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Agnandji ST, Recker M, Mordmüller B, Glöckner S, Adegnika AA, Lell B, Otieno L, Otieno W, Owusu-Agyei S, Asante KP, Agbenyega T, Ansong D, Macete E, Aide P, Sorgho H, Tinto H, Mturi N, Lusingu JPA, Gesase S, Hoffman I, Masoud NS, Newton CR, Bojang K, Krause G, Kremsner PG. Prostration and the prognosis of death in African children with severe malaria. Int J Infect Dis 2023; 134:240-247. [PMID: 37414210 DOI: 10.1016/j.ijid.2023.06.022] [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: 03/06/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain. METHODS Here we used a retrospective multi-center analysis comprising over 33,000 hospitalized children from four large studies, including two observational studies from the Severe Malaria in African Children network, a randomized controlled treatment study, and the phase-3-clinical RTS,S-malaria vaccine trial, to evaluate known risk factors of mortality and with a specific emphasis on the role of prostration. RESULTS Despite comparable age profiles of the participants, we found significant inter- and intra-study variation in the incidence of fatal malaria as well as in the derived risk ratios associated with the four risk factors: coma, deep breathing, anemia, and prostration. Despite pronounced variations, prostration was significantly associated with an increased risk of mortality (P <0.001) and its consideration resulted in improved predictive performance, both in a multivariate model and a univariate model based on the Lambaréné Organ Dysfunction Score. CONCLUSION Prostration is an important clinical criterion to determine severe pediatric malaria with possible fatal outcomes.
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Affiliation(s)
- Selidji T Agnandji
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
| | - Mario Recker
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Department of Ecology and Conservation, University of Exeter, Exeter, UK.
| | - Benjamin Mordmüller
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany; Radboud University Medical Centre, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Stephan Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Translational Infrastructure Epidemiology, German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Akim A Adegnika
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Lucas Otieno
- Kenya Medical Research Institute, KEMRI-Walter Reed Project, Kombewa, Kenya
| | - Walter Otieno
- Kenya Medical Research Institute, KEMRI-Walter Reed Project, Kombewa, Kenya
| | | | | | - Tsiri Agbenyega
- Kwame Nkrumah University of Science and Technology, Agogo, Ghana
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Agogo, Ghana
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Hermann Sorgho
- Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Santé, Nanoro, Burkina Faso
| | - Neema Mturi
- Kenya Medical Research Institute, KEMRI-Wellcome Trust Research Programme, Centre Medicine Research, Kilifi, Kenya
| | | | - Samwel Gesase
- NjugNational Institute for Medical Research, Korogwe, Tanzania
| | - Irving Hoffman
- University of North Carolina (UNC), Division of Infectious Diseases, North Carolina, USA; University of North Carolina (UNC) Project, Lilongwe, Malawi
| | - Nahya Salim Masoud
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam and Ifakara Health Institute, Bagamoyo, Tanzania
| | - Charles R Newton
- Kenya Medical Research Institute, KEMRI-Wellcome Trust Programme, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kalifa Bojang
- Medical Research Council (MRC) Unit at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Translational Infrastructure Epidemiology, German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Peter Gottfried Kremsner
- Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Translational Thematic Unit Malaria, German Center for Infection Research (DZIF), Tübingen, Germany
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Heinsohn T, Lange B, Vanella P, Rodiah I, Glöckner S, Joachim A, Becker D, Brändle T, Dhein S, Ehehalt S, Fries M, Galante-Gottschalk A, Jehnichen S, Kolkmann S, Kossow A, Hellmich M, Dötsch J, Krause G. Infection and transmission risks of COVID-19 in schools and their contribution to population infections in Germany: A retrospective observational study using nationwide and regional health and education agency notification data. PLoS Med 2022; 19:e1003913. [PMID: 36538517 PMCID: PMC9767368 DOI: 10.1371/journal.pmed.1003913] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND School-level infection control measures in Germany during the early Coronavirus Disease 2019 (COVID-19) pandemic differed across the 16 federal states and lacked a dependable evidence base, with available evidence limited to regional data restricted to short phases of the pandemic. This study aimed to assess the (a) infection risks in students and staff; (b) transmission risks and routes in schools; (c) effects of school-level infection control measures on school and population infection dynamics; and (d) contribution of contacts in schools to population cases. METHODS AND FINDINGS For this retrospective observational study, we used German federal state (NUTS-2) and county (NUTS-3) data from public health and education agencies from March 2020 to April 2022. We assessed (a) infection risk as cumulative risk and crude risk ratios and (b) secondary attack rates (SARs) with 95% confidence interval (CI). We used (c) multiple regression analysis for the effects of infection control measures such as reduced attendance, mask mandates, and vaccination coverage as absolute reduction in case incidence per 100,000 inhabitants per 14 days and in percentage relative to the population, and (d) infection dynamic modelling to determine the percentage contribution of school contacts to population cases. We included (a) nationwide NUTS-2 data from calendar weeks (W) 46-50/2020 and W08/2021-W15/2022 with 3,521,964 cases in students and 329,283 in teachers; (b) NUTS-3 data from W09-25/2021 with 85,788 student and 9,427 teacher cases; and (c) detailed data from 5 NUTS-3 regions from W09/2020 to W27/2021 with 12,814 cases (39% male, 37% female; median age 14, range 5 to 63), 43,238 contacts and 4,165 secondary cases for students (for teachers, 14,801 [22% male, 50% female; median age 39, range 16 to 75], 5,893 and 472). Infection risk (a) for students and teachers was higher than the population risk in all phases of normal presence class and highest in the early 2022 omicron wave with 30.6% (95% CI 30.5% to 32.6%) of students and 32.7% (95% CI 32.6% to 32.8%) of teachers infected in Germany. SARs (b) for students and staff were below 5% in schools throughout the study period, while SARs in households more than doubled from 13.8% (95% CI 10.6% to 17.6%) W21-39/2020 to 28.7% (95% CI 27% to 30.4%) in W08-23/2021 for students and 10.9% (95% CI 7% to 16.5%) to 32.7% (95% CI 28.2% to 37.6%) for staff. Most contacts were reported for schools, yet most secondary cases originated in households. In schools, staff predominantly infected staff. Mandatory surgical mask wearing during class in all schools was associated with a reduction in the case incidence of students and teachers (c), by 56/100,000 persons per 14 days (students: 95% CI 47.7 to 63.4; teachers: 95% CI 39.6 to 71.6; p < 0.001) and by 29.8% (95% CI 25% to 35%, p < 0.001) and 24.3% (95% CI 13% to 36%, p < 0.001) relative to the population, respectively, as were reduced attendance and higher vaccination coverage. The contribution of contacts in schools to population cases (d) was 2% to 20%, lowest during school closures/vacation and peaked during normal presence class intervals, with the overall peak early during the omicron wave. Limitations include underdetection, misclassification of contacts, interviewer/interviewee dependence of contact-tracing, and lack of individual-level confounding factors in aggregate data regression analysis. CONCLUSION In this study, we observed that open schools under hygiene measures and testing strategies contributed up to 20% of population infections during the omicron wave early 2022, and as little as 2% during vacations/school closures; about a third of students and teachers were infected during the omicron wave in early 2022 in Germany. Mandatory mask wearing during class in all school types and reduced attendance models were associated with a reduced infection risk in schools.
