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Buchholz S, Zempel H. Suppression of mature TAU isoforms prevents Alzheimer's disease-like amyloid-beta oligomer-induced spine loss in rodent neurons. Neural Regen Res 2024; 19:1655-1657. [PMID: 38103227 PMCID: PMC10960270 DOI: 10.4103/1673-5374.389644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/08/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Sarah Buchholz
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans Zempel
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Buchholz S, Zempel H. The six brain-specific TAU isoforms and their role in Alzheimer's disease and related neurodegenerative dementia syndromes. Alzheimers Dement 2024; 20:3606-3628. [PMID: 38556838 DOI: 10.1002/alz.13784] [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: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Alternative splicing of the human MAPT gene generates six brain-specific TAU isoforms. Imbalances in the TAU isoform ratio can lead to neurodegenerative diseases, underscoring the need for precise control over TAU isoform balance. Tauopathies, characterized by intracellular aggregates of hyperphosphorylated TAU, exhibit extensive neurodegeneration and can be classified by the TAU isoforms present in pathological accumulations. METHODS A comprehensive review of TAU and related dementia syndromes literature was conducted using PubMed, Google Scholar, and preprint server. RESULTS While TAU is recognized as key driver of neurodegeneration in specific tauopathies, the contribution of the isoforms to neuronal function and disease development remains largely elusive. DISCUSSION In this review we describe the role of TAU isoforms in health and disease, and stress the importance of comprehending and studying TAU isoforms in both, physiological and pathological context, in order to develop targeted therapeutic interventions for TAU-associated diseases. HIGHLIGHTS MAPT splicing is tightly regulated during neuronal maturation and throughout life. TAU isoform expression is development-, cell-type and brain region specific. The contribution of TAU to neurodegeneration might be isoform-specific. Ineffective TAU-based therapies highlight the need for specific targeting strategies.
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Affiliation(s)
- Sarah Buchholz
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Hans Zempel
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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Buchholz S, Bell-Simons M, Zempel H. Tracking Tau in Neurons: How to Transfect and Track Exogenous Tau in Primary Neurons. Methods Mol Biol 2024; 2754:499-506. [PMID: 38512685 DOI: 10.1007/978-1-0716-3629-9_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Primary murine neurons have proved to be an essential tool for the general investigation of neuronal polarity, polarized Tau distribution, and Tau-based neuronal dysfunction in disease paradigms. However, mature primary neurons are notoriously difficult to transfect with non-viral approaches and are very sensitive to cytoskeletal manipulation and imaging. Furthermore, standard non-viral transfection techniques require the use of a supportive glial monolayer or high-density cultures, both of which interfere with microscopy. Here we provide a simple non-viral liposome-based transfection method that enables transfection of Tau in low levels comparable to endogenous Tau. This allows the investigation of, for example, distribution and trafficking of Tau, without affecting other cytoskeleton-based parameters such as microtubule density or microtubule-based transport. Using this protocol, we achieve a profound transfection efficiency but avoid high overexpression rates. Importantly, this transfection method can be applied to neurons at different ages and is also suitable for very old cultures (up to 18 days in vitro). In addition, the protocol can be used in cultures without glial support and at suitable cell densities for microscopy-based single cell analysis. In sum, this protocol has proven a reliable tool suitable for most microscopy-based approaches in our laboratory.
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Affiliation(s)
- Sarah Buchholz
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Bell-Simons
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hans Zempel
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Buchholz S, Bell-Simons M, Haag N, Zempel H. Tracking Tau in Neurons: How to Grow, Fix, and Stain Primary Neurons for the Investigation of Tau in All Developmental Stages. Methods Mol Biol 2024; 2754:507-519. [PMID: 38512686 DOI: 10.1007/978-1-0716-3629-9_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Primary murine neurons are a well-established tool for investigating Tau in the context of neuronal development and neurodegeneration. However, culturing primary neurons is usually time-consuming and requires multiple feeding steps, media exchanges, proprietary media supplements, and/or preparation of complex media. Here, we describe (i) a relatively cheap and easy cell culture procedure for the cultivation of forebrain neurons from embryonic mice (E13.5) based on a commercially available neuronal supplement (NS21), (ii) a protocol for the cultivation of hippocampal and cortical neurons from postnatal (P0-P3) animals, and (iii) basic fixation and immunofluorescence techniques for the staining of neuronal markers and endogenous Tau. We demonstrate a staining technique, which minimizes antibody consumption and allows for fast and convenient processing of samples for immunofluorescence microscopy of endogenous Tau in primary neurons. We also provide a protocol that enables cryopreservation of fixed cells for years without measurable loss of Tau signal. In sum, we provide reliable protocols enabling microscopy-based studies of Tau in primary murine neurons.
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Affiliation(s)
- Sarah Buchholz
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Bell-Simons
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Natja Haag
- Institute for Human Genetics and Genomic Medicine, Medical Faculty and University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
| | - Hans Zempel
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Buchholz S, Bell-Simons M, Cakmak C, Klimek J, Gan L, Zempel H. Cultivation, Differentiation, and Lentiviral Transduction of Human-Induced Pluripotent Stem Cell (hiPSC)-Derived Glutamatergic Neurons for Studying Human Tau. Methods Mol Biol 2024; 2754:533-549. [PMID: 38512688 DOI: 10.1007/978-1-0716-3629-9_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Tau pathology is a major hallmark of many neurodegenerative diseases summarized under the term tauopathies. In most of these disorders, such as Alzheimer's disease, the neuronal axonal microtubule-binding Tau protein becomes mislocalized to the somatodendritic compartment. In human disease, this missorting of Tau is accompanied by an abnormally high phosphorylation state of the Tau protein, and several downstream pathological consequences (e.g., loss of microtubules, degradation of postsynaptic spines, impaired synaptic transmission, neuronal death). While some mechanisms of Tau sorting, missorting, and associated pathologies have been addressed in rodent models, few studies have addressed human Tau in physiological disease-relevant human neurons. Thus, suitable human-derived in vitro models are necessary. This protocol provides a simple step-by-step protocol for generating homogeneous cultures of cortical glutamatergic neurons using an engineered Ngn2 transgene-carrying WTC11 iPSC line. We further demonstrate strategies to improve neuronal maturity, that is, synapse formation, Tau isoform expression, and neuronal activity by co-culturing hiPSC-derived glutamatergic neurons with mouse-derived astrocytes. Finally, we describe a simple protocol for high-efficiency lentiviral transduction of hiPSC-derived neurons at almost all stages of differentiation.
