1
|
Lim S, Lang S, Savaglio M, Skouteris H, Moran LJ. Intervention Strategies to Address Barriers and Facilitators to a Healthy Lifestyle Using the Behaviour Change Wheel: A Qualitative Analysis of the Perspectives of Postpartum Women. Nutrients 2024; 16:1046. [PMID: 38613079 PMCID: PMC11013589 DOI: 10.3390/nu16071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Postpartum women experience unique barriers to maintaining healthy lifestyles after birth. Theory-based behaviour change techniques and intervention strategies can be integrated into postpartum lifestyle interventions to enable women to overcome barriers to change. This study aims to explore barriers and facilitators to engaging in healthy postpartum lifestyle behaviours and develop intervention strategies for integration in a postpartum lifestyle intervention using the Behaviour Change Wheel (BCW). Semi-structured interviews were conducted with women up to two years postpartum (n = 21). Interviews were thematically analysed, themes were mapped to the Capability, Opportunity, and Motivation Model of Behaviour Change and intervention strategies were developed using the BCW. Findings suggest that women face barriers and facilitators within capability (sleep deprivation, mental exhaustion, ability to plan), opportunity (support of friends, partners and extended families) and motivation (challenges with prioritising self, exercise to cope with stress). Intervention strategies included supporting behaviour regulation and sleep to enhance capability, engaging partners, strengthening peer support to create opportunities and highlighting the mental health benefits of healthy lifestyles to inspire motivation. Integrating targeted evidence-based behaviour change strategies into postpartum lifestyle interventions may support women in overcoming commonly reported barriers to a healthy lifestyle.
Collapse
Affiliation(s)
- Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, 5 Arnold Street, Boxhill, VIC 3128, Australia
- Monash Centre of Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia; (S.L.); (M.S.); (H.S.); (L.J.M.)
| | - Sarah Lang
- Monash Centre of Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia; (S.L.); (M.S.); (H.S.); (L.J.M.)
| | - Melissa Savaglio
- Monash Centre of Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia; (S.L.); (M.S.); (H.S.); (L.J.M.)
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Helen Skouteris
- Monash Centre of Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia; (S.L.); (M.S.); (H.S.); (L.J.M.)
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Lisa J. Moran
- Monash Centre of Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia; (S.L.); (M.S.); (H.S.); (L.J.M.)
| |
Collapse
|
2
|
Guberina M, Guberina N, Hoffmann C, Gogishvili A, Freisleben F, Herz A, Hlouschek J, Gauler T, Lang S, Stähr K, Höing B, Pöttgen C, Indenkämpen F, Santiago A, Khouya A, Mattheis S, Stuschke M. Prospects for online adaptive radiation therapy (ART) for head and neck cancer. Radiat Oncol 2024; 19:4. [PMID: 38191400 PMCID: PMC10775598 DOI: 10.1186/s13014-023-02390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to image-guided-radiotherapy (IGRT) in consecutive patients with tumors in the head and neck region from a prospective registry. METHODS The study comprises all consecutive patients with tumors in the head and neck area who were treated with kV-CBCT-based online ART or IGRT-modus at the linear-accelerator ETHOS™. As a measure of effectiveness, the equivalent-uniform-dose was calculated for the CTV (EUDCTV) and organs-at-risk (EUDOAR) and normalized to the prescribed dose. As an important determinant for the need of ART the interfractional shifts of anatomic landmarks related to the tongue were analyzed and compared to the intrafractional shifts. The latter determine the performance of the adapted dose distribution on the verification CBCT2 postadaptation. RESULTS Altogether 59 consecutive patients with tumors in the head-and-neck-area were treated from 01.12.2021 to 31.01.2023. Ten of all 59 patients (10/59; 16.9%) received at least one phase within a treatment course with ART. Of 46 fractions in the adaptive mode, irradiation was conducted in 65.2% of fractions with the adaptive-plan, the scheduled-plan in the remaining. The dispersion of the distributions of EUDCTV-values from the 46 dose fractions differed significantly between the scheduled and adaptive plans (Ansari-Bradley-Test, p = 0.0158). Thus, the 2.5th percentile of the EUDCTV-values by the adaptive plans amounted 97.1% (95% CI 96.6-99.5%) and by the scheduled plans 78.1% (95% CI 61.8-88.7%). While the EUDCTV for the accumulated dose distributions stayed above 95% at PTV-margins of ≥ 3 mm for all 8 analyzed treatment phases the scheduled plans did for margins ≥ 5 mm. The intrafractional anatomic shifts of all 8 measured anatomic landmarks were smaller than the interfractional with overall median values of 8.5 mm and 5.5 mm (p < 0.0001 for five and p < 0.05 for all parameters, pairwise comparisons, signed-rank-test). The EUDOAR-values for the larynx and the parotid gland were significantly lower for the adaptive compared with the scheduled plans (Wilcoxon-test, p < 0.001). CONCLUSIONS The mobile tongue and tongue base showed considerable interfractional variations. While PTV-margins of 5 mm were sufficient for IGRT, ART showed the potential of decreasing PTV-margins and spare dose to the organs-at-risk.
Collapse
Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - C Hoffmann
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Gogishvili
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Freisleben
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - K Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - B Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - C Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Khouya
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| |
Collapse
|
3
|
Haus A, Chand A, Dawson K, Lang S, Gilmer BB, Wahl CJ. Modified Lemaire Lateral Extra-Articular Tenodesis Using an Inlay Technique and All-Suture Knotless Anchor Fixation. Arthrosc Tech 2023; 12:e1607-e1613. [PMID: 37780650 PMCID: PMC10533872 DOI: 10.1016/j.eats.2023.05.004] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/09/2023] [Indexed: 10/03/2023] Open
Abstract
Appreciation of persistent anterolateral rotatory instability and graft failure after anterior cruciate ligament (ACL) reconstruction procedures has led surgeons to adopt the addition of lateral extra-articular tenodesis (LET) in both the revision and primary setting. Multiple techniques have been shown to eliminate anterolateral rotatory instability and reduce forces on the ACL graft, which has translated to lower re-rupture rates and improved patient outcomes. The risk of ACL/LET tunnel convergence can potentially compromise the fixation of one or both graft reconstructions. This article describes a technique for LET fixation which minimizes the depth of the LET femoral bone socket and utilizes low-profile implants thus mitigating this risk.
Collapse
Affiliation(s)
- Andrew Haus
- Barton Center for Orthopedics and Wellness, South Lake Tahoe, California, U.S.A
| | - Avishay Chand
- University of Nevada School of Medicine, Reno, Nevada, U.S.A
| | - Karly Dawson
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | - Sarah Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | | |
Collapse
|
4
|
Lang S, Day K, Gallaher E, Jebeile H, Collins CE, Baur LA, Truby H. Participant recruitment for paediatric research using social media: A practical 'how-to' guide for researchers. Nutr Diet 2023; 80:338-350. [PMID: 37154014 PMCID: PMC10952907 DOI: 10.1111/1747-0080.12810] [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: 12/22/2022] [Revised: 02/28/2023] [Accepted: 03/21/2023] [Indexed: 05/10/2023]
Abstract
AIM Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. METHODS The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. RESULTS A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. CONCLUSION Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.
Collapse
Affiliation(s)
- Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityNotting HillAustralia
| | - Kaitlin Day
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityNotting HillAustralia
- School of Agriculture and FoodFaculty of Science, University of MelbourneParkvilleAustralia
| | | | - Hiba Jebeile
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadAustralia
- The Children's Hospital at WestmeadInstitute of Endocrinology and DiabetesWestmeadAustralia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteRankin ParkAustralia
| | - Louise A. Baur
- Children's Hospital Westmead Clinical SchoolThe University of SydneyWestmeadAustralia
- Weight Management ServicesThe Children's Hospital at WestmeadWestmeadAustralia
| | - Helen Truby
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneAustralia
| |
Collapse
|
5
|
Piorko M, Lang S, Bean R. Deciphering the Hermeticae Philosophiae Medulla: Textual Cultures of Alchemical Secrecy. Ambix 2023; 70:150-183. [PMID: 37162130 DOI: 10.1080/00026980.2023.2201744] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article presents the decryption, historical analysis, and alchemical interpretation of an alchemical cipher found in a shared notebook of John and Arthur Dee (British Library MS Sloane 1902). The cipher is an early example of a Bellaso/Della Porta/Vigenère type, a strong encryption method which was historically deemed indecipherable. The essay explores the medical and alchemical context for the manuscript into which the cipher was copied and provides the transcription, plaintext solution (in Latin), and English translation of the encrypted text. Further, it interprets the enciphered text through the lens of alchemical practice and provides evidence for the dissemination of this cipher as part of a larger alchemical knowledge network.
