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Engel T, Hagelstein F, Rocco M, Sharkovska V, Signer A, Ulrich Y. Impact of NNLO QED corrections on lepton-proton scattering at MUSE. Eur Phys J A Hadron Nucl 2023; 59:253. [PMID: 37927902 PMCID: PMC10624749 DOI: 10.1140/epja/s10050-023-01153-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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
We present the complete next-to-next-to-leading order (NNLO) pure pointlike QED corrections to lepton-proton scattering, including three-photon-exchange contributions, and investigate their impact in the case of the MUSE experiment. These corrections are computed with no approximation regarding the energy of the emitted photons and taking into account lepton-mass effects. We contrast the NNLO QED corrections to known next-to-leading order corrections, where we include the elastic two-photon exchange (TPE) through a simple hadronic model calculation with a dipole ansatz for the proton electromagnetic form factors. We show that, in the low-momentum-transfer region accessed by the MUSE experiment, the improvement due to more sophisticated treatments of the TPE, including inelastic TPE, is of similar if not smaller size than some of the NNLO QED corrections. Hence, the latter have to be included in a precision determination of the low-energy proton structure from scattering data, in particular for electron-proton scattering. For muon-proton scattering, the NNLO QED corrections are considerably smaller.
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Affiliation(s)
- T. Engel
- Albert-Ludwigs-Universität Freiburg, Physikalisches Institut, Hermann-Herder-Straße 3, 79104 Freiburg, Germany
| | - F. Hagelstein
- Institute of Nuclear Physics and PRISMA+ Cluster of Excellence, Johannes Gutenberg-Universität, 55099 Mainz, Germany
- Paul Scherrer Institut, PSI, 5232 Villigen, Switzerland
| | - M. Rocco
- Paul Scherrer Institut, PSI, 5232 Villigen, Switzerland
| | - V. Sharkovska
- Paul Scherrer Institut, PSI, 5232 Villigen, Switzerland
- Physik-Institut, Universität Zürich, 8057 Zurich, Switzerland
| | - A. Signer
- Paul Scherrer Institut, PSI, 5232 Villigen, Switzerland
- Physik-Institut, Universität Zürich, 8057 Zurich, Switzerland
| | - Y. Ulrich
- Department of Physics, Institute for Particle Physics Phenomenology, Durham University, Durham, DH1 3LE UK
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Engel T, Dotan E, Synett Y, Held R, Soffer S, Ben‐Horin S, Kopylov U. Self-reported treatment effectiveness for Crohn's disease using a novel crowdsourcing web-based platform. United European Gastroenterol J 2023; 11:621-632. [PMID: 37370250 PMCID: PMC10493337 DOI: 10.1002/ueg2.12424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Internet and social media platforms have become an unprecedented source for sharing self-experience, potentially allowing the collection and integration of health data with patient experience. StuffThatWorks (STW) is an online open platform that applies machine learning and the power of crowdsourcing, where patients with chronic medical conditions can self-report and compare their individual outcomes using a structured online questionnaire. We aimed to conduct a cross-sectional, international, crowdsourcing, artificial-intelligence (AI) web-based study of patients with Crohn's disease (CD) self-reporting their outcomes. METHODS A proprietary STW Bayesian inference model was built to measure improvement in CD severity (on scale of 1-5) for each treatment and ranked treatments using effectiveness. The effectiveness of first-line biological treatments was analyzed by multiple comparisons and by calculating odds ratios and 95% confidence intervals for each treatment pair. RESULTS We included 7593 self-reported CD patients for the analysis. Most of the participants were female (75.8%) and from English-speaking countries (95.7%). Overall, anti-TNF drugs were the most reported tried treatment (52.8%). Infliximab (IFX) was ranked as the most effective treatment by the STW effectiveness model followed by bowel surgery (second), adalimumab (ADA, third), ustekinumab (UST, 4rd), and vedolizumab (VDZ, fifth). In paired comparison analyses, IFX was most effective, ADA had similar effectiveness compared to UST and all three were more effective than VDZ. CONCLUSION We present the first online crowdsourcing AI platform-based study of self-reported treatment effectiveness in CD. Net-based crowdsourcing patient-reported outcome platforms can potentially help both clinicians and patients select the best treatment for their condition.
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Affiliation(s)
- Tal Engel
- Department of GastroenterologySheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Eran Dotan
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- StuffThatWorks©Tel AvivIsrael
| | | | | | - Shelly Soffer
- Internal Medicine BAssuta Medical CenterAshdodIsrael
- Ben‐Gurion University of the NegevBe'er ShevaIsrael
| | - Shomron Ben‐Horin
- Department of GastroenterologySheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Uri Kopylov
- Department of GastroenterologySheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Carter D, Ram E, Engel T. Combined 3D Endoanal Ultrasound and Transperineal Ultrasound Improves the Detection of Anal Sphincter Defects. Diagnostics (Basel) 2023; 13:diagnostics13040682. [PMID: 36832170 PMCID: PMC9955566 DOI: 10.3390/diagnostics13040682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal muscle injury. However, 3D EAUS accuracy may be hampered by regional acoustic effects, such as intravaginal air. Therefore, our aim was to examine whether a combination of transperineal ultrasound (TPUS) and 3D EAUS would improve the accuracy of detection of anal sphincter injury. METHODS We prospectively performed 3D EAUS followed by TPUS in every patient evaluated for FI in our clinic between January 2020 and January 2021. The diagnosis of anal muscle defects was assessed in each ultrasound technique by two experienced observers that were blinded to each other's assessments. Interobserver agreement for the results of the 3D EAUS and the TPUS exams was examined. A final diagnosis of anal sphincter defect was based on the results of both ultrasound methods. Discordant results were re-analyzed by the two ultrasonographers for a final consensus on the presence or absence of defects. RESULTS A total of 108 patients underwent ultrasonographic assessment due to FI (mean age 69 ± 13). Interobserver agreement for the diagnosis of tear on EAUS and TPUS was high (83%) with Cohen's kappa of 0.62. EAUS confirmed anal muscle defects in 56 patients (52%), while TPUS confirmed them in 62 patients (57%). The final consensus agreed on the diagnosis of 63 (58%) muscular defects and 45 (42%) normal exams. The Cohen's kappa coefficient of agreement between the results of the 3D EAUS and the final consensus was 0.63. CONCLUSIONS The combination of 3D EAUS and TPUS improved the detection of anal muscular defects. The application of both techniques for the assessment of the anal integrity should be considered in every patient going through ultrasonographic assessment for anal muscular injury.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomer, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-35307729
| | - Edward Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department Surgery B, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Tal Engel
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomer, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Veisman I, Oppenheim A, Sub laban Z, Kenig A, Ukashi O, Shacham-Shmueli E, Engel T, Kopylov U, Ben-Horin S, Lang A. Disproportionately Low Albumin and High Neutrophil-to-Lymphocyte Ratio in Small Bowel Adenocarcinoma Patients With Long-Duration Crohn's Disease. Clin Transl Gastroenterol 2023; 14:e00553. [PMID: 36449698 PMCID: PMC9945550 DOI: 10.14309/ctg.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although Crohn's disease (CD) is a known risk factor of small bowel adenocarcinoma (SBA), early diagnosis remains a significant clinical challenge. Identification of biomarkers for SBA may lead to early detection. METHODS This is a retrospective study comparing albumin levels and neutrophil-to-lymphocyte ratio (NLR) of patients with long-standing CD who underwent small bowel resection with and without malignancy. RESULTS Forty-two patients with CD were included in this study (11 with SBA). Median NLR before surgery was 8.5 (interquartile range 6.2-31.3) in patients with SBA and 3.8 (interquartile range 2.8-5.3) for patients without SBA ( P < 0.05). Mean albumin levels before surgery were significantly lower among patients with SBA compared with patients without SBA (2.6 ± 0.6 g/dL vs 3.5 ± 0.6 g/dL, respectively, P < 0.05), despite patients with SBA being under longer total parenteral nutrition treatment duration. DISCUSSION CD patients with SBA diagnosis have increased NLR and lower albumin before surgery compared with CD patients without detection of SBA.