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Affiliation(s)
- Sarah Buchholz
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Bell-Simons
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Cagla Cakmak
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jennifer Klimek
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Li Gan
- Gladstone Institute of Neurological Disease, San Francisco, CA, USA
- Helen and Robert Appel Alzheimer's Disease Research Institute, Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Hans Zempel
- Institute of Human Genetics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Bell-Simons M, Buchholz S, Klimek J, Zempel H. Laser-Induced Axotomy of Human iPSC-Derived and Murine Primary Neurons Decreases Somatic Tau and AT8 Tau Phosphorylation: A Single-Cell Approach to Study Effects of Acute Axonal Damage. Cell Mol Neurobiol 2023; 43:3497-3510. [PMID: 37171549 PMCID: PMC10477226 DOI: 10.1007/s10571-023-01359-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
The microtubule-associated protein Tau is highly enriched in axons of brain neurons where it regulates axonal outgrowth, plasticity, and transport. Efficient axonal Tau sorting is critical since somatodendritic Tau missorting is a major hallmark of Alzheimer's disease and other tauopathies. However, the molecular mechanisms of axonal Tau sorting are still not fully understood. In this study, we aimed to unravel to which extent anterograde protein transport contributes to axonal Tau sorting. We developed a laser-based axotomy approach with single-cell resolution and combined it with spinning disk confocal microscopy enabling multi live-cell monitoring. We cultivated human iPSC-derived cortical neurons and mouse primary forebrain neurons in specialized chambers allowing reliable post-fixation identification and Tau analysis. Using this approach, we achieved high post-axotomy survival rates and observed axonal regrowth in a subset of neurons. When we assessed somatic missorting and phosphorylation levels of endogenous human or murine Tau at different time points after axotomy, we surprisingly did not observe somatic Tau accumulation or hyperphosphorylation, regardless of their regrowing activity, consistent for both models. These results indicate that impairment of anterograde transit of Tau protein and acute axonal damage may not play a role for the development of somatic Tau pathology. In sum, we developed a laser-based axotomy model suitable for studying the impact of different Tau sorting mechanisms in a highly controllable and reproducible setting, and we provide evidence that acute axon loss does not induce somatic Tau accumulation and AT8 Tau phosphorylation. UV laser-induced axotomy of human iPSC-derived and mouse primary neurons results in decreased somatic levels of endogenous Tau and AT8 Tau phosphorylation.
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Affiliation(s)
- M Bell-Simons
- Institute of Human Genetics, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - S Buchholz
- Institute of Human Genetics, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - J Klimek
- Institute of Human Genetics, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - H Zempel
- Institute of Human Genetics, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Robert-Koch-Str. 21, 50931, Cologne, Germany.
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Buck AN, Buchholz S, Schnupp JW, Rosskothen-Kuhl N. Interaural time difference sensitivity under binaural cochlear implant stimulation persists at high pulse rates up to 900 pps. Sci Rep 2023; 13:3785. [PMID: 36882473 PMCID: PMC9992369 DOI: 10.1038/s41598-023-30569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Spatial hearing remains one of the major challenges for bilateral cochlear implant (biCI) users, and early deaf patients in particular are often completely insensitive to interaural time differences (ITDs) delivered through biCIs. One popular hypothesis is that this may be due to a lack of early binaural experience. However, we have recently shown that neonatally deafened rats fitted with biCIs in adulthood quickly learn to discriminate ITDs as well as their normal hearing litter mates, and perform an order of magnitude better than human biCI users. Our unique behaving biCI rat model allows us to investigate other possible limiting factors of prosthetic binaural hearing, such as the effect of stimulus pulse rate and envelope shape. Previous work has indicated that ITD sensitivity may decline substantially at the high pulse rates often used in clinical practice. We therefore measured behavioral ITD thresholds in neonatally deafened, adult implanted biCI rats to pulse trains of 50, 300, 900 and 1800 pulses per second (pps), with either rectangular or Hanning window envelopes. Our rats exhibited very high sensitivity to ITDs at pulse rates up to 900 pps for both envelope shapes, similar to those in common clinical use. However, ITD sensitivity declined to near zero at 1800 pps, for both Hanning and rectangular windowed pulse trains. Current clinical cochlear implant (CI) processors are often set to pulse rates ≥ 900 pps, but ITD sensitivity in human CI listeners has been reported to decline sharply above ~ 300 pps. Our results suggest that the relatively poor ITD sensitivity seen at > 300 pps in human CI users may not reflect the hard upper limit of biCI ITD performance in the mammalian auditory pathway. Perhaps with training or better CI strategies good binaural hearing may be achievable at pulse rates high enough to allow good sampling of speech envelopes while delivering usable ITDs.
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Affiliation(s)
- Alexa N Buck
- Department of Neuroscience, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China.,City University of Hong Kong Shenzhen Research Institute, Shenzhen, China.,Plasticity of Central Auditory Circuits, Institut de l'Audition, Institut Pasteur, Paris, France
| | - Sarah Buchholz
- Neurobiological Research Laboratory, Section of Clinical and Experimental Otology, Department of Oto-Rhino-Laryngology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Killianst. 5, 79106, Freiburg im Breisgau, Germany
| | - Jan W Schnupp
- Department of Neuroscience, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China.,City University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Nicole Rosskothen-Kuhl
- Department of Neuroscience, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China. .,Neurobiological Research Laboratory, Section of Clinical and Experimental Otology, Department of Oto-Rhino-Laryngology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Killianst. 5, 79106, Freiburg im Breisgau, Germany. .,Bernstein Center Freiburg and Faculty of Biology, University of Freiburg, Freiburg, Germany.
