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Guberina M, Guberina N, Hoffmann C, Gogishvili A, Freisleben F, Herz A, Hlouschek J, Gauler T, Lang S, Stähr K, Höing B, Pöttgen C, Indenkämpen F, Santiago A, Khouya A, Mattheis S, Stuschke M. Prospects for online adaptive radiation therapy (ART) for head and neck cancer. Radiat Oncol 2024; 19:4. [PMID: 38191400 PMCID: PMC10775598 DOI: 10.1186/s13014-023-02390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to image-guided-radiotherapy (IGRT) in consecutive patients with tumors in the head and neck region from a prospective registry. METHODS The study comprises all consecutive patients with tumors in the head and neck area who were treated with kV-CBCT-based online ART or IGRT-modus at the linear-accelerator ETHOS™. As a measure of effectiveness, the equivalent-uniform-dose was calculated for the CTV (EUDCTV) and organs-at-risk (EUDOAR) and normalized to the prescribed dose. As an important determinant for the need of ART the interfractional shifts of anatomic landmarks related to the tongue were analyzed and compared to the intrafractional shifts. The latter determine the performance of the adapted dose distribution on the verification CBCT2 postadaptation. RESULTS Altogether 59 consecutive patients with tumors in the head-and-neck-area were treated from 01.12.2021 to 31.01.2023. Ten of all 59 patients (10/59; 16.9%) received at least one phase within a treatment course with ART. Of 46 fractions in the adaptive mode, irradiation was conducted in 65.2% of fractions with the adaptive-plan, the scheduled-plan in the remaining. The dispersion of the distributions of EUDCTV-values from the 46 dose fractions differed significantly between the scheduled and adaptive plans (Ansari-Bradley-Test, p = 0.0158). Thus, the 2.5th percentile of the EUDCTV-values by the adaptive plans amounted 97.1% (95% CI 96.6-99.5%) and by the scheduled plans 78.1% (95% CI 61.8-88.7%). While the EUDCTV for the accumulated dose distributions stayed above 95% at PTV-margins of ≥ 3 mm for all 8 analyzed treatment phases the scheduled plans did for margins ≥ 5 mm. The intrafractional anatomic shifts of all 8 measured anatomic landmarks were smaller than the interfractional with overall median values of 8.5 mm and 5.5 mm (p < 0.0001 for five and p < 0.05 for all parameters, pairwise comparisons, signed-rank-test). The EUDOAR-values for the larynx and the parotid gland were significantly lower for the adaptive compared with the scheduled plans (Wilcoxon-test, p < 0.001). CONCLUSIONS The mobile tongue and tongue base showed considerable interfractional variations. While PTV-margins of 5 mm were sufficient for IGRT, ART showed the potential of decreasing PTV-margins and spare dose to the organs-at-risk.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - C Hoffmann
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Gogishvili
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Freisleben
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - K Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - B Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - C Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Khouya
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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Höing B, Wittig L, Weber L, Stuck BA, Mattheis S, Hussain T, Lang S, Theysohn JM, Li Y, Hansen S. Abdominal ultrasound in head and neck squamous cell carcinoma staging: yes or no? Eur Arch Otorhinolaryngol 2023; 280:1885-1891. [PMID: 36357610 DOI: 10.1007/s00405-022-07723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Abdominal ultrasound is a diagnostic staging procedure for distant metastases in head and neck squamous cell carcinoma (HNSCC). However, currently performed abdominal staging procedures do not follow consistent standards. Therefore, this retrospective study on 498 patients aimed at investigating on abdominal ultrasound as a staging procedure in HNSCC. MATERIALS AND METHODS A retrospective analysis of 498 head and neck cancer patients treated in our Department of Head and Neck Surgery between 2008 and 2015 was performed. Disease-related data were collected over a mean follow-up time of 30.3 months, and results of abdominal ultrasound were analyzed. RESULTS 426 patients received abdominal ultrasound as a staging procedure. 7% (29) were suspicious for metastases. In 19 cases (66%), the detected abnormalities were masses of the liver. In four patients, abdominal metastases were confirmed at the time of initial diagnosis. 16 patients developed abdominal metastases in the course of the disease (on average 623 days after initial diagnosis). 19 out of 20 patients with abdominal metastases had an N2/N3 cervical lymph node status. In this study, the negative predictive value of abdominal ultrasound for HNSCC staging was 99.03%, while the positive predictive value yielded 5.88% (N2/N3-patients). CONCLUSION Only in patients with locally advanced lymph-node-status (N2/N3), abdominal ultrasound can be useful as a staging investigation to exclude abdominal metastasis in HNSCC patients. For N0/N1 patients, abdominal ultrasound might be dispensed. Of note, in case of a positive result, further diagnostic procedures are mandatory.
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Affiliation(s)
- Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - L Wittig
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - L Weber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Y Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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Dufour LS, Bourai A, Lang S, Nhan P, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Capderou E, Issaurat P, Jullien S, De Geyer I, Candau C, Boccara F, Assyag P, Cohen A. Four chambers strain analysis in patients with heart failure: Towards a new standard? Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Kürten C, Kulkarni A, Vujanovic L, Cillo A, Lang S, Ferris R. O1.2 Single cell RNA sequencing allows mapping of HPV transcripts in head and neck cancer epithelial cells. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hussain T, Rothkirch C, Mattheis S, Lang S. P25 The role of ultrasound elastography for clinical neck staging in HPV-related oropharyngeal cancer. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Liu J, Zhang X, Chen T, Wu T, Lin T, Jiang L, Lang S, Liu L, Natarajan L, Tu J, Kosciolek T, Morton J, Nguyen T, Schnabl B, Knight R, Feng C, Zhong Y, Tu X. A semiparametric model for between-subject attributes: Applications to beta-diversity of microbiome data. Biometrics 2022; 78:950-962. [PMID: 34010477 PMCID: PMC8602427 DOI: 10.1111/biom.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/25/2023]
Abstract
The human microbiome plays an important role in our health and identifying factors associated with microbiome composition provides insights into inherent disease mechanisms. By amplifying and sequencing the marker genes in high-throughput sequencing, with highly similar sequences binned together, we obtain operational taxonomic units (OTUs) profiles for each subject. Due to the high-dimensionality and nonnormality features of the OTUs, the measure of diversity is introduced as a summarization at the microbial community level, including the distance-based beta-diversity between individuals. Analyses of such between-subject attributes are not amenable to the predominant within-subject-based statistical paradigm, such as t-tests and linear regression. In this paper, we propose a new approach to model beta-diversity as a response within a regression setting by utilizing the functional response models (FRMs), a class of semiparametric models for between- as well as within-subject attributes. The new approach not only addresses limitations of current methods for beta-diversity with cross-sectional data, but also provides a premise for extending the approach to longitudinal and other clustered data in the future. The proposed approach is illustrated with both real and simulated data.
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Affiliation(s)
- J. Liu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - X. Zhang
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,
| | - T. Chen
- Department of Mathematics, University of Toledo, Toledo, Ohio, U.S.A
| | - T. Wu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - T. Lin
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - L. Jiang
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Center for Microbiome Innovation, UC San Diego, San Diego, California, U.S.A
| | - S. Lang
- Department of Medicine, UC San Diego, San Diego, California, U.S.A
| | - L. Liu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - L. Natarajan
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A
| | - J.X. Tu
- Physical Medicine and Rehabilitation, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - T. Kosciolek
- Department of Pediatrics, UC San Diego, San Diego, California, U.S.A.,Ma lopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - J. Morton
- Center for Computational Biology, Flatiron Institute, Simons Foundation, New York, New York, U.S.A
| | - T.T Nguyen
- Department of Psychiatry, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
| | - B. Schnabl
- Department of Medicine, UC San Diego, San Diego, California, U.S.A
| | - R. Knight
- Department of Pediatrics, UC San Diego, San Diego, California, U.S.A.,Department of Computer Science and Engineering, UC San Diego, San Diego, California, U.S.A.,Department of Bioengineering, UC San Diego, San Diego, California, U.S.A.,Center for Microbiome Innovation, UC San Diego, San Diego, California, U.S.A
| | - C. Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, U.S.A
| | - Y. Zhong
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - X.M. Tu
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, U.S.A.,Stein Institute for Research on Aging, UC San Diego, San Diego, California, U.S.A
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Holtmann LC, Deuß E, Meyer M, Kaster F, Bastian T, Schleupner MC, Hagedorn E, Lang S, Arweiler-Harbeck D. Detection accuracy of soft tissue complications during remote cochlear implant follow-up. Cochlear Implants Int 2022; 23:249-256. [PMID: 35477412 DOI: 10.1080/14670100.2022.2067644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.