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Affiliation(s)
- Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Oppenheim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Zuheir Sub laban
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Kenig
- Faculty of Medicine, the Hebrew University, Jerusalem, Israel
- Oncology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tal Engel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Lang
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ben-Horin S, Har-Noy O, Katsanos KH, Roblin X, Chen M, Gao X, Schwartz D, Cheon JH, Cesarini M, Bojic D, Protic M, Theodoropoulou A, Abu-Kaf H, Engel T, Tang J, Veyrard P, Lin X, Mao R, Christodoulou D, Karmiris K, Knezevic-Ivanovski T. Corticosteroids and Mesalamine Versus Corticosteroids for Acute Severe Ulcerative Colitis: A Randomized Controlled Trial. Clin Gastroenterol Hepatol 2022; 20:2868-2875.e1. [PMID: 35272029 DOI: 10.1016/j.cgh.2022.02.055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC). However, whether the addition/continuation of mesalamine with corticosteroids during hospitalization is superior to corticosteroids alone is unknown. METHODS This was a randomized controlled, investigator-blinded, clinical trial conducted in 10 centers in 7 countries. Patients hospitalized with ASUC (Lichtiger score ≥10) were eligible. Patients received corticosteroids alone or corticosteroid + mesalamine (4 g/day mesalamine) by a stratified randomization according to mesalamine use before admission. The primary outcome was the percentage of patients who responded to treatment by day 7, defined by a drop >3 points in the Lichtiger score and an absolute score <10 without the need for rescue medications or colectomy. RESULTS Three hundred forty-six patients were screened, and 149 were included (70/149 female; median age, 41 years). Of these, 73 received corticosteroids + mesalamine, and 76 received corticosteroids alone. For the primary outcome, 53 of 73 patients (72.6%) receiving corticosteroids with mesalamine responded versus 58 of 76 patients (76.3%) on corticosteroids alone (odds ratio, 0.82; 95% confidence interval, 0.39-1.72; P = .60). There was no difference between groups in duration of hospitalization, C-reactive protein normalization rate, or colectomy rate up to day 90. The need for biologics among patients receiving combination of corticosteroids with mesalamine was numerically lower by day 30 (P = .11) and day 90 (P = .07). CONCLUSIONS In this randomized controlled trial, combination of mesalamine with corticosteroids did not benefit hospitalized patients with ASUC more than corticosteroids alone. An exploratory signal for a reduced need for biologics at 90 days in the mesalamine group merits further evaluation. CLINICALTRIALS gov ID: NCT01941589.
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Affiliation(s)
- Shomron Ben-Horin
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Ofir Har-Noy
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Xavier Roblin
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Minhu Chen
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiang Gao
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Monica Cesarini
- Dipartimento di Medicina Interna e Specialità Mediche, "Sapienza", University of Rome, Rome, Italy
| | - Daniela Bojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Marijana Protic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | | | - Heba Abu-Kaf
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tal Engel
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jian Tang
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pauline Veyrard
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Xiaoqing Lin
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ren Mao
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dimitrios Christodoulou
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
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Yablecovitch D, Ben-Horin S, Picard O, Yavzori M, Fudim E, Nadler M, Levy I, Sakhnini E, Lang A, Engel T, Lahav M, Saker T, Neuman S, Selinger L, Dvir R, Raitses-Gurevich M, Golan T, Laish I. Serum Syndecan-1: A Novel Biomarker for Pancreatic Ductal Adenocarcinoma. Clin Transl Gastroenterol 2022; 13:e00473. [PMID: 35297817 PMCID: PMC9132524 DOI: 10.14309/ctg.0000000000000473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Syndecan-1 (SDC1) has multiple functions in tumorigenesis in general and specifically in pancreatic cancer. We aimed to evaluate SDC1 as a diagnostic and prognostic biomarker in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS In this case-control study, patients newly diagnosed with a biopsy-proven PDAC were enrolled alongside healthy individuals in a derivation-validation cohort design. Serum SDC1 was measured by enzyme-linked immunoassay. The diagnostic accuracy of SDC1 levels for diagnosing PDAC was computed. A unified cohort enriched with additional early-stage patients with PDAC was used to evaluate the association of SDC1 with survival outcomes and patient characteristics. RESULTS In the derivation cohort, serum SDC1 levels were significantly higher in patients with PDAC (n = 39) compared with healthy controls (n = 20) (40.1 ng/mL, interquartile range 29.8-95.3 vs 25.6 ng/mL, interquartile range 17.1-29.8, respectively; P < 0.001). The receiver operating characteristic analysis area under the curve was 0.847 (95% confidence interval 0.747-0.947, P < 0.001). These results were replicated in a separate age-matched validation cohort (n = 38 PDAC, n = 38 controls; area under the curve 0.844, 95% confidence interval 0.757-0.932, P < 0.001). In the combined-enriched PDAC cohort (n = 110), using a cutoff of 35 ng/mL, the median overall 5-year survival between patients below and above this cutoff was not significantly different, although a trend for better survival after 1 year was found in the lower level group (P = 0.06). There were 12 of the 110 patients with PDAC (11%) who had normal CA 19-9 in the presence of elevated SDC1. DISCUSSION These findings suggest serum SDC1 as a promising novel biomarker for early blood-based diagnosis of pancreatic cancer.
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Affiliation(s)
- Doron Yablecovitch
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Shomron Ben-Horin
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Orit Picard
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Miri Yavzori
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Ella Fudim
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Moshe Nadler
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Idan Levy
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Emad Sakhnini
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Alon Lang
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Tal Engel
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Maor Lahav
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Talia Saker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Shalvata Mental Health Center, Hod Hasharon, Israel;
| | - Sandra Neuman
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Limor Selinger
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Revital Dvir
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
| | - Maria Raitses-Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Talia Golan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Ido Laish
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
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Lichtenstein L, Koslowsky B, Ben Ya’acov A, Avni-Biron I, Ovadia B, Ben-Bassat O, Naftali T, Kopylov U, Haberman Y, Eran HB, Eliakim R, Lahat-Zok A, Hirsch A, Zittan E, Maharshak N, Waterman M, Israeli E, Goren I, Ollech JE, Yanai H, Ungar B, Avidan B, Ben Hur D, Melamud B, Segol O, Shalem Z, Dotan I, Odes SH, Ben-Horin S, Snir Y, Milgrom Y, Broide E, Goldin E, Delgado S, Ron Y, Cohen NA, Maoz E, Zborovsky M, Odeh S, Abu Freha N, Shachar E, Chowers Y, Engel T, Reiss-Mintz H, Segal A, Zinger A, Bar-Gil Shitrit A. COVID-19 in Patients with Inflammatory Bowel Disease: The Israeli Experience. Vaccines (Basel) 2022; 10:vaccines10030376. [PMID: 35335008 PMCID: PMC8950285 DOI: 10.3390/vaccines10030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated inflammatory bowel diseases (IBD) affecting millions of people worldwide. IBD therapies, designed for continuous immune suppression, often render patients more susceptible to infections. The effect of the immune suppression on the risk of coronavirus disease-19 (COVID-19) is not fully determined yet. Objective: To describe COVID-19 characteristics and outcomes and to evaluate the association between IBD phenotypes, infection outcomes and immunomodulatory therapies. Methods: In this multi-center study, we prospectively followed IBD patients with proven COVID-19. De-identified data from medical charts were collected including age, gender, IBD type, IBD clinical activity, IBD treatments, comorbidities, symptoms and outcomes of COVID-19. A multivariable regression model was used to examine the effect of immunosuppressant drugs on the risk of infection by COVID-19 and the outcomes. Results: Of 144 IBD patients, 104 (72%) were CD and 40 (28%) were UC. Mean age was 32.2 ± 12.6 years. No mortalities were reported. In total, 94 patients (65.3%) received biologic therapy. Of them, 51 (54%) at escalated doses, 10 (11%) in combination with immunomodulators and 9 (10%) with concomitant corticosteroids. Disease location, behavior and activity did not correlate with the severity of COVID-19. Biologics as monotherapy or with immunomodulators or corticosteroids were not associated with more severe infection. On the contrary, patients receiving biologics had significantly milder infection course (p = 0.001) and were less likely to be hospitalized (p = 0.001). Treatment was postponed in 34.7% of patients until recovery from COVID-19, without consequent exacerbation. Conclusion: We did not witness aggravated COVID-19 outcomes in patients with IBD. Patients treated with biologics had a favorable outcome.
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Affiliation(s)
- Lev Lichtenstein
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Benjamin Koslowsky
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Ami Ben Ya’acov
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Baruch Ovadia
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel;
| | | | - Timna Naftali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Haberman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hagar Banai Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Adi Lahat-Zok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ayal Hirsch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Zittan
- Inflammatory Bowel Disease Unit, Ha’emek Medical Center, Faculty of Medicine, Israel Institute of Technology, Afula, Israel;
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
| | - Nitsan Maharshak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Matti Waterman
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Israeli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Jacob E. Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Bella Ungar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Benjamin Avidan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dana Ben Hur
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bernardo Melamud
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology and Liver Diseases, Wolfson Medical Center, Holon, Israel
| | - Ori Segol
- Unit of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel;
| | - Zippora Shalem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Selwyn H. Odes
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Shomron Ben-Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yf’at Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; (I.A.-B.); (H.B.E.); (I.G.); (J.E.O.); (H.Y.); (I.D.); (Y.S.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
| | - Yael Milgrom
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Efrat Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Gastroenterology and Liver Diseases Institute, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Eran Goldin
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
| | - Shmuel Delgado
- Assuta Medical Center, Ben-Gurion University, Negev, Be’er Sheva, Israel;
| | - Yulia Ron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Nathaniel Aviv Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Maoz
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | - Maya Zborovsky
- Clalit Health Services, Tel Aviv, Israel; (L.L.); (E.M.); (M.Z.)
| | | | - Naim Abu Freha
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Eyal Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yehuda Chowers
- Faculty of Medicine, Israel Institute of Technology, Haifa, Israel; (M.W.); (D.B.H.); (Y.C.)
- Rambam Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Engel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hila Reiss-Mintz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (T.N.); (U.K.); (Y.H.); (R.E.); (A.L.-Z.); (A.H.); (N.M.); (E.I.); (B.U.); (B.A.); (B.M.); (Z.S.); (S.H.O.); (S.B.-H.); (E.B.); (Y.R.); (N.A.C.); (E.S.); (T.E.); (H.R.-M.)
- Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - Arie Segal
- Soroka Medical Center, Be’er Sheva, Israel; (N.A.F.); (A.S.)
| | - Adar Zinger
- Hadassah Medical Center, Jerusalem, Israel; (Y.M.); (A.Z.)
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; (B.K.); (A.B.Y.); (E.G.)
- Correspondence:
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Karl M, Engel T, Kopp M, Kress V, Berti NT, Seidler A, Garthus-Niegel S. Validierung der Employment Precariousness Scale (EPRES) an schwangeren Frauen und deren PartnerInnen in einer deutschen Population. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Karl
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Technische Universität Dresden
| | - T Engel
- Institut für Soziologie, Friedrich-Schiller-Universität Jena
| | - M Kopp
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Technische Universität Dresden
| | - V Kress
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Technische Universität Dresden
| | - NT Berti
- Escuela de Ciencias Humanas, GI Ética Aplicada Trabajo y Cambio Social, Universidad del Rosario
| | - A Seidler
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Technische Universität Dresden
| | - S Garthus-Niegel
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Technische Universität Dresden
- Department of Child Health and Development, Norwegian Institute of Public Health
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Engel T, Nguyen A, Fergus J, Dellavalle R, Maverakis E, Sivamani R. 260 Sun protection attitudes and behaviors among minority groups in a low socioeconomic community. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.282] [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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10
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Engel T, Rangchi A, Fung M, Kiuru M, Fereidouni F, Levenson R. 904 Fluorescence Imitating Brightfield Imaging (FIBI): A novel application of rapid, non-destructive and slide-free skin tissue imaging. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Engel T, Yung DE, Ma C, Pariente B, WIls P, Eliakim R, Ungar B, Ben-Horin S, Kopylov U. Effectiveness and safety of Ustekinumab for Crohn's disease; systematic review and pooled analysis of real-world evidence. Dig Liver Dis 2019; 51:1232-1240. [PMID: 31202609 DOI: 10.1016/j.dld.2019.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ustekinumab [UST] is effective in Crohn's disease (CD) in the UNITI studies. Several real-world experience (RWE) studies with UST have been published to date. Our aim was to summarize the available RWE data for UST effectiveness and safety. METHODS A systematic review of the available RWE studies of UST for CD and pooled analysis of the available effectiveness and safety data was performed. RESULTS Eight relevant studies of 6 RWE were included for analysis. Data from 578 patients were pooled for analysis. Most patients (97.7%) were anti-TNF experienced. Pooled clinical response rate was 60%, 62%, 49% at 12, 24 and 52 weeks respectively (95% CI (0.42-0.77), (0.48-0.75), (0.37-0.62)). Pooled remission rate was 39% (95% CI (0.18-0.65)) at 24 weeks and pooled endoscopic response rate was 63% (95% CI (0.53-0.72)) after approximately one year of UST; 134 adverse events (AE) were reported in total, pooled proportion 21% (95% CI (0.12-0.35)). Serious AE were reported in 19 patients, pooled proportion 5% (95% CI (0.03-0.08)). Infections were reported in 38, pooled proportion 6% (95% CI (0.04-0.11)). CONCLUSION Pooled analysis of the RWE data suggests that the real-world effectiveness and safety are comparable to that reported in the randomized control trials.
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Affiliation(s)
- Tal Engel
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Diana E Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher Ma
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin Pariente
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Pauline WIls
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bella Ungar
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Wiegmann H, Reunert J, Metze D, Marquardt T, Engel T, Kunde V, Ehl S, Foell D, van den Heuvel I, Oji V, Wittkowski H. Refining the dermatological spectrum in primary immunodeficiency: mucosa-associated lymphoid tissue lymphoma translocation protein 1 deficiency mimicking Netherton/Omenn syndromes. Br J Dermatol 2019; 182:202-207. [PMID: 31049936 DOI: 10.1111/bjd.18091] [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] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
The proteinase mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1), which forms part of the caspase recruitment domain-containing protein 11-B-cell lymphoma 10-MALT1 signalosome complex, plays a direct role in nuclear factor kappa B activation. Here, we describe the case of a female infant with severe immune dysregulation leading to recurrent systemic infections, failure to thrive and severe crises of ichthyosiform erythroderma with high levels of serum IgE. Hence, initial symptoms indicated Netherton syndrome or Omenn syndrome. Surprisingly, sequence analyses of SPINK5 and RAG1/RAG2, respectively, excluded these diseases. During the hospital stay the patient's health deteriorated, despite intensive care therapy, and she died. In order to delineate the diagnosis, whole-exome sequencing was performed. Two compound heterozygous mutations in MALT1 were found and verified by Sanger sequencing (exon 2 c.245T>C, exon 2 c.310dup), which led to a MALT1 deficiency at the protein level. Based on these results, an immunological analysis was performed, as was immunofluorescence staining of key skin proteins, to confirm a diagnosis of MALT1 deficiency. This case report provides a closer description of the clinical and histological skin phenotype of MALT1 deficiency, and we conclude that MALT1 deficiency must be considered a possible differential diagnosis of Netherton and Omenn syndromes. What's already known about this topic? Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) deficiency is a combined immunodeficiency. MALT1 is part of the caspase recruitment domain-containing protein 11-B-cell lymphoma 10-MALT1 signalosome complex, which is essential for nuclear factor kappa B activation. Current publications describe a phenotype of recurrent systemic infections; only in a few cases has an inflammatory involvement of the integument been described. What does this study add? A closer description of the cutaneous phenotype of MALT1 deficiency in a patient with two novel MALT1 mutations. Immune mapping of follicular epidermis shows lympho-epithelial Kazal-type-related inhibitor is reduced in MALT1 deficiency and absent on interfollicular staining. Clinically, MALT1 deficiency mimics Netherton syndrome and Omenn syndrome, and should be considered a differential diagnosis.
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Affiliation(s)
- H Wiegmann
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - J Reunert
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - D Metze
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - T Marquardt
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - T Engel
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - V Kunde
- Department of Neonatology, Christliches Kinderhospital Osnabrück, Osnabrück, Germany
| | - S Ehl
- Center for Chronic Immunodeficiency, University of Freiburg, Freiburg, Germany
| | - D Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany
| | - I van den Heuvel
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - V Oji
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - H Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany
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Engel T, Ehrlich M. Einzelbeitrag: Maschinen vernetzt – Menschen beteiligt? Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T Engel
- Friedrich-Schiller-Universität Jena, Institut für Soziologie Arbeitsbereich Arbeits-, Industrie- und Wirtschaftssoziologie, Jena, Deutschland
| | - M Ehrlich
- Friedrich-Schiller-Universität Jena, Institut für Soziologie Arbeitsbereich Arbeits-, Industrie- und Wirtschaftssoziologie, Jena, Deutschland
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Bretschneider M, Drössler S, Magister S, Seidler A, Engel T, Schmidt S, Vitera J, Lemanski S, Muehlan H. Digitalisierung, Industrie 4.0 und Gesundheit – ein Literaturreview zur empirischen Befundlage. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Bretschneider
- Medizinische Fakultät Carl Gustav Carus Technische Universität Dresden, Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden, Deutschland
| | - S Drössler
- Medizinische Fakultät Carl Gustav Carus Technische Universität Dresden, Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden, Deutschland
| | - S Magister
- Medizinische Fakultät Carl Gustav Carus Technische Universität Dresden, Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden, Deutschland
| | - A Seidler
- Medizinische Fakultät Carl Gustav Carus Technische Universität Dresden, Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden, Deutschland
| | - T Engel
- Friedrich-Schiller-Universität Jena, Arbeitsbereich Arbeits-, Industrie- und Wirtschaftssoziologie, Institut für Soziologie, Jena, Deutschland
| | - S Schmidt
- Universität Greifswald, Lehrstuhl Gesundheit und Prävention, Institut für Psychologie,, Greifswald, Deutschland
| | - J Vitera
- Universität Greifswald, Lehrstuhl Gesundheit und Prävention, Institut für Psychologie,, Greifswald, Deutschland
| | - S Lemanski
- Universität Greifswald, Lehrstuhl Gesundheit und Prävention, Institut für Psychologie,, Greifswald, Deutschland
| | - H Muehlan
- Universität Greifswald, Lehrstuhl Gesundheit und Prävention, Institut für Psychologie,, Greifswald, Deutschland
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Engel T, Ungar B, Yung DE, Ben-Horin S, Eliakim R, Kopylov U. Vedolizumab in IBD-Lessons From Real-world Experience; A Systematic Review and Pooled Analysis. J Crohns Colitis 2018; 12:245-257. [PMID: 29077833 DOI: 10.1093/ecco-jcc/jjx143] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vedolizumab [VDZ] is an anti-integrin monoclonal antibody effective in ulcerative colitis [UC] and Crohn's disease [CD]. Several real-world experience [RWE] studies with VDZ have been published to date. The aim of this systematic review was to summarise the available real-life experience with VDZ. METHODS We performed a systematic review of the available RWE studies of VDZ in CD and UC. We performed a pooled analysis of the available efficacy and safety data for induction and maintenance treatment in adult cohorts. A narrative review of VDZ use in special clinical settings was also performed. RESULTS Nine studies including 1565 [571 UC, 994 CD] adult patients were identified. In CD, clinical response and remission were achieved in 54% (95% confidence interval [CI] 41-66%) and 22% [95% CI 13-35%] by Week 6 and in 49% [95% CI 37-51%] and 32% [95% CI 23-42%] by Week 14; at Week 52, 45% [95% CI 28-64%] and 32% [95% CI 12-62] of the patients responded, and were in clinical remission, respectively. In UC, clinical response and remission were achieved in 43% [95% CI 37-49] and 25% [95% CI 12-45] by Week 6, respectively, and in 51% [95% CI 43-61%]and 30% [95% CI 24-36%] by Week 14/22, respectively; at week 52, clinical response and remission were achieved in 48% and 39% of the patients, respectively. Adverse effects were mostly minor and occurred in 30.6% of the patients; infections were reported in 3.4% of the patients. CONCLUSIONS VDZ is efficacious in CD and UC and has a favourable safety profile in RWE studies.