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Buchholz S, Künstner A, Bahmer T, Hansen G, von Mutius E, Rabe KF, Dittrich AM, Schaub B, Happle C, Kopp MV, Busch H, Weckmann M. Der Einfluss nasaler Methylierungsmuster auf den
Asthma-Phänotyp – Eine Clusteranalyse mittels Uniform Manifold
Approximation and Projection (UMAP). Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754463] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S Buchholz
- Klinik für Kinder- & Jugendmedizin,
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Sektion
für Pädiatrische Pneumologie und Allergologie, Lübeck,
Germany
- Leibniz Lungenzentrum Borstel, Programmbereich Chronische
Lungenerkrankungen; Epigenetik chronischer Lungenerkrankungen, Borstel,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Lübeck, Germany
| | - A Künstner
- Universität zu Lübeck, Lübecker Institut
für Experimentelle Dermatologie, Systembiologie, Lübeck,
Germany
| | - T Bahmer
- LungenClinic Grosshansdorf, Abteilung Pneumologie, Grosshansdorf,
Germany
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik
für Innere Medizin I, Kiel, Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Grosshandsdorf, Germany
| | - G Hansen
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - E von Mutius
- Ludwig-Maximilians-Universität, Haunersches Kinderspital,
Haunersches Kinderspital, München, Germany
- Comprehensive Pneumology Center (CPC-M), Mitglied des Deutschen
Zentrums für Lungenforschung (DZL), München,
Germany
| | - KF Rabe
- LungenClinic Grosshansdorf, Abteilung Pneumologie, Grosshansdorf,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Grosshandsdorf, Germany
| | - A-M Dittrich
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - B Schaub
- Ludwig-Maximilians-Universität, Haunersches Kinderspital,
Haunersches Kinderspital, München, Germany
- Comprehensive Pneumology Center (CPC-M), Mitglied des Deutschen
Zentrums für Lungenforschung (DZL), München,
Germany
| | - C Happle
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - MV Kopp
- Inselspital, Universitätsklinik für Kinderheilkunde,
Bern, Switzerland
| | - H Busch
- Universität zu Lübeck, Lübecker Institut
für Experimentelle Dermatologie, Systembiologie, Lübeck,
Germany
| | - M Weckmann
- Klinik für Kinder- & Jugendmedizin,
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Sektion
für Pädiatrische Pneumologie und Allergologie, Lübeck,
Germany
- Leibniz Lungenzentrum Borstel, Programmbereich Chronische
Lungenerkrankungen; Epigenetik chronischer Lungenerkrankungen, Borstel,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Lübeck, Germany
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Brenner P, Reichart B, Längin M, Bender M, Mayr T, Güthoff S, Sebastian M, Buchholz S, Radan J, Mokelke M, Buttgereit I, Neumann E, Bauer A, Klymiuk N, Wolf E, Walz C, Reimann K, Ayares D, Hagl C, Steen S, Abicht JM. Perioperative Cardiac Xenograft Dysfunction (PCXD) as a Major Hurdle in the Preclinical (Life-Supporting) Orthotopic (oXTx) Cardiac Xenotransplantation if Compared to the Heterotopic Thoracic (htXTx) Model. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742858] [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: 10/19/2022]
Affiliation(s)
- P. Brenner
- Department of Cardiac Surgery, Clinic of Grosshadern, University of Munich (LMU), München, Deutschland
| | - B. Reichart
- Walter-Brendel-Zentrum, University of Munich (LMU), Munich, Deutschland
| | - M. Längin
- Department of Anaesthesiology, Clinic if Grosshadern, LMU, München, Deutschland
| | - M. Bender
- Department of Anaesthesiology, Clinic of Grosshadern, LMU, Munich, Deutschland
| | - T. Mayr
- Walter-Brendel-Zentrum, München, Deutschland
| | - S. Güthoff
- Walter-Brendel-Zentrum, München, Deutschland
| | - M. Sebastian
- Clinic for cardiac surgery, Ludwig-Maximilian University, Munich, Deutschland
| | - S. Buchholz
- Department of Cardiac Surgery, LMU Munich, Munich, Deutschland
| | - J. Radan
- Walter-Brendel-Zentrum, LMU, München, Deutschland
| | - M. Mokelke
- Walter-Brendel-Zentrum, LMU, München, Deutschland
| | | | - E. Neumann
- Walter-Brendel-Zentrum, LMU, München, Deutschland
| | - A. Bauer
- Department of Anaesthesiology, LMU, Munich, Deutschland
| | - N. Klymiuk
- Department of Molecular Animal Breeding, LMU, Munich, Deutschland
| | - E. Wolf
- Institute of Molecular Animal Breeding and Biotechnology, LMU, Munich, Deutschland
| | - C. Walz
- Department of Pathology, LMU, Munich, Deutschland
| | | | - D. Ayares
- Revivicor Inc., Blackburg, United States
| | - C. Hagl
- Department of Cardiac Surgery, Clinic of Grosshadern, University of Munich (LMU), Munich, Deutschland
| | - S. Steen
- Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden
| | - J. M. Abicht
- Department of Anesthesiology, Clinic of Grosshadern, LMU, Munich, Deutschland
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Weltin A, Kieninger J, Urban GA, Buchholz S, Arndt S, Rosskothen-Kuhl N. Standard cochlear implants as electrochemical sensors: Intracochlear oxygen measurements in vivo. Biosens Bioelectron 2021; 199:113859. [PMID: 34911002 DOI: 10.1016/j.bios.2021.113859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/02/2022]
Abstract
Cochlear implants are the most successful neural prostheses worldwide and routinely restore sensorineural hearing loss by direct electrical stimulation of the auditory nerve. Enhancing this standard implant by chemical sensor functionality opens up new possibilities, ranging from access to the biochemical microenvironment of the implanted electrode array to the long-term study of the electrode status. We developed an electrochemical method to turn the platinum stimulation microelectrodes of cochlear implants into electrochemical sensors. The electrodes showed excellent and stable chemical sensor properties, as demonstrated by in vitro characterizations with combined amperometric and active potentiometric dissolved oxygen and hydrogen peroxide measurements. Linear, stable and highly reproducible sensor responses within the relevant concentration ranges with negligible offset were shown. This approach was successfully applied in vivo in an animal model. Intracochlear oxygen dynamics in rats upon breathing pure oxygen were reproducibly and precisely measured in real-time from the perilymph. At the same time, correct implant placement and its functionality was verified by measurements of electrically evoked auditory brainstem responses with clearly distinguishable peaks. Acute measurements indicated no adverse influence of electrical stimulation on electrochemical measurements and vice versa. Our work is ground-breaking towards advanced implant functionality, future implant lifetime monitoring, and implant-life-long in situ investigation of electrode degradation in cochlear implant patients.
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Affiliation(s)
- Andreas Weltin
- Laboratory for Sensors, IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany.
| | - Jochen Kieninger
- Laboratory for Sensors, IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - Gerald A Urban
- Laboratory for Sensors, IMTEK - Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - Sarah Buchholz
- Department of Oto-Rhino-Laryngology, Section of Experimental and Clinical Otology, Neurobiological Research Laboratory, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Susan Arndt
- Department of Oto-Rhino-Laryngology, Section of Experimental and Clinical Otology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nicole Rosskothen-Kuhl
- Department of Oto-Rhino-Laryngology, Section of Experimental and Clinical Otology, Neurobiological Research Laboratory, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
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Ewbank MP, Cummins R, Tablan V, Catarino A, Buchholz S, Blackwell AD. Understanding the relationship between patient language and outcomes in internet-enabled cognitive behavioural therapy: A deep learning approach to automatic coding of session transcripts. Psychother Res 2020; 31:326-338. [PMID: 32619163 DOI: 10.1080/10503307.2020.1788740] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: Understanding patient responses to psychotherapy is important in developing effective interventions. However, coding patient language is a resource-intensive exercise and difficult to perform at scale. Our aim was to develop a deep learning model to automatically identify patient utterances during text-based internet-enabled Cognitive Behavioural Therapy and to determine the association between utterances and clinical outcomes. Method: Using 340 manually annotated transcripts we trained a deep learning model to categorize patient utterances into one or more of five categories. The model was used to automatically code patient utterances from our entire data set of transcripts (∼34,000 patients), and logistic regression analyses used to determine the association between both reliable improvement and engagement, and patient responses. Results: Our model reached human-level agreement on three of the five patient categories. Regression analyses revealed that increased counter change-talk (movement away from change) was associated with lower odds of both reliable improvement and engagement, while increased change-talk (movement towards change or self-exploration) was associated with increased odds of improvement and engagement. Conclusions: Deep learning provides an effective means of automatically coding patient utterances at scale. This approach enables the development of a data-driven understanding of the relationship between therapist and patient during therapy.