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Affiliation(s)
- L C Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Deuß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - T Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M C Schleupner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Hagedorn
- CIC Ruhr Acoustics Bagus, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
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Staudacher JJ, Bauer J, Atkinson SR, Thursz M, Lang S, Schnabl B, Wiley MB, Carr R, Jung B. Systemic Activin Is Elevated in Patients With Severe Alcoholic Hepatitis. Gastro Hep Adv 2022; 1:147-149. [PMID: 35602917 PMCID: PMC9119346 DOI: 10.1016/j.gastha.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J J Staudacher
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charite-University Medicine, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Bauer
- Department of Medicine, University of Washington, Seattle, Washington
| | - S R Atkinson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - M Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - S Lang
- Department of Medicine, University of California San Diego, La Jolla, California
| | - B Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California
- Department of Medicine, VA San Diego Healthcare System, San Diego, California
| | - M B Wiley
- Department of Medicine, University of Washington, Seattle, Washington
| | - R Carr
- Department of Medicine, University of Washington, Seattle, Washington
| | - B Jung
- Department of Medicine, University of Washington, Seattle, Washington
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Lang S, Loibl M, Gläsner J, Simon M, Rupp M, Grad S, Neumann C, Alt V, Gessner A, Hanses F. Vertebral osteomyelitis is characterised by increased RANK/OPG and RANKL/OPG expression ratios in vertebral bodies and intervertebral discs. Eur Cell Mater 2021; 42:438-451. [PMID: 34846723 DOI: 10.22203/ecm.v042a27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Vertebral osteomyelitis (VO) is an infection of the spine mainly caused by bacterial pathogens. The pathogenesis leading to destruction of intervertebral discs (IVDs) and adjacent vertebral bodies (VBs) is poorly described. The present study aimed at investigating the connection between infection and bone/disc metabolism in VO patients. 14 patients with VO (infection group) and 14 patients with burst fractures of the spine (fracture group; control) were included prospectively. Tissue biopsies from affected IVDs and adjacent VBs were analysed by RT-qPCR for mRNA-expression levels of 18 target genes including chemokines, adipokines and genes involved in bone metabolism. Most importantly, the receptor activator of NF-κB/osteoprotegerin (RANK/OPG) expression ratio was drastically elevated in both VBs and IVDs of the infection group. In parallel, expression of genes of the prostaglandin-E2-dependent prostanoid system was induced. Such genes regulate tissue degradation processes via the triad OPG/RANK/RANKL as well as via the chemokines IL-8 and CCL-20, whose expression was also found to be increased upon infection. The gene expression of the adipokine leptin, which promotes inflammatory tissue degradation, was higher in IVD tissue of the infection group, whereas the transcription of omentin and resistin genes, whose functions are largely unknown in the context of infectious diseases, was lower in infected VBs. In summary, similar expression patterns of pro-inflammatory cytokines and pro-osteoclastogenic factors were identified in VBs and IVDs of patients suffering from VO. This suggests that common immuno-metabolic pathways are involved in the mechanisms leading to tissue degradation in VBs and IVDs during VO.
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Affiliation(s)
| | - M Loibl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg,
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Hill J, LaFollette R, Hughes H, Mand S, Koehler J, Li J, Baez J, Lang S, McDonough E. 344 Qualitative Description of Synchronous Online Discussions During Weekly Academic Conference. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lang S, Hoelter P, Schmidt M, Strother C, Kaethner C, Kowarschik M, Doerfler A. Artificial Intelligence-Based 3D Angiography for Visualization of Complex Cerebrovascular Pathologies. AJNR Am J Neuroradiol 2021; 42:1762-1768. [PMID: 34503946 DOI: 10.3174/ajnr.a7252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE By means of artificial intelligence, 3D angiography is a novel postprocessing method for 3D imaging of cerebral vessels. Because 3D angiography does not require a mask run like the current standard 3D-DSA, it potentially offers a considerable reduction of the patient radiation dose. Our aim was an assessment of the diagnostic value of 3D angiography for visualization of cerebrovascular pathologies. MATERIALS AND METHODS 3D-DSA data sets of cerebral aneurysms (n CA = 10), AVMs (n AVM = 10), and dural arteriovenous fistulas (dAVFs) (n dAVF = 10) were reconstructed using both conventional and prototype software. Corresponding reconstructions have been analyzed by 2 neuroradiologists in a consensus reading in terms of image quality, injection vessel diameters (vessel diameter [VD] 1/2), vessel geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of AVMs (eg, location, nidus size, feeder, associated aneurysms, drainage, Spetzler-Martin score), dAVFs (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck, size). RESULTS In total, 60 volumes have been successfully reconstructed with equivalent image quality. The specific qualitative/quantitative assessment of 3D angiography revealed nearly complete accordance with 3D-DSA in AVMs (eg, mean nidus size3D angiography/3D-DSA= 19.9 [SD, 10.9]/20.2 [SD, 11.2] mm; r = 0.9, P = .001), dAVFs (eg, mean diameter of the main feeder3D angiography/3D-DSA= 2.04 [SD, 0.65]/2.05 [SD, 0.63] mm; r = 0.9, P = .001), and cerebral aneurysms (eg, mean size3D angiography/3D-DSA= 5.17 [SD, 3.4]/5.12 [SD, 3.3] mm; r = 0.9, P = .001). Assessment of the geometry of the injection vessel in 3D angiography data sets did not differ significantly from that of 3D-DSA (vessel geometry indexAVM: r = 0.84, P = .003; vessel geometry indexdAVF: r = 0.82, P = .003; vessel geometry indexCA: r = 0.84, P <.001). CONCLUSIONS In this study, the artificial intelligence-based 3D angiography was a reliable method for visualization of complex cerebrovascular pathologies and showed results comparable with those of 3D-DSA. Thus, 3D angiography is a promising postprocessing method that provides a significant reduction of the patient radiation dose.
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Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Sciences Center, Madison, Wisconsin
| | - C Kaethner
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - M Kowarschik
- Advanced Therapies (C.K., M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., A.D.), University of Erlangen-Nuremberg, Erlangen, Germany
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Pogorzelski M, Lauri F, Hilser T, Hense J, Ting S, Kansy B, Gauler T, Stuschke M, Schmid K, Lang S, Zaun G, Grünwald V, Schuler M, Kasper S. 922P Efficacy of immunotherapy (IO) and subsequent systemic treatment after failure of IO in patients with recurrent or metastatic head and neck cancer in a real-world setting. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Soulat-Dufour L, Lang S, Ederhy S, Adavane-Scheuble S, Chauvet Droit M, Nhan P, Jean M, Kamami I, Arnaud C, Capderou E, Issaurat P, Ben Said R, Boccara F, Cohen A. Three dimensional right cardiac cavities remodeling and functional tricuspid regurgitation at one year follow up in patients with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Höing B, Hussain T, Kanaan O, Stuck BA, Mattheis S, Lang S, Hansen S. [Perioperative medical prophylaxis of venous thromboembolic events in head and neck surgery : A retrospective study and recommendations]. HNO 2021; 69:961-968. [PMID: 33594495 DOI: 10.1007/s00106-021-01003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the authors' department, a newly implemented clinical algorithm for application of perioperative thrombosis prophylaxis in head and neck surgery recommends restrictive handling of anticoagulants. This retrospective study aims to evaluate the algorithm by comparing incidences of venous thromboembolic events (VTE) and surgical revisions due to postoperative hemorrhage. MATERIALS AND METHODS Perioperative incidences of deep vein thrombosis and pulmonary embolism as well as surgical revisions due to postoperative hemorrhage after head and neck surgery were determined based on all patients operated in the department over a period of 36 months. The incidences before (group I) and after (group II) implementation of the restrictive algorithm were compared. RESULTS A total of 9276 patients were included. The incidences of VTE (0.12%) and surgical revisions due to postoperative hemorrhage (1.4%) were low. Incidences of VTE were non-significantly higher in group II (0.16%) than in group I (0.08%; p > 0.45, chi-square-test). Case analysis revealed that this difference was not due to implementation of the restrictive algorithm. The incidence of surgical revision due to postoperative hemorrhage was identical in the two groups (1.4%). CONCLUSION After restricting the indication for thrombosis prophylaxis, the incidence of VTE or surgical revision due to postoperative hemorrhage did not change significantly. The provided clinical algorithm represents a low-risk and low-cost strategy of perioperative risk stratification.
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Affiliation(s)
- B Höing
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - O Kanaan
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - S Hansen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
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Holtmann L, Hans S, Kaster F, Müller V, Lang S, Göricke S, Lang-Roth R, Arweiler-Harbeck D. Magnet dislocation following magnetic resonance imaging in cochlear implant users: Diagnostic pathways and managment. Cochlear Implants Int 2021; 22:195-202. [PMID: 33576730 DOI: 10.1080/14670100.2021.1872906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Although modern cochlear implants (CIs) are approved for magnetic resonance imaging (MRIs) adverse events still occur with unacceptable frequency. Methods: In this retrospective study, magnet displacement due to MRIs was analysed. Relevant factors e.g. symptoms during MRI, diagnostics, surgical intervention following the diagnosis and possible subsequent damage were assessed. RESULTS 16 patients were enclosed. All patients complained about pain while the scan was conducted. Computed tomography (CT) scans of the temporal bone or X-rays of the skull were performed to confirm diagnosis. Artefacts on CT scans delayed immediate diagnosis in some cases. DISCUSSION Despite various studies demonstrating the range of adverse events related to CIs following MRI, little information is available on diagnosis and radiologic recognition of magnet dislocation. In patients complaining about pain following an MRI scan an X-ray of the head should be performed immediately. Most adverse events occur in radiological centres without expertise in cochlear implants. CONCLUSION Comprehensive training of patients, surgeons and radiologists is the most efficient tool to prevent damage to the CI and the patient. X-ray of the skull is suggested to be used as the method of choice in imaging.