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Affiliation(s)
- Torben Heinsohn
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
- * E-mail:
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
| | - Patrizio Vanella
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- Chair of Empirical Methods in Social Science and Demography, University of Rostock, Rostock, Germany
- Hannover Medical School (MHH), Hannover, Germany
| | - Isti Rodiah
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
| | - Stephan Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Alexander Joachim
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis Becker
- Public Health Department Konstanz, Gottmadingen, Germany
| | - Tobias Brändle
- Institute of Educational Monitoring and Quality Development, Agency for Schools and Vocational Training, Hamburg, Germany
| | - Stefan Dhein
- Public Health Department Altenburger Land, Altenburg, Germany
| | | | - Mira Fries
- Public Health Department Cologne, Cologne, Germany
- Institute for Occupational, Social and Environmental Medicine, University Hospital, RWTH Aachen University, Aachen, Germany
| | | | | | - Sarah Kolkmann
- Public Health Department Altenburger Land, Altenburg, Germany
| | - Annelene Kossow
- Public Health Department Cologne, Cologne, Germany
- Institute of Hygiene, University Hospital of Muenster, Muenster, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany
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Jacobsen H, Strengert M, Maaß H, Ynga Durand MA, Katzmarzyk M, Kessel B, Harries M, Rand U, Abassi L, Kim Y, Lüddecke T, Metzdorf K, Hernandez P, Ortmann J, Heise JK, Castell S, Gornyk D, Glöckner S, Melhorn V, Kemmling Y, Lange B, Dulovic A, Marsall P, Häring J, Junker D, Schneiderhan-Marra N, Hoffmann M, Pöhlmann S, Krause G, Cicin-Sain L. Diminished neutralization responses towards SARS-CoV-2 Omicron VoC after mRNA or vector-based COVID-19 vaccinations. Sci Rep 2022; 12:19858. [PMID: 36400804 PMCID: PMC9673895 DOI: 10.1038/s41598-022-22552-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022] Open
Abstract
SARS-CoV-2 variants accumulating immune escape mutations provide a significant risk to vaccine-induced protection against infection. The novel variant of concern (VoC) Omicron BA.1 and its sub-lineages have the largest number of amino acid alterations in its Spike protein to date. Thus, they may efficiently escape recognition by neutralizing antibodies, allowing breakthrough infections in convalescent and vaccinated individuals in particular in those who have only received a primary immunization scheme. We analyzed neutralization activity of sera from individuals after vaccination with all mRNA-, vector- or heterologous immunization schemes currently available in Europe by in vitro neutralization assay at peak response towards SARS-CoV-2 B.1, Omicron sub-lineages BA.1, BA.2, BA.2.12.1, BA.3, BA.4/5, Beta and Delta pseudotypes and also provide longitudinal follow-up data from BNT162b2 vaccinees. All vaccines apart from Ad26.CoV2.S showed high levels of responder rates (96-100%) towards the SARS-CoV-2 B.1 isolate, and minor to moderate reductions in neutralizing Beta and Delta VoC pseudotypes. The novel Omicron variant and its sub-lineages had the biggest impact, both in terms of response rates and neutralization titers. Only mRNA-1273 showed a 100% response rate to Omicron BA.1 and induced the highest level of neutralizing antibody titers, followed by heterologous prime-boost approaches. Homologous BNT162b2 vaccination, vector-based AZD1222 and Ad26.CoV2.S performed less well with peak responder rates of 48%, 56% and 9%, respectively. However, Omicron responder rates in BNT162b2 recipients were maintained in our six month longitudinal follow-up indicating that individuals with cross-protection against Omicron maintain it over time. Overall, our data strongly argue for booster doses in individuals who were previously vaccinated with BNT162b2, or a vector-based primary immunization scheme.
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Affiliation(s)
- Henning Jacobsen
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Monika Strengert
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, Joint Venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Henrike Maaß
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Maeva Katzmarzyk
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Barbora Kessel
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Manuela Harries
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Ulfert Rand
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Leila Abassi
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Yeonsu Kim
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Tatjana Lüddecke
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Kristin Metzdorf
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Pilar Hernandez
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Julia Ortmann
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Daniela Gornyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stephan Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Vanessa Melhorn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Yvonne Kemmling
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Patrick Marsall
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Julia Häring
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Daniel Junker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | | | - Markus Hoffmann
- Deutsches Primatenzentrum, Leibniz-Institut Für Primatenforschung, Göttingen, Germany
- Faculty of Biology and Psychology, Georg-August-University, Göttingen, Germany
| | - Stefan Pöhlmann
- Deutsches Primatenzentrum, Leibniz-Institut Für Primatenforschung, Göttingen, Germany
- Faculty of Biology and Psychology, Georg-August-University, Göttingen, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
- TWINCORE, Centre for Experimental and Clinical Infection Research, Joint Venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany.
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany.
| | - Luka Cicin-Sain
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany.
- Centre for Individualized Infection Medicine (CIIM), Joint Venture of Helmholtz Centre for Infection Research and Medical School Hannover, Inhoffenstraße 7, 38124, Braunschweig, Germany.