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Affiliation(s)
- M P Ewbank
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - R Cummins
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - V Tablan
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - A Catarino
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - S Buchholz
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
| | - A D Blackwell
- Clinical Science Laboratory at Ieso, Ieso Digital Health, Cambridge, United Kingdom
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Brenner P, Reichart B, Laengin M, Michel S, Buchholz S, Dashkevich A, Wolf E, Reimann K, Ayares D, Hagl C, Steen S, Abicht J. Worldwide First Successful and Reproducable Long-Term Survival up to Half a Year: Completed Preclinical Study with Life-Supporting Orthotopic Pig-to-Baboon Cardiac Xenotransplantation (oXHTx) Fullfilling the ISHLT Prerequisite for Clinical Cardiac Xenotransplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Buchholz S, Rosenthal LL, Von Samson-Himmelstjerna P, Haas N, Hörer J, Hagl C, Michel S. Bridging Patients in Cardiogenic Shock with the Berlin Heart Excor Biventricular Assist Device to Heart Transplantation: A Single-Center Experience. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705495] [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: 10/24/2022]
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14
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Brenner P, Reichart B, Längin M, Mayr T, Buchholz S, Michel S, Wolf E, Hagl C, Steen S, Abicht JM. Completed Preclinical Life-Supporting Orthotopic Pig-to-baboon Cardiac Xenotransplantation Study (oXHTx): First Successful and Reproducible Long-Term Survival Up to Half a Year Fulfilling the ISHLT Prerequisite for Clinical Cardiac Xenotransplantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705445] [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: 10/24/2022]
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15
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Weyermann F, Spengler C, Schöffel P, Buchholz S, Steinhoff T, Sonnenkalb M, Wielenberg A, Schaffrath A. Development of AC2 for the simulation of advanced reactor design of Generation 3/3+ and light water cooled SMRs. KERNTECHNIK 2019. [DOI: 10.3139/124.190068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AbstractThe transition from Generation 2 to Generation 3/3+ and 4 reactors, as well as the development of small modular reactors (SMR), place new demands on computational programs designed to simulate conditions of normal operation, operational occurrences, design basis accidents and severe accidents. On the one hand, most passive safety systems of advanced and innovative plants operate at low pressures even down to vacuum conditions and the driving forces are low compared to active systems. On the other hand, the containment is no longer just a barrier to retain radioactive material in the event of leakage of the cooling system, but it is an important link in the passive cooling chain. This requires an expansion and improvement of the existing simulation programs for the cooling circuit and containment, as well as the realization of a coupling between these simulation programs. The new AC2 program package combines the proven simulation codes ATHLET/ATHLET-CD and COCOSYS in one software suite to hit this target. The individual components of the suite are continuously extended and validated for their application to novel safety systems. This makes it possible to simulate the entire spectrum of accidents for Generation 3/3+, 4 and light water cooled SMR systems with just one program package. This publication gives an overview of the current state of development of AC2 and its individual modules.
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Affiliation(s)
- F. Weyermann
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - C. Spengler
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - P. Schöffel
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - S. Buchholz
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - T. Steinhoff
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - M. Sonnenkalb
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - A. Wielenberg
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
| | - A. Schaffrath
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Schwertnergasse 1, 50667 Cologne (DE)
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Abstract
AbstractVerification and validation are basic quality assurance elements in code development and essential for code release. Therefore, the codes of AC2 (ATHLET – ATHLET-CD – COCOSYS) are tested on separate effect tests, integral tests as well as plant scenarios to verify and validate the models after new implementation or updates. The verification assures that the models are implemented and working correctly while the validation checks if the models predict the right phenomena and combined with other models and modules. The selected experiments are summarized in GRS's validation matrices, which in turn are based on the CSNI validation matrices derived from OECD/WGAMA task groups as well as current activities on experimental test campaigns. For ATHLET several test series are used to cover a wide range of phenomena which can occur in PWR, BWR and VVER. Additionally, plant transients are considered for German LWR. The ATHLET-CD validation matrix contains experiments covering most phenomena which can occur during a severe accident. But due to the interaction of several effects even in small scale experiments mainly integral experimental campaigns are used for the validation. Over the last decades the validation of the AC2 codeds ATHLET and ATHLET-CD has reached a high degree of fulfilment of GRS's validation matrices over all code versions. Innovative and advanced reactor concepts come with new or newly relevant phenomena, which AC2 needs to provide models for. Extending the validation base of AC2 for these models is one challenge for further code validation efforts besides the on-going update of the validation basis to recent code versions.
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Affiliation(s)
- T. Hollands
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Boltzmannstr. 14, 85748 Garching bei München
| | - S. Buchholz
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Boltzmannstr. 14, 85748 Garching bei München
| | - A. Wielenberg
- 1Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH, Boltzmannstr. 14, 85748 Garching bei München
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Brenner P, Längin M, Mayr T, Güthoff S, Buchholz S, Michel S, Dashkevich A, Lutzmann I, Werner F, Klymiuk N, Wolf E, Reimann K, Hermanns W, Ayares D, Hagl C, Steen S, Abicht JM, Reichart B. Breakthrough in Orthotopic Cardiac Xenotransplantation: In a Preclinical Life-Supporting Pig-To-Baboon Model Worldwide First Continuous Successful Long-Term Survival (Up To 172/187 Days, Both Ongoing). Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678915] [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: 10/27/2022]
Affiliation(s)
- P. Brenner
- LMU München, Klinikum Grosshadern, Herzchirurgische Klinik, München, Germany
| | - M. Längin
- LMU Munich, Anaesthesiology, München, Germany
| | - T. Mayr
- LMU Munich, Walter-Brendel-Centre, München, Germany
| | - S. Güthoff
- LMU Munich, Walter-Brendel-Centre, München, Germany
| | - S. Buchholz
- LMU München, Klinikum Grosshadern, Herzchirurgische Klinik, München, Germany
| | - S. Michel
- LMU München, Klinikum Grosshadern, Herzchirurgische Klinik, München, Germany
| | - A. Dashkevich
- LMU München, Klinikum Grosshadern, Herzchirurgische Klinik, München, Germany
| | - I. Lutzmann
- LMU München, Walter-Brendel-Centre, München, Germany
| | - F. Werner
- LMU München, Walter-Brendel-Centre, München, Germany
| | - N. Klymiuk
- LMU München, Molecular Animal Breeding and Biotechnology, München, Germany
| | - E. Wolf
- LMU München, Molecular Animal Breeding and Biotechnology, München, Germany
| | - K. Reimann
- University of Massachusetts, Mass Biologics, Boston, United States
| | - W. Hermanns
- LMU München, Veterinary Pathology, München, Germany
| | - D. Ayares
- Revivicor Inc., Blackburn, United States
| | - C. Hagl
- LMU München, Klinikum Grosshadern, Herzchirurgische Klinik, München, Germany
| | - S. Steen
- University of Lund, Cardiothoracic Surgery, Lund, Sweden
| | | | - B. Reichart
- LMU Munich, Walter-Brendel-Centre, München, Germany
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Kamla C, Buchholz S, Born F, Khaladj N, Peterss S, Brunner S, Hoechter D, Juchem G, Pichlmaier M, Hagl C, Guenther S. 6-Year Single-Center Experience of Extracorporeal Life Support in Cardiogenic Shock: What Have We Learned, Where Are We Going? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679005] [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: 10/27/2022]
Affiliation(s)
- C. Kamla
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Buchholz
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - F. Born
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - N. Khaladj
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Peterss
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Brunner
- Medical Department I (Cardiology), Ludwig-Maximilian-University, Munich, Germany
| | - D. Hoechter
- Department of Anesthesiology, Ludwig-Maximilian-University, Munich, Germany
| | - G. Juchem
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Guenther
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
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Seegers N, Buchholz S, Seitz S, Teomann A, Hollemann D, Ortmann O. Schilddrüsenkarzinom auf dem Boden einer Struma ovarii. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671335] [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)
- N Seegers
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Deutschland
| | - S Buchholz
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Deutschland
| | - S Seitz
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Deutschland
| | - A Teomann
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Deutschland
| | - D Hollemann
- University of Regensburg, Institut für Pathologie, Regensburg, Deutschland
| | - O Ortmann
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Deutschland
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Schaffrath A, Krüssenberg AK, Buchholz S, Wielenberg A. Necessary improvements of the GRS simulation chain for the simulation of light-water-cooled SMRs. KERNTECHNIK 2018. [DOI: 10.3139/124.110913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Small modular reactors (SMRs) are one interesting option for new builds in almost all countries worldwide continuing to use nuclear energy for commercial power generation. For asserting of legitimate nuclear safety and/or security interests German authorities require in this context own and independent expertise for the safety assessments. The Gesellschaft für Anlagen und Reaktorsicherheit (GRS) mbH, which is the main technical support organization in nuclear safety for the German federal government, has among others performed a study on Safety and International development of Small Modular Reactors (GRS-376) to identify essential issues of SMR safety as well as needs for adaption, improvement and validation of nuclear evidence tools developed and applied by GRS. For the light-water-cooled SMRs, which have (at least according to GRS) the best prospects for realization, selected results of this study will be presented.
