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Walits E, Schaefer S. Outcome of Candida auris contact investigations conducted in a 6 month period at a New York City hospital. Am J Infect Control 2024; 52:491-492. [PMID: 37838250 DOI: 10.1016/j.ajic.2023.10.005] [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: 07/08/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Candida auris is a multidrug-resistant fungus that has led to health care-associated outbreaks globally. Contact investigations for new cases of Candida auris are a recommended infection prevention practice; however, there is limited knowledge and experience with such investigations. We describe our institution's experience from June 2018 through January 2019.
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Affiliation(s)
- Emily Walits
- Department of Infection Prevention, The Mount Sinai Hospital, New York, NY
| | - Sarah Schaefer
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
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Eremina OE, Schaefer S, Czaja AT, Awad S, Lim MA, Zavaleta C. Multiplexing potential of NIR resonant and non-resonant Raman reporters for bio-imaging applications. Analyst 2023; 148:5915-5925. [PMID: 37850265 PMCID: PMC10947999 DOI: 10.1039/d3an01298k] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Multiplexed imaging, which allows for the interrogation of multiple molecular features simultaneously, is vital for addressing numerous challenges across biomedicine. Optically unique surface-enhanced Raman scattering (SERS) nanoparticles (NPs) have the potential to serve as a vehicle to achieve highly multiplexed imaging in a single acquisition, which is non-destructive, quantitative, and simple to execute. When using laser excitation at 785 nm, which allows for a lower background from biological tissues, near infrared (NIR) dyes can be used as Raman reporters to provide high Raman signal intensity due to the resonance effect. This class of imaging agents are known as surface-enhanced resonance Raman scattering (SERRS) NPs. Investigators have predominantly utilized two classes of Raman reporters in their nanoparticle constructs for use in biomedical applications: NIR-resonant and non-resonant Raman reporters. Herein, we investigate the multiplexing potential of five non-resonant SERS: BPE, 44DP, PTT, PODT, and BMMBP, and five NIR resonant SERRS NP flavors with heptamethine cyanine dyes: DTTC, IR-770, IR-780, IR-792, and IR-797, which have been extensively used for biomedical imaging applications. Although SERRS NPs display high Raman intensities, due to their resonance properties, we observed that non-resonant SERS NP concentrations can be quantitated by the intensity of their unique emissions with higher accuracy. Spectral unmixing of five-plex mixtures revealed that the studied non-resonant SERS NPs maintain their detection limits more robustly as compared to the NIR resonant SERRS NP flavors when introducing more components into a mixture.
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Affiliation(s)
- Olga E Eremina
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
| | - Sarah Schaefer
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
| | - Alexander T Czaja
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
| | - Samer Awad
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
| | - Matthew A Lim
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
| | - Cristina Zavaleta
- Department of Biomedical Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA 90089, USA.
- USC Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA 90089, USA
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Thompkins S, Schaefer S, Toh D, Horwood C, Thompson CH. Outlier or handover: outcomes for General Medicine inpatients. AUST HEALTH REV 2023; 47:602-606. [PMID: 37640381 DOI: 10.1071/ah22242] [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: 11/23/2022] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Objective Patients admitted from the emergency department may be co-located on the treating team's 'home ward'. If no bed is available, patients may be sent to another ward, where they may remain under the admitting team as an 'outlier'. Conversely, care may be handed over to the team on whose home ward they are located. We conducted a retrospective analysis to understand the impact of outlier status and handovers of care on outcomes for General Medicine inpatients. Methods General Medicine admissions at the Royal Adelaide Hospital between September 2020 and November 2021 were analysed. We examined the rate of hospital-acquired complications, inpatient mortality rate, mortality within 48 h of admission, Relative Stay Index, time of discharge from hospital and rate of adverse events within 28 days of discharge. Results A total of 3109 admissions were analysed. Handovers within 24 h of admission were associated with a longer length of stay. There was a trend towards higher rates of adverse events within 28 days of discharge with handovers of care. Outlier status did not affect any outcome measures. Conclusions Handovers within the first 24 h of admission are associated with longer than expected length of stay.
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Affiliation(s)
- S Thompkins
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - S Schaefer
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - D Toh
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - C Horwood
- Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - C H Thompson
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Ramírez JD, Wang CY, Bolton D, Liggayu B, Schaefer S, Patel G, Javaid W, Cordon-Cardo C, Firpo-Betancourt A, Sordillo EM, Paniz-Mondolfi A. Molecular Detection of Candida auris Using DiaSorin Molecular Simplexa ® Detection Kit: A Diagnostic Performance Evaluation. J Fungi (Basel) 2023; 9:849. [PMID: 37623620 PMCID: PMC10455898 DOI: 10.3390/jof9080849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Candida auris is a globally emerging fungal pathogen that is associated with healthcare-related infections. The accurate and rapid detection of C. auris is crucial for effective infection prevention, control, and patient management. This study aimed to validate the analytical and diagnostic performance of the DiaSorin Molecular C. auris Detection Kit. The analytical specificity, sensitivity, and reproducibility of the assay were evaluated. The limit of detection (LOD) was determined to be 266 CFU/µL using the ZeptoMetrix Candida auris Z485 strain and standard calibration curves. The assay demonstrated high analytical specificity and showed no amplification against a diverse panel of bacteria and fungi. Clinical validation was conducted using deidentified residual axillary/groin surveillance culture specimens from C. auris culture-positive and culture-negative patients. The DiaSorin Molecular Detection Kit exhibited 100% agreement in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) when compared to cultures coupled with MALDI-TOF identification. Intra- and inter-reproducibility testing demonstrated consistent and reliable diagnostic performance. This validated assay offers rapid and accurate detection of C. auris, facilitating timely implementation of infection control measures and appropriate patient care. The DiaSorin Molecular C. auris Detection Kit has the potential to aid in controlling the outbreaks caused by this emerging fungal pathogen. Providing a reliable diagnostic tool can contribute to the effective management and containment of C. auris infections in healthcare settings and ultimately improve patient outcomes.
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Affiliation(s)
- Juan David Ramírez
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
- Centro de Investigaciones en Microbiología y Biotecnología-CIMBIUR (UR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá 200433, Colombia
| | - Chin Yi Wang
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Deandra Bolton
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Bernadette Liggayu
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Sarah Schaefer
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.S.); (G.P.); (W.J.)
| | - Gopi Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.S.); (G.P.); (W.J.)
| | - Waleed Javaid
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (S.S.); (G.P.); (W.J.)
| | - Carlos Cordon-Cardo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Adolfo Firpo-Betancourt
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Emilia Mia Sordillo
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.Y.W.); (D.B.); (B.L.); (C.C.-C.); (A.F.-B.); (E.M.S.)
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Gonzalez-Reiche AS, Alshammary H, Schaefer S, Patel G, Polanco J, Carreño JM, Amoako AA, Rooker A, Cognigni C, Floda D, van de Guchte A, Khalil Z, Farrugia K, Assad N, Zhang J, Alburquerque B, Sominsky LA, Gleason C, Srivastava K, Sebra R, Ramirez JD, Banu R, Shrestha P, Krammer F, Paniz-Mondolfi A, Sordillo EM, Simon V, van Bakel H. Sequential intrahost evolution and onward transmission of SARS-CoV-2 variants. Nat Commun 2023; 14:3235. [PMID: 37270625 PMCID: PMC10239218 DOI: 10.1038/s41467-023-38867-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 10/07/2022] [Accepted: 05/16/2023] [Indexed: 06/05/2023] Open
Abstract
Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported in immune-compromised individuals and people undergoing immune-modulatory treatments. Although intrahost evolution has been documented, direct evidence of subsequent transmission and continued stepwise adaptation is lacking. Here we describe sequential persistent SARS-CoV-2 infections in three individuals that led to the emergence, forward transmission, and continued evolution of a new Omicron sublineage, BA.1.23, over an eight-month period. The initially transmitted BA.1.23 variant encoded seven additional amino acid substitutions within the spike protein (E96D, R346T, L455W, K458M, A484V, H681R, A688V), and displayed substantial resistance to neutralization by sera from boosted and/or Omicron BA.1-infected study participants. Subsequent continued BA.1.23 replication resulted in additional substitutions in the spike protein (S254F, N448S, F456L, M458K, F981L, S982L) as well as in five other virus proteins. Our findings demonstrate not only that the Omicron BA.1 lineage can diverge further from its already exceptionally mutated genome but also that patients with persistent infections can transmit these viral variants. Thus, there is, an urgent need to implement strategies to prevent prolonged SARS-CoV-2 replication and to limit the spread of newly emerging, neutralization-resistant variants in vulnerable patients.