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Affiliation(s)
- L Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - S Hans
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - V Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - S Göricke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - R Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Stöver T, Dazert S, Plontke SK, Kramer S, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Schuler PJ, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J, Hoffmann TK. [Effects of the SARS-CoV‑2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. HNO 2021; 69:633-641. [PMID: 33502578 PMCID: PMC7839289 DOI: 10.1007/s00106-021-01001-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Ab Frühjahr 2020 kam es zur weltweiten Verbreitung von SARS-CoV‑2 mit der heute als erste Welle der Pandemie bezeichneten Phase ab März 2020. Diese resultierte an vielen Kliniken in Umstrukturierungen und Ressourcenverschiebungen. Ziel unserer Arbeit war die Erfassung der Auswirkungen der Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde für die Forschung, Lehre und Weiterbildung. Material und Methoden Die Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland wurden mithilfe einer strukturierten Online-Befragung zu den Auswirkungen der Pandemie im Zeitraum von März bis April 2020 auf die Forschung, Lehre und die Weiterbildung befragt. Ergebnisse Alle 39 Direktorinnen und Direktoren beteiligten sich an der Umfrage. Hiervon gaben 74,4 % (29/39) an, dass es zu einer Verschlechterung ihrer Forschungstätigkeit infolge der Pandemie gekommen sei. Von 61,5 % (24/39) wurde berichtet, dass pandemiebezogene Forschungsaspekte aufgegriffen wurden. Von allen Kliniken wurde eine Einschränkung der Präsenzlehre berichtet und 97,5 % (38/39) führten neue digitale Lehrformate ein. Im Beobachtungszeitraum sahen 74,4 % der Klinikdirektoren die Weiterbildung der Assistenten nicht gefährdet. Schlussfolgerung Die Ergebnisse geben einen Einblick in die heterogenen Auswirkungen der Pandemie. Die kurzfristige Bearbeitung pandemiebezogener Forschungsthemen und die Einführung innovativer digitaler Konzepte für die studentische Lehre belegt eindrücklich das große innovative Potenzial und die schnelle Reaktionsfähigkeit der HNO-Universitätskliniken, um auch während der Pandemie ihre Aufgaben in der Forschung, Lehre und Weiterbildung bestmöglich zu erfüllen.
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Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland.
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S., Halle/S., Deutschland
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel, Kiel, Deutschland
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - C Betz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen, Göttingen, Deutschland
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München, München, Deutschland
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald, Greifswald, Deutschland
- Helios Hanseklinikum Stralsund, Stralsund, Deutschland
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg, Oldenburg, Deutschland
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes, Saarlandes, Deutschland
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden, Minden, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen, Deutschland
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
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Affiliation(s)
- S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
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Stöver T, Zeh R, Gängler B, Plontke SK, Ohligmacher S, Deitmer T, Hupka O, Welkoborsky HJ, Schulz M, Delank W, Strobel M, Guntinas-Lichius O, Lang S, Dietz A, Dazert S, Diensthuber M. [Regional distribution of the cochlear implant (CI) centers in Germany]. Laryngorhinootologie 2020; 99:863-871. [PMID: 33167056 DOI: 10.1055/a-1302-0368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).
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Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - R Zeh
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - B Gängler
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle (Saale)
| | - S Ohligmacher
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie e. V., Bonn
| | - O Hupka
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - M Schulz
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - W Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - M Strobel
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St.-Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum
| | - M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
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Zayet S, Lang S, Ben Abdallah Y, Klopfenstein T, Gendrin V. Asymptomatic cerebral abscesses after pleuropulmonary Nocardia farcinica infection. New Microbes New Infect 2020; 38:100808. [PMID: 33299565 PMCID: PMC7704421 DOI: 10.1016/j.nmni.2020.100808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 68-year-old man with long-term receipt of steroid therapy who was diagnosed with cerebral abscesses and pulmonary nocardiosis. This patient displayed only respiratory symptoms. Confirmation of Nocardia farcinica species was achieved by specific PCR sequencing of the 16S ribosome RNA in bronchoalveolar lavage cultures. Cerebral magnetic resonance imaging revealed abscesses. Antibiotic therapy with trimethoprim/sulfamethoxazole was prescribed given the results of susceptibility tests and was maintained for 12 months, with no evidence of relapse afterwards.
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Affiliation(s)
- S Zayet
- Infectious Diseases Department, France
| | - S Lang
- Infectious Diseases Department, France
| | - Y Ben Abdallah
- Pneumology Department, Nord Franche-Comté Hospital, Trévenans, France
| | | | - V Gendrin
- Infectious Diseases Department, France
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Kürten CHL, Deuß E, Lei YL, Höing B, Kramer B, Lang S, Ferris RL, Kansy BA. [Stimulatory and inhibitory signaling pathways of the T cell-APC interaction and the effect of TLR agonists on APCs]. HNO 2020; 68:916-921. [PMID: 33128107 DOI: 10.1007/s00106-020-00960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND CD8+ cells are key players in the identification and elimination of cancer cells. Cancers can escape an effective T cell response by inducing an exhausted cell state, which limits the cytotoxic capacity of the effector cells. Among other mechanisms, new checkpoint inhibitors reactivate exhausted, dysfunctional T cells. CD8+ T cells can eliminate tumor cells after presentation of tumor-specific antigens via antigen-presenting cells (APCs). APC-mediated tumor recognition is mainly stimulated by Toll-like receptors (TLRs). OBJECTIVE This study investigates the effect of TLR agonists on APCs as well as stimulatory and inhibitory signaling pathways of the T cell-APC interaction. MATERIALS AND METHODS Gene expression of interleukin (IL)12 and programmed death ligand 1 (PD-L1) was analyzed by quantitative polymerase chain reaction (qPCR) after 0, 8, 24, and 48 h of CD14+ cell stimulation with CpG. Protein expression of inhibitor of nuclear factor kappa B (IκBα) after CpG stimulation was investigated by western blot. CD8+ T cells were stimulated for 72 h with or without programmed cell death protein 1 (PD-1) checkpoint blockade and analyzed for expression of PD‑1, Tim‑3, CTLA4, and Lag3 by flow cytometry. RESULTS TLR stimulation (by unmethylated CpG DNA) of APCs upregulates immunostimulatory signals such as IL12 expression but also activates immunoinhibitory signaling pathways such as PD-L1 expression. This signaling is NF-κB dependent. After blockade of the PD-1/PD-L1 signaling pathway, overexpression of other immune checkpoint inhibitory receptors was observed-a potential explanation for lacking therapeutic responses after TLR stimulation with PD‑1 checkpoint blockade. CONCLUSION TLR stimulation causes APCs in the tumor microenvironment to upregulate PD-L1 in an NF-κB-mediated fashion, thereby contributing to CD8+ T cell exhaustion. The effect of PD‑1 blockade after TLR stimulation might be impaired due to upregulation of other checkpoint inhibitors.
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Affiliation(s)
- C H L Kürten
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - E Deuß
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Y L Lei
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - B Höing
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - B Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - R L Ferris
- Cancer Immunology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - B A Kansy
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
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Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Scheuble A, Boccara F, Addetia K, Lang R, Cohen A. Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.
Purpose
Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.
Methods
We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.
Results
At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p<0.001 for 2D ED TA diameter; ρ=0.34, p<0.005 for 3D ES RA Vi; ρ=0.33, p<0.005 for 3D ED RV Vi; ρ=0.29, p<0.005 for 3D ES RV Vi).
Conclusion
Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.
TR Evolution
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - A Scheuble
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
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22
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Lombardi Y, Boccara F, Baldet K, Lang S, Ederhy S, Nhan P, Riller Q, Chauvet-Droit M, Jean ML, Adavane-Scheuble S, Azoyan L, Cohen A. Prognosis of acute kidney injury during acute heart failure: the role of diuretics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute kidney injury (AKI) frequently occurs after diuretic treatment initiation during acute heart failure (AHF). Treatment-induced hemoconcentration seems associated with improved prognosis. Transient AKI, with or without hemoconcentration, is of unsettled prognosis.
Purpose
We aimed to determine the independent prognostic values of transient AKI, persistent AKI and hemoconcentration in the context of hospitalized AHF.