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Affiliation(s)
- Tal Engel
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Bella Ungar
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Diana E Yung
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shomron Ben-Horin
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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16
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Pidgeon H, Engel T, Rizvanolli L, Palter J. 413 Incorporation of a Novel Asthma Action Plan to Improve Knowledge and Symptom Management in the Low Acuity Asthmatics Presenting to the Emergency Department. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Engel T, Segal-Lieberman G, Eliakim R, Lahav M, Lang A. OR31: Short and Long Term Effect of Endoscopic Duodenal Sleeve for the Treatment of Diabetes and Obesity. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Kopylov U, Yung DE, Engel T, Vijayan S, Har-Noy O, Katz L, Oliva S, Avni T, Battat R, Eliakim R, Ben-Horin S, Koulaouzidis A. Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn's disease: Systematic review and meta-analysis. Dig Liver Dis 2017; 49:854-863. [PMID: 28512034 DOI: 10.1016/j.dld.2017.04.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE), magnetic resonance enterography (MRE) and small bowel (SB) intestinal contrast ultrasound (SICUS) are the modalities of choice for SB evaluation. This study aimed to compare the diagnostic yield (DY) of CE to MRE and SICUS in detection and monitoring of SB CD through meta-analysis of the available literature. METHODS We performed a systematic literature search for trials comparing the accuracy of CE, MRE and SICUS for detection of active SB inflammation in patients with suspected and/or established CD. Only prospective studies comparing CE with another additional diagnostic modality were included in the final analysis. Pooled odds ratios (ORs) for the DY of the three modalities were calculated. RESULTS A total of 112 studies were retrieved; following selection, 13 studies were eligible for analysis. The DY of CE for detection of active SB CD was similar to that of MRE (10 studies, 400 patients, OR 1.17; 95% CI 0.83-1.67) and SICUS (5 studies, 142 patients, OR 0.88; 95% CI 0.51-1.53). The outcomes were similar for the subgroups of suspected versus established CD and adult versus pediatric patients. CE was superior to MRE for proximal SB CD (7 studies, 251 patients, OR 2.79; 95% CI 1.2-6.48); the difference vs SICUS was not significant. CONCLUSION CE, MRE and SICUS have similar DY for detection of SB CD in both suspected and established CD. CE is superior to MRE for detection of proximal SB disease, however the risk of capsule retention should be considered.
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Affiliation(s)
- Uri Kopylov
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Diana E Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Tal Engel
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Sanju Vijayan
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ofir Har-Noy
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Lior Katz
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy
| | - Tomer Avni
- Department of Medicine E, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Robert Battat
- McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Rami Eliakim
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Israel
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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19
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Engel T, Slotboom BJ, van Maarseveen N, van Zwet AA, Nabuurs-Franssen MH, Hagen F. A multi-centre prospective evaluation of the Check-Direct ESBL Screen for BD MAX as a rapid molecular screening method for extended-spectrum beta-lactamase-producing Enterobacteriaceae rectal carriage. J Hosp Infect 2017; 97:247-253. [PMID: 28743503 DOI: 10.1016/j.jhin.2017.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/12/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A multiplex extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) quantitative polymerase chain reaction (qPCR), performed directly on rectal swabs, was compared with a culture-based protocol to study the discrepancies between the two methods, and identify existing challenges to apply this assay in routine clinical practice. The secondary objective was to assess the performance of the qPCR. MATERIALS AND METHODS In two Dutch teaching hospitals, 573 rectal swabs were collected prospectively. Culture with additional testing with the Check-MDR CT103XL (Check-Points) was compared with the Check-Direct ESBL Screen for BD MAX (Check-Points), which detects the presence of the ESBL gene families CTX-M1, CTX-M2, CTX-M9 and SHV2/5-ESBL. The culture-based protocol (with Brilliance agar) was considered as the gold standard to assess the performance of the qPCR. RESULTS Of the 573 rectal swabs, 74 (12.9%) were culture-positive. Eighty-four (14.7%) were qPCR-positive. There were eight culture-positive/qPCR-negative discrepancies and 18 culture-negative/qPCR-positive discrepancies. Sensitivity and specificity of qPCR vs culture were 87.7% [95% confidence interval (CI) 79.7-95.7] and 96.3% (95% CI 94.6-98.0), respectively. CONCLUSION The Check-Direct ESBL Screen for the BD MAX is an easy-to-perform, quick molecular diagnostic test with the potential to significantly speed up screening for rectal ESBL-E carriage. Discrepancies were observed between the culture-based protocol and the qPCR in 4.5% of tested samples. Existing challenges for implementing qPCR are its limited sensitivity, the need for thorough knowledge of the local ESBL-E genes, and interpretation of culture-negative but qPCR-positive samples. It is believed that the limited sensitivity of qPCR could be optimized by including blaTEM as a molecular target, and improving the limit of detection.
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Affiliation(s)
- T Engel
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - B J Slotboom
- Department of Medical Microbiology and Immunology, Rijnstate, Velp, The Netherlands
| | - N van Maarseveen
- Department of Medical Microbiology and Immunology, Rijnstate, Velp, The Netherlands
| | - A A van Zwet
- Department of Medical Microbiology and Immunology, Rijnstate, Velp, The Netherlands
| | - M H Nabuurs-Franssen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
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20
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Engel T, Ungar B, Ben-Haim G, Levhar N, Eliakim R, Ben-Horin S. Re-phrasing the question: A simple tool for evaluation of adherence to therapy in patients with inflammatory bowel disease. United European Gastroenterol J 2017; 5:880-886. [PMID: 29026602 DOI: 10.1177/2050640616687838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Non-adherence to medication in patients with inflammatory bowel disease (IBD) is a challenging problem which is often overlooked or under-estimated by the physician or denied by the patient. We aimed to examine if re-phrasing the wording of the question used by the physician could help in revealing more patients who are non-adherent, and for whom appropriate counseling may be instituted. METHODS A cross-sectional questionnaire-based study of IBD patients treated in a tertiary center was conducted. Patients received a questionnaire detailing their treatments and disease course, as well as their perceptions about disease. Two forms of questions about adherence were deliberately placed in two separate parts of the questionnaire: One was 'are you taking your medications regularly as prescribed?' (Standard question), and the second, more emphatic question, was 'how often does it happen that you miss a drug dosing?' (Re-phrased question). The rate of non-adherence disclosed by each of these questions was compared. Sensitivity, specificity and predicative values were computed for each question against the conventional definition of non-adherence as taking of less than 80% of prescribed medication doses disclosed by any of the methods. Predictors of non-compliance and of denying non-compliance were also explored. RESULTS Overall, 165 patients were included (49% female, mean age 33.7 ± 12.7 SD, median age 30 years, 29.6% with ulcerative colitis, 62.4% with Crohn's disease). Upon questioning, 50 (30.3%) of the patients admitted to non-adherence in the last month when asked by the emphatic re-phrased question format, compared with only 10 patients (6%) reporting non-adherence when asked directly by the standard question (OR 7.4, 95%CI 3.6-15.2, p < 0.001). Thus, a 'Do you take your medicine regularly' question format disclosed only 20% of genuinely non-compliant patients and had 16% sensitivity and 98.2% specificity for revealing non-adherence (PPV 80%, NPV 72.9%) compared with the reference re-phrased question. The leading cause for non-adherence was skepticism about drug efficacy or safety (20.5%), followed by vacation or weekend (15%), problems with prescription or pharmacy (13.5%) and forgetfulness (10%). No single demographic or clinical factor correlated with non-adherence. The only factor which correlated with higher probability for non-adherence was biological and combination treatment. CONCLUSION Non-compliance with treatment is much more common than patients admit. Asking patients how often does it happen that they miss a drug dosing is a simple, practical tool which performs significantly better in disclosing non-adherence compared with asking patients if they take their medication as they should.