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Affiliation(s)
- Ana S Gonzalez-Reiche
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hala Alshammary
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sarah Schaefer
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Gopi Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jose Polanco
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Juan Manuel Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Angela A Amoako
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Aria Rooker
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Christian Cognigni
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Daniel Floda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Adriana van de Guchte
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zain Khalil
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Keith Farrugia
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nima Assad
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jian Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Bremy Alburquerque
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Levy A Sominsky
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Charles Gleason
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Komal Srivastava
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Juan David Ramirez
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Radhika Banu
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Paras Shrestha
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Emilia Mia Sordillo
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Center for Vaccine Research and Pandemic Preparedness (C-VaRPP), Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- The Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Wurm S, Schaefer S. GAIN- BUT NOT LOSS-RELATED VIEWS ON AGING PREDICT MORTALITY OVER A PERIOD OF 23 YEARS. Innov Aging 2022. [PMCID: PMC9770221 DOI: 10.1093/geroni/igac059.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Some 2 decades ago, Levy et al. (2002) published their seminal study on the impact of SPA on mortality over a period of 23 years. Our study aimed at replicating and extending these findings. Based on a large German population-based sample of individuals aged 40+ (N = 2,400), for whom mortality was also documented over 23 years (1996–2019), we investigated the impact of gain- and loss-related SPA and SA on mortality. Data were analyzed with hierarchical Cox proportional hazard regressions. For individuals who perceived aging as ongoing development risk of death was half that of individuals with less gain-related SPA. Viewing aging as associated with physical or social losses could not predict mortality after controlling for covariates (age, gender, education, health-related variables, and psychological variables). Neither could SA predict mortality. The results suggest that mainly gain-related SPA explain differences in mortality and should thus be addressed in intervention studies.
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Affiliation(s)
- Susanne Wurm
- University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Sarah Schaefer
- Leibniz Institute for Resilience Research, Mainz, Rheinland-Pfalz, Germany
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7
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Amaral T, Kiecker F, Schaefer S, Stege H, Kaehler K, Terheyden P, Gesierich A, Gutzmer R, Haferkamp S, Uttikal J, Berking C, Rafei-Shamsabadi D, Reinhardt L, Meier F, Karoglan A, Posch C, Gambichler T, Pfoehler C, Thoms K, Tietze J, Debus D, Herbst R, Emmert S, Loquai C, Hassel JC, Meiss F, Tueting T, Heinrich V, Eigentler T, Garbe C, Zimmer L. Combined immunotherapy with nivolumab and ipilimumab with and without local therapy in patients with melanoma brain metastasis: a DeCOG* study in 380 patients. J Immunother Cancer 2021; 8:jitc-2019-000333. [PMID: 32221017 PMCID: PMC7206917 DOI: 10.1136/jitc-2019-000333] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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] [Accepted: 03/11/2020] [Indexed: 12/29/2022] Open
Abstract
Background Nivolumab combined with ipilimumab have shown activity in melanoma brain metastasis (MBM). However, in most of the clinical trials investigating immunotherapy in this subgroup, patients with symptomatic MBM and/or prior local brain radiotherapy were excluded. We studied the efficacy of nivolumab plus ipilimumab alone or in combination with local therapies regardless of treatment line in patients with asymptomatic and symptomatic MBM. Methods Patients with MBM treated with nivolumab plus ipilimumab in 23 German Skin Cancer Centers between April 2015 and October 2018 were investigated. Overall survival (OS) was evaluated by Kaplan-Meier estimator and univariate and multivariate Cox proportional hazard analyses were performed to determine prognostic factors associated with OS. Results Three hundred and eighty patients were included in this study and 31% had symptomatic MBM (60/193 with data available) at the time of start nivolumab plus ipilimumab. The median follow-up was 18 months and the 2 years and 3 years OS rates were 41% and 30%, respectively. We identified the following independently significant prognostic factors for OS: elevated serum lactate dehydrogenase and protein S100B levels, number of MBM and Eastern Cooperative Oncology Group performance status. In these patients treated with checkpoint inhibition first-line or later, in the subgroup of patients with BRAFV600-mutated melanoma we found no differences in terms of OS when receiving first-line either BRAF and MEK inhibitors or nivolumab plus ipilimumab (p=0.085). In BRAF wild-type patients treated with nivolumab plus ipilimumab in first-line or later there was also no difference in OS (p=0.996). Local therapy with stereotactic radiosurgery or surgery led to an improvement in OS compared with not receiving local therapy (p=0.009), regardless of the timepoint of the local therapy. Receiving combined immunotherapy for MBM in first-line or at a later time point made no difference in terms of OS in this study population (p=0.119). Conclusion Immunotherapy with nivolumab plus ipilimumab, particularly in combination with stereotactic radiosurgery or surgery improves OS in asymptomatic and symptomatic MBM.
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Affiliation(s)
- Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Eberhard Karls University of Tuebingen, Tubingen, Germany
| | - Felix Kiecker
- Skin Cancer Center, Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Schaefer
- Skin Cancer Center, Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Henner Stege
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Katharina Kaehler
- Skin Cancer Center, Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - Patrick Terheyden
- Skin Cancer Center, Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ralf Gutzmer
- Skin Cancer Center Hannover, Department of Dermatology, Hannover Medical School, Hannover, Germany
| | | | - Jochen Uttikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Germany.,Department of Dermatology and Allergy, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - David Rafei-Shamsabadi
- Skin Cancer Center, Department of Dermatology and Venerology, Medical Centre University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Ante Karoglan
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christian Posch
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.,Sigmund Freud Universität Wien, Faculty of Medicine, Wien, Austria
| | - Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Claudia Pfoehler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany
| | - Kai Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Tietze
- Department of Dermatology and Allergology, Augsburg Medical Center, Augsburg, Germany
| | - Dirk Debus
- Skin Cancer Center, Department of Dermatology, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | | | - Steffen Emmert
- Clinic for Dermatology and Venereology, University Medical Center, Rostock, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Jessica C Hassel
- Skin Cancer Center, Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Meiss
- Skin Cancer Center, Department of Dermatology and Venerology, Medical Centre University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Tueting
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Heinrich
- Clinic of Radiation Oncology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thomas Eigentler
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Eberhard Karls University of Tuebingen, Tubingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Eberhard Karls University of Tuebingen, Tubingen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
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Shea SM, Patel G, Schaefer S, Nowak MD, Sordillo EM, Paniz-Mondolfi A, Gitman MR. 421. If at first you do not succeed…. Repeat SARS-COV2 PCR testing. Open Forum Infect Dis 2020. [PMCID: PMC7776324 DOI: 10.1093/ofid/ofaa439.615] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Nucleic Acid Amplification Tests (NAATs) of nasopharyngeal specimens (NPS) have become standard for diagnosis of SARS-COV2. IDSA guidelines suggest repeat testing after 24–48 h when initially negative and clinical suspicion persists. We characterized patients from whom initial NPS were NAAT-negative, but repeats were NAAT-positive, in order to identify which patients might benefit from repeat NAAT for SARS-CoV-2, and the appropriate interval. Methods We conducted an IRB-approved retrospective review of laboratory and electronic medical record data for all patients evaluated for SARS-CoV-2 infection at the Mount Sinai Health System, whose initial NAATs were done between March 16 – March 30, 2020, and who were retested within one month. NAATs were performed on NPS in viral transport medium using the Roche Diagnostics cobas® 6800 SARS-CoV-2 Test. Baseline patient characteristics, clinical and radiographic findings were identified. Results Of 235 patients eligible for inclusion, 172 (70.5%) were initially NAAT-negative, and 118 (68.6%) remained NAAT-negative over 1 month follow up. 54 (31.4%) converted to NAAT-positive over the next 1-month. Of patients who became NAAT-positive, 31 (57.4%) were inpatients who converted results within a single admission; the average interval was 6d 7h between the NAAT-negative and NAAT-positive results, and the minimum interval was 10.5 h. Symptoms examined for correlation for conversion to NAAT-positive were: fever, cough, shortness of breath, and combined nausea/vomiting/diarrhea. Duration of symptoms reported at triage did not appear to affect time to conversion to NAAT-positive. No individual symptom was more likely to be associated with conversion to NAAT- positive. However, time to conversion to NAAT-positive was shorter for patients with multiple symptoms. In general, chest radiography (CXR) findings correlated with NAAT results; interval to NAAT-positive was shorter for patients with worsening CXR findings. Conclusion Our data supports repeat testing in patients with multiple clinical symptoms suggestive of SARS CoV-2 infection and negative initial NP test results. Further studies are needed to determine the true clinical sensitivity and specificity of SARS-CoV-2 NAAT assays. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Gopi Patel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Schaefer
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Hoechter DJ, Becker-Pennrich A, Langrehr J, Bruegel M, Zwissler B, Schaefer S, Spannagl M, Hinske LC, Zoller M. Higher procoagulatory potential but lower DIC score in COVID-19 ARDS patients compared to non-COVID-19 ARDS patients. Thromb Res 2020; 196:186-192. [PMID: 32891904 PMCID: PMC7441951 DOI: 10.1016/j.thromres.2020.08.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 is a novel viral disease. Severe courses may present as ARDS. Several publications report a high incidence of coagulation abnormalities in these patients. We aimed to compare coagulation and inflammation parameters in patients with ARDS due to SARS-CoV-2 infection versus patients with ARDS due to other causes. METHODS This retrospective study included intubated patients admitted with the diagnosis of ARDS to the ICU at Munich university hospital. 22 patients had confirmed SARS-CoV2-infection (COVID-19 group), 14 patients had bacterial or other viral pneumonia (control group). Demographic, clinical parameters and laboratory tests including coagulation parameters and thromboelastometry were analysed. RESULTS No differences were found in gender ratios, BMI, Horovitz quotients and haemoglobin values. The median SOFA score, serum lactate levels, renal function parameters (creatinine, urea) and all inflammation markers (IL-6, PCT, CRP) were lower in the COVID-19 group (all: p < 0.05). INR (p < 0.001) and antithrombin (p < 0.001) were higher in COVID-19 patients. D-dimer levels (p = 0.004) and consecutively the DIC score (p = 0.003) were lower in this group. In ExTEM®, Time-to-Twenty (TT20) was shorter in the COVID-19 group (p = 0.047), these patients also had higher FibTEM® MCF (p = 0.005). Further, these patients presented with elevated antigen and activity levels of von-Willebrand-Factor (VWF). CONCLUSION COVID-19 patients presented with higher coagulatory potential (shortened global clotting tests, increased viscoelastic and VWF parameters), while DIC scores were lower. An intensified anticoagulation regimen based on an individual risk assessment is advisable to avoid thromboembolic complications.