Methods
Data were obtained from our institution's Clinical Data Warehouse. Patients that visited our unit at least once were screened. All hospitalizations in our institution were examined (>30 hospitals). Inclusion criteria were: ≥1 hospitalization with ≥1 recorded furosemide administration and ≥1 AHF ICD-10 code. Only the first hospitalization fulfilling these criteria was considered. AKI during 1–13 days following first furosemide administration was defined based on Kidney Disease Improving Global Outcome guidelines. Hemoconcentration was defined as an increase in serum proteins ≥5 g/l during the same period. We performed multivariate logistic regression to determine which characteristics were predictive of AKI. We used Cox regression of 100-days all-cause mortality using several confounders to determine the prognostic values of transient AKI (lasting <14 days), persistent AKI (lasting ≥14 days) and hemoconcentration. To account for immortality bias, AKI and hemoconcentration were treated as time-dependent covariates.
Results
We included 579 patients in the study. Median follow-up was 114 days. AKI following furosemide initiation occurred in 234 patients (40.4%). Patients that experienced AKI more frequently suffered from chronic kidney disease (43.6% vs. 33%, p=0.01) or presented with right ventricular dilatation (12% vs. 6.7%, p=0.04). Independent predictors of AKI were arterial hypertension (adjusted OR: 1.86 [1.08–3.22]), elevated serum creatinine at baseline (adjusted OR: 1.07 [1.01–1.14] per 10 μmol/l increase) and initial intravenous furosemide (adjusted OR: 2.42 [1.39–4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p<0.001). In Cox regression, persistent AKI was independently associated with increased mortality in a period of 100 days following furosemide initiation (adjusted HR: 2.31 [1.07–4.99]). Transient AKI was not significantly associated with mortality (adjusted HR: 0.64 [0.34–1.19]). Hemoconcentration was independently associated with decreased mortality (adjusted HR: 0.46 [0.27–0.79]).
Conclusion
In the context of hospitalized AHF, AKI that developed 1–13 days after furosemide initiation and that lasted ≥14 days was independently associated with decreased 100 days survival. Hemoconcentration, using a clinically relevant definition, was independently associated with improved survival. These findings show that serum creatinine and proteins, routinely used and with limited cost, accurately stratify mortality risk during AHF.
Kaplan-Meier curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Lombardi
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - F Boccara
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - K Baldet
- University Hospital Center, Department of Nephrology, Dijon, France
| | - S Lang
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - S Ederhy
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - P Nhan
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - Q Riller
- Hospital Pitie-Salpetriere, Department of Internal Medicine, Paris, France
| | - M Chauvet-Droit
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | - M.-L Jean
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
| | | | - L Azoyan
- Hospital Tenon, Department of Internal Medicine, Paris, France
| | - A Cohen
- Hospital Saint-Antoine, Department of Cardiology, Paris, France
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23
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Fastner C, Akin I, Yuecel G, Rudic B, El-Battrawy I, Kruska M, Lang S, Liebe V, Tueluemen E, Borggrefe M, Kuschyk J. Cardiac contractility modulation efficacy: is there a difference between ischemic vs. non-ischemic patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Cardiac contractility modulation (CCM) is an FDA approved device therapy for systolic heart failure patients with narrow QRS complex who are symptomatic despite optimal medical therapy. It is used in patients with a wide range of different cardiomyopathies. However, little is known whether the therapy is comparably effective in different entities.
Purpose
This work investigated the long-term therapeutic effect in patients with ischemic (ICMP) compared to patients with non-ischemic cardiomyopathy (NICMP).
Methods
102 patients of our single center registry with known form of cardiomyopathy were included in this retrospective analysis (from 2011–2019). In 68 patients data of a clinical 3-year follow-up were available. The actual mortality rate within one and three years was compared with the one predicted by the MAGGIC risk score and compared between the two groups. In addition, changes in NYHA class, left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) and NT-proBNP values were compared as functional parameters.
Results
Patients with an ICMP (65%) were older (67±1 vs. 57±2 years (SD±SEM); p<0.001) but had a comparable MLHFQ score (42±3 vs. 48±6; p=NS), mean peak VO2 (9.7±1.2 vs. 14.5±2.2 ml/kg/min; p=NS) and QRS width (115±3 vs. 112±4 ms; p=NS). Both groups initially had a comparably advanced limitation during physical activity (median NYHA class III; p=NS); 40% of patients responded with an improvement of at least 1 NYHA class within 3 years (p=NS). The LVEF was 24±1 vs. 22±1% in the beginning and improved to 32±2 vs. 38±2% within 3 years (+33 vs. +73%; p<0.001 in comparison over time; p<0.001 in comparison of the percentage changes ICMP vs. NICMP). While LVEDD was initially significantly wider in NICMP patients (51±2 vs. 67±2 mm; p<0.001), this was offset under therapy, mainly due to a reduction in LVEDD in NICMP patients (+3±2 vs. −7±3 mm; p=0.023). The NT-proBNP values decreased from 4872±776 vs. 5354±1153 to 2051±578 vs. 843±363 ng/l (−58 vs. −84%; p=NS in comparison over time; p=0.093 in comparison of the percentage changes ICMP vs. NICMP). ICMP patients had a higher MAGGIC risk score (27±1 vs. 24±1; p=0.019). Mortality rates at 1 year were 7.4 vs. 17.1% and at 3 years 40.5 vs. 35.5% (each p=NS) compared to mortality rates estimated from the MAGGIC risk score of 21.2 vs. 16.0% (p=0.028) and 44.0 vs. 37.2% (p=0.071), respectively. Chi-square test for comparison of observed and expected frequencies revealed that the number of deaths during 1-year follow-up was significantly lower than predicted only in ICMP patients (p=0.018 compared to the estimated risk).
Conclusions
NICMP patients had a significantly greater increase in LVEF. Moreover, reverse remodeling with reduction of the LVEDD was only observed in NICMP patients. In summary, significant differences in functional therapy response could be identified between ICMP vs. NICMP patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Fastner
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - I Akin
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - G Yuecel
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - B Rudic
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - I El-Battrawy
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - M Kruska
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - S Lang
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - V Liebe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - E Tueluemen
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - M Borggrefe
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
| | - J Kuschyk
- University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, First Department of Medicine, and DZHK partner site Heidelberg/Mannheim, Mannheim, Germany
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Philabout P, Soulat-Dufour L, Benhamou-Tarallo I, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Jean M, Ben Said R, Boccara F, Addetia K, Lang R, Cohen A. Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome.
Purpose
To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6).
Methods
In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7)
Results
In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure).
Conclusion
Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm.
Evolution of strain between M0 and M6
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Philabout
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | | | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - M Jean
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936, Paris, France
| | - K Addetia
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - R Lang
- University of Chicago, Cardiac Imaging, Chicago, United States of America
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166, Paris, France
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25
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Barnicot K, Michael C, Trione E, Lang S, Saunders T, Sharp M, Crawford MJ. Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis. Clin Psychol Rev 2020; 82:101929. [PMID: 33126038 DOI: 10.1016/j.cpr.2020.101929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/18/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.
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Affiliation(s)
- K Barnicot
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom; School of Health Sciences, City University of London, Myddleton Street Building, 1Myddleton Street, London EC1R 1UW, United Kingdom.
| | - C Michael
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - E Trione
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - S Lang
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - T Saunders
- St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom
| | - M Sharp
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - M J Crawford
- Division of Psychiatry, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, United Kingdom
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26
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Lang S, Brandau S, Marchesi JR, Jablonska J, Thurnher D, Mattheis S, Buer J, Hussain T. [The microbiome in head and neck tumors-initial findings and outlook]. HNO 2020; 68:905-910. [PMID: 32995898 DOI: 10.1007/s00106-020-00950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
Technical progress in molecular biology has allowed for a more detailed analysis of the composition of the human microbiome in recent years. Inter- and intraindividual differences in microbiome composition have been demonstrated, which in part correlate with the occurrence of certain diseases. For some of the so-called oncomicrobes, a direct relationship between their effect on the host organism and carcinogenesis has been demonstrated, predominantly for gastrointestinal cancers. Initial results for head and neck cancer show inter- and intraindividual differences in the local microbiota of the tumor environment, with certain bacterial strains over- or underrepresented. Our results confirm these findings, e.g., by showing a relative abundance of fusobacteria in tumor tissue while streptococci were relatively reduced. Currently available results show a high degree of inter- and intraindividual variation, thus requiring larger patient cohorts for functional analyses.
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Affiliation(s)
- S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - S Brandau
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J R Marchesi
- School of Biosciences, Cardiff University, Cardiff, Großbritannien
| | - J Jablonska
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - D Thurnher
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J Buer
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Universität Duisburg-Essen Essen, Essen, Deutschland
| | - T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
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Abstract
Exosomes, virus-sized nanovesicles, are utilized as messenger systems of our body to communicate with other body cells and regulate immune functions. Almost all cells produce exosomes and are able to interact with immune cells in the blood stream and peripheral body areas. Different markers on the surface of exosomes are necessary for immune cell adhesion and interaction. Furthermore, many types of exosome-immune cell interaction, such as surface receptor contact and phagocytosis, are known. As carriers of different cargos, exosomes affect different immune cell types in head and neck cancers: So far, T cells, natural killer cells, macrophages, and dendritic cells have been described in this context. For diagnostic purposes, a combined analysis of different parameters including protein amount, nucleic acid/protein expression, and the immunosuppressive impact of exosomes could empower exosomes as useful tools for evaluation of tumor promotion and progression in the future.
