higher exposure quartiles (Q2-4) to their corresponding matched control.
Results:
Historical T-DM1 population PK model well described T-DM1 PK in TH3RESA study. In CPH analyses with OS and PFS, hazard ratios (HR) of both efficacy endpoints consistently decreased with increasing T-DM1 exposure. The E-R relationship is supported by case matching analyses, where T-DM1 treated patients were stratified by model-predicted Cycle 1 Cmin. HRs of OS and PFS for patients at Q2−4 versus their matched TPC patients (HR (95%CI): 0.58 (0.44, 0.78) for OS; 0.47 (0.36, 0.62) for PFS) were numerically smaller than that of T-DM1 treated patients at Q1 versus their corresponding matched TPC patients (HR (95%CI): 0.96 (0.63, 1.47) for OS; 0.92 (0.64, 1.32) for PFS). For ORR, an E-R trend was also noted. On the other hand, no E-R relationship was identified with key safety endpoints.
HR for Quartile of Cmin Before and After Adjusting for Risk Factors QuartileUnadjusted HR (95% CI)Adjusted HR (95% CI)OSQ11.14 (0.832, 1.55)0.886 (0.64, 1.23) Q20.828 (0.6, 1.14)0.685 (0.493, 0.952) Q30.532 (0.374, 0.757)0.559 (0.391, 0.798) Q40.352 (0.238, 0.521)0.405 (0.272, 0.603)PFSQ10.852 (0.63, 1.15)0.831 (0.614, 1.12) Q20.635 (0.463, 0.872)0.619 (0.451, 0.85) Q30.428 (0.3, 0.609)0.442 (0.31, 0.632) Q40.237 (0.158, 0.357)0.258 (0.171, 0.389)
HR for Quartile of AUCss Before and After Adjusting for Risk Factors QuartileUnadjusted HR (95% CI)Adjusted HR (95% CI)OSQ11.07 (0.782, 1.47)0.774 (0.555, 1.08) Q20.651 (0.464, 0.912)0.567 (0.402, 0.801) Q30.662 (0.472, 0.929)0.736 (0.523, 1.04) Q40.406 (0.280, 0.588)0.458 (0.315, 0.667)PFSQ10.69 (0.505, 0.941)0.657 (0.481, 0.897) Q20.66 (0.479, 0.908)0.681 (0.494, 0.940) Q30.524 (0.377, 0.730)0.545 (0.390, 0.760) Q40.235 (0.155, 0.355)0.253 (0.167, 0.383)
Conclusion:
T-DM1 PK in TH3RESA patient population is similar to historical data. Although an E-R relationship was observed for efficacy, the results need to be interpreted with caution given the potential confounding association between risk factor and PK. No E-R relationship was observed for the safety endpoints examined.
Citation Format: Chen S-C, Polhamus D, Riggs M, French J, Wang X, Smitt M, Hoersch S, Strasak A, Chernyukhin N, Quartino A, Jin J, Girish S, Li C. Population pharmacokinetics (PK) and exposure-response (E-R) analysis of trastuzumab emtansine (T-DM1) in patients with HER2+ metastatic breast cancer (MBC) who have received at least two prior regimens of HER2-directed therapy [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 P4-21-26.
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Affiliation(s)
- S-C Chen
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - D Polhamus
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - M Riggs
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - J French
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - X Wang
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - M Smitt
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - S Hoersch
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - A Strasak
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - N Chernyukhin
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - A Quartino
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - J Jin
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - S Girish
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
| | - C Li
- Genentech, Inc., South San Francisco, CA; Metrum Research Group, Tariffville, CT; Roche, Basel, Switzerland
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Wieczorek G, Bigaud M, Pfister S, Hoersch S, McMichael K, Afatsawo C, Hamburger M, Texier C, Cojean C, Henry M, Rush J. AB0137 CD40-Pathway Activation in Ectopic Lymphoid Structure (ELS)-Resident B Cells Contributes To Disease Pathology in Primary Sjögren's Syndrome. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mörsdorf P, Herath SC, Groesdonk HV, Hoersch S, Pohlemann T, Burkhardt M. [Penetrating injury of two body cavities with a 20 cm long dagger-like sliver after falling into a glass door]. Unfallchirurg 2015; 118:982-6. [PMID: 25747944 DOI: 10.1007/s00113-014-2719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.
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Affiliation(s)
- P Mörsdorf
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland.