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Affiliation(s)
- D J Hoechter
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - A Becker-Pennrich
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - J Langrehr
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Bruegel
- Institute of Laboratory Medicine, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - B Zwissler
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pulmonary Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S Schaefer
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Spannagl
- Department of Transfusion Medicine and Haemostasis, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L C Hinske
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany; The Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M Zoller
- Department of Anesthesiology, LMU Klinikum, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Stiefelmaier J, Strieth D, Schaefer S, Kronenberger D, Wrabl B, Bröckel U, Ulber R. Untersuchung der Oberflächenadhäsion von Biofilmen. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055063] [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: 11/07/2022]
Affiliation(s)
- J. Stiefelmaier
- TU Kaiserslautern Lehrgebiet Bioverfahrenstechnik Gottlieb-Daimler-Str. 49 67663 Kaiserslautern Deutschland
| | - D. Strieth
- TU Kaiserslautern Lehrgebiet Bioverfahrenstechnik Gottlieb-Daimler-Str. 49 67663 Kaiserslautern Deutschland
| | - S. Schaefer
- Hochschule Trier, Umweltcampus Birkenfeld Institut für Mikroverfahrenstechnik und Partikeltechnik Campusallee Gebäude 9916 55768 Hoppstädten-Weiersbach Deutschland
| | - D. Kronenberger
- TU Kaiserslautern Lehrgebiet Bioverfahrenstechnik Gottlieb-Daimler-Str. 49 67663 Kaiserslautern Deutschland
| | - B. Wrabl
- TU Kaiserslautern Lehrgebiet Bioverfahrenstechnik Gottlieb-Daimler-Str. 49 67663 Kaiserslautern Deutschland
| | - U. Bröckel
- Hochschule Trier, Umweltcampus Birkenfeld Institut für Mikroverfahrenstechnik und Partikeltechnik Campusallee Gebäude 9916 55768 Hoppstädten-Weiersbach Deutschland
| | - R. Ulber
- TU Kaiserslautern Lehrgebiet Bioverfahrenstechnik Gottlieb-Daimler-Str. 49 67663 Kaiserslautern Deutschland
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11
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Scherer K, Soerjawinata W, Schaefer S, Kampeis P, Bröckel U, Wahl M, Ulber R. Transmissionseigenschaften von Füllkörperschüttungen für die phototrophe Kultivierung von Biofilmen terrestrischer Cyanobakterien. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055011] [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: 11/07/2022]
Affiliation(s)
- K. Scherer
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - W. Soerjawinata
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - S. Schaefer
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - P. Kampeis
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - U. Bröckel
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - M. Wahl
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Deutschland
| | - R. Ulber
- Technische Universität Kaiserslautern Gottlieb-Daimler-Straße 49 67663 Kaiserslautern Deutschland
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12
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Schaefer S, Soerjawinata W, Schüffler A, Ulber R, Bröckel U, Kampeis P. Characterization of the interaction between fungi and biocarriers with micro‐computed tomography. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055281] [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: 11/06/2022]
Affiliation(s)
- S. Schaefer
- Trier University of Applied Sciences Institute of Micro-Process-Engineering and Particle Technology Campusallee building 9916 55768 Hoppstädten-Weiersbach Germany
| | - W. Soerjawinata
- Trier University of Applied Sciences Institute for Biotechnical Process Design Campusallee building 9913 55768 Hoppstädten-Weiersbach Germany
| | - A. Schüffler
- Institut für Biotechnologie und Wirkstoff-Forschung gGmbH (IBWF) Erwin-Schrödinger-Str. 56 67663 Kaiserslautern Germany
| | - R. Ulber
- Technical University Kaiserslautern Institute of Bioprocess Engineering Gottlieb-Daimler-Str. building 49 67663 Kaiserslautern Germany
| | - U. Bröckel
- Trier University of Applied Sciences Institute of Micro-Process-Engineering and Particle Technology Campusallee building 9916 55768 Hoppstädten-Weiersbach Germany
| | - P. Kampeis
- Trier University of Applied Sciences Institute for Biotechnical Process Design Campusallee building 9913 55768 Hoppstädten-Weiersbach Germany
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13
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Scherer K, Schaefer S, Bröckel U, Ulber R, Wahl M. Aerosol‐based bioreactor system for the cultivation of terrestrial cyanobacteria using bulk materials. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055012] [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. Scherer
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Germany
| | - S. Schaefer
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Germany
| | - U. Bröckel
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Germany
| | - R. Ulber
- Technische Universität Kaiserslautern Gottlieb-Daimler-Sraße 49 67663 Kaiserslautern Germany
| | - M. Wahl
- Hochschule Trier – Umwelt-Campus Birkenfeld Campusallee 55768 Hoppstädten-Weiersbach Germany
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Walits E, Patel G, Lavache S, Faotto RM, Pobliner A, Wilson S, Schaefer S. Management of Candida auris in an inpatient acute rehabilitation setting. Am J Infect Control 2020; 48:222-223. [PMID: 31706548 DOI: 10.1016/j.ajic.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Abstract
Candida auris is an emerging, multidrug-resistant yeast that is considered a threat to patients and health care facilities worldwide. As the incidence of C auris increases, the management of patients with C auris will expand beyond acute care hospitals and long-term care facilities. We discuss the infection prevention measures implemented to prevent the transmission of Candida auris on an inpatient acute rehabilitation unit while ensuring that appropriate patient care was provided.
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15
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Schaefer S, Neumann JT, Soerensen NA, Gossling A, Ojeda F, Blankenberg S, Westermann D. P3600High-sensitivity troponin I can predict reduced TIMI coronary grade flow in patients with suspected myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0460] [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
Serial measurements of high-sensitivity troponin (hs-Tn) is recommended for rule-out or rule-in of myocardial infarction (MI) in patients presenting with acute chest pain. Based on dynamic hs-Tn changes invasive angiography is recommended in order to identify a culprit lesion. However, the association of hs-Tn with the intracoronary flow is unknown.
Purpose
We aimed to evaluate the association of hs-TnI with intracoronary flow, measured by the TIMI Coronary Grade Flow in coronary angiography, and its association with outcome.
Methods
1,940 consecutive patients presenting with suspected MI to the emergency department were included. Among those 543 patients underwent coronary angiography. Patients with prior coronary artery bypass graft surgery and patients with chronic total occlusion were excluded from further analysis, resulting in 420 available individuals. TIMI Coronary Grade Flow was scored in accordance with the definition of the TIMI study group. For further analysis two groups were distinguished. Group 1: Minimum TIMI Grade Flow <3 (no complete perfusion in at least one of the coronary arteries) and Group 2: Minimum TIMI Grade Flow = 3 (normal flow in all coronary arteries). Troponin I was measured using the ARCHITECT STAT high sensitive Troponin I immunoassay directly at admission, after 1 and 3 hours. Receiver Operating Characteristic (ROC) curves were used to investigate the association of hs-TnI with a reduced TIMI Grade Flow. Survival curves were produced for a combined endpoint of all-cause mortality, rehospitalisation, PCI and MI after 12 months.
Results
In patients with reduced TIMI Grade Flow the level of hs-TnI was significantly higher at admission (Group 2: 87.3 ng/l vs. Group 1: 15.0 ng/l, p<0.001), after 1 hour (298.3 ng/l vs 18.5 ng/l, p<0.001) and after 3 hours (1,071 ng/l vs. 27.7 ng/l, p<0.001). The prediction of reduced TIMI flow based on the absolute value of hs-TnI improved over time from admission (AUC 0.701, optimal cut off 34.8 ng/l, 95% CI (9.7, 74.6)), to 1 hour (AUC 0.759, optimal cut off 65.1 ng/l, 95% CI (25.1, 279.5)) and 3 hours (AUC 0.777, optimal cut off 90.7 ng/l, 95% CI (14.8, 200)). Using the hs-TnI delta to predict a reduced TIMI Grade Flow improved the accuracy only slightly with time from admission: hs-TnI 0/1h delta (AUC 0.758) vs. 0/3h delta (AUC 0.765). The survival curve for a combined endpoint after one year was significantly reduced in patients with reduced TIMI Grade Flow (Figure 1, p=0.012)
Figure 1
Conclusion
Absolute value and delta change of hs-TnI after 1 and 3 hours help to predict the presence of reduced TIMI Grade Flow in coronary arteries. Patients suffering from a lowered TIMI Grade Flow have higher event rates after 12-months.