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Affiliation(s)
- A. Schaffrath
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching bei München
| | - A.-K. Krüssenberg
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching bei München
| | - S. Buchholz
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching bei München
| | - A. Wielenberg
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching bei München
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21
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Seegers N, Buchholz S, Seitz S, Teoman A, Hollemann D, Ortmann O. Schilddrüsenkarzinom auf dem Boden einer Struma ovarii. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655527] [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)
- N Seegers
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - S Buchholz
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - S Seitz
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - A Teoman
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
| | - D Hollemann
- University Medical Center Regensburg, Klinik für Pathologie
| | - O Ortmann
- University Medical Center Regensburg, Klinik für Frauenheilkunde und Geburtshilfe
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Fleming G, Francis PA, Láng I, Ciruelos EM, Bellet M, Bonnefoi HR, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer CE, Walley BA, Coleman RE, Kerbrat P, Buchholz S, Ingle JN, Rabaglio-Poretti M, Colleoni M, Regan MM. Abstract GS4-03: Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs4-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The primary results of SOFT at 5.6 years median follow-up found adding OFS to T did not provide a significant benefit in the overall study population of premenopausal women with HR+ BC (Francis et al, NEJM 2015). For those women at sufficient risk for recurrence to warrant adjuvant chemotherapy (CT) and who remained premenopausal, the addition of OFS improved disease outcomes. Follow-up was immature for overall survival (OS). We report a planned update with visit cut-off of 31Dec16 after 8 yrs median follow-up.
Methods: SOFT randomized premenopausal women with HR+ BC from Nov 2003 to Jan 2011 to 5 yrs of T vs T+OFS vs Exemestane(E)+OFS. OFS was by choice of GnRH agonist triptorelin, oophorectomy or ovarian irradiation. SOFT was stratified by the use of prior CT; 47% received no CT and 53% remained premenopausal after prior CT, determined by premenopausal estradiol level within 8 months of CT completion. The primary endpoint was invasive disease-free survival (DFS; randomization until invasive local, regional, distant recurrence or contralateral breast; invasive second malignancy; death). Secondary endpoints included invasive breast cancer-free interval (BCFI), distant recurrence-free interval (DRFI) and OS. NCT00066690.
Results: DFS for patients assigned T+OFS (n=1015) was significantly improved over T (n=1018; HR=0.76 [95%CI 0.62-0.93]) and 8yr DFS was 83.2% vs 78.9%, respectively; BCFI and DRFI results were supportive (see Table). Hazard ratios for these 3 endpoints showed no heterogeneity by use of prior CT. For patients with prior CT, 8yr DFS was 76.7% with T+OFS vs 71.4% with T (Δ=5.3%); in those without CT, 8yr DFS was 90.6% vs 87.4% (Δ=3.2%). E+OFS (n=1014) improved outcomes relative to T (Table); 8yr DFS for E+OFS was 85.9% (80.4% with use of prior CT and 92.5% for those without CT). OS was improved with T+OFS vs T (8yr OS 93.3% vs 91.5%). 8yr OS was 92.1% with E+OFS. 201/225 deaths occurred in women with prior CT. For women without CT there have been 10, 5 and 9 deaths in the T+OFS, T and E+OFS groups (total n=1419), respectively, only half of these deaths after breast cancer event.
N. EventsHazard Ratio (95% CI)Endpoint(3 arms)T+OFS vs TE+OFS vs TDFS5180.76 (0.62-0.93) P=0.0090.65 (0.53-0.81)BCFI4370.76 (0.61-0.95)0.64 (0.51-0.81)DRFI3060.86 (0.66-1.13)0.73 (0.55-0.96)OS2250.67 (0.48-0.92)0.85 (0.62-1.15)
Overall toxicity was worse with T+ OFS than with T, including 32% vs 25% grade 3+ targeted AEs. Early cessation of tamoxifen occurred for 19% assigned T+OFS and 22% of women assigned T; the cumulative incidence of early cessation of triptorelin on the T+OFS arm was 23% by 4yrs. Early cessation of exemestane occurred for 28% and of triptorelin for 21% by 4yrs on the E+OFS arm.
Conclusions: With additional follow-up to a median of 8yrs, SOFT further supports the value of OFS for some premenopausal women. Follow-up continues, which will further clarify the safety and the benefit of OFS for late recurrence and overall survival. Oncologists appear to be able to select a low risk group (no chemotherapy) for whom treatment escalation is unlikely to improve survival.
Citation Format: Fleming G, Francis PA, Láng I, Ciruelos EM, Bellet M, Bonnefoi HR, Climent MA, Pavesi L, Burstein HJ, Martino S, Davidson NE, Geyer Jr CE, Walley BA, Coleman RE, Kerbrat P, Buchholz S, Ingle JN, Rabaglio-Poretti M, Colleoni M, Regan MM. Randomized comparison of adjuvant tamoxifen (T) plus ovarian function suppression (OFS) versus tamoxifen in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): Update of the SOFT trial [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 GS4-03.