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Dulovic A, Kessel B, Harries M, Becker M, Ortmann J, Griesbaum J, Jüngling J, Junker D, Hernandez P, Gornyk D, Glöckner S, Melhorn V, Castell S, Heise JK, Kemmling Y, Tonn T, Frank K, Illig T, Klopp N, Warikoo N, Rath A, Suckel C, Marzian AU, Grupe N, Kaiser PD, Traenkle B, Rothbauer U, Kerrinnes T, Krause G, Lange B, Schneiderhan-Marra N, Strengert M. Comparative Magnitude and Persistence of Humoral SARS-CoV-2 Vaccination Responses in the Adult Population in Germany. Front Immunol 2022; 13:828053. [PMID: 35251012 PMCID: PMC8888837 DOI: 10.3389/fimmu.2022.828053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
Abstract
Recent increases in SARS-CoV-2 infections have led to questions about duration and quality of vaccine-induced immune protection. While numerous studies have been published on immune responses triggered by vaccination, these often focus on studying the impact of one or two immunisation schemes within subpopulations such as immunocompromised individuals or healthcare workers. To provide information on the duration and quality of vaccine-induced immune responses against SARS-CoV-2, we analyzed antibody titres against various SARS-CoV-2 antigens and ACE2 binding inhibition against SARS-CoV-2 wild-type and variants of concern in samples from a large German population-based seroprevalence study (MuSPAD) who had received all currently available immunisation schemes. We found that homologous mRNA-based or heterologous prime-boost vaccination produced significantly higher antibody responses than vector-based homologous vaccination. Ad26.CoV2S.2 performance was particularly concerning with reduced titres and 91.7% of samples classified as non-responsive for ACE2 binding inhibition, suggesting that recipients require a booster mRNA vaccination. While mRNA vaccination induced a higher ratio of RBD- and S1-targeting antibodies, vector-based vaccines resulted in an increased proportion of S2-targeting antibodies. Given the role of RBD- and S1-specific antibodies in neutralizing SARS-CoV-2, their relative over-representation after mRNA vaccination may explain why these vaccines have increased efficacy compared to vector-based formulations. Previously infected individuals had a robust immune response once vaccinated, regardless of which vaccine they received, which could aid future dose allocation should shortages arise for certain manufacturers. Overall, both titres and ACE2 binding inhibition peaked approximately 28 days post-second vaccination and then decreased.
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Affiliation(s)
- Alex Dulovic
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Barbora Kessel
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Manuela Harries
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Matthias Becker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Julia Ortmann
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Johanna Griesbaum
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Jennifer Jüngling
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Daniel Junker
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Pilar Hernandez
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Daniela Gornyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stephan Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Vanessa Melhorn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Yvonne Kemmling
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Torsten Tonn
- German Red Cross Blood Donation Service North East, Dresden, Germany
| | - Kerstin Frank
- German Red Cross Blood Donation Service North East, Dresden, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Norman Klopp
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Neha Warikoo
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Angelika Rath
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Christina Suckel
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Anne Ulrike Marzian
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Nicole Grupe
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Philipp D. Kaiser
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Bjoern Traenkle
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Ulrich Rothbauer
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
- Pharmaceutical Biotechnology, Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany
| | - Tobias Kerrinnes
- Department of RNA-Biology of Bacterial Infections, Helmholtz Institute for RNA-Based Infection Research, Würzburg, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | | | - Monika Strengert
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, a Joint Venture of the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
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5
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Gornyk D, Harries M, Glöckner S, Strengert M, Kerrinnes T, Heise JK, Maaß H, Ortmann J, Kessel B, Kemmling Y, Lange B, Krause G. SARS-CoV-2 Seroprevalence in Germany. Dtsch Arztebl Int 2021; 118:824-831. [PMID: 35191825 DOI: 10.3238/arztebl.m2021.0364] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/10/2021] [Accepted: 10/08/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Until now, information on the spread of SARS-CoV-2 infections in Germany has been based mainly on data from the public health offices. It may be assumed that these data do not include many cases of asymptomatic and mild infection. METHODS We determined seroprevalence over the course of the pandemic in a sequential, multilocal seroprevalence study (MuSPAD). Study participants were recruited at random in seven administrative districts (Kreise) in Germany from July 2020 onward; each participant was tested at two different times 3-5 months apart. Test findings on blood samples were used to determine the missed-case rate of reported infections, the infection fatality rate (IFR), and the association between seropositivity and demographic, socio-economic, and health-related factors, as well as to evaluate the self-reported results of PCR and antigenic tests. The registration number of this study is DRKS00022335. RESULTS Among non-vaccinated persons, the seroprevalence from July to December 2020 was 1.3-2.8% and rose between February and May 2021 to 4.1-13.1%. In July 2021, 35% of tested persons in Chemnitz were not vaccinated, and the seroprevalence among these persons was 32.4% (07/2021). The surveillance detection ratio (SDR), i.e., the ratio between the true number of infections estimated from seroprevalence and the actual number or reported infections, varied among the districts included in the study from 2.2 to 5.1 up to December 2020 and from 1.3 to 2.9 up to June 2021, and subsequently declined. The IFR was in the range of 0.8% to 2.4% in all regions except Magdeburg, where a value of 0.3% was calculated for November 2020. A lower educational level was associated with a higher seropositivity rate, smoking with a lower seropositivity rate. On average, 1 person was infected for every 8.5 persons in quarantine. CONCLUSION Seroprevalence was low after the first wave of the pandemic but rose markedly during the second and third waves. The missed-case rate trended downward over the course of the pandemic.
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Affiliation(s)
- Daniela Gornyk
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig; RNA Biology of Bacterial Infections, Helmholtz Institute for RNA-Based Infection Research, Würzburg; TI Bioresources, Biodata, and Digital Health (TI BBD), German Center for Infection Research (DZIF), Braunschweig; TWINCORE, Center for Experimental and Clinical Infection Research, Hanover
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6
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Wehner A, Glöckner S, Weiss B, Ballhausen D, Stockhaus C, Zablotski Y, Hartmann K. Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane. Vet J 2021; 276:105740. [PMID: 34416401 DOI: 10.1016/j.tvjl.2021.105740] [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] [Received: 10/12/2020] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.