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Affiliation(s)
- S Schaefer
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - J T Neumann
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - N A Soerensen
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - A Gossling
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - F Ojeda
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - D Westermann
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
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16
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Schmiedeke E, Schaefer S, Aminoff D, Schwarzer N, Jenetzky E. Non-financial conflicts of interest: contribution to a surgical dilemma by the European Reference Networks for Rare Diseases. Pediatr Surg Int 2019; 35:999-1004. [PMID: 31278479 DOI: 10.1007/s00383-019-04516-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Conflicts of interest can impede both research and medical treatment. The European Reference Networks require their members to deal with financial and non-financial conflicts according to an explicit protocol. In a literature review, we identified relevant interests in paediatric surgery, and drafted such a policy. METHODS We conducted a Pubmed query and identified additional publications based on the content of the papers. RESULTS 58 titles were identified. According to their abstracts, 10 publications were studied in full text. A scientific taxonomy does not yet exist, but a variety of factors are mentioned. Non-financial conflicts of interest are addressed less accurately and less frequently than financial ones, especially regarding surgical treatment. Since the clinical effect of surgical volume was identified as being relevant, additional 29 respective publications were analysed. This volume-quality relationship causes conflicts of interest for the many surgeons treating a broad spectrum of rare conditions. We present a recommendation that may guide referral of patients requiring complex surgery to centres with a higher volume. CONCLUSIONS Non-financial conflicts of interest need to be dealt with more accuracy, especially with regard to surgery in rare, complex congenital conditions. The European Reference Networks offer a framework to mitigate these conflicts.
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Affiliation(s)
- E Schmiedeke
- Clinic for Pediatric Surgery and Pediatric Urology, Klinikum Bremen Mitte, eUROGEN-ERN, 28177, Bremen, Germany.
| | | | - D Aminoff
- ePAG eUROGEN-ERN, AIMAR Patient Organisation, Rome, Italy
| | - N Schwarzer
- ePAG ERNICA-ERN, SoMA Patient Organisation, Munich, Germany
| | - E Jenetzky
- SoMA Patient Organisation, Munich, Germany.,Department of Child- and Adolescent- Psychiatry and -Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Director of the German CURE-Net and the European ARM-Net-Registries, Mainz, Germany
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17
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Mazo D, Gottlieb L, Schaefer S, Alexander K, Ehni J, Javaid W, Patel G, Aberg J, Lorin S. LB13. Candida auris in NYC: A Health System’s Experience Treating the Emerging Drug-Resistant Yeast. Open Forum Infect Dis 2018. [PMCID: PMC6254832 DOI: 10.1093/ofid/ofy229.2187] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Candida auris is emerging multidrug-resistant yeast that can cause serious infections with published mortality rates as high as 60%. It was first recognized in 2009 and has been reported in over a dozen countries. The current United States outbreak was identified in 2016 with New York City (NYC) as the epicenter. The aim of this evaluation was to describe the clinical infections and outcomes with C. auris in a large health system in NYC. Methods Cases were identified from clinical specimens collected December 2015–June 2018 from the Mount Sinai Hospital Clinical Microbiology Laboratory, the central laboratory for the Mount Sinai Health System, which encompasses seven hospitals across NYC. All C. auris isolates were confirmed by the New York State Department of Health Wadsworth Center. Medical charts were reviewed. A case was included if C. auris grew from a sterile body site, an antifungal treatment was initiated or the patient expired before the yeast was identified on Gram stain. Results Twenty-nine possible cases were identified with 23 meeting the case definition. These cases included 19 bloodstream infections (BSI), two intra-abdominal abscesses, one skin soft tissue infection, and one otitis externa. Using the MIC breakpoints recommended by the Centers for Disease Control and Prevention, 100% of isolates tested were susceptible to caspofungin, 29% were susceptible to amphotericin B, and 17% were susceptible to fluconazole. Nineteen patients received antifungal treatment, 13 with caspofungin monotherapy and four with sequential therapy of caspofungin followed by an azole (three with fluconazole, one with posaconazole). Fifteen (65%) patients expired within 90 days of the positive culture. Fourteen of the deaths were in candidemic patients, despite that eight (57%) of these patients had documented microbiologic clearance after appropriate therapy. The 90-day mortality rate was 74% for BSI. Conclusions This case series is the largest reported in the United States. Candidemia was the most common site of infection and had a very high 90-day mortality rate, despite sterilization of the blood. These findings highlight the significant morbidity and mortality associated with C. auris and the need to focus efforts on rapid diagnostics and infection prevention. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Dana Mazo
- Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lindsey Gottlieb
- Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah Schaefer
- Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kinta Alexander
- Infection Prevention, Mount Sinai Brooklyn, Brooklyn, New York
| | - Jordan Ehni
- Infection Prevention, Mount Sinai Downtown, New York, New York
| | - Waleed Javaid
- Infection Prevention, Mount Sinai Brooklyn, Brooklyn, New York
- Infection Prevention, Mount Sinai Downtown, New York, New York
| | - Gopi Patel
- Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judith Aberg
- Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Walter C, Hengge C, Lindauer B, Schaefer S. DECLINES IN MOTOR TRANSFER FOLLOWING UPPER EXTREMITY TASK-SPECIFIC TRAINING IN OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3399] [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: 11/14/2022] Open
Affiliation(s)
- C Walter
- University of Arkansas for Medical Sciences
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Schaefer S, Altay A, Waldeyer C, Appelbaum S, Ojeda F, Schnabel R, Ruhe J, Lackner K, Blankenberg S, Zeller T, Karakas M. P658Intrinsic iron release is associated with lower mortality in patients with stable coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Schaefer S, Viswanathan S, Widjaja A, Hubner N, Moreno-Moral A, Soon JL, Chao VT, Chakaramakkil MJ, Sin KY, Cook SA. 2885Integrated target discovery screens identify a novel therapeutic target for cardiovascular fibrosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx494.2885] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sadeghi B, Kaiser LL, Schaefer S, Tseregounis IE, Martinez L, Gomez-Camacho R, de la Torre A. Multifaceted community-based intervention reduces rate of BMI growth in obese Mexican-origin boys. Pediatr Obes 2017; 12:247-256. [PMID: 27071684 DOI: 10.1111/ijpo.12135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/10/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Latino children and youth have some of the highest rates of overweight and obesity. Early intervention is important to prevent future obesity and illness in this population. METHODS A 3-year, multifaceted intervention was designed to reduce the rate of growth of body mass index (BMI) among Mexican-origin children. Two communities in California's agricultural Central Valley were targeted for intervention and comparison. To assess impact, anthropometric measures of participating children (N = 422) were collected and analysed at baseline and after 1 year of intervention. RESULTS After 1 year of intervention, triceps skin-fold thickness in girls showed a significant decrease in unadjusted analysis between children in the two communities. In multivariate analysis, a reduction in BMI growth was seen among obese boys in the intervention community (ß-coefficient = -1.94, P = 0.05). Obese boys in the intervention community also had a smaller increase in waist circumference (ß-coefficient = -5.2, P = 0.04) than the comparison community. CONCLUSIONS These early findings indicate the intervention's effectiveness for preventing BMI growth among obese boys. Longitudinal follow-up is needed to determine the sustainability of results and whether similar results extend to obese girls and overweight boys or girls.
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Affiliation(s)
- B Sadeghi
- UC Davis Department of Internal Medicine, Sacramento, CA, USA
| | - L L Kaiser
- Department of Nutrition, University of California, Davis, CA, USA
| | - S Schaefer
- Foods for Health Institute, Food Science & Technology Department, University of California, Davis, CA, USA
| | - I E Tseregounis
- Center for Transnational Health, University of California, Davis, CA, USA
| | - L Martinez
- Center for Transnational Health, University of California, Davis, CA, USA
| | - R Gomez-Camacho
- Center for Transnational Health, University of California, Davis, CA, USA
| | - A de la Torre
- Center for Transnational Health, University of California, Davis, CA, USA
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22
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Ioannou P, Burki U, Greally E, Laval S, Schaefer S, Straub V. NHE1 inhibition as a potential therapy to attenuate DMD pathology. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schaefer S, Glaser A, Gottlieb L, Huprikar S. Inappropriate Testing and Treatment of Asymptomatic Bacteriuria: Assessment of Provider Behavior and the Effectiveness of an Audit and Feedback Intervention in the Hospital. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Schaefer
- Infectious Diseases, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Allison Glaser
- Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Lindsey Gottlieb
- Internal Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Shirish Huprikar
- Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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Schaefer S, Felix EM, Muench F, Antoni M, Lohaus C, Brötz J, Kunz U, Gärtner I, Ensinger W. NiCo nanotubes plated on Pd seeds as a designed magnetically recollectable catalyst with high noble metal utilisation. RSC Adv 2016. [DOI: 10.1039/c6ra10235b] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The tailored structure of a bifunctional, semi-homogeneous NiCo-nanotube catalyst system with embedded Pd nanoparticles, is synthesised by electroless plating.