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Affiliation(s)
- S Ludwig
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M-N Theodoraki
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - J Jablonska
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - A Lammert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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28
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Richter K, Kojadinovic M, Lang S, Singer J, Robleto G, Hübner C, Alex J, Bitter E. DynaWater4.0 – Dynamische Vernetzung von Wasseraufbereitung und industrieller Produktion. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Richter
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - M. Kojadinovic
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - S. Lang
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - J. Singer
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
| | - G. Robleto
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - C. Hübner
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - J. Alex
- ifak e.V Werner-Heisenberg-Str. 1 39106 Magdeburg Deutschland
| | - E. Bitter
- EnviroChemie GmbH Forschung und Entwicklung In den Leppsteinswiesen 9 64380 Roßdorf Deutschland
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Stöver T, Dazert S, Hoffmann TK, Plontke SK, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Kramer S, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J. [Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]. Laryngorhinootologie 2020; 99:694-706. [PMID: 32767296 PMCID: PMC7645814 DOI: 10.1055/a-1232-4911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ± 14.2 % and in surgical treatments by 65.9 % to 34.1 ± 13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.
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Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg
| | - C Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | | | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen
| | - J-P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité Berlin
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden
| | - S Strieth
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - B A Stuck
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg
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Stähr K, Lang S, Mattheis S. [Primary cutaneous CD4+ small to medium-sized T-cell lymphoma in an adolescent patient]. HNO 2020; 68:695-697. [PMID: 32728760 DOI: 10.1007/s00106-020-00912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A rare finding of primary cutaneous CD4+ small to medium-sized T‑cell lymphoma (SMPTCL) in a fifteen-year-old patient is reported. This is a rare tumor entity for which there is currently no standardized treatment recommendation. At the interdisciplinary tumor board, the decision was made to resect the tumor and reconstruct the defect with a nasolabial advancement flap in a two-stage process. Follow-up examinations, currently over 3 years, have shown the patient to be free of recurrences.
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Affiliation(s)
- K Stähr
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Hussain T, Mattheis S, Lang S. [The role of surgery and salvage surgery in the era of HPV-associated oropharyngeal carcinomas]. HNO 2020; 68:688-694. [PMID: 32638060 DOI: 10.1007/s00106-020-00900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of human papillomavirus (HPV)-positive oropharyngeal carcinomas is increasing worldwide. Due to a markedly different response to treatment compared to HPV-negative oropharyngeal carcinomas, determining the ideal therapeutic approach can be challenging. Particularly in never-smokers, HPV-positive oropharyngeal carcinomas respond well to primary radiation therapy; at the same time recent studies indicate comparable survival after primary surgery. For stage I tumors according to TNM‑8, retrospective analyses show very good oncologic outcomes after surgery alone, and no added benefit of adjuvant radio- or chemotherapy. Results of prospective treatment deintensification trials are expected in the coming years. Minimally invasive transoral surgical approaches for selected oropharyngeal cancers can improve preservation of postoperative function and quality of life. For both HPV-positive and HPV-negative oropharyngeal carcinomas, salvage surgery is the treatment of choice for resectable recurrent locoregional disease and resectable distant metastases.
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Affiliation(s)
- T Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie des Universitätsklinikums Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Chalard C, Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Adavane-Scheuble S, Chauvet-Droit M, Nhan P, Ben Said R, Boccara F, Cohen A. P350 Right atrial remodelling in atrial fibrillation using three dimensional transthoracic echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.202] [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
Evaluation of right atrial cavities and right atrial (RA) remodelling in atrial fibrillation (AF) has been poorly studied.
Purpose
The aim of this study was to evaluate in AF, the role of three-dimensional (3D) transthoracic echocardiography (TTE) and strain to refine the evaluation of the RA according to evolution of cardiac rhythm ad mid-term follow-up.
Methods
A complete 2D and 3D TTE was performed in patient hospitalized for AF. In addition to the usual parameters, RA parameters were specifically assessed: 3D RA end-systolic (ES) and end-diastolic (ED) volume, RA ejection fraction (EF) and the global longitudinal strain (GLS) of the RA. A complete clinical evaluation and electrocardiogram were performed at admission (M0) and 6 months after inclusion (M6) to determine the cardiac rhythm at follow-up.
Results
34 consecutive patients hospitalized for AF were analysed. At M0, there was no significant difference between 2D RA ES volume and the 3D RA ES volume. Three groups of patients were individualized according to cardiac rhythm at M0 and M6: AF at M0 and AF at M6 (AF-AF), AF at M0 and sinus rhythm (SR) at M6 (AF-SR), SR at M0 (spontaneous reduction before the admission ECG) and SR at M6 (SR-SR). At M0 echocardiography, in the AF-AF group and AF-SR in comparison with SR-SR group were as follow: the 3D RA ED volume was significantly higher (respectively 21.6 (18.2-26.6) and 26.9 (19.4-36.8) versus 11.3 (6.9-16.6) mL/m2 ; p = 0.0025), the 3D RAEF was significantly lower (42.2 (35.1-44.7) and 34.5 (24.1-38.6) versus 57.6 (53.4-62.2)%; p = 0.0105) and the RA GLS was also significantly lower (7.6 (6.5-10.5) and 9.1 (5.8-11.2) versus 26.6 (22.0-35.0)%; p = 0.0001) (Figure 1).
Conclusion
3D ultrasound and strain could be useful tools for evaluating the anatomical and functional RA remodelling in AF, to be further validated in a larger ongoing study.
Abstract P350 Figure 1
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Affiliation(s)
- C Chalard
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - L Soulat-Dufour
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
| | - S Lang
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - S Ederhy
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
| | - Y Ancedy
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | | | - M Chauvet-Droit
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - P Nhan
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - R Ben Said
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - F Boccara
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM UMRS 936 , Paris, France
| | - A Cohen
- Sorbonne Université, APHP, Hôpital Saint Antoine, INSERM, UMRS-ICAN 1166 , Paris, France
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Davies A, Waylen A, Leary S, Thomas S, Pring M, Janssen B, Beynon R, Lang S, Schimansky S, Hurley K, Ness A. Assessing the validity of EQ-5D-5L in people with head & neck cancer: Does a generic quality of life measure perform as well as a disease-specific measure in a patient population? Oral Oncol 2019; 101:104504. [PMID: 31835074 DOI: 10.1016/j.oraloncology.2019.104504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) is an important cause of morbidity and mortality globally. Radical treatment methods may result in facial disfigurement and/or functional difficulties with subsequent adverse impacts on health-related quality of life (HRQoL). Guidelines suggest that HRQoL should be measured repeatedly throughout treatment to enable refined treatment protocols and tailored follow-up support but questionnaires are often long and burdensome. We compared condition-specific and generic metrics to assess HRQoL for people with this condition. METHODS We used data from the prospective Head and Neck 5000 clinical cohort study - 5511 participants with a new diagnosis of HNC between 2011 and 2014. HRQoL data were collected at baseline from 2065 people who completed both the condition-specific EORTC-QLQ-C30 and the shorter, generic EQ-5D-5L questionnaires. RESULTS There was strong evidence of association between comparable scales on each questionnaire at baseline: higher levels of functioning and lower levels of reported symptoms assessed with EQ-5D-5L were associated with lower EORTC-QLQ-C30 symptom scores. A moderate relationship (0.61) was found between overall QoL in the EQ-5D-5L index and self-perceived health (EQ VAS). CONCLUSIONS HRQoL data collected from the generic EQ-5D-5L and cancer-specific EORTC-QLQ-C30 questionnaires are comparable at baseline for people diagnosed with HNC. This would allow a reduced burden of data collection but the EQ-5D-5L may not be sensitive to some condition-specific symptoms. Clinicians and researchers must clarify their aims and outcomes of interest before choosing their HRQoL measures. Further work is required to examine the ability to detect change in these measures over time.
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Affiliation(s)
- A Davies
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - A Waylen
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - S Leary
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - S Thomas
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - M Pring
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - B Janssen
- EuroQoL Research Foundation, Marten Meesweg 107, 3068 AV Rotterdam, the Netherlands
| | - R Beynon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - S Lang
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - S Schimansky
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - K Hurley
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - A Ness
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK; Bristol Medical School, 1(st) Floor, 5 Tyndall Ave, Bristol BS8 1UD, UK
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Lang S, Zayet S, Toko L, Royer P, Ruyer O, Gendrin V. Emergence d’un agent aquatique pathogène : Leclercia adecarboxylata, à propos de 6 cas. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Fireworks injuries are frequently caused by malfunction or incorrect operation of fireworks. Injuries often affect the eyeball and the periorbit. After treatment of life-threatening bleeding, injuries of the eyeball have priority over the treatment of periorbital lacerations and burns. The aim of eyelid surgery in firework-related injuries is to prevent delayed damage, such as lagophthalmos, symblepharon, entropion with trichiasis, and keratinization of the conjunctiva of the eyelid and eyelid margin. The treatment requires a considerable amount of time and patience both for the elaborate surgical procedures as well as for the necessary healing and rest phases. Many patients, however, are left with serious visual impairments and stressful esthetic deformities, which result in considerable occupational and social impairments.