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Affiliation(s)
- T Engel
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - B Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G Ben-Haim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Levhar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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21
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Ungar B, Kopylov U, Engel T, Yavzori M, Fudim E, Picard O, Lang A, Williet N, Paul S, Chowers Y, Bar-Gil Shitrit A, Eliakim R, Ben-Horin S, Roblin X. Addition of an immunomodulator can reverse antibody formation and loss of response in patients treated with adalimumab. Aliment Pharmacol Ther 2017. [PMID: 27862102 DOI: 10.1111/apt.13862s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anti-adalimumab antibodies (AAA) are associated with loss of clinical response (LOR). Addition of an immunomodulator has been shown to reverse immunogenicity and regain response with infliximab monotherapy. Similar data on adalimumab are lacking. AIM To study the impact of immunomodulator addition on the emergence of AAA and LOR among adalimumab therapy patients. METHODS The databases of three tertiary medical centres were reviewed to identify patients who developed AAA during adalimumab monotherapy with resultant LOR, and received an immunomodulator as a salvage combination therapy. All sera were prospectively analysed using previously described ELISA assays. Clinical response was determined using appropriate clinical scores. Elimination of AAA, designated as 'sero-reversal', elevation of drug levels and regained clinical response were the sought outcomes. RESULTS Twenty-three patients (21 Crohn's disease, and 2 ulcerative colitis) developed AAA with subsequent LOR and were thereafter prescribed an immunomodulator as salvage therapy (thiopurine n = 14, methotrexate n = 9). Eleven patients (48%) underwent sero-reversal with gradual elimination of AAA, increase in drug trough levels and restoration of clinical response (median time to sero-reversal 5 months). In 12 patients (52%), immunogenicity and loss of response could not be reversed. There was no difference between responders and nonresponders in the type of immunomodulators used or baseline clinical characteristics. CONCLUSIONS In almost half of inflammatory bowel disease patients developing anti-adalimumab antibodies and loss of response, established immunogenicity of adalimumab can be gradually reversed by the addition of immunomodulator therapy with restoration of a clinico-biological response. However, these observations need to be confirmed with larger studies.
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Affiliation(s)
- B Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - T Engel
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Yavzori
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Fudim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Picard
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Lang
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Williet
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - S Paul
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Y Chowers
- Rambam Health Care Campus, Bruce & Ruth Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - A Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - R Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - X Roblin
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
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22
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Ungar B, Kopylov U, Engel T, Yavzori M, Fudim E, Picard O, Lang A, Williet N, Paul S, Chowers Y, Bar-Gil Shitrit A, Eliakim R, Ben-Horin S, Roblin X. Addition of an immunomodulator can reverse antibody formation and loss of response in patients treated with adalimumab. Aliment Pharmacol Ther 2017; 45:276-282. [PMID: 27862102 DOI: 10.1111/apt.13862] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [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] [Received: 08/20/2016] [Revised: 09/15/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-adalimumab antibodies (AAA) are associated with loss of clinical response (LOR). Addition of an immunomodulator has been shown to reverse immunogenicity and regain response with infliximab monotherapy. Similar data on adalimumab are lacking. AIM To study the impact of immunomodulator addition on the emergence of AAA and LOR among adalimumab therapy patients. METHODS The databases of three tertiary medical centres were reviewed to identify patients who developed AAA during adalimumab monotherapy with resultant LOR, and received an immunomodulator as a salvage combination therapy. All sera were prospectively analysed using previously described ELISA assays. Clinical response was determined using appropriate clinical scores. Elimination of AAA, designated as 'sero-reversal', elevation of drug levels and regained clinical response were the sought outcomes. RESULTS Twenty-three patients (21 Crohn's disease, and 2 ulcerative colitis) developed AAA with subsequent LOR and were thereafter prescribed an immunomodulator as salvage therapy (thiopurine n = 14, methotrexate n = 9). Eleven patients (48%) underwent sero-reversal with gradual elimination of AAA, increase in drug trough levels and restoration of clinical response (median time to sero-reversal 5 months). In 12 patients (52%), immunogenicity and loss of response could not be reversed. There was no difference between responders and nonresponders in the type of immunomodulators used or baseline clinical characteristics. CONCLUSIONS In almost half of inflammatory bowel disease patients developing anti-adalimumab antibodies and loss of response, established immunogenicity of adalimumab can be gradually reversed by the addition of immunomodulator therapy with restoration of a clinico-biological response. However, these observations need to be confirmed with larger studies.
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Affiliation(s)
- B Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - T Engel
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Yavzori
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Fudim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - O Picard
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Lang
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Williet
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - S Paul
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Y Chowers
- Rambam Health Care Campus, Bruce & Ruth Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - A Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - R Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - X Roblin
- Service de Gastrologie-Entérologie-Hépatologie, CHU de Saint-Etienne, Saint-Etienne, France
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Har-Noy O, Kim B, Haiat R, Engel T, Ungar B, Eliakim R, Ho Kim W, Hee Cheon J, Ben-Horin S. Combination of Corticosteroids with 5-Aminosalicylic Acids Compared to Corticosteroids Alone for Hospitalized Patients with Active Ulcerative Colitis. Isr Med Assoc J 2016; 18:613-618. [PMID: 28471622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although 5-amino-salycilic acids (5-ASA) are often used with corticosteroid treatment in moderate-to-severe ulcerative colitis, the value of continuing/initiating 5-ASA in this clinical setting has not been explored. OBJECTIVES To investigate the impact of a combination 5-ASA+corticosteroid therapy on the outcome of hospitalized patients with acute moderate-severe ulcerative colitis. METHODS We conducted a retrospective study of patients hospitalized with moderate-severe ulcerative colitis in two centers, Israel and South Korea. Patients were classified into those who received 5-ASA and corticosteroids and those who received corticosteroids alone. Analysis was performed for each hospitalization event. The primary outcome was the rate of treatment failure defined as the need for salvage therapy (cyclosporin-A/infliximab/colectomy). The secondary outcomes were 30 days re-admission rates, in-hospital mortality rates, time to improvement, and length of hospitalization. RESULTS We analyzed 209 hospitalization events: 151 patients (72%) received 5-ASA+corticosteroids and 58 (28%) corticosteroids alone. On univariate analysis the combination therapy group had a lower risk for treatment failure (11% vs. 31%, odds ratio 0.28, 95% confidence interval 0.13-0.59, P = 0.001). However, this difference disappeared on multivariate analysis, which showed pre-admission oral corticosteroid treatment to be the most significant factor associated with the need for salvage therapy. CONCLUSIONS A signal for possible benefit of a combination 5-ASA and corticosteroids therapy was found, but was confounded by the impact of pre-admission corticosteroid treatment.
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Affiliation(s)
- Ofir Har-Noy
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Israel
| | - Bun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Rivi Haiat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Engel
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Israel
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Won Ho Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hee Cheon
- Yonsei University College of Medicine, Seoul, South Korea
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Crohn's disease (CD) is an inflammatory bowel disease (IBD) with uncertain etiology. Biologic agents have revolutionized the treatment of CD but nonresponders remain a challenge. Ustekinumab is an interleukin 12/23p40 inhibitor that was recently found effective in treating CD. We reviewed the current literature regarding the efficacy of ustekinumab in treating CD and concluded that ustekinumab is a novel, promising and relatively safe agent for the treatment of moderate to severe CD. Additional data from randomized controlled studies and real-life cohorts are pending.
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Affiliation(s)
- Tal Engel
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, 52621, Israel
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Louveton N, McCall R, Koenig V, Avanesov T, Engel T. Driving while using a smartphone-based mobility application: Evaluating the impact of three multi-choice user interfaces on visual-manual distraction. Appl Ergon 2016; 54:196-204. [PMID: 26851479 DOI: 10.1016/j.apergo.2015.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 11/23/2015] [Accepted: 11/28/2015] [Indexed: 05/16/2023]
Abstract
Innovative in-car applications provided on smartphones can deliver real-time alternative mobility choices and subsequently generate visual-manual demand. Prior studies have found that multi-touch gestures such as kinetic scrolling are problematic in this respect. In this study we evaluate three prototype tasks which can be found in common mobile interaction use-cases. In a repeated-measures design, 29 participants interacted with the prototypes in a car-following task within a driving simulator environment. Task completion, driving performance and eye gaze have been analysed. We found that the slider widget used in the filtering task was too demanding and led to poor performance, while kinetic scrolling generated a comparable amount of visual distraction despite it requiring a lower degree of finger pointing accuracy. We discuss how to improve continuous list browsing in a dual-task context.
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Affiliation(s)
- N Louveton
- Interdisciplinary Centre for Security, Reliability and Trust, Weicker Building, Université du Luxembourg, 4, Rue Alphonse Weicker, L-2721 Luxembourg, Luxembourg.
| | - R McCall
- Interdisciplinary Centre for Security, Reliability and Trust, Weicker Building, Université du Luxembourg, 4, Rue Alphonse Weicker, L-2721 Luxembourg, Luxembourg; ERIN Department, Luxembourg Institute of Science and Technology, 5, avenue des Hauts-Fourneaux, L-4362 Esch-sur-Alzette, Luxembourg.
| | - V Koenig
- Interdisciplinary Centre for Security, Reliability and Trust, Weicker Building, Université du Luxembourg, 4, Rue Alphonse Weicker, L-2721 Luxembourg, Luxembourg; ECCS Research Unit, Campus Walferdange, Université du Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg.
| | - T Avanesov
- Interdisciplinary Centre for Security, Reliability and Trust, Weicker Building, Université du Luxembourg, 4, Rue Alphonse Weicker, L-2721 Luxembourg, Luxembourg.
| | - T Engel
- Interdisciplinary Centre for Security, Reliability and Trust, Weicker Building, Université du Luxembourg, 4, Rue Alphonse Weicker, L-2721 Luxembourg, Luxembourg.