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Affiliation(s)
- S. Schaefer
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - E.-M. Felix
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - F. Muench
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - M. Antoni
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - C. Lohaus
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - J. Brötz
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - U. Kunz
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
| | - I. Gärtner
- Technische Universität Darmstadt
- MPA/IfW Darmstadt
- 64283 Darmstadt
- Germany
| | - W. Ensinger
- Technische Universität Darmstadt
- Department of Materials Science
- 64287 Darmstadt
- Germany
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25
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Luiz T, Scherer G, Wickenkamp A, Blaschke F, Hoffmann W, Schiffer M, Zimmer J, Schaefer S, Voigt C. [Prehospital analgesia by paramedics in Rhineland-Palatinate : Feasability, analgesic effectiveness and safety of intravenous paracetamol]. Anaesthesist 2015; 64:927-936. [PMID: 26497656 DOI: 10.1007/s00101-015-0089-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/27/2015] [Revised: 06/05/2015] [Accepted: 08/20/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND In contrast to the widespread practice in life-threatening emergencies, delegation of medical pain therapy to paramedics by the medical director of Emergency Medical Services, EMS, are still the exception in Germany. This is due to the fact that in non-life-threatening situations, the expected benefit and potential side effects of drug therapy have to be carefully weighed. In addition, in Germany federal law generally restricts the administration of opiates to physicians. METHODS In 2011 the medical directors of EMS in the German state of Rhineland- Palatinate (4 million inhabitants) developed and implemented a standard operating procedure (SOP) for paramedics related to the prehospital parenteral administration of paracetamol for patients with isolated limb trauma. After a 2 h training session and examination, paramedics were authorized to administer 1 g of paracetamol to patients with a pain score > 5 points on an 11-point numerical rating scale (NRS). For purposes of quality management, every administration of paracetamol had to be prospectively documented on a specific electronic mission form. RESULTS A total of 416 mission forms could be analyzed. After administration of paracetamol the median NRS score decreased from 8 points (interquartile range: 6; 8) to 4 points (interquartile range: 3; 7). In 51.2 % of the patients the pain intensity was reduced by at least 3 NRS points and in 50.5 % of the patients the NRS was less than 5 points after treatment. The extent of pain reduction was positively correlated with the initial NRS value (r = 0.31, p < 0.0001). No serious side effects were noted. The percentage of patients with an initial heart rate > 100/min declined from 14.6 % to 5.2 % after the administration of paracetamol (p < 0.0001), 18.7 % of the patients received paracetamol for trauma not related to the extremities and 7 % of the patients for nontraumatic pain. An emergency physician was involved in 50 % of the EMS missions and 98.6 % of the patients were transported to a hospital for further diagnostics and treatment. CONCLUSION The prehospital intravenous administration of paracetamol by paramedics to patients with limb trauma is simple, safe and in 50 % of the patients effective in achieving a NRS value < 5; however, further improvements in prehospital pain therapy initiated by paramedics are desirable, especially in patients with an initial NRS value > 7.
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Affiliation(s)
- T Luiz
- Deutsches Zentrum für Notfallmedizin & Informationstechnologie, Fraunhofer IESE, Fraunhofer-Platz 1, 67663, Kaiserslautern, Deutschland. .,Klinik für Anästhesie, Intensiv- und Notfallmedizin 1, Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland.
| | - G Scherer
- Rettungsdienstbereiche Rheinhessen & Bad Kreuznach, Ingelheim am Rhein, Deutschland
| | - A Wickenkamp
- Deutsches Zentrum für Notfallmedizin & Informationstechnologie, Fraunhofer IESE, Fraunhofer-Platz 1, 67663, Kaiserslautern, Deutschland
| | - F Blaschke
- Rettungsdienstbereiche Ludwigshafen & Südpfalz, Ludwigshafen, Deutschland
| | - W Hoffmann
- Rettungsdienstbereich Kaiserslautern, Kaiserslautern, Deutschland
| | - M Schiffer
- Rettungsdienstbereich Trier, Trier, Deutschland
| | - J Zimmer
- Rettungsdienstbereich Trier, Trier, Deutschland
| | - S Schaefer
- Rettungsdienstbereiche Koblenz & Montabaur, Koblenz, Deutschland
| | - C Voigt
- Rettungsdienstbereiche Koblenz & Montabaur, Koblenz, Deutschland
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26
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Elfenbein DM, Schaefer S, Shumway C, Chen H, Sippel RS, Schneider DF. Prospective Intervention of a Novel Levothyroxine Dosing Protocol Based on Body Mass Index after Thyroidectomy. J Am Coll Surg 2015; 222:83-8. [PMID: 26584573 DOI: 10.1016/j.jamcollsurg.2015.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/29/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Weight-based postoperative levothyroxine (LT4) dosing often fails to appropriately dose overweight and underweight patients. Previously, we created an LT4-dosing algorithm based on BMI. We hypothesize that more patients will achieve euthyroidism at their postoperative visit with the use of the protocol. STUDY DESIGN A prospective evaluation was performed of our previously published BMI-based LT4 dosing. All adults who underwent thyroidectomy for benign disease between January 1, 2011 and December 31, 2013 were included; the new protocol was implemented in October 2012. Serum TSH was measured for all patients 6 to 8 weeks postoperatively, and adjustments were based on TSH. RESULTS Three hundred and thirty patients were included, with 54% undergoing thyroidectomy after institution of the protocol. The groups were well matched. Before protocol implementation, LT4 was dosed solely by weight and 25% of patients were euthyroid at initial follow-up. After the protocol, 39% of patients were euthyroid (p = 0.01). The percentage of patients who were given too high a dose of LT4 remained the same (46% vs 42%), and there was a significant reduction in the number of patients who were given too little (29% vs 19%; p = 0.05). The effect was most profound in patients with low and normal BMI, and there were slight differences between sexes. CONCLUSIONS Although correct initial dosing of LT4 remains challenging, this dosing protocol that we developed and implemented has improved patient care by increasing the number of patients who achieve euthyroidism at the first postoperative visit. We have made a change to our original protocol to incorporate sex differences into the calculation.
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Affiliation(s)
- Dawn M Elfenbein
- University of California, Irvine School of Medicine, Irvine, CA.
| | - Sarah Schaefer
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Cynthia Shumway
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Rebecca S Sippel
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David F Schneider
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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27
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Affiliation(s)
- Sarah Schaefer
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael Simon
- University of Kentucky College of Medicine, Lexington, KY, USA
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28
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Weiss A, Gernert K, Schaefer S, Maegel L, Jonigk D, Ghofrani A, Weissmann N, Grimminger F, Seeger W, Schermuly R. MicroRNA-9 is a regulator of PDGFRβ expression in pulmonary arterial hypertension. Pneumologie 2015. [DOI: 10.1055/s-0035-1556634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Martel-Laferrière V, Michel A, Schaefer S, Bindal S, Bichoupan K, Branch AD, Huprikar S, Schiano TD, Perumalswami PV. Clinical characteristics of human immunodeficiency virus patients being referred for liver transplant evaluation: a descriptive cohort study. Transpl Infect Dis 2015; 17:527-35. [PMID: 25929731 DOI: 10.1111/tid.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/02/2015] [Accepted: 04/05/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a treatment option for select human immunodeficiency virus (HIV)-infected patients with advanced liver disease. The aim of this study was to describe LT evaluation outcomes in HIV-infected patients. METHODS All HIV-infected patients referred for their first LT evaluation at the Mount Sinai Medical Center were included in this retrospective, descriptive cohort study. Multivariable logistic regression was used to identify factors independently associated with listing. RESULTS Between February 2000 and April 2012, 366 patients were evaluated for LT, with 66 (18.0%) listed for LT and 300 (82.0%) not listed. Fifty-one patients (13.9%) died before completing evaluation and 85 (23.2%) were too early for listing. Reasons patients were declined for listing were psychosocial (15.8%), HIV-related (10.4%), loss to follow-up (9.6%), surgical/medical (6.0%), liver-related (4.4%), patient choice (3.4%), and financial (1.6%). Listed patients were more likely to have hepatocellular carcinoma (HCC) (43.1% vs. 17.1%; P < 0.0001) and less likely to have hepatitis B (6.2% vs. 15.7%; P = 0.04) or a psychiatric history (19.7% vs. 35.2%; P = 0.02) than those not listed. In multivariable analysis, HCC (odds ratio [OR] 5.79; 95% confidence interval [95% CI]: 2.97-11.28), model for end-stage liver disease (MELD) score at referral (OR 1.06; 95% CI 1.01-1.11), and hepatitis B (OR 0.26; 95% CI 0.08-0.79) were associated with listing. CONCLUSION MELD score and HCC were positive predictors of listing in HIV-infected patients referred for LT evaluation and, therefore, timely referrals are vital in these patients. As MELD is a predictor for death while undergoing evaluation, rapid evaluation should be performed in HIV-infected patients with a higher MELD score.