| | - S C Herath
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland
| | - H V Groesdonk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - S Hoersch
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - T Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland
| | - M Burkhardt
- Abteilung für Unfallchirurgie & Orthopädie, Evangelisches Stadtkrankenhaus Saarbrücken, Saarbrücken, Deutschland
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7
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Schmoll H, Tabernero J, Maroun J, De Braud F, Price T, Van Cutsem E, Hill M, Hoersch S, Rittweger K, Haller D. TP, TS AND DPD as Potential Predictors of Outcome Following Capecitabine Plus Oxaliplatin (XELOX) vs. Bolus 5-Fluorouracil/Leucovorin (5-FU/LV) as Adjuvant Therapy for Stage III Colon Cancer: Updated Biomarker Findings from Study NO16968 (XELOXA). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buzdar AU, Xu B, Digumarti R, Goedhals L, Hu X, Semiglazov V, Cheporov S, Gotovkin E, Hoersch S, Rittweger K, Miles DW, O'Shaughnessy J, Tjulandin S. Randomized phase II non-inferiority study (NO16853) of two different doses of capecitabine in combination with docetaxel for locally advanced/metastatic breast cancer. Ann Oncol 2012; 23:589-597. [PMID: 21633047 DOI: 10.1093/annonc/mdr256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This phase II study investigated whether a lower-than-approved dose of capecitabine, plus docetaxel (XT), would improve tolerability versus standard-dose XT without compromising efficacy. PATIENTS AND METHODS Women aged ≥18 years with locally advanced/metastatic breast cancer resistant to anthracycline-based chemotherapy in the (neo)adjuvant, first- or second-line metastatic setting were eligible. Patients were randomly assigned to receive standard-dose XT (capecitabine 1250 mg/m(2) twice daily, days 1-14; docetaxel 75 mg/m(2), day 1 every 3 weeks) or low-dose XT (capecitabine 825 mg/m(2) twice daily, days 1-14; docetaxel as above). The primary objective was to demonstrate non-inferiority of low-dose to standard-dose XT in terms of progression-free survival (PFS). RESULTS 470 patients were randomly allocated in a 1 : 1 ratio to standard-dose or low-dose XT. Median PFS was 7.9 versus 5.8 months [hazard ratio 1.16, 95% confidence interval (CI) 0.95-1.43] in the standard-dose and low-dose arms, respectively. The upper limit of the 95% CI was above the predefined non-inferiority margin (1.35, P = 0.078). Secondary efficacy end points were consistent with PFS. The frequency and severity of adverse events was similar in both treatment arms. CONCLUSIONS Non-inferiority of low-dose to standard-dose XT in terms of PFS was not demonstrated; this may be due to regional subgroup effects.
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Affiliation(s)
- A U Buzdar
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - B Xu
- Department of Medical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - R Digumarti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - L Goedhals
- Department of Oncotherapy, National Hospital, Bloemfontein, South Africa
| | - X Hu
- Cancer Hospital, Fudan University, Shanghai, China
| | - V Semiglazov
- Breast Cancer Department, NN Petrov Research Institute of Oncology, St Petersburg, Russia
| | - S Cheporov
- Department of Oncology, Regional Clinical Oncology Hospital, Yaroslavl, Russia
| | - E Gotovkin
- Department of Oncology, Regional Oncology Dispensary, Ivanovo, Russia
| | - S Hoersch
- Department of Statistics, Dr Manfred Köhler GmbH, Freiburg, Germany
| | - K Rittweger
- Product Development Oncology Department, Hoffmann-La Roche Inc, Nutley, USA
| | - D W Miles
- Department of Medical Oncology, East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, Middlesex, UK
| | - J O'Shaughnessy
- Department of Medical Oncology, Baylor-Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - S Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, Blokhin Cancer Research Center, Moscow, Russia
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9
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Pusztai L, Wang J, Coombes K, Hoersch S, Ayers M, Ross J, Hess K, Hortobagyi G, Symmans W, Stec J. Cross platform comparison of multigene predictors of response to neoadjuvant paclitaxel/FAC chemotherapy in breast cancer generated by cDNA arrays and Affymetrix GeneChips. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L. Pusztai
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Wang
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - K. Coombes
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - S. Hoersch
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - M. Ayers
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Ross
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - K. Hess
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - G. Hortobagyi
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - W. Symmans
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - J. Stec
- U Texas M. D. Anderson Cancer Center, Houston, TX; Millennium Pharmaceuticals, Inc., Cambridge, MA
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10
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Affiliation(s)
- S Hoersch
- European Bioinformatics Institute (EBI), Wellcome Trust Genome Campus, Cambridge, UK CB10 1SD
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11
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Andrade MA, Brown NP, Leroy C, Hoersch S, de Daruvar A, Reich C, Franchini A, Tamames J, Valencia A, Ouzounis C, Sander C. Automated genome sequence analysis and annotation. Bioinformatics 1999; 15:391-412. [PMID: 10366660 DOI: 10.1093/bioinformatics/15.5.391] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
MOTIVATION Large-scale genome projects generate a rapidly increasing number of sequences, most of them biochemically uncharacterized. Research in bioinformatics contributes to the development of methods for the computational characterization of these sequences. However, the installation and application of these methods require experience and are time consuming. RESULTS We present here an automatic system for preliminary functional annotation of protein sequences that has been applied to the analysis of sets of sequences from complete genomes, both to refine overall performance and to make new discoveries comparable to those made by human experts. The GeneQuiz system includes a Web-based browser that allows examination of the evidence leading to an automatic annotation and offers additional information, views of the results, and links to biological databases that complement the automatic analysis. System structure and operating principles concerning the use of multiple sequence databases, underlying sequence analysis tools, lexical analyses of database annotations and decision criteria for functional assignments are detailed. The system makes automatic quality assessments of results based on prior experience with the underlying sequence analysis tools; overall error rates in functional assignment are estimated at 2.5-5% for cases annotated with highest reliability ('clear' cases). Sources of over-interpretation of results are discussed with proposals for improvement. A conservative definition for reporting 'new findings' that takes account of database maturity is presented along with examples of possible kinds of discoveries (new function, family and superfamily) made by the system. System performance in relation to sequence database coverage, database dynamics and database search methods is analysed, demonstrating the inherent advantages of an integrated automatic approach using multiple databases and search methods applied in an objective and repeatable manner. AVAILABILITY The GeneQuiz system is publicly available for analysis of protein sequences through a Web server at http://www.sander.ebi.ac. uk/gqsrv/submit
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Affiliation(s)
- M A Andrade
- European Bioinformatics Institute (EBI), Wellcome Trust Genome Campus, Cambridge CB10 1SD, UK
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