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Kopinski S, Engel T, Cassel M, Fröhlich K, Mayer F, Carlsohn A. Ultrasound Applied to Subcutaneous Fat Tissue Measurements in International Elite Canoeists. Int J Sports Med 2015; 36:1134-41. [PMID: 26332903 DOI: 10.1055/s-0035-1555857] [Citation(s) in RCA: 5] [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] [Indexed: 10/23/2022]
Abstract
Subcutaneous adipose tissue (SAT) measurements with ultrasound have recently been introduced to assess body fat in elite athletes. However, appropriate protocols and data on various groups of athletes are missing. We investigated intra-rater reliability of SAT measurements using ultrasound in elite canoe athletes. 25 international level canoeists (18 male, 7 female; 23±4 years; 81±11 kg; 1.83±0.09 m; 20±3 training h/wk) were measured on 2 consecutive days. SAT was assessed with B-mode ultrasound at 8 sites (ISAK): triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, front thigh, medial calf, and quantified using image analysis software. Data was analyzed descriptively (mean±SD, [range]). Coefficient of variation (CV%), intraclass correlation coefficient (ICC, 2.1) and absolute (LoA) and ratio limits of agreement (RLoA) were calculated for day-to-day reliability. Mean sum of SAT thickness was 30.0±19.4 mm [8.0, 80.1 mm], with 3.9±1.8 mm [1.2 mm subscapular, 8.0 mm abdominal] for individual sites. CV for the sum of sites was 4.7%, ICC 0.99, LoA 1.7±3.6 mm, RLoA 0.940 ( * /÷1.155). Measuring SAT with ultrasound has proved to have excellent day-to-day reliability in elite canoe athletes. Recommendations for standardization of the method will further increase accuracy and reproducibility.
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Affiliation(s)
- S Kopinski
- Sports and Health Sciences, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany
| | - T Engel
- Sports and Health Sciences, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany
| | - M Cassel
- Sports and Health Sciences, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany
| | - K Fröhlich
- Sports and Health Sciences, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany
| | - F Mayer
- Sports and Health Sciences, University Outpatient Clinic Potsdam, University of Potsdam, Potsdam, Germany
| | - A Carlsohn
- Institute of Health Sciences, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
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Hairaye C, Mermet F, Engel T, Montgomery PC, Fontaine J. Functionalization of surfaces by ultrafast laser micro/nano structuring. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/558/1/012063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McCormick S, Engel T, Thomas C, Medado P, Reed B, Millis S, O'Neil B. 197 Physician Perception in Predicting Good Neurological Outcomes in Patients Resuscitated from Cardiac Arrest. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.223] [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: 12/01/2022]
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Fliedner S, Engel T, Lendvai N, Shankavaram U, Nölting S, Wesley R, Elkalouhn A, Ungefroren H, Lehnert H, Timmers H, Pacak K. Anti-cancer potential of MAPK pathway inhibition in paragangliomas – effect of different statins on mouse pheochromocytoma cells. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To report a case of acute pancreatitis in a patient receiving nilotinib for chronic myelogenous leukemia (CML). CASE SUMMARY A 69-year-old man recently diagnosed with chronic phase CML received nilotinib 300 mg twice daily and was admitted with acute pancreatitis that appeared the day after the first dose. The patient had normal levels of triglycerides and denied alcohol use. Serum pancreatic enzymes were within normal limits the day before nilotinib initiation. Abdominal computed tomography demonstrated a normal liver, bile duct without stones, and findings that were consistent with focal pancreatitis. The patient's history was significant for concomitant use of enalapril and simvastatin; both have been associated with pancreatitis, but the patient had been taking these medications for at least 5 years without adverse effects. Nilotinib was immediately discontinued. Abdominal pain resolved and serum pancreatic enzymes levels returned to normal 2 weeks later. DISCUSSION One of the adverse effects of some tyrosine kinase inhibitors is increased levels of serum pancreatic enzymes. Accordingly, nilotinib labeling includes “high lipase levels in serum” as an adverse event. There are few case reports of acute pancreatitis associated with nilotinib in the literature and some are incomplete. We present a well-documented case of nilotinib-associated acute pancreatitis. Consistent with Badalov's new classification system for drug-induced acute pancreatitis and with the Naranjo probability scale, this case represents a possible adverse reaction of pancreatitis associated with nilotinib therapy. As rechallenge is unethical, treatment with nilotinib has not been resumed. CONCLUSIONS This case demonstrates a possible association between acute pancreatitis and nilotinib use. Although a rare phenomenon, clinicians should be alert for signs and symptoms of pancreatitis, as treatment with nilotinib for CML is becoming more common.
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Affiliation(s)
- Tal Engel
- Tal Engel MD, Resident, Department of Internal Medicine E, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Justo
- Dan Justo MD, Senior Physician, Department of Internal Medicine E, Chaim Sheba Medical Center; Sackler School of Medicine
| | - Michal Amitai
- Michal Amitai MD, Senior Physician, Department of Radiology, Chaim Sheba Medical Center; Sackler School of Medicine
| | - Yulia Volchek
- Yulia Volchek MD, Senior Physician, Department of Hematology, Chaim Sheba Medical Center; Sackler School of Medicine
| | - Haim Mayan
- Haim Mayan MD, Head, Department of Internal Medicine E, Chaim Sheba Medical Center; Sackler School of Medicine
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Halperin E, Engel T, Sherman S, Justo D. Low admission Norton scale scores are associated with falls long after rehabilitation in the elderly with hip fractures. Clin Interv Aging 2012; 7:431-6. [PMID: 23109805 PMCID: PMC3479894 DOI: 10.2147/cia.s35717] [Citation(s) in RCA: 4] [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] [Indexed: 11/23/2022] Open
Abstract
Background In this study, we investigated if low admission Norton scale scores (ANSS) are associated with falls, fractures, hospitalizations, and death, after rehabilitation in the elderly with hip fractures. Methods This prospective historical study followed consecutive elderly patients (≥65 years) who were admitted for rehabilitation following hip fracture surgery during 2009 and followed up in January or February 2012. The incidence of falls, number of falls, incidence of fractures, number of hospitalizations, and death rates were compared between patients with low (≤14) and high (≥15) ANSS. Results The final cohort included 174 patients of mean age 83.6 ± 6.2 years, with 133 (76.4%) being women. Fifty-seven (27.0%) patients died during follow-up. Of the remaining 127 patients, 44 (34.6%) fell at least once and 15 (11.8%) suffered fractures. Overall, 81 (46.6%) patients had a low ANSS. Relative to patients with a high ANSS, they had a higher incidence of falls (odds ratio 3.3, 95% confidence interval 1.5–7.1; P = 0.002) and fell more times (1.2 ± 1.8 versus 0.6 ± 1.7; P = 0.002). Regression analysis showed that ANSS (as a parametric variable) as well as a low ANSS (as a nonparametric variable) were independently associated with falls (P = 0.002 and P = 0.009, respectively). There were no differences between patients with low and high ANSS in terms of incidence of fractures, number of hospitalizations, and death rates. Conclusion The Norton scoring system may be used for predicting falls long after rehabilitation in the elderly with hip fractures.
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Affiliation(s)
- Ehud Halperin
- Department of Internal Medicine D, Sourasky Medical Center, Tel-Aviv, Israel
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Sherman S, Justo D, Engel T, Yossepowitch O, Bregman N, Gadoth A, Paran Y. Cytomegalovirus-associated cerebral sinus vein thrombosis. J Med Virol 2012; 84:1934-6. [DOI: 10.1002/jmv.23424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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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Wilburn J, Cloyd J, O'Neil B, Medado P, Scott T, Engel T. 211 Comparison of Emergency Department and Out-of-Hospital Cardiac Arrest Patients Monitored With End Tidal CO2 and Cerebral Oximetry. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.06.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marquass B, Mahn T, Engel T, Gossner J, Theopold JD, von Dercks N, Racynski C, Rose T, Josten C, Hepp P. [Clinical and radiological mid-term results after autologous osteochondral transplantation under consideration of quality of life]. Z Orthop Unfall 2012; 150:360-7. [PMID: 22918823 DOI: 10.1055/s-0032-1314958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment of full-thickness cartilage defects remains a challenge in musculoskeletal surgery. Autologous osteochondral transplantation represents a possible solution for the repair of affected areas. However, some problems like degenerative changes of the transplanted cylinders and the surrounding cartilage or lack of cylinder integration to the surrounding cartilage arise with this method. Thus mid-term results respecting the quality of life are useful for assessment of the method. PATIENTS/MATERIAL AND METHODS We investigated 22 patients with a mean follow-up of 88 ± 14.5 months after autologous osteochondral transplantation due to a full-thickness cartilage defect of the medial femoral condyle. Beside clinical scores we assessed at follow-up the quality of life using the SF-36 health survey and the EQ-5D. Furthermore, radiological changes were detected and MRI was performed in 21 patients. A control group of 19 patients, treated with microfracture, was matched in terms of BMI, gender and age. Exclusion criteria for this group were tibial kissing lesion, ligament instability, arthrosis and malalignment. RESULTS In a longitudinal comparison with results 13.5 months after operation, no difference in Lysholm score was found. In plain radiographs higher degrees of arthritic changes in the medial compartment compared to the unaffected knee were observed. MRI revealed a mean modified MOCART score of 41.2 ± 7.7 for the OAT group and of 39.4 ± 16.1 for the microfracture group, without being significant. For OAT patients all cylinders showed an osseous integration. However, cylinder oedema was found in 9 patients. Those patients had a higher intensity of pain on a visual analogue scale. Quality of life was better for OAT patients in the physical scale of SF-36, but not in the mental scale. CONCLUSION Autologous osteochondral transplantation has an unaltered significance in treating full-thickness cartilage defects and leads to satisfying mid-term results. The development of early arthritic changes might not be preventable by this method. Oedema of the transplanted cylinders is attended by higher pain intensity and might be an indirect sign of cartilage degeneration.