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Affiliation(s)
- V Martel-Laferrière
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - A Michel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Schaefer
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Bindal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - K Bichoupan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - A D Branch
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - S Huprikar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - T D Schiano
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - P V Perumalswami
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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30
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Myrdal Miller A, Mills K, Wong T, Drescher G, Lee S, Sirimuangmoon C, Schaefer S, Langstaff S, Minor B, Guinard JX. Flavor-Enhancing Properties of Mushrooms in Meat-Based Dishes in Which Sodium Has Been Reduced and Meat Has Been Partially Substituted with Mushrooms. J Food Sci 2014; 79:S1795-804. [DOI: 10.1111/1750-3841.12549] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - K. Mills
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - T. Wong
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - G. Drescher
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - S.M. Lee
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | - C. Sirimuangmoon
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | - S. Schaefer
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | | | - B. Minor
- The Culinary Inst. of America at Greystone; St. Helena CA USA
- Mushroom Council; San José CA USA
| | - J.-X Guinard
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
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31
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Pathak P, Holden S, Schaefer S, Leverson G, Chen H, Sippel R. PTH Elevation After Curative Parathyroidectomy Delays Symptom Improvement. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.422] [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: 10/25/2022]
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32
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Arndt AK, Schaefer S, Siebert R, Cook SA, Berger F, Kramer HH, MacRae CA, Klaassen S. Identification of PRDM 16 as a Novel Gene for Cardiomyopathy and a Possible Therapeutic Target for Heart Failure. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354457] [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: 10/26/2022]
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33
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Wege AK, Schardt K, Schaefer S, Kroemer A, Brockhoff G, Jung EM. High resolution ultrasound including elastography and contrast-enhanced ultrasound (CEUS) for early detection and characterization of liver lesions in the humanized tumor mouse model. Clin Hemorheol Microcirc 2013; 52:93-106. [PMID: 22975935 DOI: 10.3233/ch-2012-1587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE In this study we investigated the sensitivity of high resolution ultrasound (HRU) in the detection of small liver tumors and its microcirculation in a humanized tumor mouse model (HTM). These mice develop a complete human immune system and human breast cancer growth in the liver which allows the investigation of antibody based immunotherapies under human like conditions. METHOD HTM were generated by the co-transplantation of human breast cancer cells and human hematopoietic stem cells. HRU, Doppler sonography (CCDS), contrast enhanced ultrasound (CEUS) and color-coded elastography were performed on all HTM and confirmed by histopathological assessment. RESULTS Using HRU and CEUS, noncystic solid liver lesions between 2 and 11 mm (mean 3.5 mm) size were detectable in HTM. Granulomatous areas were identified by B-scan imaging, showing areas of higher stiffness in elastography and areas without contrast media uptake in the late phase (CEUS). In addition, CEUS detected capillary microcirculation of benign and malignant liver lesions smaller than 10 mm. CONCLUSION Beyond human breast cancer HTM additionally developed small parenchymal liver lesions, which could be characterized by HRU in combination with CEUS and elastography in-vivo. Nevertheless, the defined diagnoses of solid liver lesions less than 5 mm require confirmation by histopathology.
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Affiliation(s)
- A K Wege
- Clinic of Gynecology and Obstetrics, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
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34
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Kukuk GM, Schaefer S, Fimmers R, Schild HH, Willinek WA. T1-gewichtete MRT nach Gd-EOB-DTPA (Primovist®) als Biomarker für die hepatozelluläre Funktion bei Patienten mit fokalen und diffusen Lebererkrankungen. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346401] [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: 10/26/2022]
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35
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Scherr RE, Linnell J, Smith M, Nicholson Y, Spezzano T, Bergman J, Brian K, Briggs M, Feenstra G, Hillhouse C, Keen CL, Nguyen L, Ontai L, Schaefer S, Steinberg F, Sutter C, Wright J, Young H, Zidenberg‐Cherr S. The Shaping Healthy Choices Program: A Multi‐Component, School‐Based Approach to Improve Children's Nutrition and Health Behaviors While Supporting Regional Agriculture. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.623.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel E Scherr
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - J Linnell
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - M Smith
- Center for Nutrition in SchoolsUniversity of CaliforniaDavisCA
- Population Health and ReproductionUniversity of CaliforniaDavisCA
| | | | | | - J Bergman
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - K Brian
- UCCE Sacramento CountyUC ANRSacramentoCA
| | - M Briggs
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - G Feenstra
- Agricultural Sustainability InstituteUniversity of CaliforniaDavisCA
| | - C Hillhouse
- Agricultural Sustainability InstituteUniversity of CaliforniaDavisCA
| | - C L Keen
- NutritionUniversity of CaliforniaDavisCA
| | - L Nguyen
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - L Ontai
- Human EcologyUniversity of CaliforniaDavisCA
| | - S Schaefer
- Foods For Health InstituteUniversity of CaliforniaDavisCA
| | | | - C Sutter
- Human EcologyUniversity of CaliforniaDavisCA
| | - J Wright
- Plant SciencesUniversity of CaliforniaDavisCA
| | - H Young
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
| | - S Zidenberg‐Cherr
- NutritionUniversity of CaliforniaDavisCA
- Betty Irene Moore School of NursingUniversity of California DavisSacramentoCA
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36
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Scherr RE, Linnell J, Nicholson Y, Spezzano T, Bergman J, Brian K, Briggs M, Cherr SE, Ermakov I, Feenstra G, Gellermann W, Hillhouse C, Nguyen L, Ontai L, Schaefer S, Smith M, Sutter C, Wright J, Zidenberg‐Cherr S. Assessment of Nutrition and Physical Activity in Children Participating in the Shaping Healthy Choices Program. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.624.3] [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: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - K Brian
- UCCE Sacramento CountyUC ANRSacCA
| | | | | | | | | | | | | | | | - L Ontai
- Human EcologyUC DavisDavisCA
| | | | - M Smith
- Human EcologyUC DavisDavisCA
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37
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Murray S, Pathak P, Schaefer S, Schneider D, Chen H, Sippel R. Modern-Day Presentation of Primary Hyperparathyroidism. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.819] [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: 10/27/2022]
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38
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Reiher AE, Mazeh H, Schaefer S, Gould J, Chen H, Sippel RS. Symptoms of gastroesophageal reflux disease improve after parathyroidectomy. Surgery 2013; 152:1232-7. [PMID: 23158189 DOI: 10.1016/j.surg.2012.08.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/23/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary hyperparathyroidism can be associated with symptoms related to GERD, but it is unclear which symptoms of GERD improve after parathyroidectomy. Our goal was to assess prospectively for changes in specific GERD symptoms after parathyroidectomy using a validated questionnaire. METHODS Using the GERD health-related quality of life (GERD-HRQL) questionnaire, symptoms of heartburn were prospectively assessed before and 6 months after treatment of hyperparathyroidism with parathyroidectomy. This validated questionnaire includes 10 items, with a Likert scale of 0-5. Scores range from 0 to 45, a lesser score indicates fewer/less severe symptoms. RESULTS Pre- and postoperative surveys were available for 51 patients. Parathyroidectomy improved the overall questionnaire score (12.5 ± 1.3 vs 4.5 ± 0.9, P < .0001). Overall scores for each question improved after parathyroidectomy, including symptoms of dysphagia (P = .001) and overall satisfaction with symptoms (P < .0001). However, the number of patients taking antireflux medication before and after parathyroidectomy was not substantially different (34 vs 28 patients, P = .17). CONCLUSION All symptoms of GERD improved after parathyroidectomy for hyperparathyroidism. Despite the decrease in symptoms, there was not a change in the number of patients who remained on anti-reflux therapy. For patients with symptoms of GERD, a trial off antireflux medications after parathyroidectomy should be considered.
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Affiliation(s)
- Alexandra E Reiher
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792-3284, USA
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39
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Ojomo KA, Schneider DF, Reiher AE, Lai N, Schaefer S, Chen H, Sippel RS. Using body mass index to predict optimal thyroid dosing after thyroidectomy. J Am Coll Surg 2013; 216:454-60. [PMID: 23318118 DOI: 10.1016/j.jamcollsurg.2012.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Current postoperative thyroid replacement dosing is weight based, with adjustments made after thyroid-stimulating hormone values. This method can lead to considerable delays in achieving euthyroidism and often fails to accurately dose over- and underweight patients. Our aim was to develop an accurate dosing method that uses patient body mass index (BMI) data. STUDY DESIGN A retrospective review of a prospectively collected thyroid database was performed. We selected adult patients undergoing thyroidectomy, with benign pathology, who achieved euthyroidism on thyroid hormone supplementation. Body mass index and euthyroid dose were plotted and regression was used to fit curves to the data. Statistical analysis was performed using STATA 10.1 software (Stata Corp). RESULTS One hundred twenty-two patients met inclusion criteria. At initial follow-up, only 39 patients were euthyroid (32%). Fifty-three percent of patients with BMI >30 kg/m(2) were overdosed, and 46% of patients with BMI <25 kg/m(2) were underdosed. The line of best fit demonstrated an overall quadratic relationship between BMI and euthyroid dose. A linear relationship best described the data up to a BMI of 50. Beyond that, the line approached 1.1 μg/kg. A regression equation was derived for calculating initial levothyroxine dose (μg/kg/d = -0.018 × BMI + 2.13 [F statistic = 52.7, root mean square error of 0.24]). CONCLUSIONS The current standard of weight-based thyroid replacement fails to appropriately dose underweight and overweight patients. Body mass index can be used to more accurately dose thyroid hormone using a simple formula.
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Affiliation(s)
- Kristin A Ojomo
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792, USA
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Abstract
Haemochromatosis may impair the function of endocrine organs, amongst others the pituitary gland. It was the aim of this study to determine pituitary function in adult patients with genetically defined hereditary haemochromatosis in a prospective diagnostic study using a standardised stimulation test. Therefore, 22 patients (7 females, 15 males; age at diagnosis of haemochromatosis 48.1 ± 7.9 years; age at study inclusion 50.7 ± 7.7 years) with genetically defined hereditary haemochromatosis were investigated by a combined pituitary stimulation test (CRH, GHRH/arginine, GnRH, TRH). In 11 patients (50% of the study population; 2 females, 9 males), pituitary insufficiencies were detected [isolated corticotrophic insufficiency (peak cortisol < 181.25 μg/l/500 nmol/l) n=10 (2 females, 8 males); combined corticotrophic and borderline gonadotrophic insufficiency (basal testosterone 2.4-3.0 μg/l without basal LH-elevation) in 1 male]. Somatotrophic pituitary insufficiencies were not found. IFG-1 concentrations below -2 standard deviations in 7 patients (32%) may be attributed to impaired hepatic IGF-1 synthesis. Hypopituitarism, particularly corticotrophic insufficiency, seems to be prevalent in a considerable number of middle-aged patients with hereditary haemochromatosis. Despite normal somatotrophic function, low IGF-1 serum concentrations may be found in a subgroup of haemochromatosis patients.