Collapse
Affiliation(s)
- Megan Piorko
- Distinctive Collections & Digital Engagment, Villanova University, Villanova, United States
| | - Sarah Lang
- Zentrum für Informationsmodellierung, University of Graz, Graz, Austria
| | - Richard Bean
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Höing B, Wittig L, Weber L, Stuck BA, Mattheis S, Hussain T, Lang S, Theysohn JM, Li Y, Hansen S. Abdominal ultrasound in head and neck squamous cell carcinoma staging: yes or no? Eur Arch Otorhinolaryngol 2023; 280:1885-1891. [PMID: 36357610 DOI: 10.1007/s00405-022-07723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Abdominal ultrasound is a diagnostic staging procedure for distant metastases in head and neck squamous cell carcinoma (HNSCC). However, currently performed abdominal staging procedures do not follow consistent standards. Therefore, this retrospective study on 498 patients aimed at investigating on abdominal ultrasound as a staging procedure in HNSCC. MATERIALS AND METHODS A retrospective analysis of 498 head and neck cancer patients treated in our Department of Head and Neck Surgery between 2008 and 2015 was performed. Disease-related data were collected over a mean follow-up time of 30.3 months, and results of abdominal ultrasound were analyzed. RESULTS 426 patients received abdominal ultrasound as a staging procedure. 7% (29) were suspicious for metastases. In 19 cases (66%), the detected abnormalities were masses of the liver. In four patients, abdominal metastases were confirmed at the time of initial diagnosis. 16 patients developed abdominal metastases in the course of the disease (on average 623 days after initial diagnosis). 19 out of 20 patients with abdominal metastases had an N2/N3 cervical lymph node status. In this study, the negative predictive value of abdominal ultrasound for HNSCC staging was 99.03%, while the positive predictive value yielded 5.88% (N2/N3-patients). CONCLUSION Only in patients with locally advanced lymph-node-status (N2/N3), abdominal ultrasound can be useful as a staging investigation to exclude abdominal metastasis in HNSCC patients. For N0/N1 patients, abdominal ultrasound might be dispensed. Of note, in case of a positive result, further diagnostic procedures are mandatory.
Collapse
Affiliation(s)
- Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - L Wittig
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - L Weber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Y Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| |
Collapse
|
7
|
Dufour LS, Bourai A, Lang S, Nhan P, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Capderou E, Issaurat P, Jullien S, De Geyer I, Candau C, Boccara F, Assyag P, Cohen A. Four chambers strain analysis in patients with heart failure: Towards a new standard? Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.094] [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: 12/31/2022]
|
8
|
Kürten C, Kulkarni A, Vujanovic L, Cillo A, Lang S, Ferris R. O1.2 Single cell RNA sequencing allows mapping of HPV transcripts in head and neck cancer epithelial cells. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106169] [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: 11/11/2022]
|
9
|
Hussain T, Rothkirch C, Mattheis S, Lang S. P25 The role of ultrasound elastography for clinical neck staging in HPV-related oropharyngeal cancer. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106158] [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: 11/10/2022]
|
10
|
Ohliger J, Haus A, Fong R, Lang S, Gilmer BB, Wahl CJ. Modified Bosworth Technique for Medial Collateral Ligament Reconstruction of the Knee Using Semitendinosus Tendon Autograft. Arthrosc Tech 2022; 11:e1903-e1909. [PMID: 36457399 PMCID: PMC9705397 DOI: 10.1016/j.eats.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 02/03/2023] Open
Abstract
The medial collateral ligament (MCL) is a major contributor to knee joint stability and is the most common ligament involved in knee injuries. When conservative management for high-grade MCL injuries fails, operative treatment is indicated. Various reconstruction techniques are described in the literature. The following report describes a reconstruction technique based on the modified Bosworth. We present a step-by-step technique for using autograft semitendinosus tendon as a double limb to reconstruct the MCL and if necessary, the posterior oblique ligament. The technique is versatile with respect to a spectrum of MCL injury patterns, isometric, incorporates techniques that are common to other knee reconstructions, and uses readily available autograft. It has been used extensively by the senior authors as an adjunct/augmentation to the repair of acute MCL injuries as well as in the reconstruction of chronic MCL laxity. The technique restores stability to rotation and valgus stress while maintaining the distal insertion of the semitendinosus intact.
Collapse
Affiliation(s)
- James Ohliger
- Barton Center for Orthopedics and Wellness, South Lake Tahoe, California
| | - Andrew Haus
- Barton Center for Orthopedics and Wellness, South Lake Tahoe, California
| | - Rodney Fong
- University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Sarah Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California
| | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California,Address correspondence to Brian Gilmer, M.D., Mammoth Orthopedic Institute, 85 Sierra Park Rd., Mammoth Lakes, CA 93546.
| | | |
Collapse
|
11
|
Liu J, Zhang X, Chen T, Wu T, Lin T, Jiang L, Lang S, Liu L, Natarajan L, Tu J, Kosciolek T, Morton J, Nguyen T, Schnabl B, Knight R, Feng C, Zhong Y, Tu X. A semiparametric model for between-subject attributes: Applications to beta-diversity of microbiome data. Biometrics 2022; 78:950-962. [PMID: 34010477 PMCID: PMC8602427 DOI: 10.1111/biom.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/25/2023]
Abstract
The human microbiome plays an important role in our health and identifying factors associated with microbiome composition provides insights into inherent disease mechanisms. By amplifying and sequencing the marker genes in high-throughput sequencing, with highly similar sequences binned together, we obtain operational taxonomic units (OTUs) profiles for each subject. Due to the high-dimensionality and nonnormality features of the OTUs, the measure of diversity is introduced as a summarization at the microbial community level, including the distance-based beta-diversity between individuals. Analyses of such between-subject attributes are not amenable to the predominant within-subject-based statistical paradigm, such as t-tests and linear regression. In this paper, we propose a new approach to model beta-diversity as a response within a regression setting by utilizing the functional response models (FRMs), a class of semiparametric models for between- as well as within-subject attributes. The new approach not only addresses limitations of current methods for beta-diversity with cross-sectional data, but also provides a premise for extending the approach to longitudinal and other clustered data in the future. The proposed approach is illustrated with both real and simulated data.
Collapse
Affiliation(s)
- J. Liu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - X. Zhang
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,
| | - T. Chen
- Department of Mathematics, University of Toledo, Toledo, Ohio, U.S.A
| | - T. Wu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - T. Lin
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - L. Jiang
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Center for Microbiome Innovation, UC San Diego, San Diego, California, U.S.A
| | - S. Lang
- Department of Medicine, UC San Diego, San Diego, California, U.S.A
| | - L. Liu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - L. Natarajan
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - J.X. Tu
- Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - T. Kosciolek
- Department of Pediatrics, UC San Diego, San Diego, California, U.S.A.,Ma lopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - J. Morton
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, New York, U.S.A
| | - T.T Nguyen
- Department of Psychiatry, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - B. Schnabl
- Department of Medicine, UC San Diego, San Diego, California, U.S.A
| | - R. Knight
- Department of Pediatrics, UC San Diego, San Diego, California, U.S.A.,Department of Computer Science and Engineering, UC San Diego, San Diego, California, U.S.A.,Department of Bioengineering, UC San Diego, San Diego, California, U.S.A.,Center for Microbiome Innovation, UC San Diego, San Diego, California, U.S.A
| | - C. Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, U.S.A
| | - Y. Zhong
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - X.M. Tu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| |
Collapse
|
12
|
Holtmann LC, Deuß E, Meyer M, Kaster F, Bastian T, Schleupner MC, Hagedorn E, Lang S, Arweiler-Harbeck D. Detection accuracy of soft tissue complications during remote cochlear implant follow-up. Cochlear Implants Int 2022; 23:249-256. [PMID: 35477412 DOI: 10.1080/14670100.2022.2067644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.
Collapse
Affiliation(s)
- L C Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Deuß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - T Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M C Schleupner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Hagedorn
- CIC Ruhr Acoustics Bagus, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
13
|
Staudacher JJ, Bauer J, Atkinson SR, Thursz M, Lang S, Schnabl B, Wiley MB, Carr R, Jung B. Systemic Activin Is Elevated in Patients With Severe Alcoholic Hepatitis. Gastro Hep Adv 2022; 1:147-149. [PMID: 35602917 PMCID: PMC9119346 DOI: 10.1016/j.gastha.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Staudacher
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charite-University Medicine, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bauer
- Department of Medicine, University of Washington, Seattle, Washington
| | - S R Atkinson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - M Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - S Lang
- Department of Medicine, University of California San Diego, La Jolla, California
| | - B Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California
- Department of Medicine, VA San Diego Healthcare System, San Diego, California
| | - M B Wiley
- Department of Medicine, University of Washington, Seattle, Washington
| | - R Carr
- Department of Medicine, University of Washington, Seattle, Washington
| | - B Jung
- Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
14
|
Elliott A, Lang S, Truby H, Brennan L, Gibson S. Tackling the challenge of treating obesity using design research methods: A scoping review. Obes Rev 2022; 23:e13360. [PMID: 34545669 DOI: 10.1111/obr.13360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 01/10/2023]
Abstract
Design research methods, including user-centered design, human-centered design, and design thinking, are iterative processes and frameworks that engage stakeholders to inform the design of initiatives, programs, or research interventions. Design research methods are not yet widely applied in healthcare. To date, there is a limited understanding of how design research methodologies can be applied to develop client-centered weight loss interventions. This scoping review explores the extent, range, and nature of research projects that used design research methods to guide the development of an obesity treatment intervention. A systematic search of eight databases identified projects that used design research methods to develop a weight loss intervention or strategy. The method and practical application of design research processes for each eligible article were extracted and explored. Design research methods were used to generate ideas or guide the development of a mobile application (n = 6), mHealth device (n = 1), eHealth solution (n = 1), health promotion program (n = 1), or patient-clinician communication tools (n = 2). There was considerable variation in the application of design research processes between studies. Design research methods may provide an iterative, flexible framework to facilitate the development of client-centered, inclusive interventions and strategies. Design research methods may support research teams to move away from the one-size-fits-all approach to obesity treatment.