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Affiliation(s)
- H Mittelviefhaus
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland.
| | - S Lang
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland
| | - C Auw-Hädrich
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland
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Boccara F, Lang S, Ederhy S, Soulat-Dufour L, Adavane-Scheuble S, Ancedy Y, Chauvet M, Nhan P, Meynard JL, Valantin MA, Slama L, Pialoux G, Katlama C, Girard PM, Cohen A. P5338Atherosclerotic cardiovascular events in people living with Human Immunodeficiency Virus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People living with Human Immunodeficiency Virus (PLWHIV) under antiretrovirals have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. The risk factors associated with ASCVD events in this high risk population are various including traditional vascular risk factors and specific HIV-related factors. However their respective influence is questionable.
Purpose
Our aim was to determine the incidence of ASCVD events in a large cohort of PLWHIV and to identify the risk factors associated.
Methods
We conducted a longitudinal observational cohort study of asymptomatic PLWHIV at high risk of ASCVD addressed to our preventive cardiovascular unit for non-invasive cardiovascular evaluation. The first ASCVD event was censored and included CV death, acute coronary syndromes, coronary and peripheral revascularizations (PCI or CABG or endarterectomy or limb procedures) and ischemic strokes.
Results
From January 2003 to December 2014, 763 consecutive asymptomatic PLWHIV were enrolled (mean age of 51.3±8.3 years, 87% men, 90% were free of known coronary artery disease, mean Left ventricular ejection fraction 60%). At baseline, traditional CV risk factors were as follow: 54% had dyslipidemia, 43% hypertension, 35% were active smokers, 22% had family history of CAD and 11% were diabetics. Statins were prescribed in 38% of the cohort, aspirin in 14%, clopidogrel in 14% betablockers in 14%, RAS blockers in 32%, Calcium channel blockers in 8%. At baseline, median duration of HIV seropositivity was 19.8 years (14.0–23.6), 94% were under ARV predominantly protease inhibitors (68%). Median CD4 cell count was 545/mm3 (404–745) and 92% had undetectable HIV viral load. During a median follow up of 5.8 years (3.7–8.7), 58 (7.3%) subjects had a first ASCVD event (incidence of 12.70 [9.78–16.51] per 1000 persons-years) including 5 cardiovascular deaths, 14 ACS, 20 coronary revascularizations, 13 peripheral vascular procedures and 6 strokes) with a median time of occurrence of 3.1 years (1.5–5.1). CV death (first and second ASCVD events) occurred in 8 patients (22%) after CV death related to malignancies (33%) but before deaths related to unexplained causes (21%), infectious disease (13%), liver disease (8%) and suicides (3%). Coronary events including coronary death, MI, and coronary revascularization occurred in 39 patients (5.2%); Incidence of 8.28 [6.00–11.43] per 1000 persons-years. Conventional multivariate Cox model shows that age and tobacco were the independent risk factors associated with ACSVD events [Hazard ratio (HR) 1.04, 95% CI 0.99–1.09, p=0.05 and HR 2.17, 95% CI 1.07–4.38, p=0.03].
Conclusion
Traditional vascular risk factors (age and active smoking) are associated with the occurrence of ASCVD events predominantly coronary artery disease in our observational cohort of asymptomatic PLWIHV at high risk for ASCVD. Cardiovascular prevention including tobacco cease action is mandatory in the aging HIV population.
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Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Lang
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Ederhy
- AP-HP - Hospital Saint Antoine, Paris, France
| | | | | | - Y Ancedy
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M Chauvet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - P Nhan
- AP-HP - Hospital Saint Antoine, Paris, France
| | - J L Meynard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M A Valantin
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - L Slama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - G Pialoux
- Hospital Tenon, Infectious Diseases Department, Paris, France
| | - C Katlama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - P M Girard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - A Cohen
- AP-HP - Hospital Saint Antoine, Paris, France
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Schmidt C, Wiedmann F, Beyersdorf C, Zhao Z, El-Battrawy I, Kraft M, Lang S, Szabo G, Karck M, Zhou X, Borggrefe M, Thomas D, Haefeli WE, Decher N, Katus H. 1206Doxapram is a promising new antiarrhythmic drug for an atrial-specific therapy of atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
TASK-1 (K2P3.1) is an atrial-specific two-pore domain potassium channel that is significantly upregulated in atrial fibrillation (AF) patients resulting in shortened atrial action potential duration (APD). Inhibition of TASK-1 in human atrial cardiomyocytes reverses AF-related APD shortening to values observed in patients with sinus rhythm (SR). By in silico-modelling and experimental characterization of drug binding sites, doxapram was identified as specific inhibitor of TASK-1.
Purpose
In this study, we investigated the antiarrhythmic efficacy of doxapram in a porcine model of AF to convert and suppress AF.
Methods
We established a new porcine model of persistent AF without induced tachymyopathy. AF was induced in domestic pigs by intermittent atrial burst stimulation using implanted pacemakers. During AF episodes, burst stimulation was inhibited by an integrated pacemaker biofeedback algorithm. AV-node ablation was performed to prevent AF-associated heart failure. All pigs underwent catheter-based electrophysiological investigations prior to and after 14 days doxapram treatment. Pigs in the treatment group received intravenous applications of doxapram twice per day. Rhythm status was continuously recorded by intracardiac long-term ECG monitors. The application of doxapram for cardioversion and long term suppression of AF in pigs with persistent AF was evaluated. Subsequent to the doxapram treatment, porcine cardiomyocytes were isolated from right and left atria and electrophysiologically investigated by patch-clamp and multi-electrode experiments. Atrial electrical remodeling was characterized by analyses of ion channel expression at mRNA and protein levels.
Results
TASK-1 mRNA, protein and transmembrane current were significantly increased in AF pigs compared to SR controls, resulting in shortened atrial APDs. In doxapram-treated AF pigs the AF burden was significantly reduced. After 14 days treatment with doxapram, TASK-1 currents and atrial APDs recorded in porcine cardiomyocytes were reduced and similar to values of SR animals. Doxapram could be successfully applied for cardioversion in pigs with persistent AF. On average, cardioversion was observed 3 minutes after doxapram application.
Conclusion
Doxapram significantly suppressed AF episodes and normalized cellular electrophysiological characteristics in a porcine model of AF through inhibition of the TASK-1 ion channel. Furthermore, doxapram rapidly converted AF into SR in pigs. Therefore, doxapram might serve as a new antiarrhythmic drug to treat AF in patients.
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Affiliation(s)
- C Schmidt
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - F Wiedmann
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - C Beyersdorf
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - Z Zhao
- University Medical Centre of Mannheim, Mannheim, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Kraft
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - S Lang
- University Medical Centre of Mannheim, Mannheim, Germany
| | - G Szabo
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - M Karck
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - X Zhou
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Borggrefe
- University Medical Centre of Mannheim, Mannheim, Germany
| | - D Thomas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - W E Haefeli
- University Hospital of Heidelberg, Pharmacology, Heidelberg, Germany
| | - N Decher
- Philipps University of Marburg, Physiology, Marburg, Germany
| | - H Katus
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
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Kraft J, Mayinger M, Willmann J, Schanne D, Lang S, Willke L, Lohaus N, Guckenberger M, Andratschke N. Leukoencephalopathy after Prophylactic Whole-Brain Irradiation with or without Hippocampal Sparing: A Long-Term MRI Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2342] [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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Lang S, Hoelter P, Birkhold AI, Schmidt M, Endres J, Strother C, Doerfler A, Luecking H. Quantitative and Qualitative Comparison of 4D-DSA with 3D-DSA Using Computational Fluid Dynamics Simulations in Cerebral Aneurysms. AJNR Am J Neuroradiol 2019; 40:1505-1510. [PMID: 31467234 DOI: 10.3174/ajnr.a6172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/01/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D-DSA allows time-resolved 3D imaging of the cerebral vasculature. The aim of our study was to evaluate this method in comparison with the current criterion standard 3D-DSA by qualitative and quantitative means using computational fluid dynamics. MATERIALS AND METHODS 3D- and 4D-DSA datasets were acquired in patients with cerebral aneurysms. Computational fluid dynamics analysis was performed for all datasets. Using computational fluid dynamics, we compared 4D-DSA with 3D-DSA in terms of both aneurysmal geometry (quantitative: maximum diameter, ostium size [OZ1/2], volume) and hemodynamic parameters (qualitative: flow stability, flow complexity, inflow concentration; quantitative: average/maximum wall shear stress, impingement zone, low-stress zone, intra-aneurysmal pressure, and flow velocity). Qualitative parameters were descriptively analyzed. Correlation coefficients (r, P value) were calculated for quantitative parameters. RESULTS 3D- and 4D-DSA datasets of 10 cerebral aneurysms in 10 patients were postprocessed. Evaluation of aneurysmal geometry with 4D-DSA (r maximum diameter = 0.98, P maximum diameter <.001; r OZ1/OZ2 = 0.98/0.86, P OZ1/OZ2 < .001/.002; r volume = 0.98, P volume <.001) correlated highly with 3D-DSA. Evaluation of qualitative hemodynamic parameters (flow stability, flow complexity, inflow concentration) did show complete accordance, and evaluation of quantitative hemodynamic parameters (r average/maximum wall shear stress diastole = 0.92/0.88, P average/maximum wall shear stress diastole < .001/.001; r average/maximum wall shear stress systole = 0.94/0.93, P average/maximum wall shear stress systole < .001/.001; r impingement zone = 0.96, P impingement zone < .001; r low-stress zone = 1.00, P low-stress zone = .01; r pressure diastole = 0.84, P pressure diastole = .002; r pressure systole = 0.9, P pressure systole < .001; r flow velocity diastole = 0.95, P flow velocity diastole < .001; r flow velocity systole = 0.93, P flow velocity systole < .001) did show nearly complete accordance between 4D- and 3D-DSA. CONCLUSIONS Despite a different injection protocol, 4D-DSA is a reliable basis for computational fluid dynamics analysis of the intracranial vasculature and provides equivalent visualization of aneurysm geometry compared with 3D-DSA.