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Affiliation(s)
- P M Uitz
- Division of Endocrinology & Diabetology, Faculty of Medicine and University Hospital, Philipp's University, Marburg, Germany
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Mazeh H, Khan Q, Schneider DF, Schaefer S, Sippel RS, Chen H. Same-day thyroidectomy program: Eligibility and safety evaluation. Surgery 2012; 152:1133-41. [DOI: 10.1016/j.surg.2012.08.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Patients with goiter often complain of compressive symptoms, which may contribute to symptoms of obstructive sleep apnea (OSA). However, the impact of thyroid enlargement on these symptoms is not clear. Therefore, we sought to evaluate whether symptoms of sleep apnea resolved after thyroidectomy by using a validated questionnaire. METHODS The Berlin Questionnaire, a validated sleep apnea assessment tool, was provided to patients at a single academic institution before and after thyroidectomy. Patients who admitted to symptoms of snoring were asked to complete the questionnaire before and 8 weeks after surgery to assess for improvement in symptoms. The questionnaire uses 3 categories of questions to determine risk of sleep apnea. Two symptom categories must be positive for a patient to be considered high risk for sleep apnea. RESULTS Forty-five patients completed both pre- and postoperative questionnaires. The average age of patients completing the questionnaire was 53±2 years, and 78% of patients were female. Average body mass index was 33.3±1.4 kg/m(2). Based on their preoperative questionnaire score, 71% of patients were considered to be high risk for OSA, and this decreased to 51% after surgery (p=0.002). Overall scores significantly improved after surgery (mean 2.0 vs. 1.6, p<0.0001). Specifically, patients noted a significant decrease in snoring frequency after surgery (p=0.002), as well as a significant decrease in whether or not their snoring bothered others (p=0.004). The frequency of nodding off during the day also significantly decreased after surgery (p=0.02). Among patients with ≥25% improvement compared with those with <25% improvement in scores, the only significant difference found was a higher preoperative thyrotropin among patients with <25% improvement (p=0.03). No significant difference was found between age, gender, presence of compressive symptoms, gland weight at resection, presence of thyroiditis, or the largest dimension of the gland at resection. CONCLUSIONS Thyroid surgery appears to significantly improve symptoms of OSA in patients who screened positive for symptoms before surgery. Evaluation of patients with OSA should include evaluation of thyroid disease, as symptoms of sleep apnea may improve with thyroidectomy.
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Affiliation(s)
- Alexandra E Reiher
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792-3284, USA
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Totzeck M, Hendgen-Cotta U, Rammos C, Petrescu A, Stock P, Goedecke A, Shiva S, Kelm M, Rassaf T, Duerr GD, Heuft T, Klaas T, Suchan G, Roell W, Zimmer A, Welz A, Fleischmann BK, Dewald O, Luedde M, Carter N, Lutz M, Sosna J, Jacoby C, Floegel U, Hippe HJ, Adam D, Heikenwaelder M, Frey N, Sobierajski J, Luedicke P, Hendgen-Cotta U, Lue H, Totzeck M, Dewor M, Kelm M, Bernhagen J, Rassaf T, Cortez-Dias N, Costa M, Carrilho-Ferreira P, Silva D, Jorge C, Robalo Martins S, Fiuza M, Pinto FJ, Nunes Diogo A, Enguita FJ, Tsiachris D, Tsioufis C, Kasiakogias A, Flessas D, Antonakis V, Kintis K, Giakoumis M, Hatzigiannis P, Katsimichas T, Stefanadis C, Andrikou E, Tsioufis C, Thomopoulos C, Kasiakogias A, Tzamou V, Andrikou I, Bafakis I, Lioni L, Kintis K, Stefanadis C, Lazaros G, Tsiachris D, Tsioufis C, Vlachopoulos C, Brili S, Chrysohoou C, Tousoulis D, Stefanadis C, Santos De Sousa CI, Pires S, Nunes A, Cortez Dias N, Belo A, Cabrita I, Pinto FJ, Benova T, Radosinska J, Viczenczova C, Bacova B, Knezl V, Dosenko V, Navarova J, Zeman M, Tribulova N, Maceira Gonzalez AM, Cosin Sales J, Igual B, Ruvira J, Diago JL, Aguilar J, Lopez Lereu MP, Monmeneu JV, Estornell J, Choi JC, Cha KS, Lee HW, Yun EY, Ahn JH, Oh JH, Choi JH, Lee HC, Hong TJ, Manzano Fernandez S, Lopez-Cuenca A, Januzzi JL, Mateo-Martinez A, Sanchez-Martinez M, Parra-Pallares S, Orenes-Pinero E, Romero-Aniorte AI, Valdes-Chavarri M, Marin F, Bouzas Mosquera A, Peteiro J, Broullon FJ, Alvarez Garcia N, Couto Mallon D, Bouzas Zubeldia B, Martinez Ruiz D, Yanez Wonenburger JC, Fabregas Casal R, Castro Beiras A, Backus BE, Six AJ, Cullen L, Greenslade J, Than M, Kameyama T, Sato T, Noto T, Nakadate T, Ueno H, Yamada K, Inoue H, Albrecht-Kuepper B, Kretschmer A, Kast R, Baerfacker L, Schaefer S, Kolkhof P, Andersson C, Kober L, Christensen SB, Nguyen CD, Nielsen MB, Olsen AMS, Gislason GH, Torp-Pedersen C, Shigekiyo M, Harada K, Lieu H, Neutel J, Maddock S, Goldsmith S, Koren M, Antwerp BV, Burnett J, Christensen SB, Charlot MG, Madsen M, Andersson C, Kober L, Gustafsson F, Torp-Pedersen C, Gislason GH, Cavusoglu Y, Mert KU, Nadir A, Mutlu F, Gencer E, Ulus T, Birdane A, Lim HS, Tahk SJ, Yang HM, Kim JW, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Russ MA, Wackerl C, Hochadel M, Brachmann J, Mudra H, Zeymer U, Weber MA, Menozzi A, Saia F, Valgimigli M, Belotti LM, Casella G, Manari A, Cremonesi A, Piovaccari G, Guastaroba P, Marzocchi A, Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Takabatake Y, Yokoi H, Toyota F, Nobuyoshi M, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Ando K, Arita T, Nobuyoshi M, Shizuta S, Kimura T, Isshiuki T, Trucco ME, Tolosana JM, Castel MA, Borras R, Sitges M, Khatib M, Arbelo E, Berruezo A, Brugada J, Mont L, Romanov A, Pokushalov E, Prokhorova D, Chernyavskiy A, Shabanov V, Goscinska-Bis K, Bis J, Bochenek A, Gersak B, Karaskov A, Linde C, Daubert C, Bergemann TL, Abraham WT, Gold MR, Van Boven N, Bogaard K, Ruiter JH, Kimman GP, Kardys I, Umans VA, Cipriani M, Lunati M, Landolina M, Vittori C, Vargiu S, Ghio S, Petracci B, Campo C, Bisetti S, Frigerio M, Bongiorni MG, Soldati E, Segreti L, Zucchelli G, Di Cori A, De Lucia R, Viani S, Paperini L, Boem A, Levorato D, Kutarski A, Malecka B, Zabek A, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Maciag A, Kempa M, Golzio PG, Fanelli A, Vinci M, Pelissero E, Morello M, Grosso Marra W, Gaita F, Kutarski A, Czajkowski M, Pietura R, Golzio PG, Vinci M, Pelissero E, Fanelli A, Ferraris F, Gaita F, Cuypers JAAE, Menting ME, Opic P, Utens EMWJ, Van Domburg RT, Helbing WA, Witsenburg M, Van Den Bosch AE, Bogers AJJC, Roos-Hesselink JW, Van Der Linde D, Takkenberg JJM, Rizopoulos D, Heuvelman HJ, Witsenburg M, Budts W, Van Dijk APJ, Bogers AJJC, Oechslin EN, Roos-Hesselink JW, Diller GP, Kempny A, Liodakis E, Alonso-Gonzalez R, Orwat S, Dimopoulos K, Swan L, Li W, Gatzoulis MA, Baumgartner H, Andrade AC, Voges I, Jerosch-Herold M, Pham M, Hart C, Hansen T, Kramer HH, Rickers C, Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Piorkowski A, Yacoub MH, Gatzoulis MA, Swan L, Diller GP, Mueller J, Weber R, Pringsheim M, Hoerer J, Hess J, Hager A, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knob S, Ertl G, Bijnens B, Weidemann F, Mornos C, Cozma D, Dragulescu D, Ionac A, Mornos A, Petrescu L, Mingo S, Ruiz Bautista L, Monivas Palomero V, Prados C, Maiz L, Giron R, Martinez M, Cavero Gibanel MA, Segovia J, Pulpon L, Kato H, Kubota S, Takasawa Y, Kumamoto T, Iacoviello M, Puzzovivo A, Forleo C, Lattarulo MS, Monitillo F, Antoncecchi V, Malerba G, Marangelli V, Favale S, Ruiz Bautista L, Mingo S, Monivas V, Segovia J, Prados C, Maiz L, Giron R, Martinez MT, Gonzalez Estecha M, Alonso Pulpon LA, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Ten Cate F, Geleijnse M, Looi JL, Lam YY, Yu CM, Lee PW, Apor A, Sax B, Huttl T, Nagy A, Kovacs A, Merkely B, Vecera J, Bartunek J, Vanderheyden M, Mertens P, Bodea O, Penicka M, Biaggi P, Gaemperli O, Corti R, Gruenenfelder J, Felix C, Bettex D, Datta S, Jenni R, Tanner F, Herzog B, Fattouch K, Murana G, Castrovinci S, Sampognaro R, Bertolino EC, Caccamo G, Ruvolo G, Speziale G, Lancellotti P. Saturday, 25 August 2012. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pinchot SN, Youngwirth L, Rajamanickam V, Schaefer S, Sippel R, Chen H. Changes in swallowing-related quality of life after parathyroidectomy for hyperparathyroidism: a prospective cohort study. Oncologist 2012; 17:1271-6. [PMID: 22829568 DOI: 10.1634/theoncologist.2012-0203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the impact of parathyroidectomy on swallowing-related quality of life using the Swallowing Quality Of Life (SWAL-QOL) validated outcomes assessment tool. BACKGROUND Many patients with primary hyperparathyroidism report nonspecific symptoms, such as fatigue, irritability, cognitive impairment, sleep disturbances, and dysphagia. To date, there have been no prospective studies evaluating swallowing function before and after parathyroid surgery. METHODS Patients undergoing parathyroidectomy from September 2007 to January 2009 completed the SWAL-QOL questionnaire before and one year after surgery. Data were collected on demographic and clinicopathologic variables. Comparisons were made to determine the effect of surgery on patients' perceptions of swallowing function. RESULTS Of 151 eligible patients, 102 (68%) completed the study. The mean patient age was 60 years, and 79% were female. A total of 73 patients (67%) had minimally invasive parathyroidectomies, whereas the remainder had bilateral explorations. In all, 83 patients (81%) had a parathyroid adenoma, 16 patients (16%) had hyperplasia, and 3 patients (3%) had a double adenoma on final pathologic interpretation. Mean preoperative SWAL-QOL scores were <90 for 4 of the 11 domains, indicating the perception of oropharyngeal dysphagia and diminished quality of life. Following parathyroidectomy, significant improvements were demonstrated in eight SWAL-QOL domains. CONCLUSIONS Many patients with parathyroid disease have the perception of abnormal swallowing function. In these patients with symptoms of dysphagia, parathyroid surgery leads to significant improvements in many aspects of swallowing-related quality of life measured by the SWAL-QOL instrument. This study represents the first use of a condition-specific instrument to assess swallowing-related quality of life for patients with parathyroid disease before and after parathyroid surgery.