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Affiliation(s)
- B Marquass
- Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universitätsklinikum Leipzig.
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Stumpe B, Engel T, Steinweg B, Marschner B. Application of PCA and SIMCA statistical analysis of FT-IR spectra for the classification and identification of different slag types with environmental origin. Environ Sci Technol 2012; 46:3964-3972. [PMID: 22390718 DOI: 10.1021/es204187r] [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
In the past, different slag materials were often used for landscaping and construction purposes or simply dumped. Nowadays German environmental laws strictly control the use of slags, but there is still a remaining part of 35% which is uncontrolled dumped in landfills. Since some slags have high heavy metal contents and different slag types have typical chemical and physical properties that will influence the risk potential and other characteristics of the deposits, an identification of the slag types is needed. We developed a FT-IR-based statistical method to identify different slags classes. Slags samples were collected at different sites throughout various cities within the industrial Ruhr area. Then, spectra of 35 samples from four different slags classes, ladle furnace (LF), blast furnace (BF), oxygen furnace steel (OF), and zinc furnace slags (ZF), were determined in the mid-infrared region (4000-400 cm(-1)). The spectra data sets were subject to statistical classification methods for the separation of separate spectral data of different slag classes. Principal component analysis (PCA) models for each slag class were developed and further used for soft independent modeling of class analogy (SIMCA). Precise classification of slag samples into four different slag classes were achieved using two different SIMCA models stepwise. At first, SIMCA 1 was used for classification of ZF as well as OF slags over the total spectral range. If no correct classification was found, then the spectrum was analyzed with SIMCA 2 at reduced wavenumbers for the classification of LF as well as BF spectra. As a result, we provide a time- and cost-efficient method based on FT-IR spectroscopy for processing and identifying large numbers of environmental slag samples.
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Affiliation(s)
- B Stumpe
- Department Soil Science/Soil Ecology, Institute of Geography, Ruhr-Universität Bochum, Bochum, Germany.
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Engel T, Schlemmer AC. Measuring adherence to antiretroviral treatment and assessing factors affecting adherence in a state primary healthcare clinic, Mitchells Plain Community Health Centre. S Afr Fam Pract (2004) 2012. [DOI: 10.1080/20786204.2012.10874180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- T Engel
- Family Medicine and Primary Care, University of Stellenbosch
| | - AC Schlemmer
- Family Medicine and Primary Care, University of Stellenbosch
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Bunk EC, König HG, Bernas T, Engel T, Henshall DC, Kirby BP, Prehn JHM. BH3-only proteins BIM and PUMA in the regulation of survival and neuronal differentiation of newly generated cells in the adult mouse hippocampus. Cell Death Dis 2011; 1:e15. [PMID: 21364616 PMCID: PMC3039291 DOI: 10.1038/cddis.2009.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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: 12/31/2022]
Abstract
Neurogenesis persists in the adult hippocampus, where several thousand neurons are born every day. Most of the newly generated cells are eliminated by apoptosis, possibly because of their failure to integrate properly into neural networks. The BH3-only proteins Bim and Puma have been shown to mediate trophic factor withdrawal- and anoikis-induced apoptosis in various systems. We therefore determined their impact on proliferation, survival, and differentiation of adult-generated cells in the mouse hippocampus using gene-deficient mice. Wild-type, bim-, and puma-deficient mice showed similar rates of precursor cell proliferation, as evidenced by 5-bromo-2-deoxyuridine (BrdU)-incorporation. Deficiency in either bim or puma significantly increased the survival of adult-born cells in the dentate gyrus (DG) after 7 days. Consistently, we detected increased numbers of doublecortin (DCX)-positive and fewer terminal deoxynucleotidyl transferase-mediated dUTP nick end-labelled-positive cells in the DG of bim- and puma-deficient mice. Bim and puma deficiency did not change early markers of neuronal differentiation, as evidenced by BrdU/DCX double-labelling. However, BrdU/NeuN double-labelling revealed that deficiency of bim, but not puma, accelerated the differentiation of newly generated cells into a neuronal phenotype. Our data show that Bim and Puma are prominently involved in the regulation of neuronal progenitor cell survival in the adult DG, but also suggest that Bim has an additional role in neuronal differentiation of adult-born neural precursor cells.
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Affiliation(s)
- E C Bunk
- Department of Physiology and Medical Physics, RCSI Neuroscience Research Centre, Dublin, Ireland
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Hesse D, Hommel A, Jaschke A, Völker W, Engel T, Chadt A, Blüher M, Ruschke K, Kluge R, Joost HG, Schürmann A. Durch eine Beeinträchtigung der Lipidtropfenbildung und eine erhöhte Lipolyse resultiert die Deletion der GTPase Arfrp1 im Fettgewebe in einem lipodystrophen Phänotyp. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Engel T, Hatazaki S, Tanaka K, Prehn JHM, Henshall DC. Deletion of Puma protects hippocampal neurons in a model of severe status epilepticus. Neuroscience 2010; 168:443-50. [PMID: 20362645 DOI: 10.1016/j.neuroscience.2010.03.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/23/2010] [Accepted: 03/26/2010] [Indexed: 02/04/2023]
Abstract
Prolonged seizures (status epilepticus) can activate apoptosis-associated signaling pathways. The extent to which such pathways contribute to cell death might depend on the insult intensity, whereby the programmed or apoptotic cell death component is reduced when seizures are more severe or protracted. We recently showed that mice lacking the pro-apoptotic Bcl-2 homology domain 3-only protein Puma (Bbc3) were potently protected against damage caused by status epilepticus. In the present study we examined whether Puma deficiency was protective when the seizure episode was more severe. Intra-amygdala microinjection of 1 microg kainic acid (KA) into C57BL/6 mice triggered status epilepticus that lasted about twice as long as with 0.3 microg KA prior to lorazepam termination. Hippocampal damage was also significantly greater in the higher-dose group. Over 80% of degenerating neurons after seizures were positive for DNA fragmentation assessed by terminal deoxynucleotidyl dUTP nick end labeling (TUNEL). Microscopic analysis of neuronal nuclear morphology in TUNEL-positive cells revealed the proportion displaying large rounded clumps of condensed chromatin was approximately 50% lower in the high-dose versus low-dose KA group. Nevertheless, compared to heterozygous and wild-type mice subject to status epilepticus by high-dose KA, neuronal death was reduced by approximately 50% in the hippocampus of Puma-deficient mice. These data suggest aspects of the apoptotic component of seizure-induced neuronal death are insult duration- or severity-dependent. Moreover, they provide further genetic evidence that seizure-induced neuronal death is preventable by targeting so-called apoptosis-associated signaling pathways and Puma loss likely disrupts caspase-independent or non-apoptotic seizure-induced neuronal death.