Collapse
Affiliation(s)
- Andrea Elliott
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Linda Brennan
- School of Media and Communication, RMIT University, Melbourne, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
15
|
Lang S. A Machine Reasoning Algorithm for the Digital Analysis of Alchemical Language and its Decknamen. Ambix 2022; 69:65-83. [PMID: 35272570 DOI: 10.1080/00026980.2022.2038428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Alchemical language has been addressed in several lexicographical studies, historically and recently. This paper discusses the current state of the field and proposes a digital distant-reading approach to the issue of decoding alchemical Decknamen. This paper presents an algorithm for the digital analysis of alchemical language using the corpus of printed works by Michael Maier (1568-1622). Alchemical language was used as a medium for negotiating authority, inclusion, and exclusion in alchemical and chymical communities and also as a tool for social and scholarly knowledge-making. This paper addresses the historical problem of understanding early modern alchemical language by computational analysis. Previous studies have applied close reading methodologies to decode Decknamen; however, this paper offers a machine reasoning approach to analyse patterns in alchemical language.
Collapse
|
16
|
Lang S, Simone-Finstrom M, Healy K. Context-Dependent Viral Transgenerational Immune Priming in Honey Bees (Hymenoptera: Apidae). J Insect Sci 2022; 22:6523140. [PMID: 35137131 PMCID: PMC8826052 DOI: 10.1093/jisesa/ieac001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 06/01/2023]
Abstract
Transgenerational immune priming is the process of increased resistance to infection in offspring due to parental pathogen exposure. Honey bees (Apis mellifera L. (Hymenoptera: Apidae)) are hosts to multiple pathogens, and this complex immune function could help protect against overwhelming infection. Honey bees have demonstrated transgenerational immune priming for the bacterial pathogen Paenibacillus larvae; however, evidence for viral transgenerational immune priming is lacking across insects in general. Here we test for the presence of transgenerational immune priming in honey bees with Deformed wing virus (DWV) by injecting pupae from DWV-exposed queens and measuring virus titer and immune gene expression. Our data suggest that there is evidence for viral transgenerational immune priming in honey bees, but it is highly context-dependent based on route of maternal exposure and potentially host genetics or epigenetic factors.
Collapse
Affiliation(s)
- Sarah Lang
- Department of Entomology, Louisiana State University and AgCenter Louisiana State University 404 Life Sciences Building, Louisiana State University, Baton Rouge, LA 70803, USA
- USDA ARS Honey Bee, Breeding and Physiology Lab, 1157 Ben Hur Road, Baton Rouge, LA 70820, USA
| | - Michael Simone-Finstrom
- USDA ARS Honey Bee, Breeding and Physiology Lab, 1157 Ben Hur Road, Baton Rouge, LA 70820, USA
| | - Kristen Healy
- Department of Entomology, Louisiana State University and AgCenter Louisiana State University 404 Life Sciences Building, Louisiana State University, Baton Rouge, LA 70803, USA
| |
Collapse
|
17
|
Lang S, Loibl M, Gläsner J, Simon M, Rupp M, Grad S, Neumann C, Alt V, Gessner A, Hanses F. Vertebral osteomyelitis is characterised by increased RANK/OPG and RANKL/OPG expression ratios in vertebral bodies and intervertebral discs. Eur Cell Mater 2021; 42:438-451. [PMID: 34846723 DOI: 10.22203/ecm.v042a27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Vertebral osteomyelitis (VO) is an infection of the spine mainly caused by bacterial pathogens. The pathogenesis leading to destruction of intervertebral discs (IVDs) and adjacent vertebral bodies (VBs) is poorly described. The present study aimed at investigating the connection between infection and bone/disc metabolism in VO patients. 14 patients with VO (infection group) and 14 patients with burst fractures of the spine (fracture group; control) were included prospectively. Tissue biopsies from affected IVDs and adjacent VBs were analysed by RT-qPCR for mRNA-expression levels of 18 target genes including chemokines, adipokines and genes involved in bone metabolism. Most importantly, the receptor activator of NF-κB/osteoprotegerin (RANK/OPG) expression ratio was drastically elevated in both VBs and IVDs of the infection group. In parallel, expression of genes of the prostaglandin-E2-dependent prostanoid system was induced. Such genes regulate tissue degradation processes via the triad OPG/RANK/RANKL as well as via the chemokines IL-8 and CCL-20, whose expression was also found to be increased upon infection. The gene expression of the adipokine leptin, which promotes inflammatory tissue degradation, was higher in IVD tissue of the infection group, whereas the transcription of omentin and resistin genes, whose functions are largely unknown in the context of infectious diseases, was lower in infected VBs. In summary, similar expression patterns of pro-inflammatory cytokines and pro-osteoclastogenic factors were identified in VBs and IVDs of patients suffering from VO. This suggests that common immuno-metabolic pathways are involved in the mechanisms leading to tissue degradation in VBs and IVDs during VO.
Collapse
Affiliation(s)
| | - M Loibl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg,
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Penn HJ, Simone-Finstrom M, Lang S, Chen J, Healy K. Host Genotype and Tissue Type Determine DWV Infection Intensity. Front Insect Sci 2021; 1:756690. [PMID: 38468897 PMCID: PMC10926404 DOI: 10.3389/finsc.2021.756690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/12/2021] [Indexed: 03/13/2024]
Abstract
Varroa mite-vectored viruses such as Deformed wing virus (DWV) are of great concern for honey bee health as they can cause disease in individuals and increase colony mortality. Two genotypes of DWV (A and B) are prevalent in the United States and may have differential virulence and pathogenicity. Honey bee genetic stocks bred to resist Varroa mites also exhibit differential infection responses to the Varroa mite-vectored viruses. The goal of this project was to determine if interactions between host genotype could influence the overall infection levels and dissemination of DWV within honey bees. To do this, we injected DWV isolated from symptomatic adult bees into mite-free, newly emerged adult bees from five genetic stocks with varying levels of resistance to Varroa mites. We measured DWV-A and DWV-B dissemination among tissues chosen based on relevance to general health outcomes for 10 days. Injury from sham injections did not increase DWV-A levels but did increase DWV-B infections. DWV injection increased both DWV-A and DWV-B levels over time with significant host stock interactions. While we did not observe any differences in viral dissemination among host stocks, we found differences in virus genotype dissemination to different body parts. DWV-A exhibited the highest initial levels in heads and legs while the highest initial levels of DWV-B were found in heads and abdomens. These interactions underscore the need to evaluate viral genotype and tissue specificity in conjunction with host genotype, particularly when the host has been selected for traits relative to virus-vector and virus resistance.