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Affiliation(s)
- G Fleming
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - PA Francis
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - I Láng
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - EM Ciruelos
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Bellet
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - HR Bonnefoi
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - MA Climent
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - L Pavesi
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - HJ Burstein
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - S Martino
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - NE Davidson
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - CE Geyer
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - BA Walley
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - RE Coleman
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - P Kerbrat
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - S Buchholz
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - JN Ingle
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Rabaglio-Poretti
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - M Colleoni
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
| | - MM Regan
- SOFT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Group
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Günther SPW, Born F, Buchholz S, von Dossow V, Schramm R, Brunner S, Massberg S, Pichlmaier AM, Hagl C. Patienten unter Reanimation: Kandidaten für „Extracorporeal Life Support“? Z Herz- Thorax- Gefäßchir 2018. [DOI: 10.1007/s00398-017-0199-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buchholz S, Born F, Brunner S, Polycarpou A, von Dossow V, Bagaev E, Schramm R, Pichlmaier M, Massberg S, Hagl C, Guenther S. Extracorporeal Cardiopulmonary Resuscitation: How to Triage the Patients? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627875] [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]
Affiliation(s)
- S. Buchholz
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - F. Born
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - S. Brunner
- Medical Department I (Cardiology), Ludwig-Maximilian-University Munich, Munich, Germany
| | - A. Polycarpou
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - V. von Dossow
- Department of Anesthesiology, Ludwig-Maximilian-University Munich, Munich, Germany
| | - E. Bagaev
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - R. Schramm
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - S. Massberg
- Medical Department I (Cardiology), Ludwig-Maximilian-University Munich, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - S. Guenther
- Department of Cardiac Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
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Brenner P, Reichart B, Mayr T, Längin M, Guethoff S, Buchholz S, Dashkevich A, Michel S, Lutzmann I, Werner F, Bauer A, Klymiuk N, Wolf E, Reimann K, Hermanns W, Ayares D, Hagl C, Steen S, Abicht JM. Worldwide First Successful Long-term Survival after Orthotopic Cardiac Xenotransplantation of Multitransgenic Pig Hearts into Baboons Using a CD40mAb or CD40L Costimulation Blockade. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628008] [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]
Affiliation(s)
- P. Brenner
- Department of Cardiac Surgery, LMU München, Munich, Germany
| | - B. Reichart
- Walter-Brendel-Centre, LMU Munich, Munich, Germany
| | - T. Mayr
- Walter-Brendel-Centre, LMU Munich, Munich, Germany
| | - M. Längin
- Department of Anesthesiology, LMU München, Munich, Germany
| | - S. Guethoff
- Walter-Brendel-Centre, LMU Munich, Munich, Germany
| | - S. Buchholz
- Department of Cardiac Surgery, LMU München, Munich, Germany
| | - A. Dashkevich
- Department of Cardiac Surgery, LMU München, Munich, Germany
| | - S. Michel
- Department of Cardiac Surgery, LMU München, Munich, Germany
| | - I. Lutzmann
- Walter-Brendel-Centre, LMU Munich, Munich, Germany
| | - F. Werner
- Walter-Brendel-Centre, LMU Munich, Munich, Germany
| | - A. Bauer
- Department of Anesthesiology, LMU München, Munich, Germany
| | - N. Klymiuk
- Department of Molecular Animal Breeding and Biotechnology, LMU Munich, Munich, Germany
| | - E. Wolf
- Department of Molecular Animal Breeding and Biotechnology, LMU Munich, Munich, Germany
| | | | - W. Hermanns
- Department of Veterinary Pathology, LMU, Munich, Germany
| | | | - C. Hagl
- Department of Cardiac Surgery, LMU München, Munich, Germany
| | - S. Steen
- Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden
| | - J.-M. Abicht
- Department of Anesthesiology, LMU München, Munich, Germany
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Brenner P, Mayr T, Reichart B, Guethoff S, Buchholz S, Dashkevich A, Michel S, Lutzmann I, Werner F, Bauer A, Klymiuk N, Wolf E, Reimann K, Mohiuddin M, Hermanns W, Ayares D, McGregor C, Steen S, Abicht J. New Standards in Orthotopic Cardiac Xenotransplantation of Multitransgenic Pig Hearts Preserved with “Steens” Cold Blood Cardioplegia Perfusion in a Pig-to-Baboon Model with CD40mAb or CD40L Costimulation Blockade. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598771] [Citation(s) in RCA: 1] [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: 10/20/2022]
Affiliation(s)
- P. Brenner
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - T. Mayr
- Walter-Brendel-Centre, LMU, Munich, Germany
| | | | | | - S. Buchholz
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - A. Dashkevich
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | - S. Michel
- Ludwig-Maximilians-University (LMU), Department of Cardiac Surgery, Munich, Germany
| | | | - F. Werner
- Walter-Brendel-Centre, LMU, Munich, Germany
| | - A. Bauer
- Ludwig-Maximilians-University (LMU), Department of Anaesthesiology, Munich, Germany
| | - N. Klymiuk
- Ludwig-Maximilians-University (LMU), Department of Molecular Animal Breeding and Biotechnology, Munich, Germany
| | - E. Wolf
- Ludwig-Maximilians-University (LMU), Department of Molecular Animal Breeding and Biotechnology, Munich, Germany
| | - K. Reimann
- University of Massachusetts Medical School, MassBiologics, Boston, United States
| | - M. Mohiuddin
- NHLBI, NIH, Cardiothoracic Surgery Research Laboratory, Bethesda, United States
| | - W. Hermanns
- Ludwig-Maximilians-University (LMU), Department of Veterinary Pathology, Munich, Germany
| | - D. Ayares
- Revivicor Inc, Blackburg, United States
| | - C. McGregor
- University College, Department of Cardiothoracic Surgery, London, United Kingdom
| | - S. Steen
- University of Lund, Department of Cardiothoracic Surgery, Lund, Sweden
| | - J.M. Abicht
- Ludwig-Maximilians-University (LMU), Department of Anaesthesiology, Munich, Germany
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Guenther S, Buchholz S, Born F, Brunner S, Schramm R, Hoechter D, von Dossow V, Pichlmaier M, Hagl C, Khaladj N. Retrieval of Patients in Severe Cardiogenic Shock with Mobile Extracorporeal Life Support (ECLS) Implantation and Subsequent Air- or Ground-Based Transport. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598690] [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: 10/20/2022]
Affiliation(s)
- S.P.W. Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - S. Buchholz
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - F. Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - S. Brunner
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - R. Schramm
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - D. Hoechter
- Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - V. von Dossow
- Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - N. Khaladj
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
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Papukchiev A, Buchholz S. Validation of ANSYS CFX for gas and liquid metal flows with conjugate heat transfer within the European project THINS. Nuclear Engineering and Design 2017. [DOI: 10.1016/j.nucengdes.2016.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Abstract
GRS has been developing the system code ATHLET over many years. Because ATHLET, among other codes, is widely used in nuclear licensing and supervisory procedures, it has to represent the current state of science and technology. New reactor concepts such as Generation III+ and IV reactors and SMR are using passive safety systems intensively. The simulation of passive safety systems with the GRS system code ATHLET is still a big challenge, because of non-defined operation points and self-setting operation conditions. Additionally, the driving forces of passive safety systems are smaller and uncertainties of parameters have a larger impact than for active systems. This paper addresses the code validation and qualification work of ATHLET on the example of slightly inclined horizontal heat exchangers, which are e. g. used as emergency condensers (e. g. in the KERENA and the CAREM) or as heat exchanger in the passive auxiliary feed water systems (PAFS) of the APR+.