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Affiliation(s)
- T Engel
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Clark O, Engel T, Clark L, Paladini L, Faleiros E, Pegoretti B. Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatments: Systematic review and meta-analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20620 Background: Chemotherapy-induced nausea and vomiting (CINV) are frequent side effects of cancer treatment, with negative effects on quality of life. CINV may be acute (occurring within 24 hours after the chemotherapy) or delayed (up to 7 days after it). There are currently five serotonin inhibitors (5-HT3R) available on the market. PAL has the longer half-life, but there are controversies regarding if a better control of CINV (particularly delayed) is obtained with it. This controversy is reflected in recommendations of practice guidelines. Objective: To perform a systematic review and meta-analysis of all randomized controlled trials comparing a single intravenous dose of PAL 0,25mg with other 5-HT3R in patients receiving MoHE chemotherapy. Methods: We searched several databases, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoints were the incidence of acute and delayed nausea and vomiting. The side effects of each treatment were analyzed. A subgroup analysis on the impact of added corticosteroids was performed.The results of individual studies were pooled in a meta-analysis, using the RevMan 5.1 software. The results are expressed as Risk Ratio (RR) and the correspondent 95% Confidence Interval (CI). Results: We included 4 studies, with 1,298 patients. PAL was compared to ondansetron, granisetron and dolasetron. Patients in PAL group had less nausea, either acute (RR=0.75; CI= 0.64 to 0.88; P = 0.0004) or delayed (RR= 0.73; CI= 0.66 to 0.82; P < 0.00001). They also had less acute vomiting (RR = 0.78; CI= 0.67 to 0.90; P = 0.0008) and delayed vomiting (RR= 0.75; CI= 0.67 to 0.84; P < 0.00001). There were no statistical differences in side effects like headache (RR = 0.83; P = 0.29), dizziness (RR = 0.40; P = 0.12), constipation (RR = 1.35; P = 0.30) or diarrhea (RR = 0.67; P = 0.44). Patients receiving PAL presented less nausea and vomiting regardless of the use of corticoids. There was no statistical heterogeneity in the analises. Conclusions: PAL was more effective than the other 5-HT3R in preventing acute and delayed CINV in patients receiving MoHE treatments, regardless of the use of concomitant corticosteroids. [Table: see text]
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Hommel A, Hesse D, Blüher M, Engel T, Zahn C, Moser M, Kluge R, Joost HG, Schürmann A. The Ras-homologous GTPase Arfrp1 is involved in the regulation of triglyceride storage in mouse and human adipose tissue. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221808] [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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Osterhoff G, Hepp P, Engel T, Josten C. [Joint reconstruction with autologous bone cylinder and locked intramedullary nail: proximal humeral shaft fracture with ipsilateral reverse Hill-Sachs lesion]. Unfallchirurg 2009; 112:327-31. [PMID: 19212733 DOI: 10.1007/s00113-008-1540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The case of a 51-year-old patient is presented, with a humeral shaft fracture in combination with an ipsilateral reverse Hill-Sachs lesion, presumably after posterior shoulder dislocation as a result of an electrical accident followed by a fall from a ladder. After corresponding diagnostics, osteosynthesis of the shaft fracture was performed with a locked antegrade intramedullary nail. Simultaneously the reverse Hill-Sachs lesion was elevated und supplemented with the bone core that accrues during drilling of the nail entrance. In the follow-up period good fragment alignment, persistent joint stability and freedom of pain could be observed. On the basis of this case and the current literature the injury mechanism and potential therapy alternatives are discussed.
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Affiliation(s)
- G Osterhoff
- Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Engel T, Goñi-Oliver P, Gomez-Ramos P, Morán M, Lucas J, Avila J, Hernández F. Hippocampal neuronal subpopulations are differentially affected in double transgenic mice overexpressing frontotemporal dementia and parkinsonism linked to chromosome 17 tau and glycogen synthase kinase-3β. Neuroscience 2008; 157:772-80. [DOI: 10.1016/j.neuroscience.2008.09.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 11/26/2022]
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Engel T, Goñi-Oliver P, Gómez de Barreda E, Lucas JJ, Hernández F, Avila J. Lithium, a potential protective drug in Alzheimer's disease. NEURODEGENER DIS 2008; 5:247-9. [PMID: 18322403 DOI: 10.1159/000113715] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Alzheimer's disease is characterized by the presence of two histopathological aberrant structures, the senile plaques and the neurofibrillary tangles. The main component of these tangles is the cytoskeletal protein tau in hyperphosphorylated form. Since a main tau kinase is glycogen synthase kinase 3 (GSK-3), the use of specific GSK-3 inhibitors, like lithium, could be a potential therapy in Alzheimer's disease. In this short article, we have done a review on tau phosphorylation in Alzheimer's disease and other tauopathies, and on the inhibition of kinases like GSK-3, involved in tau modification.
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Affiliation(s)
- T Engel
- Centro de Biología Molecular Severo Ochoa, CSIC-UAM, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
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Hepp P, Theopold J, Engel T, Marquass B, Düsing T, Josten C. [Lesser tuberosity avulsion in combination with multifragment fracture of the greater tuberosity. A rare entity at the proximal humerus]. Unfallchirurg 2008; 111:628-31. [PMID: 18270680 DOI: 10.1007/s00113-007-1375-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/25/2022]
Abstract
Isolated fractures of the greater tuberosity represent 14-21% of all proximal humeral fractures. Lesser tuberosity fractures have mainly been mentioned in case reports. We report a rare case of a combination of a lesser tuberosity avulsion with a multifragment fracture of the greater tuberosity of the proximal humerus in a young man. The injury mechanism might be a complex interaction between abduction and external rotation with impaction and shearing against the glenoid and acromion.
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Affiliation(s)
- P Hepp
- Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103 Leipzig.
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Marquass B, Engel T, Hepp P, Theopold J, Josten C. Ein- und zweizeitiges Vorgehen bei Revisionschirurgie des vorderen Kreuzbandes. Z Orthop Unfall 2007; 145:712-8. [DOI: 10.1055/s-2007-965805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lill H, Hepp P, Rose T, Engel T, Künzel E, Josten C. Fresh meniscal allograft transplantation and autologous ACL/PCL reconstruction in a patient with complex knee trauma following knee dislocation--a case report. Scand J Med Sci Sports 2004; 14:112-5. [PMID: 15043633 DOI: 10.1111/j.1600-0838.2003.00326.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/27/2022]
Abstract
Instability of the knee joint, particularly in combination with the loss of one meniscus, regularly leads to the early development of arthritis. This paper describes the case of a 19-year-old male with ruptures of the anterior (ACL) and posterior cruciate ligament (PCL) along with the loss of the medial meniscus due to knee dislocation. Combined, time-delayed reconstruction of both the ACL and PCL and the allogenic fresh meniscal transplantation of the medial meniscus without bone plugs were performed. The control arthroscopy performed 6 months post-transplantation revealed good vitality and integration of the grafts as assessed both macroscopically and histologically. A small portion of the posterior horn had to be refixated, and the anterior horn was atrophic. At 24 months after trauma and 13 months following meniscal transplantation, the patient achieved a Lysholm score of 88 points and clinical examination indicated a stable knee. Fresh meniscal allograft transplantation, in combination with autologous ACL and PCL reconstruction, constitutes--in specialized centers--an alternative treatment option for complex trauma of the knee joint with loss of a meniscus.
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Affiliation(s)
- H Lill
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Germany.
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Abstract
Between October 1996 and January 1999,29 patients (f:16,m:13,age: 22-86) with fractures of the lateral tibial plateau were operated on arthroscopic,fluoroscopic control or were treated with open reduction and internal fixation. 15 of them were retrospective and 14 prospective analysed. The metaphyseal defect after elevation of the depressed fragment was augmented in 11 cases with autologous spongeous bone grafting,in 9 cases with biodegradable bone cement (Norian SRS). Augmentation was unnecessary in 9 cases. The results according to the Lysholm score and the radiological results were good or excellent. Concerning the kind of augmentation no difference was noted. In the Norian SRS-group the duration of postoperative treatment was shorter than in the other group. The duration of partial weight bearing was shorter too. The results of the present study suggest that an injectable calcium phosphate cement may be a competent material for augmentation in lateral tibial plateau fractures because of the application form and the initial high mechanical stability.
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Affiliation(s)
- T Engel
- Klinik für Unfall- und Wiederherstellungschirurgie, Universität Leipzig
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Abstract
Thirty-eight patients (mean age 49 years; range 19-91 years; nine of them over 60 years; 28 women, 10 men) suffering from an isolated Weber B fracture with a dislocation of less than 1 mm underwent functional therapy using a pneumatic ankle brace and were included in a prospective study. The clinical outcome was measured according to the Olerud-Molander ankle score. Functional therapy was finished in 34 cases successfully. Twenty-one patients were scored after 17 months on average (range 8-27 months) with the Olerud-Molander ankle score. A very good result was seen in 18 patients, including 12 with 100 points, a complete remission. The remaining 3 patients showed good results (1 had 90, 2 had 85). However, functional treatment failed in 4 cases due to secondary dislocation. These patients underwent surgery without further complications. The control group, 31 operated patients, did not show as good results. Functional therapy of stable Weber-B ankle fractures appears to be superior to surgery. We were able to avoid surgery in 90% of our patients and got better results than with patients undergoing open reduction and internal fixation.
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Affiliation(s)
- A Dietrich
- Clinic for General, Thoracic and Oncological Surgery, Leipzig University, Liebigstr. 20 a, 04103 Leipzig, Germany.
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Engel T, Käb G, Lanig H. Intramolecular Photoinduced Electron Transfer in Zwitterionic Quinolinium Dyes – Experimental and Theoretical Studies. Z PHYS CHEM 2002. [DOI: 10.1524/zpch.2002.216.3.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Quinolinium cations and quinolinium betaines were investigated in the representative solvents water and acetonitrile at room temperature using stationary and time-resolved fluorescence spectroscopy (Experimental results reveal that sulfoalkyl- and carboxyalkyl-quinolinium compounds display a strikingly different behavior in the two solvents. Furthermore, the fluorescence lifetime depends on the length of the spacer for the sulfoalkyl compounds in acetonitrile and the carboxyalkyl compounds in water, respectively. This suggests an intramolecular interaction of the anionic headgroups with the quinolinium system in the excited state. To support this idea, different positions at the chromophore are substituted by a methylgroup in order to perturb the proposed interaction.With the intention to understand the dynamics of the postulated photoinduced electron transfer from the anionic group onto the excited quinolinium chromophore, semiempirical quantum chemical calculations were performed on the species using the PM3 hamiltonian including solvent effects by a self consistent reaction field (SCRF).We show that the Marcus theory of electron transfer may serve as a theoretical basis for a natural interpretation of the dynamic fluorescence quenching behavior.
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