Collapse
Affiliation(s)
- Hannah J. Penn
- United States Department of Agriculture (USDA) Agricultural Research Service (ARS), Sugarcane Research Unit, Houma, LA, United States
| | - Michael Simone-Finstrom
- United States Department of Agriculture (USDA) Agricultural Research Service (ARS), Honey Bee Breeding, Genetics and Physiology Research Laboratory, Baton Rouge, LA, United States
| | - Sarah Lang
- United States Department of Agriculture (USDA) Agricultural Research Service (ARS), Honey Bee Breeding, Genetics and Physiology Research Laboratory, Baton Rouge, LA, United States
| | - Judy Chen
- United States Department of Agriculture (USDA) Agricultural Research Service (ARS), Bee Research Laboratory, Beltsville, MD, United States
| | - Kristen Healy
- Department of Entomology, Louisiana State University Agriculture Center, Baton Rouge, LA, United States
| |
Collapse
|
19
|
Hill J, LaFollette R, Hughes H, Mand S, Koehler J, Li J, Baez J, Lang S, McDonough E. 344 Qualitative Description of Synchronous Online Discussions During Weekly Academic Conference. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.358] [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]
|
20
|
Lang S, Hoelter P, Schmidt M, Strother C, Kaethner C, Kowarschik M, Doerfler A. Artificial Intelligence-Based 3D Angiography for Visualization of Complex Cerebrovascular Pathologies. AJNR Am J Neuroradiol 2021; 42:1762-1768. [PMID: 34503946 DOI: 10.3174/ajnr.a7252] [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] [Received: 05/25/2020] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE By means of artificial intelligence, 3D angiography is a novel postprocessing method for 3D imaging of cerebral vessels. Because 3D angiography does not require a mask run like the current standard 3D-DSA, it potentially offers a considerable reduction of the patient radiation dose. Our aim was an assessment of the diagnostic value of 3D angiography for visualization of cerebrovascular pathologies. MATERIALS AND METHODS 3D-DSA data sets of cerebral aneurysms (n CA = 10), AVMs (n AVM = 10), and dural arteriovenous fistulas (dAVFs) (n dAVF = 10) were reconstructed using both conventional and prototype software. Corresponding reconstructions have been analyzed by 2 neuroradiologists in a consensus reading in terms of image quality, injection vessel diameters (vessel diameter [VD] 1/2), vessel geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of AVMs (eg, location, nidus size, feeder, associated aneurysms, drainage, Spetzler-Martin score), dAVFs (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck, size). RESULTS In total, 60 volumes have been successfully reconstructed with equivalent image quality. The specific qualitative/quantitative assessment of 3D angiography revealed nearly complete accordance with 3D-DSA in AVMs (eg, mean nidus size3D angiography/3D-DSA= 19.9 [SD, 10.9]/20.2 [SD, 11.2] mm; r = 0.9, P = .001), dAVFs (eg, mean diameter of the main feeder3D angiography/3D-DSA= 2.04 [SD, 0.65]/2.05 [SD, 0.63] mm; r = 0.9, P = .001), and cerebral aneurysms (eg, mean size3D angiography/3D-DSA= 5.17 [SD, 3.4]/5.12 [SD, 3.3] mm; r = 0.9, P = .001). Assessment of the geometry of the injection vessel in 3D angiography data sets did not differ significantly from that of 3D-DSA (vessel geometry indexAVM: r = 0.84, P = .003; vessel geometry indexdAVF: r = 0.82, P = .003; vessel geometry indexCA: r = 0.84, P <.001). CONCLUSIONS In this study, the artificial intelligence-based 3D angiography was a reliable method for visualization of complex cerebrovascular pathologies and showed results comparable with those of 3D-DSA. Thus, 3D angiography is a promising postprocessing method that provides a significant reduction of the patient radiation dose.
Collapse
Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Sciences Center, Madison, Wisconsin
| | - C Kaethner
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - M Kowarschik
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
21
|
Pogorzelski M, Lauri F, Hilser T, Hense J, Ting S, Kansy B, Gauler T, Stuschke M, Schmid K, Lang S, Zaun G, Grünwald V, Schuler M, Kasper S. 922P Efficacy of immunotherapy (IO) and subsequent systemic treatment after failure of IO in patients with recurrent or metastatic head and neck cancer in a real-world setting. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1332] [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
|
22
|
Tipton CC, Gilmer BB, Marvil S, Lang S, Unal K, Guttmann D. An Arthroscopic Technique for Release of the Middle Glenohumeral Ligament and the Effect on External Rotation of the Shoulder. Arthrosc Tech 2021; 10:e2121-e2125. [PMID: 34504751 PMCID: PMC8417305 DOI: 10.1016/j.eats.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/18/2021] [Indexed: 02/03/2023] Open
Abstract
The middle glenohumeral ligament (MGHL) is well recognized as a primary stabilizer of the shoulder. Its role in shoulder pathologies such as adhesive capsulitis, subscapularis tendon tear, and glenohumeral arthritis is less understood. Biomechanically, the MGHL plays an important role in range of motion, specifically involving normal and pathologic external rotation in less than 45° of abduction. In this Technical Note, we present a technique for arthroscopic release of the MGHL in the setting of a stable shoulder with preoperative loss of external rotation and a patient at risk for postoperative restriction of external rotation.
Collapse
Affiliation(s)
| | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
- Address correspondence to Brian Gilmer, M.D., Mammoth Orthopedic Institute, 85 Sierra Park Rd., Mammoth Lakes, CA 93546.
| | | | - Sarah Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | - Kaan Unal
- Taos Orthopedic Institute, Taos, New Mexico
| | | |
Collapse
|
23
|
Jeon S, Jeon L, Lang S, Newell K. Teacher Depressive Symptoms and Child Math Achievement in Head Start: The Roles of Family-Teacher Relationships and Approaches to Learning. Child Dev 2021; 92:2478-2495. [PMID: 34131906 DOI: 10.1111/cdev.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined the direct and indirect associations of teachers' depressive symptoms with children's math achievement through teachers' reports of family-teacher relationships and children's approaches to learning (ATL) in Head Start. This study included 3- and 4-year-old 1,547 children (49% female; 27% White, 24% Black, 41% Hispanic/Latino, and 8% others) who attended Head Start from fall 2014 through spring 2015. Results indicated that teachers' depressive symptoms were directly associated with lower gains in children's math skills over a year. In addition, teachers who reported higher depressive symptoms were less likely to report positive family-teacher relationships. This, in turn, resulted in lower gains in children's ATL and was associated with lower achievement in math skills (r2 = .69).
Collapse
|
24
|
Soulat-Dufour L, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet Droit M, Nhan P, Jean M, Kamami I, Arnaud C, Capderou E, Issaurat P, Ben Said R, Boccara F, Cohen A. Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.032] [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: 10/21/2022]
|
25
|
Fournier M, Corning E, Witt A, Lang S, Gilmer BB. Arthroscopically Assisted Fixation of Terrible Triad Variant Injuries of the Elbow With Small-Bore Needle Arthroscopy. Arthrosc Tech 2021; 10:e1469-e1474. [PMID: 34258191 PMCID: PMC8252851 DOI: 10.1016/j.eats.2021.02.011] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
The range of diagnostic and therapeutic applications of needle arthroscopy (NA) continue to expand due to advances in image quality and resolution. Minimally invasive techniques can be augmented by the smaller camera size and reduced fluid use made possible by NA. Small-bore arthroscopy presents opportunities for use in smaller joints, such as the elbow, where applications of standard arthroscopic equipment may be limited by small anatomic spaces and fluid extravasation. In this Technical Note, we present our technique for NA-assisted treatment of terrible triad injuries, specifically in the setting of an intact radial head. The technique describes a stepwise approach to arthroscopically aided fixation of the coronoid process, followed by open reconstruction of the lateral collateral ligament complex.
Collapse
Affiliation(s)
- Matt Fournier
- Tahoe Orthopedic and Sports Medicine, South Lake Tahoe, California, U.S.A
| | - Evan Corning
- Tahoe Orthopedic and Sports Medicine, South Lake Tahoe, California, U.S.A
| | - Austin Witt
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | - Sarah Lang
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
| | - Brian B. Gilmer
- Mammoth Orthopedic Institute, Mammoth Hospital, Mammoth Lakes, California, U.S.A
- Address correspondence to Brian B. Gilmer, M.D., F.A.A.O.S., F.A.A.N.A., Mammoth Orthopedic Institute, 85 Sierra Park Rd., Mammoth Lakes, CA 93546.
| |
Collapse
|
26
|
Sundercombe SL, Berbic M, Evans CA, Cliffe C, Elakis G, Temple SEL, Selvanathan A, Ewans L, Quayum N, Nixon CY, Dias KR, Lang S, Richards A, Goh S, Wilson M, Mowat D, Sachdev R, Sandaradura S, Walsh M, Farrar MA, Walsh R, Fletcher J, Kirk EP, Teunisse GM, Schofield D, Buckley MF, Zhu Y, Roscioli T. Clinically Responsive Genomic Analysis Pipelines: Elements to Improve Detection Rate and Efficiency. J Mol Diagn 2021; 23:894-905. [PMID: 33962052 DOI: 10.1016/j.jmoldx.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Massively parallel sequencing has markedly improved mendelian diagnostic rates. This study assessed the effects of custom alterations to a diagnostic genomic bioinformatic pipeline in response to clinical need and derived practice recommendations relative to diagnostic rates and efficiency. The Genomic Annotation and Interpretation Application (GAIA) bioinformatics pipeline was designed to detect panel, exome, and genome sample integrity and prioritize gene variants in mendelian disorders. Reanalysis of selected negative cases was performed after improvements to the pipeline. GAIA improvements and their effect on sensitivity are described, including addition of a PubMed search for gene-disease associations not in the Online Mendelian Inheritance of Man database, inclusion of a process for calling low-quality variants (known as QPatch), and gene symbol nomenclature consistency checking. The new pipeline increased the diagnostic rate and reduced staff costs, resulting in a saving of US$844.34 per additional diagnosis. Recommendations for genomic analysis pipeline requirements are summarized. Clinically responsive bioinformatics pipeline improvements increase diagnostic sensitivity and increase cost-effectiveness.