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Affiliation(s)
- A Wehner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany.
| | - S Glöckner
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - B Weiss
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - D Ballhausen
- Veterinay Clinic for Small Animals, Haar, Germany
| | - C Stockhaus
- Veterinay Clinic for Small Animals, Haar, Germany
| | - Y Zablotski
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
| | - K Hartmann
- Center of Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig Maximilian University, Munich, Germany
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7
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Reuken PA, Andreas N, Grunert PC, Glöckner S, Kamradt T, Stallmach A. T Cell Response After SARS-CoV-2 Vaccination in Immunocompromised Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 16:251-258. [PMID: 34379729 PMCID: PMC8385945 DOI: 10.1093/ecco-jcc/jjab147] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vaccination is a promising strategy to protect vulnerable groups like immunocompromised inflammatory bowel disease [IBD] patients from an infection with SARS-CoV-2. These patients may have lower immune responses. Little is known about the cellular and humoral immune response after a SARS-CoV-2 vaccination in IBD patients. METHODS Totals of 28 patients with IBD and 27 age- and sex-matched healthy controls were recruited at Jena University Hospital. Blood samples were taken before, after the first, and in a subgroup of 11 patients after second dose of a SARS-CoV-2 vaccination. Cellular immune response, including IFN-γ and TNF-α response and antibody titres, were analysed. RESULTS Overall, 71.4% of the IBD patients and 85.2% of the controls showed levels of anti-SARS-CoV-2 antibodies above the cutoff of 33.8 BAU/ml [p = 0.329] after the first dose. Even in the absence of SARS-CoV-2 antibodies, IBD patients showed significant T cell responses after first SARS-CoV-2 vaccination compared with healthy controls, which was not influenced by different immunosuppressive regimens. Associated with the vaccination, we could also detect a slight increase of the TNF production among SARS-CoV-2-reactive TH cells in healthy donorsn [HD] and IBD patients. After the second dose of vaccination, in IBD patients a further increase of humoral immune response in all but one patient was observed. CONCLUSIONS Already after the first dose of a SARS-CoV-2 vaccination, cellular immune response in IBD patients is comparable to controls, indicating a similar efficacy. However, close monitoring of long-term immunity in these patients should be considered.
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Affiliation(s)
- P A Reuken
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany,Address for Correspondence: Philipp Reuken, Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, 07747 Jena, Germany. Fax: +49-3641-9324222,
| | - N Andreas
- Institute for Immunology, Jena University Hospital, Jena, Germany
| | - P C Grunert
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany
| | - S Glöckner
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - T Kamradt
- Institute for Immunology, Jena University Hospital, Jena, Germany,Core Facility Cytometry, Jena University Hospital, Jena, Germany
| | - A Stallmach
- Jena University Hospital, Department of Internal Medicine IV, Jena, Germany
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8
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Nguyen MTH, Krause G, Keller-Stanislawski B, Glöckner S, Mentzer D, Ott JJ. Postmarketing Safety Monitoring After Influenza Vaccination Using a Mobile Health App: Prospective Longitudinal Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e26289. [PMID: 33960950 PMCID: PMC8140379 DOI: 10.2196/26289] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/05/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background For the safety monitoring of vaccinations postlicensure, reports of adverse events after immunization (AEFIs) are crucial. New technologies such as digital mobile apps can be used as an active approach to capture these events. We therefore conducted a feasibility study among recipients of the influenza vaccination using an app for assessment of the reporting of AEFIs. Objective The goal of the research was to determine factors influencing adherence to and correct use of a newly developed app for individuals to report AEFI for 3 months using regular reminder functions, to identify determinants of AEFI occurrence and define reported AEFI types. Methods We developed the app (SafeVac) and offered it to recipients of the influenza vaccination in 3 occupational settings in fall 2018. In this prospective longitudinal feasibility study, data on AEFIs were generated through SafeVac for 3 months. Using logistic and Cox regression, we assessed associations between app adherence, correct app entry, AEFIs, and sociodemographic parameters. Results Of the individuals who logged into SafeVac, 61.4% (207/337) used the app throughout a 3-month period. App use adherence was negatively associated with female sex (odds ratio [OR] 0.47; CI 0.25-0.91) and correct app entry was negatively associated with older age (OR 0.96; CI 0.93-0.99) and lower education (OR 0.31; CI 0.13-0.76). AEFI occurrence was associated with female sex (hazard ratio 1.41; CI 1.01-1.96) and negatively with older age (hazard ratio 0.98; CI 0.97-0.99). The most common AEFIs reported were injection site pain (106/337), pain in extremity (103/337), and fatigue/asthenia (73/337). Conclusions Digital AEFI reporting was feasible with SafeVac and generated plausible results for this observation period and setting. Studies directly comparing SafeVac with conventional passive reporting schemes could determine whether such digital approaches improve completeness, timeliness, and sensitivity of vaccine vigilance. Further studies should evaluate if these results are transferable to other vaccinations and populations and if introduction of such a tool has an influence on vaccination readiness and therefore vaccine safety.
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Affiliation(s)
- Minh Tam H Nguyen
- PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany
| | - Gérard Krause
- PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany.,Hannover Medical School, Hannover, Germany
| | | | - Stephan Glöckner
- PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany
| | | | - Jördis J Ott
- PhD Programme Epidemiology, Hannover Biomedical Research School, Hannover Medical School, Hannover, Germany.,Hannover Medical School, Hannover, Germany
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9
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Karch A, Schindler D, Kühn-Steven A, Blaser R, Kuhn KA, Sandmann L, Sommerer C, Guba M, Heemann U, Strohäker J, Glöckner S, Mikolajczyk R, Busch DH, Schulz TF. The transplant cohort of the German center for infection research (DZIF Tx-Cohort): study design and baseline characteristics. Eur J Epidemiol 2021; 36:233-241. [PMID: 33492549 PMCID: PMC7987595 DOI: 10.1007/s10654-020-00715-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/19/2020] [Indexed: 01/14/2023]
Abstract
Infectious complications are the major cause of morbidity and mortality after solid organ and stem cell transplantation. To better understand host and environmental factors associated with an increased risk of infection as well as the effect of infections on function and survival of transplanted organs, we established the DZIF Transplant Cohort, a multicentre prospective cohort study within the organizational structure of the German Center for Infection Research. At time of transplantation, heart-, kidney-, lung-, liver-, pancreas- and hematopoetic stem cell- transplanted patients are enrolled into the study. Follow-up visits are scheduled at 3, 6, 9, 12 months after transplantation, and annually thereafter; extracurricular visits are conducted in case of infectious complications. Comprehensive standard operating procedures, web-based data collection and monitoring tools as well as a state of the art biobanking concept for blood, purified PBMCs, urine, and faeces samples ensure high quality of data and biosample collection. By collecting detailed information on immunosuppressive medication, infectious complications, type of infectious agent and therapy, as well as by providing corresponding biosamples, the cohort will establish the foundation for a broad spectrum of studies in the field of infectious diseases and transplant medicine. By January 2020, baseline data and biosamples of about 1400 patients have been collected. We plan to recruit 3500 patients by 2023, and continue follow-up visits and the documentation of infectious events at least until 2025. Information about the DZIF Transplant Cohort is available at https://www.dzif.de/en/working-group/transplant-cohort.