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Affiliation(s)
- S Lang
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - P Hoelter
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - A I Birkhold
- Siemens Healthcare GmbH (A.I.B.), Erlangen, Germany
| | - M Schmidt
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Endres
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Strother
- Department of Radiology (C.S.), Clinical Sciences Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - H Luecking
- From the Department of Neuroradiology (S.L., P.H., M.S., J.E., A.D., H.L.), University of Erlangen-Nuremberg, Erlangen, Germany
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Droege F, Lueb C, Thangavelu K, Stuck BA, Lang S, Geisthoff U. Nasal self-packing for epistaxis in Hereditary Hemorrhagic Telangiectasia increases quality of life. Rhinology 2019; 57:231-239. [PMID: 30739126 DOI: 10.4193/rhin18.141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STATEMENT OF PROBLEM Hereditary hemorrhagic telangiectasia (HHT) is characterized by recurrent epistaxis that can lead to a feeling of losing control. We assessed potential benefits and side effects of different nasal packings used by patients themselves. METHOD OF STUDY An online-questionnaire in English and German was used to analyze nasal self-packings. RESULTS 588 of the 915 respondents suffered from HHT with most of them having moderate or severe epistaxis. Almost two thirds of the patients had already treated themselves with nasal packings. While one quarter used non-pneumatic nasal packings (NPNP) or pneumatic nasal packings (PNP), nearly half of the patients took only tissues to stop the bleeding. Patients with severe epistaxis used PNP more often than NPNP. Using nasal packings, most patients could stop their nosebleeds after a while. Patients using PNP reported the feeling of losing control less often and significant improvements in quality of life with a positive GBI. CONCLUSIONS Our study showed that most patients with HHT using nasal self-packings could stop the bleeding after a while. Nasal self-packing is a user-friendly and secure method leaving patients more self-confident and independent.
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Affiliation(s)
- F Droege
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - C Lueb
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - K Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Marburg, Philipps-Universitat Marburg, Marburg, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - U Geisthoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Marburg, Philipps-Universitat Marburg, Marburg, Germany
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DeMario N, Lang S, Lian MGJ. Teachers’ Self-assessed Competence and Attitudes toward Literary Braille and the Nemeth Code. Journal of Visual Impairment & Blindness 2019. [DOI: 10.1177/0145482x9809200515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- N.C. DeMario
- Department of Special Education, Campus Box 5910. Illinois-State University, Normal, IL 61790-5910
| | - S. Lang
- Sangamon Area Special Education District, 2500 Taylor Avenue, Springfield, IL 62703
| | - M-G J. Lian
- Department of Special Education, Campus Box 5910, Illinois State University
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Tao WK, Iguchi T, Lang S. Expanding the Goddard CSH Algorithm for GPM: New Extratropical Retrievals. J Appl Meteorol Climatol 2019; 58:921-946. [PMID: 32636716 PMCID: PMC7340152 DOI: 10.1175/jamc-d-18-0215.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Goddard Convective-Stratiform Heating (CSH) algorithm has been used to retrieve latent heating (LH) associated with clouds and cloud systems in support of the Tropical Rainfall Measuring Mission (TRMM) and Global Precipitation Measurement (GPM) mission. The CSH algorithm required the use of a cloud-resolving model (CRM) to simulate LH profiles to build look-up tables (LUTs). However, the current LUTs in the CSH algorithm are not suitable for retrieving LH profiles at high latitudes or winter conditions that are needed for GPM. The NASA Unified-Weather Research and Forecasting (NU-WRF) model is used to simulate three eastern continental US (CONUS) synoptic winter and three western coastal/offshore events. The relationship between LH structures (or profiles) and other precipitation properties (radar reflectivity, freezing level height, echo-top height, maximum radar reflectivity height and surface precipitation rate) is examined, and a new classification system is adopted with varying ranges for each of these precipitation properties to create LUTs representing high latitude/winter conditions. The performance of the new LUTs is examined using a self-consistency check for one CONUS and one West Coast offshore event by comparing LH profiles retrieved from the LUTs using model-simulated precipitation properties with those originally simulated by the model. The results of the self-consistency check validate the new classification and LUTs. High latitude retrievals from the new LUTs are merged with those from the CSH algorithm to retrieve LH profiles over the GPM domain using precipitation properties retrieved from the GPM combined algorithm.
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Affiliation(s)
- W-K Tao
- Mesoscale Atmospheric Processes Laboratory NASA/Goddard Space Flight Center Greenbelt, MD 20771
| | - T Iguchi
- Mesoscale Atmospheric Processes Laboratory NASA/Goddard Space Flight Center Greenbelt, MD 20771
- Earth System Science Interdisciplinary Center University of Maryland College Park, MD
| | - S Lang
- Mesoscale Atmospheric Processes Laboratory NASA/Goddard Space Flight Center Greenbelt, MD 20771
- Science Systems and Applications, Inc. Lanham, MD 20706
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Lang S, Gan L, Alrazi T, Monchi O. High definition transcranial alternating current stimulation of the right fusiform cortex improves visual associative memory. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.389] [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] Open
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Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Forbes A, Myles P, Smith J, Cooper DJ, Silbert B, McNeil J, Marasco S, Esmore D, Krum H, Tonkin A, Buxton B, Heritier S, Merry A, Liew D, McNeil J, Forbes A, Cooper D, Wallace S, Meehan A, Myles P, Wallace S, Galagher W, Farrington C, Ditoro A, Wutzlhofer L, Story D, Peyton P, Baulch S, Sidiropoulos S, Potgieter D, Baker R, Pesudovs B, O'Loughlin J Wells E, Coutts P, Bolsin S, Osborne C, Ives K, Smith J, Hulley A, Christie-Taylor G, Painter T, Lang S, Mackay H, Cokis C, March S, Bannon P, Wong C, Turner L, Scott D, Silbert B, Said S, Corcoran P, Painter T, de Prinse L, Bussières J, Gagné N, Lamy A, Semelhago L, Chan M, Underwood M, Choi G, Fung B, Landoni G, Lembo R, Monaco F, Simeone F, Marianello D, Alvaro G, De Vuono G, van Dijk D, Dieleman J, Numan S, McGuinness S, Parke R, Raudkivi P, Gilder E, Byrne K, Dunning J, Termaat J, Mans G, Jayarajah M, Alderton J, Waugh D, Platt M, Pai A, Sevillano A, Lal A, Sinclair C, Kunst G, Knighton A, Cubas G, Saravanan P, Millner R, Vasudevan V, Patteril M, Lopez E, Basu R, Lu J. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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Grüneboom A, Hawwari I, Weidner D, Culemann S, Müller S, Henneberg S, Brenzel A, Merz S, Bornemann L, Zec K, Wuelling M, Kling L, Hasenberg M, Voortmann S, Lang S, Baum W, Ohs A, Kraff O, Quick HH, Jäger M, Landgraeber S, Dudda M, Danuser R, Stein JV, Rohde M, Gelse K, Garbe AI, Adamczyk A, Westendorf AM, Hoffmann D, Christiansen S, Engel DR, Vortkamp A, Krönke G, Herrmann M, Kamradt T, Schett G, Hasenberg A, Gunzer M. A network of trans-cortical capillaries as mainstay for blood circulation in long bones. Nat Metab 2019; 1:236-250. [PMID: 31620676 PMCID: PMC6795552 DOI: 10.1038/s42255-018-0016-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [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] [Indexed: 12/12/2022]
Abstract
Closed circulatory systems (CCS) underlie the function of vertebrate organs, but in long bones their structure is unclear, although they constitute the exit route for bone marrow (BM) leukocytes. To understand neutrophil emigration from BM, we studied the vascular system of murine long bones. Here we show that hundreds of capillaries originate in BM, cross murine cortical bone perpendicularly along the shaft and connect to the periosteal circulation. Structures similar to these trans-cortical-vessels (TCVs) also exist in human limb bones. TCVs express arterial or venous markers and transport neutrophils. Furthermore, over 80% arterial and 59% venous blood passes through TCVs. Genetic and drug-mediated modulation of osteoclast count and activity leads to substantial changes in TCV numbers. In a murine model of chronic arthritic bone inflammation, new TCVs develop within weeks. Our data indicate that TCVs are a central component of the CCS in long bones and may represent an important route for immune cell export from the BM.