Collapse
Affiliation(s)
| | - Marina Berbic
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales Sydney, Kensington, New South Wales, Australia
| | - Carey-Anne Evans
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Corrina Cliffe
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - George Elakis
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Suzanna E L Temple
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia
| | - Arthavan Selvanathan
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
| | - Lisa Ewans
- Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Central Clinical School, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Nila Quayum
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Cheng-Yee Nixon
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Kerith-Rae Dias
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales Sydney, Kensington, New South Wales, Australia
| | - Sarah Lang
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Anna Richards
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Shuxiang Goh
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Meredith Wilson
- Department of Clinical Genetics, Children's Hospital at Westmead, Sydney, Westmead, New South Wales, Australia
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia
| | - Rani Sachdev
- Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia
| | - Sarah Sandaradura
- Department of Clinical Genetics, Children's Hospital at Westmead, Sydney, Westmead, New South Wales, Australia
| | - Maie Walsh
- Genetic Medicine Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michelle A Farrar
- School of Women's and Children's Health, University of New South Wales Sydney, Kensington, New South Wales, Australia; Neurology Department, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia
| | - Rebecca Walsh
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janice Fletcher
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Edwin P Kirk
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales Sydney, Kensington, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia
| | - Guus M Teunisse
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Michael Francis Buckley
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ying Zhu
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Genetics of Learning Disability Service, Hunter Genetics, Waratah Newcastle, New South Wales, Australia
| | - Tony Roscioli
- NSW Health Pathology Randwick Genomics, Prince of Wales Hospital, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia.
| |
Collapse
|
27
|
Lang S, Gibson S, Ng KW, Truby H. Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review. Obes Rev 2021; 22:e13172. [PMID: 33331090 DOI: 10.1111/obr.13172] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Abstract
Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.
Collapse
Affiliation(s)
- Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Ker Wei Ng
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Höing B, Hussain T, Kanaan O, Stuck BA, Mattheis S, Lang S, Hansen S. [Perioperative medical prophylaxis of venous thromboembolic events in head and neck surgery : A retrospective study and recommendations]. HNO 2021; 69:961-968. [PMID: 33594495 DOI: 10.1007/s00106-021-01003-6] [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] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the authors' department, a newly implemented clinical algorithm for application of perioperative thrombosis prophylaxis in head and neck surgery recommends restrictive handling of anticoagulants. This retrospective study aims to evaluate the algorithm by comparing incidences of venous thromboembolic events (VTE) and surgical revisions due to postoperative hemorrhage. MATERIALS AND METHODS Perioperative incidences of deep vein thrombosis and pulmonary embolism as well as surgical revisions due to postoperative hemorrhage after head and neck surgery were determined based on all patients operated in the department over a period of 36 months. The incidences before (group I) and after (group II) implementation of the restrictive algorithm were compared. RESULTS A total of 9276 patients were included. The incidences of VTE (0.12%) and surgical revisions due to postoperative hemorrhage (1.4%) were low. Incidences of VTE were non-significantly higher in group II (0.16%) than in group I (0.08%; p > 0.45, chi-square-test). Case analysis revealed that this difference was not due to implementation of the restrictive algorithm. The incidence of surgical revision due to postoperative hemorrhage was identical in the two groups (1.4%). CONCLUSION After restricting the indication for thrombosis prophylaxis, the incidence of VTE or surgical revision due to postoperative hemorrhage did not change significantly. The provided clinical algorithm represents a low-risk and low-cost strategy of perioperative risk stratification.
Collapse
Affiliation(s)
- B Höing
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - O Kanaan
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - S Hansen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| |
Collapse
|
29
|
Holtmann L, Hans S, Kaster F, Müller V, Lang S, Göricke S, Lang-Roth R, Arweiler-Harbeck D. Magnet dislocation following magnetic resonance imaging in cochlear implant users: Diagnostic pathways and managment. Cochlear Implants Int 2021; 22:195-202. [PMID: 33576730 DOI: 10.1080/14670100.2021.1872906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Although modern cochlear implants (CIs) are approved for magnetic resonance imaging (MRIs) adverse events still occur with unacceptable frequency. Methods: In this retrospective study, magnet displacement due to MRIs was analysed. Relevant factors e.g. symptoms during MRI, diagnostics, surgical intervention following the diagnosis and possible subsequent damage were assessed. RESULTS 16 patients were enclosed. All patients complained about pain while the scan was conducted. Computed tomography (CT) scans of the temporal bone or X-rays of the skull were performed to confirm diagnosis. Artefacts on CT scans delayed immediate diagnosis in some cases. DISCUSSION Despite various studies demonstrating the range of adverse events related to CIs following MRI, little information is available on diagnosis and radiologic recognition of magnet dislocation. In patients complaining about pain following an MRI scan an X-ray of the head should be performed immediately. Most adverse events occur in radiological centres without expertise in cochlear implants. CONCLUSION Comprehensive training of patients, surgeons and radiologists is the most efficient tool to prevent damage to the CI and the patient. X-ray of the skull is suggested to be used as the method of choice in imaging.
Collapse
Affiliation(s)
- L Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - S Hans
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - V Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - S Göricke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - R Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
30
|
Stöver T, Dazert S, Plontke SK, Kramer S, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Schuler PJ, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J, Hoffmann TK. [Effects of the SARS-CoV‑2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. HNO 2021; 69:633-641. [PMID: 33502578 PMCID: PMC7839289 DOI: 10.1007/s00106-021-01001-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Ab Frühjahr 2020 kam es zur weltweiten Verbreitung von SARS-CoV‑2 mit der heute als erste Welle der Pandemie bezeichneten Phase ab März 2020. Diese resultierte an vielen Kliniken in Umstrukturierungen und Ressourcenverschiebungen. Ziel unserer Arbeit war die Erfassung der Auswirkungen der Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde für die Forschung, Lehre und Weiterbildung. Material und Methoden Die Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland wurden mithilfe einer strukturierten Online-Befragung zu den Auswirkungen der Pandemie im Zeitraum von März bis April 2020 auf die Forschung, Lehre und die Weiterbildung befragt. Ergebnisse Alle 39 Direktorinnen und Direktoren beteiligten sich an der Umfrage. Hiervon gaben 74,4 % (29/39) an, dass es zu einer Verschlechterung ihrer Forschungstätigkeit infolge der Pandemie gekommen sei. Von 61,5 % (24/39) wurde berichtet, dass pandemiebezogene Forschungsaspekte aufgegriffen wurden. Von allen Kliniken wurde eine Einschränkung der Präsenzlehre berichtet und 97,5 % (38/39) führten neue digitale Lehrformate ein. Im Beobachtungszeitraum sahen 74,4 % der Klinikdirektoren die Weiterbildung der Assistenten nicht gefährdet. Schlussfolgerung Die Ergebnisse geben einen Einblick in die heterogenen Auswirkungen der Pandemie. Die kurzfristige Bearbeitung pandemiebezogener Forschungsthemen und die Einführung innovativer digitaler Konzepte für die studentische Lehre belegt eindrücklich das große innovative Potenzial und die schnelle Reaktionsfähigkeit der HNO-Universitätskliniken, um auch während der Pandemie ihre Aufgaben in der Forschung, Lehre und Weiterbildung bestmöglich zu erfüllen.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland.
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S., Halle/S., Deutschland
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel, Kiel, Deutschland
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - C Betz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen, Göttingen, Deutschland
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München, München, Deutschland
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald, Greifswald, Deutschland
- Helios Hanseklinikum Stralsund, Stralsund, Deutschland
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg, Oldenburg, Deutschland
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes, Saarlandes, Deutschland
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden, Minden, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen, Deutschland
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| |
Collapse
|
31
|
Karstens S, Lang S, Saunders B. Patients' Views on the Implementation Potential of a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study. Health Serv Insights 2020; 13:1178632920977894. [PMID: 33343197 PMCID: PMC7727085 DOI: 10.1177/1178632920977894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022] Open
Abstract
Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.