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Affiliation(s)
- André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany. .,German Center for Infection Research, Hannover-Braunschweig Site, Brunswick, Germany.
| | - Daniela Schindler
- Department of Nephrology, Klinikum rechts der Isar of the Technical University Munich, Munich, Germany.,German Center for Infection Research, Munich Site, Munich, Germany
| | - Andrea Kühn-Steven
- German Center for Infection Research, Munich Site, Munich, Germany.,German Research Center for Environmental Health, Helmholtz Zentrum München, Munich, Germany
| | - Rainer Blaser
- German Center for Infection Research, Munich Site, Munich, Germany.,Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Munich, Germany
| | - Klaus A Kuhn
- German Center for Infection Research, Munich Site, Munich, Germany.,Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Munich, Germany
| | - Lisa Sandmann
- German Center for Infection Research, Hannover-Braunschweig Site, Brunswick, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School (MHH), Hannover, Germany
| | - Claudia Sommerer
- German Center for Infection Research, Heidelberg Site, Heidelberg, Germany.,Nierenzentrum Heidelberg, Heidelberg, Germany
| | - Markus Guba
- German Center for Infection Research, Munich Site, Munich, Germany.,Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar of the Technical University Munich, Munich, Germany.,German Center for Infection Research, Munich Site, Munich, Germany
| | - Jens Strohäker
- German Center for Infection Research, Tübingen Site, Tübingen, Germany.,University Hospital for General, Visceral and Transplant Surgery, Tübingen, Germany
| | - Stephan Glöckner
- German Center for Infection Research, Hannover-Braunschweig Site, Brunswick, Germany.,Epidemiology, Helmholtz Center for Infection Research Braunschweig, Brunswick, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Dirk H Busch
- German Center for Infection Research, Munich Site, Munich, Germany.,Institute for Medical Microbiology, Immunology and Hygiene (MIH), Technical University of Munich, Munich, Germany
| | - Thomas F Schulz
- German Center for Infection Research, Hannover-Braunschweig Site, Brunswick, Germany.,Institute of Virology, Hannover Medical School (MHH), Hannover, Germany
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10
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Fricke LM, Glöckner S, Dreier M, Lange B. Impact of non-pharmaceutical interventions targeted at COVID-19 pandemic on influenza burden - a systematic review. J Infect 2021; 82:1-35. [PMID: 33278399 PMCID: PMC9183207 DOI: 10.1016/j.jinf.2020.11.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To better understand the impact of comprehensive COVID-19 targeted non-pharmaceutical interventions (NPIs) on influenza burden worldwide. METHODS We conducted a systematic literature search in selected databases (PubMed, WHO COVID-19), preprint servers (medRxiv, bioRxiv) and websites of European Public Health institutes. Documents that compared influenza estimates in the 2019/2020 season with previous seasons were included. Information synthesis was qualitative due to a high heterogeneity in the number and periods of comparative seasons, outcome measures and statistical methods. RESULTS We included 23 records reporting from 15 countries/regions as well as 8 reports from European Public Health agencies. Estimates in the 2019/2020 season based on influenza virus tests (4 out of 7 countries/regions), defined influenza cases (8 out of 9), influenza positivity rate (7 out of 8), and severe complications (1 out of 2) were lower than in former seasons. Results from syndromic indicators, such as influenza-like-illness (ILI), were less clear or even raised (4 out of 7) after the influenza season indicating a misclassification with COVID-19 cases. CONCLUSIONS Evidence synthesis suggests that NPIs targeted at SARS-CoV-2-transmission reduce influenza burden as well. Low threshold NPIs need to be more strongly emphasized in influenza prevention strategies.
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Affiliation(s)
- Lara Marleen Fricke
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124 Braunschweig, Germany; Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Stephan Glöckner
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124 Braunschweig, Germany; German Center for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
| | - Maren Dreier
- Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Berit Lange
- Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124 Braunschweig, Germany; German Center for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany.
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11
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Sargeant A, von Landesberger T, Baier C, Bange F, Dalpke A, Eckmanns T, Glöckner S, Kaase M, Krause G, Marschollek M, Malone B, Niepert M, Rey S, Wulff A, Scheithauer S. Early Detection of Infection Chains & Outbreaks: Use Case Infection Control. Stud Health Technol Inform 2019; 258:245-246. [PMID: 30942759] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Within the HiGHmed Project there are three medical use cases. The use cases include the scopes cardiology, oncology and infection. They serve to specify the requirements for the development and implementation of a local and federated platform, with the result that data from medical care and research should be retrievable, reusable and interchangeable. The Use Case Infection Control aims to establish an early detection of transmission events as well as clusters and outbreaks of various pathogens. Therefore the use case wants to establish the smart infection control system (SmICS).
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Affiliation(s)
| | | | | | | | | | | | | | - M Kaase
- University Medicine Goettingen
| | - G Krause
- Helmholtz Centre for Infection Research
| | - M Marschollek
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School
| | | | | | - S Rey
- University Medicine Goettingen
| | - A Wulff
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School
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12
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Dreyer H, Grischke J, Tiede C, Eberhard J, Schweitzer A, Toikkanen SE, Glöckner S, Krause G, Stiesch M. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018; 53:657-681. [PMID: 29882313 DOI: 10.1111/jre.12562] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
The purpose of this systematic review and meta-analysis was to assess the prevalence, incidence and risk factors of peri-implantitis in the current literature. An electronic search was performed to identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri-implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta-analysis were performed for selected potential risk factors of peri-implantitis. The search retrieved 8357 potentially relevant studies. Fifty-seven studies were included in the systematic review. Overall, the prevalence of peri-implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri-implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non-smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium-high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25-2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4-4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri-implantitis. There is medium-high evidence that patient's age (effect summary OR 1.0, 95% CI 0.87-1.16), gender and maxillary implants are not related to peri-implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri-implantitis. Based on the data analyzed in this systematic review, insufficient high-quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri-implantitis; however, this study design may contribute to examine further the potential risk factors.
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Affiliation(s)
- H Dreyer
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - J Grischke
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - C Tiede
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - J Eberhard
- Faculty of Dentistry and the Charles Perkins Centre, University of Sydney, Sydney, NSW,, Australia
| | - A Schweitzer
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S E Toikkanen
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Translational Infrastructure Epidemiology, German Centre for Infection Research, Braunschweig, Germany
| | - G Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Twincore, Centre for Experimental and Clinical Infections Research, Hanover, Germany.,Hannover Medical School, Hanover, Germany
| | - M Stiesch
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
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13
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Glöckner S, Schindler D, Karch A. Interactive Feedback of Data Quality in Clinical Research. A Case Study from an Infectious Diseases Cohort. Stud Health Technol Inform 2018; 253:23-27. [PMID: 30147033] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To improve data quality, clinical cohort studies require ongoing centralized data monitoring. Results of data quality monitoring are often reported in a general format, without individual feedback for different types of users within the research consortium. Several R packages provide the possibility for an easy to use approach to analyze and communicate information in interactive web-based forms. This article describes a pilot, which is applied in a German infectious disease cohort using interactive feedback and gamification to report data quality, to ultimately increase the quality of research outcomes.