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Affiliation(s)
- S. Buchholz
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching
| | - D. von der Cron
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching
| | - A. Schaffrath
- Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) gGmbH , Forschungszentrum, Boltzmannstraße 14 , 85748 Garching
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Nemec W, Inwald EC, Buchholz S, Klinkhammer Schalke M, Gerken M, Ortmann O. Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma. Arch Gynecol Obstet 2016; 294:825-31. [PMID: 27105972 DOI: 10.1007/s00404-016-4086-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/28/2015] [Accepted: 03/24/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Clinical long-term outcomes of women with uterine leiomyosarcoma (ULMS) with different types of hysterectomy (open abdominal, vaginal, laparoscopic and switch from laparoscopic to open abdominal) were compared according to morcellation and other factors. MATERIALS The clinical cancer registry Regensburg (Germany) registered 64 patients between 2004 and 2013 with ULMS. A retrospective cohort analysis was performed using the Kaplan-Meier method to estimate 5-year overall survival (OAS), recurrence-free survival (RFS) and recurrence rates. To compare surgery with or without morcellation log rank test was used. To adjust for age, FIGO stage, grading and other factors multivariable Cox regression models were applied to estimate hazard ratios (HR). RESULTS In the cohort of 64 patients 15 underwent morcellation, preferably during laparoscopic surgery. Although numbers were small we performed analysis for OAS and RFS. Median OAS for morcellation was 10.6 vs. 6.4 years for non morcellation. 5y-OAS was 76.0 % for morcellation compared to 54.8 % in patients without morcellation (p = 0.115). Cox regression models rendered an unadjusted (univariable) HR 0.428 for morcellation vs. non-morcellation (p = 0.125) and an adjusted (multivariable) HR 0.644 (p = 0.406). 5y-RFR was 64.0 % compared to 42.8 % in patients without morcellation (p = 0.104; unadjusted HR 0.484, p = 0.111; adjusted HR 0.607, p = 0.306). CONCLUSION In general, the prognosis of patients with ULMS is poor. In our cohort, women who underwent hysterectomy with morcellation had a better cumulative OAS and RFS than women without morcellation. Although we adjusted for differences between women with and without morcellation regarding age, grading and stage, there were no statistically significant differences between the groups.
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Affiliation(s)
- W Nemec
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - E C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | - S Buchholz
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany
| | | | - M Gerken
- Tumor Center Regensburg e.V., University Regensburg, Regensburg, Germany
| | - O Ortmann
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
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31
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Brenner P, Mayr T, Guethoff S, Buchholz S, Pöttinger T, Lutzmann I, Werner F, Bauer A, Klymiuk N, Wolf E, Reimann K, Mohiuddin M, Hermanns W, Ayares D, McGregor C, Lambris J, Hagl C, Reichart B, Abicht JM. Costimulation Blockade with CD40mAb in (Life-Supporting) Heterotopic and Orthotopic Cardiac Xenotransplantation of GalT-KO/hCD46/hTM Transgenic Pig Hearts in a Pig-to-Baboon Model. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buchholz S, Graetz D, Michel S, Wellmann P, Meiser B, Überfuhr P, Reichart B, Hagl C, Schramm R. Combined Heart and Lung Transplantation - A Retrospective Analysis of 27 Years at the Klinikum Grosshadern. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Mueller C, Sipahi N, Buchholz S, Vlachea P, Hagl C, Juchem G. Change of Paradigm? Ten-year Outcome of Aortic Pericardial Tissue Valves in Patients Younger than 50 Years of Age - is the „Bio“-Trend Justified? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Mayr B, Buchholz S, Lühr M, Hagl C, Pichlmaier M. Idiopathic Right Coronary Artery Rupture: A Rare Diagnosis in Young Adults. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Gomez R, Buchholz S, Suikkanen H. Experimental and numerical investigation of heat transfer and pressure drop for innovative gas cooled systems. Nuclear Engineering and Design 2015. [DOI: 10.1016/j.nucengdes.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Donders G, Bellen G, Neven P, Grob P, Prasauskas V, Buchholz S, Ortmann O. Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors. Eur J Clin Microbiol Infect Dis 2015. [PMID: 26223323 PMCID: PMC4565868 DOI: 10.1007/s10096-015-2447-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/28/2022]
Abstract
This study was a detailed microscopic analysis of the changes of vaginal microflora characteristics after application of 0.03 mg estriol-lactobacilli combination on the vaginal ecosystem in postmenopausal breast cancer (BC) survivors on aromatase inhibitors (AI) with severe atrophic vaginitis. A total of 16 BC women on AI applied daily one vaginal tablet of Gynoflor® for 28 days followed by a maintenance therapy of three tablets weekly for 8 weeks. During four follow up visits a smear from the upper lateral vaginal wall was analysed by phase contrast microscopy at 400 times magnification in order to classify the lactobacillary grades(LBG), bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidosis (VVC), proportional number of leukocytes and evidence of parabasal cells and epitheliolysis. LBG improved from 81 % LBG-III at entry to 88 % LBG-I&IIa after 2 weeks of initial therapy, which further improved upon follow up (p < 0.001). Whereas BV was a rare event, AV was frequent and substantially improved during treatment (p < 0.01). While at entry most patients had moderate or severe AV, after maintenance therapy no patient except one had AV. The number of leukocytes dropped dramatically from a score of 1.78 ± 0.70 to 1.06 ± 0.25 which was consistent till the end of the study (p < 0.01). Parabasal cells dropped from a score of 3.4 ± 0.64 at entry to 1.3 ± 0.60 at the final visit (ptrend < 0.01). Starting from a low rate of Candida colonisation of 2/14 (14 %), a sudden rise to 7/16 (44 %) occurred after 2 weeks, to return back to base levels at susequent visits. The vaginal use of ultra-low dose estriol and lactobacilli results in rapid and enduring improvement of all markers of the vaginal microflora and epithelial vaginal cell quality in women with breast cancer on AI with dyspareunia. Candida may develop soon after its use, but rapidly disappears again upon their prolonged use. Due to its excellent safety profiles and clinical efficacy we recommend this product as first choice in women on AI with severe dyspareunia.