Collapse
Affiliation(s)
- Sven Karstens
- Department of Computer Science; Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
| | - Sarah Lang
- MSc Sport Physiotherapy, German Sport University Cologne, Cologne, Germany
| | - Benjamin Saunders
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| |
Collapse
|
32
|
Affiliation(s)
- S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| |
Collapse
|
33
|
Stöver T, Zeh R, Gängler B, Plontke SK, Ohligmacher S, Deitmer T, Hupka O, Welkoborsky HJ, Schulz M, Delank W, Strobel M, Guntinas-Lichius O, Lang S, Dietz A, Dazert S, Diensthuber M. [Regional distribution of the cochlear implant (CI) centers in Germany]. Laryngorhinootologie 2020; 99:863-871. [PMID: 33167056 DOI: 10.1055/a-1302-0368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - R Zeh
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - B Gängler
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle (Saale)
| | - S Ohligmacher
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie e. V., Bonn
| | - O Hupka
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - M Schulz
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - W Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - M Strobel
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St.-Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum
| | - M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| |
Collapse
|
34
|
Zayet S, Lang S, Ben Abdallah Y, Klopfenstein T, Gendrin V. Asymptomatic cerebral abscesses after pleuropulmonary Nocardia farcinica infection. New Microbes New Infect 2020; 38:100808. [PMID: 33299565 PMCID: PMC7704421 DOI: 10.1016/j.nmni.2020.100808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 68-year-old man with long-term receipt of steroid therapy who was diagnosed with cerebral abscesses and pulmonary nocardiosis. This patient displayed only respiratory symptoms. Confirmation of Nocardia farcinica species was achieved by specific PCR sequencing of the 16S ribosome RNA in bronchoalveolar lavage cultures. Cerebral magnetic resonance imaging revealed abscesses. Antibiotic therapy with trimethoprim/sulfamethoxazole was prescribed given the results of susceptibility tests and was maintained for 12 months, with no evidence of relapse afterwards.
Collapse
Affiliation(s)
- S Zayet
- Infectious Diseases Department, France
| | - S Lang
- Infectious Diseases Department, France
| | - Y Ben Abdallah
- Pneumology Department, Nord Franche-Comté Hospital, Trévenans, France
| | | | - V Gendrin
- Infectious Diseases Department, France
| |
Collapse
|
35
|
Kürten CHL, Deuß E, Lei YL, Höing B, Kramer B, Lang S, Ferris RL, Kansy BA. [Stimulatory and inhibitory signaling pathways of the T cell-APC interaction and the effect of TLR agonists on APCs]. HNO 2020; 68:916-921. [PMID: 33128107 DOI: 10.1007/s00106-020-00960-8] [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] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND CD8+ cells are key players in the identification and elimination of cancer cells. Cancers can escape an effective T cell response by inducing an exhausted cell state, which limits the cytotoxic capacity of the effector cells. Among other mechanisms, new checkpoint inhibitors reactivate exhausted, dysfunctional T cells. CD8+ T cells can eliminate tumor cells after presentation of tumor-specific antigens via antigen-presenting cells (APCs). APC-mediated tumor recognition is mainly stimulated by Toll-like receptors (TLRs). OBJECTIVE This study investigates the effect of TLR agonists on APCs as well as stimulatory and inhibitory signaling pathways of the T cell-APC interaction. MATERIALS AND METHODS Gene expression of interleukin (IL)12 and programmed death ligand 1 (PD-L1) was analyzed by quantitative polymerase chain reaction (qPCR) after 0, 8, 24, and 48 h of CD14+ cell stimulation with CpG. Protein expression of inhibitor of nuclear factor kappa B (IκBα) after CpG stimulation was investigated by western blot. CD8+ T cells were stimulated for 72 h with or without programmed cell death protein 1 (PD-1) checkpoint blockade and analyzed for expression of PD‑1, Tim‑3, CTLA4, and Lag3 by flow cytometry. RESULTS TLR stimulation (by unmethylated CpG DNA) of APCs upregulates immunostimulatory signals such as IL12 expression but also activates immunoinhibitory signaling pathways such as PD-L1 expression. This signaling is NF-κB dependent. After blockade of the PD-1/PD-L1 signaling pathway, overexpression of other immune checkpoint inhibitory receptors was observed-a potential explanation for lacking therapeutic responses after TLR stimulation with PD‑1 checkpoint blockade. CONCLUSION TLR stimulation causes APCs in the tumor microenvironment to upregulate PD-L1 in an NF-κB-mediated fashion, thereby contributing to CD8+ T cell exhaustion. The effect of PD‑1 blockade after TLR stimulation might be impaired due to upregulation of other checkpoint inhibitors.
Collapse
Affiliation(s)
- C H L Kürten
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - E Deuß
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Y L Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - B Höing
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - B Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - R L Ferris
- Cancer Immunology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - B A Kansy
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| |
Collapse
|
36
|
Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Scheuble A, Boccara F, Addetia K, Lang R, Cohen A. Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.
Purpose
Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.
Methods
We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.
Results
At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p<0.001 for 2D ED TA diameter; ρ=0.34, p<0.005 for 3D ES RA Vi; ρ=0.33, p<0.005 for 3D ED RV Vi; ρ=0.29, p<0.005 for 3D ES RV Vi).
Conclusion
Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.
TR Evolution
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - A Scheuble
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| |
Collapse
|
37
|
Lombardi Y, Boccara F, Baldet K, Lang S, Ederhy S, Nhan P, Riller Q, Chauvet-Droit M, Jean ML, Adavane-Scheuble S, Azoyan L, Cohen A. Prognosis of acute kidney injury during acute heart failure: the role of diuretics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute kidney injury (AKI) frequently occurs after diuretic treatment initiation during acute heart failure (AHF). Treatment-induced hemoconcentration seems associated with improved prognosis. Transient AKI, with or without hemoconcentration, is of unsettled prognosis.
Purpose
We aimed to determine the independent prognostic values of transient AKI, persistent AKI and hemoconcentration in the context of hospitalized AHF.
Methods
Data were obtained from our institution's Clinical Data Warehouse. Patients that visited our unit at least once were screened. All hospitalizations in our institution were examined (>30 hospitals). Inclusion criteria were: ≥1 hospitalization with ≥1 recorded furosemide administration and ≥1 AHF ICD-10 code. Only the first hospitalization fulfilling these criteria was considered. AKI during 1–13 days following first furosemide administration was defined based on Kidney Disease Improving Global Outcome guidelines. Hemoconcentration was defined as an increase in serum proteins ≥5 g/l during the same period. We performed multivariate logistic regression to determine which characteristics were predictive of AKI. We used Cox regression of 100-days all-cause mortality using several confounders to determine the prognostic values of transient AKI (lasting <14 days), persistent AKI (lasting ≥14 days) and hemoconcentration. To account for immortality bias, AKI and hemoconcentration were treated as time-dependent covariates.
Results
We included 579 patients in the study. Median follow-up was 114 days. AKI following furosemide initiation occurred in 234 patients (40.4%). Patients that experienced AKI more frequently suffered from chronic kidney disease (43.6% vs. 33%, p=0.01) or presented with right ventricular dilatation (12% vs. 6.7%, p=0.04). Independent predictors of AKI were arterial hypertension (adjusted OR: 1.86 [1.08–3.22]), elevated serum creatinine at baseline (adjusted OR: 1.07 [1.01–1.14] per 10 μmol/l increase) and initial intravenous furosemide (adjusted OR: 2.42 [1.39–4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p<0.001). In Cox regression, persistent AKI was independently associated with increased mortality in a period of 100 days following furosemide initiation (adjusted HR: 2.31 [1.07–4.99]). Transient AKI was not significantly associated with mortality (adjusted HR: 0.64 [0.34–1.19]). Hemoconcentration was independently associated with decreased mortality (adjusted HR: 0.46 [0.27–0.79]).
Conclusion
In the context of hospitalized AHF, AKI that developed 1–13 days after furosemide initiation and that lasted ≥14 days was independently associated with decreased 100 days survival. Hemoconcentration, using a clinically relevant definition, was independently associated with improved survival. These findings show that serum creatinine and proteins, routinely used and with limited cost, accurately stratify mortality risk during AHF.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- Y Lombardi
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - F Boccara
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - K Baldet
- University Hospital Center, Department of Nephrology, Dijon, France
| | - S Lang
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - S Ederhy
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - P Nhan
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - Q Riller
- Hospital Pitie-Salpetriere, Department of Internal Medicine, Paris, France
| | - M Chauvet-Droit
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - M.-L Jean
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | | | - L Azoyan
- Hospital Tenon, Department of Internal Medicine, Paris, France
| | - A Cohen
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| |
Collapse
|
38
|
Fastner C, Akin I, Yuecel G, Rudic B, El-Battrawy I, Kruska M, Lang S, Liebe V, Tueluemen E, Borggrefe M, Kuschyk J. Cardiac contractility modulation efficacy: is there a difference between ischemic vs. non-ischemic patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Cardiac contractility modulation (CCM) is an FDA approved device therapy for systolic heart failure patients with narrow QRS complex who are symptomatic despite optimal medical therapy. It is used in patients with a wide range of different cardiomyopathies. However, little is known whether the therapy is comparably effective in different entities.
Purpose
This work investigated the long-term therapeutic effect in patients with ischemic (ICMP) compared to patients with non-ischemic cardiomyopathy (NICMP).
Methods
102 patients of our single center registry with known form of cardiomyopathy were included in this retrospective analysis (from 2011–2019). In 68 patients data of a clinical 3-year follow-up were available. The actual mortality rate within one and three years was compared with the one predicted by the MAGGIC risk score and compared between the two groups. In addition, changes in NYHA class, left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) and NT-proBNP values were compared as functional parameters.