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Affiliation(s)
- Stephan Glöckner
- Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | | | - André Karch
- Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
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14
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Tom-Aba D, Toikkanen SE, Glöckner S, Adeoye O, Mall S, Fähnrich C, Denecke K, Benzler J, Kirchner G, Schwarz N, Poggensee G, Silenou BC, Ameh CA, Nguku P, Olubunmi O, Ihekweazu C, Krause G. User Evaluation Indicates High Quality of the Surveillance Outbreak Response Management and Analysis System (SORMAS) After Field Deployment in Nigeria in 2015 and 2018. Stud Health Technol Inform 2018; 253:233-237. [PMID: 30147081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
During the West African Ebola virus disease outbreak in 2014-15, health agencies had severe challenges with case notification and contact tracing. To overcome these, we developed the Surveillance, Outbreak Response Management and Analysis System (SORMAS). The objective of this study was to measure perceived quality of SORMAS and its change over time. We ran a 4-week-pilot and 8-week-implementation of SORMAS among hospital informants in Kano state, Nigeria in 2015 and 2018 respectively. We carried out surveys after the pilot and implementation asking about usefulness and acceptability. We calculated the proportions of users per answer together with their 95% confidence intervals (CI) and compared whether the 2015 response distributions differed from those from 2018. Total of 31 and 74 hospital informants participated in the survey in 2015 and 2018, respectively. In 2018, 94% (CI: 89-100%) of users indicated that the tool was useful, 92% (CI: 86-98%) would recommend SORMAS to colleagues and 18% (CI: 10-28%) had login difficulties. In 2015, the proportions were 74% (CI: 59-90%), 90% (CI: 80-100%), and 87% (CI: 75-99%) respectively. Results indicate high usefulness and acceptability of SORMAS. We recommend mHealth tools to be evaluated to allow repeated measurements and comparisons between different versions and users.
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Affiliation(s)
- Daniel Tom-Aba
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
| | - Salla E Toikkanen
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
| | - Stephan Glöckner
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
| | | | | | | | - Kerstin Denecke
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
| | | | | | - Norbert Schwarz
- Bernhard-Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Bernard C Silenou
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
| | | | - Patrick Nguku
- African Field Epidemiology Network (AFENET), Abuja, Nigeria
| | - Ojo Olubunmi
- Nigeria Center for Disease Control (NCDC), Abuja, Nigeria
| | | | - Gérard Krause
- Helmholtz Centre for Infection Research, Epidemiology, Braunschweig, Germany
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15
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Toikkanen SE, Adeoye O, Ameh C, Glöckner S, Poggensee G, Krause G. Piloting SORMAS (Surveillance Outbreak Response Management and Analysis System): Association between task execution time and user feedback. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- SE Toikkanen
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
| | - O Adeoye
- African Field Epidemiology Network (AFENET), Abuja
| | - C Ameh
- African Field Epidemiology Network (AFENET), Abuja
| | - S Glöckner
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
| | - G Poggensee
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja
| | - G Krause
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
- Twincore, Centre for Experimental and Clinical Infections Research, Hanover
- Hanover Medical School (MHH), Hanover
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16
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Glöckner S, Schäfer F, Rübsamen N, Krause G, Castell S. Acceptance of self-reporting technologies and self-sampling of biospecimen in infectious disease epidemiology: a survey in Lower Saxony. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Glöckner
- German Center for Infection Research (DZIF), Braunschweig
| | - F Schäfer
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
| | - N Rübsamen
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
| | - G Krause
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
- Twincore, Centre for Experimental and Clinical Infections Research, Hanover
- Hanover Medical School (MHH), Hanover
| | - S Castell
- Helmholtz Center for Infection Research, Epidemiology, Braunschweig
- Twincore, Centre for Experimental and Clinical Infections Research, Hanover
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17
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Pamporaki C, Därr R, Bursztyn M, Glöckner S, Bornstein SR, Lenders JWM, Pacak K, Krinner A, Eisenhofer G. Plasma-free vs deconjugated metanephrines for diagnosis of phaeochromocytoma. Clin Endocrinol (Oxf) 2013; 79:476-83. [PMID: 23461656 PMCID: PMC3762922 DOI: 10.1111/cen.12191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/13/2013] [Accepted: 02/09/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of phaeochromocytoma is commonly performed by the measurements of plasma-free normetanephrine and metanephrine. Plasma-deconjugated normetanephrine and metanephrine have been proposed as alternative, equivalent, but easier to measure biomarkers. OBJECTIVE The aim of this study was to compare the diagnostic performance of plasma-free vs deconjugated normetanephrine and metanephrine in patients tested for phaeochromocytoma. METHODS The study population included a reference group of 262 normotensive and hypertensive volunteers, 198 patients with phaeochromocytoma and 528 patients initially suspected of having the tumour, but with negative investigations after at least 2 years of follow-up. Measurements were performed using liquid chromatography with electrochemical detection. RESULTS Plasma concentrations of free normetanephrine were 17-fold higher in patients with phaeochromocytoma than in the reference population, a 72% larger (P < 0·001) difference than that for the 10-fold higher levels of plasma-deconjugated normetanephrine. In contrast, relative increases in plasma concentrations of free and deconjugated metanephrine were similar. Using upper cut-offs established in the reference population, measurements of plasma-free metabolites provided superior diagnostic performance than deconjugated metabolites according to measures of both sensitivity (97% vs 92%, P = 0·002) and specificity (93% vs 89%, P = 0·012). The area under the receiver operating characteristic curve for the free metabolites was larger than that for the deconjugated metabolites (0·986 vs 0·965, P < 0·001). CONCLUSION Measurements of plasma-free normetanephrine and metanephrine are superior to the deconjugated metabolites for diagnosis of phaeochromocytoma.
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Affiliation(s)
- Christina Pamporaki
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, Dresden, Germany.