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Affiliation(s)
- Anika Grüneboom
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Ibrahim Hawwari
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Daniela Weidner
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Stephan Culemann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Sylvia Müller
- Institute of Immunology, Universitätsklinikum Jena, Jena, Germany
| | - Sophie Henneberg
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Alexandra Brenzel
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Simon Merz
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Lea Bornemann
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kristina Zec
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Manuela Wuelling
- Department of Developmental Biology, Centre of Medical Biotechnology, Faculty of Biology, University Duisburg-Essen, Essen, Germany
| | - Lasse Kling
- Max Planck Institute for the Science of Light, Christiansen Research Group, Erlangen, Germany
- Helmholtz-Zentrum Berlin, Institute for Nanoarchitectures for Energy Conversion, Berlin, Germany
| | - Mike Hasenberg
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Sylvia Voortmann
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Stefanie Lang
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Baum
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Alexandra Ohs
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics and Trauma Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Marcel Dudda
- Department of Orthopaedics and Trauma Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Renzo Danuser
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Jens V Stein
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Manfred Rohde
- Central Facility for Microscopy, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Kolja Gelse
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg andUniversitaetsklinikum Erlangen, Erlangen, Germany
| | - Annette I Garbe
- Osteoimmunology, DFG-Center for Regenerative Therapies Dresden, Center for Molecular and Cellular Bioengineering , Technische Universität Dresden, Cluster of Excellence, Dresden, Germany
| | - Alexandra Adamczyk
- Institute of Medical Microbiology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Astrid M Westendorf
- Institute of Medical Microbiology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Daniel Hoffmann
- Bioinformatics and Computational Biophysics, Faculty of Biology, University Duisburg-Essen, Essen, Germany
| | - Silke Christiansen
- Max Planck Institute for the Science of Light, Christiansen Research Group, Erlangen, Germany
- Helmholtz-Zentrum Berlin, Institute for Nanoarchitectures for Energy Conversion, Berlin, Germany
| | - Daniel Robert Engel
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Andrea Vortkamp
- Department of Developmental Biology, Centre of Medical Biotechnology, Faculty of Biology, University Duisburg-Essen, Essen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Thomas Kamradt
- Institute of Immunology, Universitätsklinikum Jena, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Anja Hasenberg
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany.
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital, University Duisburg-Essen, Essen, Germany.
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Schön C, Wacker R, Micka A, Steudle J, Lang S, Bonnländer B. Bioavailability Study of Maqui Berry Extract in Healthy Subjects. Nutrients 2018; 10:nu10111720. [PMID: 30423989 PMCID: PMC6267473 DOI: 10.3390/nu10111720] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/12/2018] [Revised: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/18/2022] Open
Abstract
Several health promoting effects have been reported for maqui berry, rich in anthocyanins. Direct effects of anthocyanins as well as bioactive metabolites might be involved. Within the study, bioavailability of a proprietary standardized maqui berry extract Delphinol® was investigated based on two selected anthocyanins (delphinidin-3-O-glucoside (DS) + cyanidin-3-O-sambubioside (CS)) and two breakdown products (protocatechuic acid (PCA) + gallic acid (GA)) after a single-dose supplementation in humans. Pharmacokinetic parameters were calculated from individual concentration time curves. In all 12 subjects a significant increase was noted in plasma values of DG and CS after intake of maqui berry extract. Maximum concentration of DG was observed after 1.0 ± 0.3 h and CS after 2.0 ± 1.1 h. Within 8 h, concentrations nearly returned to baseline levels. The results confirm a fast uptake and metabolism of the two selected key substances. Additionally, the phenolic acids GA and PCA were observed as breakdown products of anthocyanins. In summary, the study clearly confirms the bioavailability of maqui berry extract and its specific anthocyanin compounds and related breakdown products in healthy subjects.
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Affiliation(s)
| | - Roland Wacker
- BioTeSys GmbH, Schelztorstr. 54⁻56, 73728 Esslingen, Germany.
| | - Antje Micka
- BioTeSys GmbH, Schelztorstr. 54⁻56, 73728 Esslingen, Germany.
| | - Jasmin Steudle
- BioTeSys GmbH, Schelztorstr. 54⁻56, 73728 Esslingen, Germany.
| | - Stefanie Lang
- Anklam Extrakt GmbH, Marienbergstr. 92, 90411 Nuremberg, Germany.
| | - Bernd Bonnländer
- Anklam Extrakt GmbH, Marienbergstr. 92, 90411 Nuremberg, Germany.
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Christov F, Gluth MB, Lahti SJ, Ludwig S, Hans S, Holtmann LC, Lang S, Arweiler-Harbeck D. Electric compound action potentials (ECAPs) and impedances in an open and closed operative site during cochlear implantation. Cochlear Implants Int 2018; 20:23-30. [PMID: 30350745 DOI: 10.1080/14670100.2018.1534667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In patients undergoing cochlear implantation, intraoperative measures of impedance and electrically evoked compound action potentials (ECAPs) are used to confirm device integrity and electrode array position. However, these electrophysiological parameters have been shown to decrease over time, with a small decrement observable as early as 24 h post implantation and becoming more apparent after 6 months. Whether the intraoperatively measured impedances and ECAPs recorded immediately after electrode insertion versus later in the operation or in an open versus closed operative site vary has not been documented. Such variation in measurement procedure may affect the ultimate operative outcome. PATIENTS AND METHODS Between February and October 2016, 38 patients received a cochlear implant (Cochlear®), with half receiving a CI 522 device and the other half receiving a CI 512 device. These patients were distributed into three groups. In the first (group A; n = 21), the impedance and threshold neural response telemetry (tNRT) measures were taken before (M1) and after cutaneous suture (M2), whereas in the second group (group B; n = 11) they were taken twice in the open operative site, once at the time of electrode insertion (M1) and then again 10 min later (M2). The last group (group C; n = 6) was measured only once after a 10 min waiting time before closing the operative site. RESULTS tNRTs of both group A and B were significantly higher at M1 than measured at M2. The magnitude of change in tNRT did vary significantly by group (P = .027) with group A having a bigger decrease than group B. For impedances there was evidence for a significant difference in M2 between the three groups (P = .012), with group C having significantly higher values compared to group A and B. CONCLUSION Intraoperative tNRT measures change significantly over time, including within the first 10 min of implantation. One underlying etiology of this phenomenon for tNRTs seems to be the condition of the surgical site whereas changes of impedances can be best explained by the 'electrochemical cleaning' theory associated with the first stimulation of the electrode. However, for both impedances and tNRTs there also is an important impact of time as well as of acute perioperative changes in electrical conductivity.
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Affiliation(s)
- F Christov
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany.,b Section of Otolaryngology-Head & Neck Surgery , University of Chicago Medicine , Illinois , USA
| | - M B Gluth
- b Section of Otolaryngology-Head & Neck Surgery , University of Chicago Medicine , Illinois , USA
| | - S J Lahti
- c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - S Ludwig
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany
| | - S Hans
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany
| | - L C Holtmann
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany
| | - S Lang
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany
| | - D Arweiler-Harbeck
- a Department of Otolaryngology, Head and Neck Surgery , University Hospital Essen , Essen , Germany
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Grohe C, Zander I, Lüdtke-Heckenkamp K, Blau W, Krüger S, Franke C, Mueller-Huesmann H, Brückl W, Basara N, Ukena D, Lang S, Atz J, Kaiser R. Nintedanib plus docetaxel in routine clinical practice: VARGADO, a German prospective non-interventional study (NIS) reflecting routine treatment conditions in an evolving NSCLC treatment landscape. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rusnak J, Behnes M, Saleh A, Fastner C, Sattler K, Barth C, Wenke A, Sartorius B, Mashayekhi K, Hoffmann U, Yuecel G, Lang S, Borggrefe M, Akin I. Interventional left atrial appendage closure may affect metabolism of essential amino acids and bioenergetic efficacy. Int J Cardiol 2018; 268:125-131. [DOI: 10.1016/j.ijcard.2018.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
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