Results
Patients with an ICMP (65%) were older (67±1 vs. 57±2 years (SD±SEM); p<0.001) but had a comparable MLHFQ score (42±3 vs. 48±6; p=NS), mean peak VO2 (9.7±1.2 vs. 14.5±2.2 ml/kg/min; p=NS) and QRS width (115±3 vs. 112±4 ms; p=NS). Both groups initially had a comparably advanced limitation during physical activity (median NYHA class III; p=NS); 40% of patients responded with an improvement of at least 1 NYHA class within 3 years (p=NS). The LVEF was 24±1 vs. 22±1% in the beginning and improved to 32±2 vs. 38±2% within 3 years (+33 vs. +73%; p<0.001 in comparison over time; p<0.001 in comparison of the percentage changes ICMP vs. NICMP). While LVEDD was initially significantly wider in NICMP patients (51±2 vs. 67±2 mm; p<0.001), this was offset under therapy, mainly due to a reduction in LVEDD in NICMP patients (+3±2 vs. −7±3 mm; p=0.023). The NT-proBNP values decreased from 4872±776 vs. 5354±1153 to 2051±578 vs. 843±363 ng/l (−58 vs. −84%; p=NS in comparison over time; p=0.093 in comparison of the percentage changes ICMP vs. NICMP). ICMP patients had a higher MAGGIC risk score (27±1 vs. 24±1; p=0.019). Mortality rates at 1 year were 7.4 vs. 17.1% and at 3 years 40.5 vs. 35.5% (each p=NS) compared to mortality rates estimated from the MAGGIC risk score of 21.2 vs. 16.0% (p=0.028) and 44.0 vs. 37.2% (p=0.071), respectively. Chi-square test for comparison of observed and expected frequencies revealed that the number of deaths during 1-year follow-up was significantly lower than predicted only in ICMP patients (p=0.018 compared to the estimated risk).
Conclusions
NICMP patients had a significantly greater increase in LVEF. Moreover, reverse remodeling with reduction of the LVEDD was only observed in NICMP patients. In summary, significant differences in functional therapy response could be identified between ICMP vs. NICMP patients.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- C Fastner
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - I Akin
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - G Yuecel
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - B Rudic
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - I El-Battrawy
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - M Kruska
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - S Lang
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - V Liebe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - E Tueluemen
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - M Borggrefe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - J Kuschyk
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| |
Collapse
|
39
|
Philabout P, Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Boccara F, Addetia K, Lang R, Cohen A. Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome.
Purpose
To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6).
Methods
In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7)
Results
In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure).
Conclusion
Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm.
Evolution of strain between M0 and M6
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- P Philabout
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| |
Collapse
|
40
|
Barnicot K, Michael C, Trione E, Lang S, Saunders T, Sharp M, Crawford MJ. Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev 2020; 82:101929. [PMID: 33126038 DOI: 10.1016/j.cpr.2020.101929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.
Collapse
Affiliation(s)
- K Barnicot
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom; School of Health Sciences, City University of London, Myddleton Street Building, 1Myddleton Street, London EC1R 1UW, United Kingdom.
| | - C Michael
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - E Trione
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - S Lang
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - T Saunders
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - M Sharp
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - M J Crawford
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom
| |
Collapse
|
41
|
Lang S, Brandau S, Marchesi JR, Jablonska J, Thurnher D, Mattheis S, Buer J, Hussain T. [The microbiome in head and neck tumors-initial findings and outlook]. HNO 2020; 68:905-910. [PMID: 32995898 DOI: 10.1007/s00106-020-00950-w] [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] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
Technical progress in molecular biology has allowed for a more detailed analysis of the composition of the human microbiome in recent years. Inter- and intraindividual differences in microbiome composition have been demonstrated, which in part correlate with the occurrence of certain diseases. For some of the so-called oncomicrobes, a direct relationship between their effect on the host organism and carcinogenesis has been demonstrated, predominantly for gastrointestinal cancers. Initial results for head and neck cancer show inter- and intraindividual differences in the local microbiota of the tumor environment, with certain bacterial strains over- or underrepresented. Our results confirm these findings, e.g., by showing a relative abundance of fusobacteria in tumor tissue while streptococci were relatively reduced. Currently available results show a high degree of inter- and intraindividual variation, thus requiring larger patient cohorts for functional analyses.
Collapse
Affiliation(s)
- S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - S Brandau
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J R Marchesi
- School of Biosciences, Cardiff University, Cardiff, Großbritannien
| | - J Jablonska
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - D Thurnher
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J Buer
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Universität Duisburg-Essen Essen, Essen, Deutschland
| | - T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| |
Collapse
|
42
|
Abstract
Exosomes, virus-sized nanovesicles, are utilized as messenger systems of our body to communicate with other body cells and regulate immune functions. Almost all cells produce exosomes and are able to interact with immune cells in the blood stream and peripheral body areas. Different markers on the surface of exosomes are necessary for immune cell adhesion and interaction. Furthermore, many types of exosome-immune cell interaction, such as surface receptor contact and phagocytosis, are known. As carriers of different cargos, exosomes affect different immune cell types in head and neck cancers: So far, T cells, natural killer cells, macrophages, and dendritic cells have been described in this context. For diagnostic purposes, a combined analysis of different parameters including protein amount, nucleic acid/protein expression, and the immunosuppressive impact of exosomes could empower exosomes as useful tools for evaluation of tumor promotion and progression in the future.
Collapse
Affiliation(s)
- S Ludwig
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M-N Theodoraki
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - J Jablonska
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - A Lammert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| |
Collapse
|
43
|
Richter K, Kojadinovic M, Lang S, Singer J, Robleto G, Hübner C, Alex J, Bitter E. DynaWater4.0 – Dynamische Vernetzung von Wasseraufbereitung und industrieller Produktion. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Richter
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - M. Kojadinovic
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - S. Lang
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - J. Singer
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - G. Robleto
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - C. Hübner
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - J. Alex
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - E. Bitter
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| |
Collapse
|
44
|
Stöver T, Dazert S, Hoffmann TK, Plontke SK, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Kramer S, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J. [Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]. Laryngorhinootologie 2020; 99:694-706. [PMID: 32767296 PMCID: PMC7645814 DOI: 10.1055/a-1232-4911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ± 14.2 % and in surgical treatments by 65.9 % to 34.1 ± 13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.
Collapse
Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg
| | - C Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | | | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen
| | - J-P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité Berlin
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden
| | - S Strieth
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - B A Stuck
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg
| |
Collapse
|
45
|
Stähr K, Lang S, Mattheis S. [Primary cutaneous CD4+ small to medium-sized T-cell lymphoma in an adolescent patient]. HNO 2020; 68:695-697. [PMID: 32728760 DOI: 10.1007/s00106-020-00912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A rare finding of primary cutaneous CD4+ small to medium-sized T‑cell lymphoma (SMPTCL) in a fifteen-year-old patient is reported. This is a rare tumor entity for which there is currently no standardized treatment recommendation. At the interdisciplinary tumor board, the decision was made to resect the tumor and reconstruct the defect with a nasolabial advancement flap in a two-stage process. Follow-up examinations, currently over 3 years, have shown the patient to be free of recurrences.
Collapse
Affiliation(s)
- K Stähr
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| |
Collapse
|
46
|
Hussain T, Mattheis S, Lang S. [The role of surgery and salvage surgery in the era of HPV-associated oropharyngeal carcinomas]. HNO 2020; 68:688-694. [PMID: 32638060 DOI: 10.1007/s00106-020-00900-6] [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
The incidence of human papillomavirus (HPV)-positive oropharyngeal carcinomas is increasing worldwide. Due to a markedly different response to treatment compared to HPV-negative oropharyngeal carcinomas, determining the ideal therapeutic approach can be challenging. Particularly in never-smokers, HPV-positive oropharyngeal carcinomas respond well to primary radiation therapy; at the same time recent studies indicate comparable survival after primary surgery. For stage I tumors according to TNM‑8, retrospective analyses show very good oncologic outcomes after surgery alone, and no added benefit of adjuvant radio- or chemotherapy. Results of prospective treatment deintensification trials are expected in the coming years. Minimally invasive transoral surgical approaches for selected oropharyngeal cancers can improve preservation of postoperative function and quality of life. For both HPV-positive and HPV-negative oropharyngeal carcinomas, salvage surgery is the treatment of choice for resectable recurrent locoregional disease and resectable distant metastases.