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Affiliation(s)
- G Donders
- Department of Obstetrics and Gynecology, University Antwerp, Antwerp, Belgium. .,Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium.
| | - G Bellen
- Femicare vzw, Clinical Research for Women, Gasthuismolenstraat 31, 3300, Tienen, Belgium
| | - P Neven
- Department of Obstetrics and Gynecology, Gasthuisberg Hospital, University Leuven, Leuven, Belgium
| | - P Grob
- Medinova AG, Zurich, Switzerland
| | | | - S Buchholz
- Department of Obstetrics and Gynecology, University Medical Center Regensburg, Regensburg, Germany
| | - O Ortmann
- Department of Obstetrics and Gynecology, University Medical Center Regensburg, Regensburg, Germany
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Mögele M, Lintermans A, Bellen G, Prasauskas V, Ortmann O, Grob P, Neven P, Donders G, Buchholz S. Effekte einer vaginalen Applikation von ultra-niedrig dosiertem Estriol (Gynoflor®) auf die Sexualität bei Brustkrebspatientinnen mit atropher Vaginitis unter Aromatasehemmer Therapie. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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38
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Brenner P, Abicht J, Guethoff S, Buchholz S, Mayr T, Bauer A, Blanck S, Kessler B, Wolf E, Becker C, Ayares D, Belka C, Hagl C, Reichart B. The Heterotopic Thoracic Cardiac Xenotransplantation Model (Pig-to-Baboon): Results With and Without a Myelodepressive Protocol. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.765] [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: 11/26/2022] Open
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39
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Lattrich C, Diller M, Schüler S, Buchholz S, Treeck O, Ortmann O. P036 Effects of estriol on growth, gene expression and ERE activation in human breast cancer cell lines. Breast 2015. [DOI: 10.1016/s0960-9776(15)70086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Brenner P, Abicht JM, Guethoff S, Buchholz S, Mayr T, Bauer A, Blank S, Kessler B, Wolf E, Becker C, Ayares D, McGregor C, Belka C, Hagl C, Reichart B. The Heterotopic Thoracic Cardiac Xenotransplantation Model (Pig-to-baboon) in Two Different Groups without and with an Additional Myelodepressive Regime. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Buchholz S, Mögele M, Lintermans A, Bellen G, Prasauskas V, Ortmann O, Grob P, Neven P, Donders G. Vaginal estriol-lactobacilli combination and quality of life in endocrine-treated breast cancer. Climacteric 2015; 18:252-9. [PMID: 25427450 DOI: 10.3109/13697137.2014.991301] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 12/14/2022]
Abstract
OBJECTIVE We investigated the effect of a combination of vaginal ultra-low-dose estriol with lactobacilli on the sexual functioning domain of quality of life during the treatment of breast cancer survivors on an aromatase inhibitor with vaginal atrophy. SUBJECTS AND METHODS This was an open-label, bicentric, exploratory, clinical study in 16 postmenopausal breast cancer survivors on aromatase inhibitors suffering from vaginal atrophy-induced sexual disorders. Atrophy symptoms were assessed by scoring with an 11-point estimation scale (0 = not at all, 10 = worst imaginable feeling). Sexuality parameters of quality of life and medication adherence were recorded in a patient's diary and in the Female Somatic Sexual Experience Instrument (FSSEI) questionnaire. Patients underwent an initial treatment for 4 weeks (one vaginal tablet of Gynoflor(®) containing 0.03 mg estriol daily), followed by maintenance therapy (three vaginal Gynoflor(®) tablets weekly) for 8 weeks. RESULTS Vaginal dryness continuously improved from a median score of 8 at entry to a score of 4 at the end of initial therapy, and a median score of 2 at the end of maintenance therapy. Normal sexual activity before breast cancer diagnosis was reported by 14 women (88%). At study entry, only three women (19%) were sexually active. At the end of the Gynoflor(®) regimen, ten women (63%) reported sexual activity, of which seven (44%) reported sexual intercourse. The FSSEI demonstrated a non-significant trend of improvement of parameters related to sexuality. CONCLUSIONS Local vaginal therapy with Gynoflor(®) in breast cancer survivors on aromatase inhibitors reporting atrophic vaginitis could be considered as a useful treatment for the quality of sexual life.
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Affiliation(s)
- S Buchholz
- Department of Obstetrics and Gynecology, University Medical Center , Regensburg , Germany
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Gluer R, Boteju I, Haladyn K, Zhang M, Buchholz S. Predictors of delay to thrombolysis in STEMI patients in a peripheral centre. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.114] [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: 11/30/2022]
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43
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Habibian M, Crane K, Beattie V, Bazley M, Zhang M, Buchholz S. Inappropriate use of continuous cardiac telemetry and its potential adverse impact on human resources management and financial burdens. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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44
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Challa A, Bhadange N, Habibian M, Zhang M, Buchholz S. Recurrence of atrial fibrillation after electrical cardioversion is not predicted by electrocardiographic P wave duration or PR interval. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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Buchholz S, Schrale R, Zhang M. Successful palliative valvuloplasty for critical aortic valve stenosis in aspartylglucosaminuria (AGU) syndrome. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.450] [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: 11/28/2022]
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46
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Tatavarti S, Raghuraman H, Buchholz S. Influence of heart rate correction on guideline-driven classification of valvular aortic stenosis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Habibian M, Yedalian A, Raghuraman H, Zhang M, Buchholz S. Is bicuspid aortic valve phenotype heterogeneity predicting aortopathy or accelerated valve dysfunction? Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.548] [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: 11/28/2022]
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48
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Buchholz S, Bolbol B, Somaratna K, Zhang M. Initial experience with semi-supine bicycle stress echocardiography in a regional setting. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.547] [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: 11/17/2022]
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49
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Kwok CW, Treeck O, Buchholz S, Seitz S, Ortmann O, Engel JB. Receptors for luteinizing hormone-releasing hormone (GnRH) as therapeutic targets in triple negative breast cancers (TNBC). Target Oncol 2014; 10:365-73. [DOI: 10.1007/s11523-014-0340-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/25/2014] [Indexed: 12/25/2022]
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50
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Buchholz S, Hannig K, Schirmel J. Losing uniqueness - shifts in carabid species composition during dry grassland and heathland succession. Anim Conserv 2013; 16:661-670. [PMID: 32313440 PMCID: PMC7159390 DOI: 10.1111/acv.12046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
Dry sand ecosystems, such as dry grasslands and heathlands, have suffered habitat loss and degradation due to land‐use changes and are today among the most endangered habitats in Central Europe. To evaluate the impact of degradation processes on habitat quality, we investigated how succession from sparse vegetated sand ecosystems to grass‐invaded and tree‐dominated ecosystems and the environmental parameters associated with it influences carabid assemblages. We also determined to what extent typical xerophilic species assemblages still exist. Pitfall trapping at 28 study sites in northwestern Germany yielded 111 carabid species that were grouped using Kendall's W coefficient of concordance. Ordination revealed that the differences between the four species groups resulted from vegetation cover and soil humidity, indicating that carabid distribution clearly reflects degradation processes. Our results suggest that areas in which succession proceeds were unsuitable for assemblages typical of dry grasslands and heathlands. In all, 35 species are lost due to succession from dry grassland and heathland to grass‐invaded and tree‐dominated sites. We discuss implications for habitat management and restoration, since dry sand ecosystems comprise a very high number of specialized and endangered species.
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Affiliation(s)
- S Buchholz
- Department of Ecology Technische Universität Berlin Berlin Germany
| | | | - J Schirmel
- Ecosystem Analysis Institute of Environmental Science University of Koblenz-Landau Landau Germany
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