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18
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Eisenhofer G, Brown S, Peitzsch M, Pelzel D, Lattke P, Glöckner S, Stell A, Prejbisz A, Fassnacht M, Beuschlein F, Januszewicz A, Siegert G, Reichmann H. Levodopa therapy in Parkinson's disease: influence on liquid chromatographic tandem mass spectrometric-based measurements of plasma and urinary normetanephrine, metanephrine and methoxytyramine. Ann Clin Biochem 2013; 51:38-46. [PMID: 23873873 DOI: 10.1177/0004563213487894] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 11/15/2022]
Abstract
BACKGROUND Medication-related interferences with measurements of catecholamines and their metabolites represent important causes of false-positive results during diagnosis of phaeochromocytomas and paragangliomas (PPGLs). Such interferences are less troublesome with measurements by liquid chromatography with tandem mass-spectrometry (LC-MS/MS) than by other methods, but can still present problems for some drugs. Levodopa, the precursor for dopamine used in the treatment of Parkinson's disease, represents one potentially interfering medication. METHODS Plasma and urine samples, obtained from 20 Parkinsonian patients receiving levodopa, were analysed for concentrations of catecholamines and their O-methylated metabolites by LC-MS/MS. Results were compared with those from a group of 120 age-matched subjects and 18 patients with PPGLs. RESULTS Plasma and urinary free and deconjugated (free + conjugated) methoxytyramine, as well as urinary dopamine, showed 22- to 148-fold higher (P < 0.0001) concentrations in patients receiving levodopa than in the reference group. In contrast, plasma normetanephrine, urinary noradrenaline and urinary free and deconjugated normetanephrine concentrations were unaffected. Plasma free metanephrine, urinary adrenaline and urinary free and deconjugated metanephrine all showed higher (P < 0.05) concentrations in Parkinsonian patients than the reference group, but this was only a problem for adrenaline. Similar to normetanephrine, plasma and urinary metanephrine remained below the 97.5 percentiles of the reference group in almost all Parkinsonian patients. CONCLUSIONS These data establish that although levodopa treatment confounds identification of PPGLs that produce dopamine, the therapy is not a problem for use of LC-MS/MS measurements of plasma and urinary normetanephrine and metanephrine to diagnose more commonly encountered PPGLs that produce noradrenaline or adrenaline.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University of Dresden, Dresden, Germany
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19
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Wiggermann P, Jung EM, Glöckner S, Hoffstetter P, Uller W, Vasilj A, Schreyer A, Stroszczynski C. Real-time elastography of hepatic thermal lesions in vitro: histopathological correlation. Ultraschall Med 2012; 33:170-174. [PMID: 22161611 DOI: 10.1055/s-0031-1281904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate the reliability of elastography, a new ultrasonographic method, for delineating thermal lesion boundaries in porcine liver tissue by comparing lesion dimensions determined by real-time elastography with the findings at gross pathology. MATERIALS AND METHODS A total of 15 thermal lesions with diameters ranging from 17 to 60 mm were created using radiofrequency ablation (RFA). Color-coded elastography was performed by one experienced examiner, using a 6 - 15 MHz high frequency linear transducer (LOGIQ E9, GE). Lesions were examined using B-mode and real-time elastography (RTE). Lesion detection, delineation and size were assessed using B-mode and RTE immediately after each thermal ablation ( < 5 min). Measurements of the sections representing the same image plane used for elastography were taken during pathologic examination and compared to the measurements obtained from the elastograms. RESULTS In our sample a statistically significant correlation in vitro between RTE and pathological measurements with respect to the lesion's principal axis and area (r2 = 0.9338 long axis, r2 = 0.8998 short axis and r2 = 0.9676 area) was found. Overall, elastography slightly underestimated the lesion size, as judged by the digitalized pathologic images. CONCLUSION These results support that RTE outperforms conventional B-mode ultrasound and could potentially be used for the routine assessment of thermal therapies.
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Affiliation(s)
- P Wiggermann
- Institut für Röntgendiagnostik, Klinikum der Universität Regensburg, Germany.
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20
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Glöckner S, Lehmann U, Wilke N, Kleeberger W, Länger F, Kreipe H. Detection of gene amplification in intraductal and infiltrating breast cancer by laser-assisted microdissection and quantitative real-time PCR. Pathobiology 2001; 68:173-9. [PMID: 11279343 DOI: 10.1159/000055920] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Gene amplification is one essential mechanism leading to oncogene activation which is supposed to play a major role in the pathogenesis of invasive breast cancer. However, using standard methodologies the detection of gene amplifications has been limited especially in small-sized lesions, like pre-invasive precursor lesions. The combination of two novel technologies, laser-based microdissection and quantitative real-time PCR, facilitates the detection of low-level amplifications in morphologically defined lesions. As a model system we investigated in situ breast cancer (ductal carcinoma in situ, DCIS) classified according to the morphology-based Van Nuys grading system for amplification of growth-regulatory genes. In this study 83 formalin-fixed, paraffin-embedded archival DCIS specimens were examined after laser-based microdissection by quantitative real-time PCR using the TaqMan detection system for amplification of the c-erbB2, topoisomerase IIalpha, c-myc and cyclinD1 gene. In a subset of 17 DCIS with adjacent infiltrating tumour components we compared intraductal and invasive tumour components in parallel for differences in amplification status. The combination of these new techniques represents an excellent tool to gain new insights into carcinogenesis by analyzing genetic alterations in morphologically identified heterogeneous lesions in breast cancer progression within the very same specimen or even tissue slide.
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MESH Headings
- Antigens, Neoplasm/genetics
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Cell Separation/instrumentation
- Cell Separation/methods
- Cyclin D1/genetics
- DNA Topoisomerases, Type II/genetics
- DNA-Binding Proteins
- Dissection/instrumentation
- Dissection/methods
- Female
- Gene Amplification/genetics
- Genotype
- Humans
- Isoenzymes/genetics
- Lasers
- Phenotype
- Polymerase Chain Reaction/methods
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Affiliation(s)
- S Glöckner
- Institute of Pathology, Medizinische Hochschule Hannover, Germany.
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21
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Abstract
Laser microdissection enables the contamination-free isolation of morphologically defined pure cell populations from archival formalin-fixed paraffin-embedded tissue specimens. Cells isolated by this method have been characterized by a wide variety of qualitative molecular assays, e.g. loss of heterozygosity, point mutations, clonality and lineage origin. The recently introduced real-time PCR technology renders the reliable quantification of very small amounts of nucleic acids possible. Several groups including our own showed that this technique can be successfully applied for the quantification of DNA and RNA isolated from microdissected archival tissue sections, even after immunohistochemical staining. The exact analysis of quantitative changes of nucleic acids during the course of pathological alterations has thus become possible. In many situations these quantitative changes can be expected to be more important than qualitative changes. The new technology for the quantification of structural genomic alterations and changes in the gene expression pattern in conjunction with microdissection have equipped morphologists with a powerful tool to study reactive and neoplastic changes of tissues.