Collapse
Affiliation(s)
- T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| |
Collapse
|
47
|
Lunke S, Eggers S, Wilson M, Patel C, Barnett CP, Pinner J, Sandaradura SA, Buckley MF, Krzesinski EI, de Silva MG, Brett GR, Boggs K, Mowat D, Kirk EP, Adès LC, Akesson LS, Amor DJ, Ayres S, Baxendale A, Borrie S, Bray A, Brown NJ, Chan CY, Chong B, Cliffe C, Delatycki MB, Edwards M, Elakis G, Fahey MC, Fennell A, Fowles L, Gallacher L, Higgins M, Howell KB, Hunt L, Hunter MF, Jones KJ, King S, Kumble S, Lang S, Le Moing M, Ma A, Phelan D, Quinn MCJ, Richards A, Richmond CM, Riseley J, Rodgers J, Sachdev R, Sadedin S, Schlapbach LJ, Smith J, Springer A, Tan NB, Tan TY, Temple SL, Theda C, Vasudevan A, White SM, Yeung A, Zhu Y, Martyn M, Best S, Roscioli T, Christodoulou J, Stark Z. Feasibility of Ultra-Rapid Exome Sequencing in Critically Ill Infants and Children With Suspected Monogenic Conditions in the Australian Public Health Care System. JAMA 2020; 323:2503-2511. [PMID: 32573669 PMCID: PMC7312414 DOI: 10.1001/jama.2020.7671] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Widespread adoption of rapid genomic testing in pediatric critical care requires robust clinical and laboratory pathways that provide equitable and consistent service across health care systems. OBJECTIVE To prospectively evaluate the performance of a multicenter network for ultra-rapid genomic diagnosis in a public health care system. DESIGN, SETTING, AND PARTICIPANTS Descriptive feasibility study of critically ill pediatric patients with suspected monogenic conditions treated at 12 Australian hospitals between March 2018 and February 2019, with data collected to May 2019. A formal implementation strategy emphasizing communication and feedback, standardized processes, coordination, distributed leadership, and collective learning was used to facilitate adoption. EXPOSURES Ultra-rapid exome sequencing. MAIN OUTCOMES AND MEASURES The primary outcome was time from sample receipt to ultra-rapid exome sequencing report. The secondary outcomes were the molecular diagnostic yield, the change in clinical management after the ultra-rapid exome sequencing report, the time from hospital admission to the laboratory report, and the proportion of laboratory reports returned prior to death or hospital discharge. RESULTS The study population included 108 patients with a median age of 28 days (range, 0 days to 17 years); 34% were female; and 57% were from neonatal intensive care units, 33% were from pediatric intensive care units, and 9% were from other hospital wards. The mean time from sample receipt to ultra-rapid exome sequencing report was 3.3 days (95% CI, 3.2-3.5 days) and the median time was 3 days (range, 2-7 days). The mean time from hospital admission to ultra-rapid exome sequencing report was 17.5 days (95% CI, 14.6-21.1 days) and 93 reports (86%) were issued prior to death or hospital discharge. A molecular diagnosis was established in 55 patients (51%). Eleven diagnoses (20%) resulted from using the following approaches to augment standard exome sequencing analysis: mitochondrial genome sequencing analysis, exome sequencing-based copy number analysis, use of international databases to identify novel gene-disease associations, and additional phenotyping and RNA analysis. In 42 of 55 patients (76%) with a molecular diagnosis and 6 of 53 patients (11%) without a molecular diagnosis, the ultra-rapid exome sequencing result was considered as having influenced clinical management. Targeted treatments were initiated in 12 patients (11%), treatment was redirected toward palliative care in 14 patients (13%), and surveillance for specific complications was initiated in 19 patients (18%). CONCLUSIONS AND RELEVANCE This study suggests feasibility of ultra-rapid genomic testing in critically ill pediatric patients with suspected monogenic conditions in the Australian public health care system. However, further research is needed to understand the clinical value of such testing, and the generalizability of the findings to other health care settings.
Collapse
Affiliation(s)
| | - Sebastian Lunke
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Stefanie Eggers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Meredith Wilson
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Jason Pinner
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Sarah A Sandaradura
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Michael F Buckley
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Emma I Krzesinski
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Michelle G de Silva
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Gemma R Brett
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Kirsten Boggs
- Australian Genomics Health Alliance, Parkville, Australia
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - David Mowat
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Edwin P Kirk
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Lesley C Adès
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Lauren S Akesson
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Monash Genetics, Monash Health, Melbourne, Australia
| | - David J Amor
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Samantha Ayres
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Anne Baxendale
- Women's and Children's Hospital, North Adelaide, Australia
| | - Sarah Borrie
- Women's and Children's Hospital, North Adelaide, Australia
| | - Alessandra Bray
- Australian Genomics Health Alliance, Parkville, Australia
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Natasha J Brown
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Cheng Yee Chan
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Belinda Chong
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Corrina Cliffe
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Matthew Edwards
- Hunter Genetics, Newcastle, Australia
- Department of Paediatrics, School of Medicine, University of Western Sydney, Sydney, Australia
| | - George Elakis
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Michael C Fahey
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Andrew Fennell
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Lindsay Fowles
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lyndon Gallacher
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Megan Higgins
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Katherine B Howell
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Lauren Hunt
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Matthew F Hunter
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Kristi J Jones
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Sarah King
- Australian Genomics Health Alliance, Parkville, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide
| | - Smitha Kumble
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Lang
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Maelle Le Moing
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Alan Ma
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Dean Phelan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael C J Quinn
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Anna Richards
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Christopher M Richmond
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jessica Riseley
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan Rodgers
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rani Sachdev
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Simon Sadedin
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, the University of Queensland and Queensland Children's Hospital, Brisbane, Australia
| | - Janine Smith
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Amanda Springer
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Natalie B Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tiong Y Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Suzanna L Temple
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Christiane Theda
- University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Australia
| | | | - Susan M White
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Alison Yeung
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Genetics, Monash Health, Melbourne, Australia
| | - Ying Zhu
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney
| | - Tony Roscioli
- University of New South Wales, Sydney, Australia
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - John Christodoulou
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- University of Sydney, Sydney, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| |
Collapse
|
48
|
Lang S, Loving S, McCarthy ND, Ramsay ME, Salisbury D, Pollard AJ. Two centuries of immunisation in the UK (part II). Arch Dis Child 2020; 105:216-222. [PMID: 31302603 DOI: 10.1136/archdischild-2019-317707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/04/2022]
Abstract
The centrally coordinated response that controlled the polio epidemics of the 1950s through immunisation led to the development of a national immunisation strategy in the UK and the formation of the Joint Committee on Vaccination and Immunisation (JCVI) in 1963, which oversees the immunisation programme and advises the UK Department of Health on new vaccine introductions. As a result of technological advances in vaccine development and scientific advances in immunology and microbiology over the 56 years since then, and the formation of a comprehensive public health surveillance system for vaccine-preventable disease, the National Health Service immunisation programme now covers 18 serious diseases of childhood, with an astonishing impact on child health. Here we consider the formation of the JCVI and the development of the national immunisation programme and review the introduction of vaccines over the past half century to defend public health.
Collapse
Affiliation(s)
- Sarah Lang
- Immunisation, Hepatitis, Blood Safety and Countermeasures Response National Infection Service, Public Health England, London, UK
| | | | | | | | | | | |
Collapse
|
49
|
Buckley MF, Elakis G, Lang S, Richards A, Cliffe C, Chan CY, Kirk EP, Zhu Y, Roscioli T. Indications and outcomes of rapid turn around time whole exome sequencing studies. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
Lang S, Loving S, McCarthy ND, Ramsay ME, Salisbury D, Pollard AJ. Two centuries of immunisation in the UK (part 1). Arch Dis Child 2020; 105:115-121. [PMID: 31272966 DOI: 10.1136/archdischild-2019-317314] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/03/2022]
Abstract
The impact of immunisation is best understood through a historical lens, since so many of the diseases which placed a burden on our population have been eliminated or controlled through immunisation. The United Kingdom (UK) National Health Service (NHS), which celebrated its 70th birthday in 2018, is responsible for delivering the highly successful universal national immunisation programme. However, the first vaccines used in the UK were not part of a centrally coordinated programme until the 1960s. Resources that summarise the first 200 years of immunisation in the UK are not readily accessible. Here we provide a two part chronological insight into the history of the UK immunisation programme from primary sources. In Part I, we highlight the importance of wartime conditions, unprecedented vaccine development, and the polio outbreaks in the in driving developments in immunisation and discuss subsequent changes in the use of the original vaccines of the immunisation programme, namely, diphtheria, tetanus, pertussis, and polio. In Part 2, we discuss the formation of the Joint Committee on Vaccination and Immunisation and its role, working with public health agencies and advising the UK Governments on vaccine policy, to bring a comprehensive programme to defend the health of the population against serious infectious diseases, highlighting the importance of programme organisation and leadership.
Collapse
Affiliation(s)
- Sarah Lang
- South London HealthProtection Team, Public Health England, London, UK
| | - Sarah Loving
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - David Salisbury
- Centreon Global Health Security, Royal Institute of International Affairs, Chatham House, London, UK
| | | |
Collapse
|