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Affiliation(s)
- Scott N Pinchot
- F.A.C.S., K3-705 Clinical Science Center, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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Reiher AE, Schaefer S, Chen H, Sippel RS. Does the final intraoperative PTH level really have to fall into the normal range to signify cure? Ann Surg Oncol 2011; 19:1862-7. [PMID: 22203183 DOI: 10.1245/s10434-011-2192-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intraoperative parathyroid hormone (IOPTH) helps shorten the duration of surgery and increase the likelihood of surgical cure. Although general consensus agrees that the IOPTH should fall by 50%, there is much debate as to whether the IOPTH needs to fall into the normal range. METHODS We retrospectively reviewed a prospective database of patients undergoing surgery for treatment of primary hyperparathyroidism. We included all patients with an IOPTH that fell by >50% by 10 or 15 min, but that did not fall into the normal range (parathyroid hormone remained ≥ 60 pg/ml). We excluded patients who had undergone prior neck surgery or had known multiple endocrine neoplasia 1 or 2. RESULTS A total of 1,231 patients underwent a parathyroidectomy, 155 of whom met the study's inclusion/exclusion criteria (12.6%). A total of 117 patients had an IOPTH fall by 50% by 10 min, and 38 patients' IOPTH fell by 50% by 15 min. Overall surgical cure rate was 98.7%. One patient from the 10-minute group and one patient from the 15-minute group had persistent disease on follow-up. One patient in the 15-minute group had recurrent disease. With a mean ± SEM 18.1 ± 2.1 months' follow-up, the recurrence rate in this cohort was 0.6%. The average calcium at last follow-up was 9.4 ± 0.0 mg/dl. CONCLUSIONS Allowing the IOPTH to fall by 50% by 15 min, regardless of whether the IOPTH falls into the normal range, results in a high success rate when performed by experienced surgeons. This helps reduce intraoperative time used waiting for additional parathyroid hormone levels and the risks associated with unnecessary bilateral neck exploration.
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Affiliation(s)
- Alexandra E Reiher
- Division of Endocrinology, Department of Internal Medicine, University of Wisconsin, Madison, WI, USA
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Wang Q, So A, Nussberger J, Schaefer S, Burnier M. IMPACT OF NALP3 INFLAMMASOME ON BLOOD PRESSURE, RENIN AND RENAL AND CARDIAC HYPERTROPHY IN 2K1C AND DOCA/SALT MICE. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adler JT, Chen H, Schaefer S, Sippel RS. What is the Added Benefit of Cervical Ultrasound to 99mTc-Sestamibi Scanning in Primary Hyperparathyroidism? Ann Surg Oncol 2011; 18:2907-11. [DOI: 10.1245/s10434-011-1724-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 11/18/2022]
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Amini-Bavil-Olyaee S, Pourkarim MR, Schaefer S, Mahboudi F, Van Ranst M, Adeli A, Trautwein C, Tacke F. Single-step real-time PCR to quantify hepatitis B virus and distinguish genotype D from non-D genotypes. J Viral Hepat 2011; 18:300-4. [PMID: 20367802 DOI: 10.1111/j.1365-2893.2010.01308.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatitis B virus (HBV) viral load and its genotype play important roles in clinical outcome, management of disease and response to antiviral therapy. In many parts of the world such as Europe or the Middle East, distinguishing HBV genotype D from non-D is most relevant for treatment decisions, because genotype D-infected patients respond poorly to interferon-based therapeutic regimens. Here, we developed an in-house real-time PCR to concordantly assess HBV genotype (D vs non-D) based on melt curve analysis and quantify the viral load. Genotype distinction was established with control plasmids of all HBV genotypes and validated with 57 clinical samples from patients infected with six different HBV genotypes. Our in-house real-time PCR assay could discriminate HBV genotype D from non-D using single-step melt curve analysis with a 2 °C difference in the melt curve temperature in all samples tested. Viral load quantification was calibrated with the WHO HBV international standard, demonstrating an excellent correlation with a commercial kit (r = 0.852; P < 0.0001) in a linear range from 3.2 × 10(2) to 3.2 × 10(10) IU/mL. In conclusion, we developed a rapid, simple and cost-effective method to simultaneously quantify and distinguish HBV genotypes D from non-D with a single-step PCR run and melt curve analysis. This assay should be a useful diagnostic alternative to aid clinical decisions about initiation and choice of antiviral therapy, especially in geographical regions with a high prevalence of HBV genotype D.
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Schaefer B, Goldwasser R, Schaefer S, Heckert KH, Schaefer F, Schmitt CP. Kombinierte versus sequentielle Hämodialyse und Plasmapherese Behandlung bei Kindern. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huypens P, Pillai R, Sheinin T, Schaefer S, Huang M, Odegaard ML, Ronnebaum SM, Wettig SD, Joseph JW. The dicarboxylate carrier plays a role in mitochondrial malate transport and in the regulation of glucose-stimulated insulin secretion from rat pancreatic beta cells. Diabetologia 2011; 54:135-45. [PMID: 20949348 DOI: 10.1007/s00125-010-1923-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/27/2010] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS We have previously described a strong correlation between pyruvate cycling and insulin secretion. We have also demonstrated a particularly important role for a pyruvate-isocitrate cycling pathway involving the mitochondrial citrate/isocitrate carrier (CIC) and cytosolic NADP-dependent isocitrate dehydrogenase. CIC requires cytosolic malate as a counter-substrate during citrate and isocitrate export. Thus, considering that the mitochondrial dicarboxylate carrier (DIC) provides an important source of cytosolic malate, we investigated the potential role of DIC in control of glucose-stimulated insulin secretion (GSIS). METHODS We used pharmacological and small interfering RNA (siRNA) tools to assess the role of DIC in insulin release in clonal insulin-secreting 832/13 cells and isolated rat islets. RESULTS Butylmalonate, an inhibitor of malate transport, reduced cytosolic malate and citrate levels, and inhibited GSIS in a dose-dependent manner in 832/13 cells. Suppression of DIC expression resulted in inhibition of GSIS by 5% to 69%, the extent of inhibition of insulin secretion being proportional to the level of Dic (also known as Slc25a10) gene knockdown. The most effective siRNA duplex against Dic did not affect glucose utilisation, glucose oxidation or ATP/ADP ratio, but did suppress glucose-induced increments of the NADPH/NADP(+) ratio. Confirmation of our results in primary cultures of isolated rat islets showed that butylmalonate and an adenovirus expressing an siRNA against Dic-inhibited GSIS. CONCLUSIONS/INTERPRETATION Malate transport by DIC may play an important role in GSIS, possibly by providing cytosolic malate as a counter-substrate for citrate and/or isocitrate export by CIC. These studies also suggest that malate transport by DIC is (1) a critical component of NADPH production mediated by pyruvate-cycling and (2) regulates GSIS.
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Affiliation(s)
- P Huypens
- University of Waterloo, Kitchener, ON, Canada
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