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Affiliation(s)
- U Lehmann
- Institute of Pathology, Medizinische Hochschule Hannover, Germany.
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22
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Kleeberger W, Rothämel T, Glöckner S, Lehmann U, Kreipe H. Laser-assisted microdissection and short tandem repeat PCR for the investigation of graft chimerism after solid organ transplantation. Pathobiology 2001; 68:196-201. [PMID: 11279346 DOI: 10.1159/000055923] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The detection of donor-derived cells in the blood and tissues of graft recipients after solid organ transplantation is a readily observed phenomenon called microchimerism. Yet very little is known about the persistence and integration of recipient-derived cells in the transplanted organ, indicating a form of intragraft chimerism. To further study this phenomenon and its possible influence on graft acceptance or rejection, we developed the following novel approach. Immunohistochemically labeled cells were isolated by means of laser-based microdissection and subsequent laser pressure catapulting from paraffine-embedded posttransplantation biopsies. The following use of a highly sensitive PCR assay analyzing one polymorphic short tandem repeat (STR) marker enabled us to clearly identify the genotypes in samples containing as little as 10 isolated cells. The combination of laser-based microdissection and STR-PCR thus provides a powerful tool for the genotyping of even very few cells isolated from routinely processed biopsies after solid organ transplantation.
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Affiliation(s)
- W Kleeberger
- Institute of Pathology, Medizinische Hochschule Hannover, Germany.
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23
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Glöckner S, Lehmann U, Wilke N, Kleeberger W, Länger F, Kreipe H. Amplification of growth regulatory genes in intraductal breast cancer is associated with higher nuclear grade but not with the progression to invasiveness. J Transl Med 2001; 81:565-71. [PMID: 11304576 DOI: 10.1038/labinvest.3780265] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ductal carcinoma in situ (DCIS), as an identifiable progenitor lesion of invasive breast cancer, represents a morphologically, biologically, and prognostically heterogeneous disease. It is not clear which molecular mechanisms are involved in progression to infiltrative growth. In this study, 83 DCIS classified according to the Van Nuys grading scheme were examined for amplification of growth regulatory genes that have been found to be amplified in invasive breast cancer (c-erbB2, topoisomerase IIalpha, c-myc, and cyclinD1 genes). Exact quantification of gene amplification was enabled by a combination of laser microdissection of paraffin-embedded tissue with real-time PCR. In DCIS, gene amplifications of all tested genes were found. The most frequently amplified gene was c-erbB2 found in 21 of 83 (25%) cases. Amplification of the other genes under investigation was observed in 4% to 6% of cases, high-grade DCIS being predominantly affected. High-grade DCIS differed significantly from low- and intermediate-grade DCIS in frequency and level of c-erbB2 amplification. In addition, high-grade DCIS revealed an accumulation of genetic aberrations. Amplification status in pure in situ lesions did not differ from intraductal carcinoma with an infiltrative component, indicating that although associated with a higher nuclear grade gene amplification might not represent an independent prognostic marker of disease progression.
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MESH Headings
- Breast Neoplasms/classification
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/classification
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Cell Nucleus/ultrastructure
- Disease Progression
- Female
- Gene Amplification
- Gene Expression Regulation, Neoplastic
- Genes, erbB-2
- Growth Substances/genetics
- Humans
- Neoplasm Invasiveness
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Affiliation(s)
- S Glöckner
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
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Lehmann U, Glöckner S, Kleeberger W, von Wasielewski HF, Kreipe H. Detection of gene amplification in archival breast cancer specimens by laser-assisted microdissection and quantitative real-time polymerase chain reaction. Am J Pathol 2000; 156:1855-64. [PMID: 10854209 PMCID: PMC1850085 DOI: 10.1016/s0002-9440(10)65059-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gene amplification is one of the most important mechanisms leading to deregulated gene expression in cancer. The exact quantitative detection of this frequent genomic alteration in solid tumors is often hampered by an admixture of nonneoplastic bystander and stroma cells. To overcome this obstacle and to develop an objective quantitative method we have combined laser-assisted microdissection of tumor cells with the novel 5'-exonuclease-based real-time polymerase chain reaction (PCR) assay. The latter method enables the highly reproducible exact quantification of minute amounts of nucleic acids. As a model system amplification of c-erbB2/Her-2/neu gene and the adjacent topoisomerase IIalpha gene was determined in paraffin-embedded breast cancer specimens (n = 23) after immunohistochemical labeling and laser-based microdissection of tumor cells. The high sensitivity of real-time PCR enabled the reliable and objective detection of low-level amplifications in as few as 50 cells from archival tissue sections. Low-level amplifications were shown to escape from detection unless tumor cells were isolated by microdissection. In selected cases intratumor heterogeneity was demonstrated using areas of approximately 50 to 100 cells. This novel approach combining immunohistochemistry, laser microdissection, and quantitative kinetic PCR allows morphology-guided studies in archival tissue specimens and will enable the exact quantification of gene copy numbers in even small and precancerous lesions.
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Affiliation(s)
- U Lehmann
- Institute of Pathology, Medizinische Hochschule Hannover, Germany.
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25
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Lehmann U, Glöckner S, Kleeberger W, von Wasielewski R, Kreipe H. Exact quantification of gene amplification in archival tissue sections by laser-assisted microdissection and real-time PCR. Breast Cancer Res 2000. [PMCID: PMC3300873 DOI: 10.1186/bcr175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
We investigate the behavior of microlens arrays consisting of lenslets that have statistically distributed parameters (focal length, offset phase, lens center). In theoretical investigations we introduce a lens-array coherence parameter kappa, which describes the statistical variations of the lenslets. In experiments we measured this parameter for concrete lens arrays.
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Abstract
A light modulator with microlens arrays in a confocal arrangement and with various filters in the common focal plane of the arrays, which are translated with the help of piezoelectric actuators, is proposed. The theoretical analysis deals with the influence of the lens arrays on the performance of the modulator. The system is investigated for spatially incoherent beams. It is shown that the configuration is suited for efficient modulation of radiation emitted by multimode fibers. A choice of the proper focal length of the microlens arrays and lens pitch d results in a good transmission efficiency (above 90%) combined with a large number of possible switching states.
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