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Csoma B, Sydó N, Szűcs G, Seres É, Erdélyi T, Horváth G, Csulak E, Merkely B, Müller V. Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes. Med Sci Sports Exerc 2024:00005768-990000000-00484. [PMID: 38650115 DOI: 10.1249/mss.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes. METHODS Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total IgE, FENO measurements, and skin prick testing were performed. A scoring system from BEC, FENO, serum IgE, and skin test positivity was constructed by dichotomising the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from 0 to 4. RESULTS A total of 48 participants were enrolled (age 21 ± 4 years, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and FENO levels were higher in asthmatic individuals (68 [27-176] vs. 24 ([1-44], p = 0.01; 20 [17-26] vs. 15 [11-22], p = 0.02), and positive prick test was also more frequent (55% vs. 8%, p < 0.01). Asthmatic participants had higher composite variable scores (2 ([1-3] vs. 1 [0-1], p = 0.02). ROC analysis showed that total IgE, FENO, and the composite variable were suitable for identifying asthmatic participants (AUC 0.72, p = 0.01; 0.70, p = 0.02, and 0.69, p = 0.03). A composite score of >2 reached a specificity of 96.2%, sensitivity of 36.4%, and likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR 2.71 (95% CI 1.17-6.23), p = 0.02). CONCLUSIONS Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion.
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Affiliation(s)
- Balázs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Nóra Sydó
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Gergő Szűcs
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Éva Seres
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Tamás Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Gábor Horváth
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Emese Csulak
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
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Schønberg-Moe A, Csoma B, Bikov A, Müller V, Lázár Z. Platelet count and platelet-to-lymphocyte ratio at the onset of a severe COPD exacerbation are unrelated to the time till the next moderate or severe relapse. Adv Med Sci 2024; 69:160-166. [PMID: 38518832 DOI: 10.1016/j.advms.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/25/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Acute exacerbations (AE) are severe complications of chronic obstructive pulmonary disease (COPD); however, the need for biomarkers which predict them is still unmet. High platelet count (PLC) and platelet-to-lymphocyte ratio (PLR) are associated with higher mortality in patients with COPD. We investigated if PLC and PLR at the onset of a severe AE could predict the time of the next relapse. METHODS In a prospective observational cohort study, data of 152 patients hospitalized with AECOPD were collected, and patients were divided into PLC-low (<239 × 109/L, n = 51), PLC-medium (239-297 × 109/L, n = 51) and PLC-high (>297 × 109/L, n = 50) or PLR-low (<147, N = 51), PLR-medium (147-295, n = 51) and PLR high (>295, n = 50) groups based on PLC and PLR tertiles using admission laboratory results. Clinical characteristics and the time to the next severe or moderate AE within 52 weeks were compared among subgroups using log-rank test. RESULTS PLC and PLR tertiles did not differ in clinical characteristics or the time till the next AE (p > 0.05). PLC and PLR showed a direct weak correlation to neutrophil count (Pearson r = 0.26, p < 0.01 and r = 0.20, p = 0.01) and PLC also demonstrated a weak relationship to white blood cell counts (Pearson r = 0.29, p < 0.001). However, PLR presented an inverse relationship to monocyte and eosinophil counts (r = -0.32, p < 0.001 and r = -0.17, p = 0.03). CONCLUSION PLC and PLR do not predict the time till the next relapse; however, they may reflect on neutrophilic inflammatory response during an exacerbation of COPD.
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Affiliation(s)
- Andreas Schønberg-Moe
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., Budapest, 1083, Hungary
| | - Balázs Csoma
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., Budapest, 1083, Hungary
| | - András Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, United Kingdom; Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, United Kingdom
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., Budapest, 1083, Hungary
| | - Zsófia Lázár
- Department of Pulmonology, Semmelweis University, 25-29 Tömő Str., Budapest, 1083, Hungary.
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Lázár Z, Horváth A, Kiss-Dala S, Abonyi-Tóth Z, Csoma B, Kontz K, Tamási L, Müller V. Assessment of bronchodilator responsiveness to salbutamol or ipratropium using different criteria in treatment-naïve patients with asthma and COPD. Eur Clin Respir J 2024; 11:2328434. [PMID: 38529514 PMCID: PMC10962294 DOI: 10.1080/20018525.2024.2328434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/06/2024] [Indexed: 03/27/2024] Open
Abstract
Background The criteria for significant bronchodilator responsiveness (BDR) were published in 2005 by the European Respiratory Society/American Thoracic Society, which were revised in 2021, however, data on the agreement between these two recommendations in untreated patients with airflow limitation are missing. Aims We aimed to study BDR to salbutamol (SABA) or ipratropium bromide (SAMA) in patients with suspected bronchial asthma or COPD at initial clinical presentation using the 2005 and 2021 criteria and explore clinical factors associated with BDR+. Methods Symptomatic, treatment-naïve patients with expiratory airflow limitation (n = 105, 57 men, age (mean ± standard deviation): 65 ± 10 years) underwent BDR testing with 400 mcg salbutamol (day 1) or 80 mcg ipratropium bromide (day 2) and BDR was measured after 15 and 30 minutes. Clinical factors with risk for BDR+ were assessed with binomial logistic regression analysis. Results We found a good agreement between the number of 2005-BDR+ and 2021-BDR+ patients at 15 and 30 minutes post-salbutamol and post-ipratropium (88.6-94.8%). More patients showed BDR+ after 30 minutes than following 15 minutes using either criterion. When results at 30 minutes are considered, the number of patients with 2005-BDR+ (82%) was higher than that of 2021-BDR+ (75%), with the proportion of SAMA+ patients being higher than that of SABA+ (2005: 70% vs. 49%, Fisher exact p < 0.01; 2021: 64% vs. 41%, p = 0.001). 2005-BDR+ and 2021-BDR+ to SABA were associated with decreasing pre-BD FEV1% predicted and the presence of cough. More patients with asthma were in the SABA+ group compared to the SAMA+ group (2005: 71% vs. 53%, Fischer exact p = 0.04; 2021: 77% vs. 52%, p = 0.02). Conclusions Fewer patients show BDR+ according to the 2021 criteria in comparison with the 2005 recommendations, and protocols for BDR testing may consider the assessment of response to both SABA and SAMA after 30 minutes.
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Affiliation(s)
- Zsófia Lázár
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
- Medical Department, Chiesi Hungary Ltd., Budapest, Hungary
| | | | | | - Balázs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Katalin Kontz
- Health and Social Public Benefit Nonprofit Ltd., Dunakeszi, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Gregor J, Adir Y, Šterclová M, Mogulkoc N, Kramer MR, Doubková M, Plačková M, Müller V, Studnicka M, Žurková M, Lacina L, Lewandowska K, Bartoš V, Ovesná P, Májek O, Koziar Vašáková M. The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry. Arch Bronconeumol 2024; 60:80-87. [PMID: 38160169 DOI: 10.1016/j.arbres.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Most patients with idiopathic pulmonary fibrosis (IPF) treated with antifibrotics (AF) have progressive disease despite treatment. A switch of AF may improve survival, but evidence from randomised controlled trials is missing. We aimed to evaluate the efficacy of an AF switch on survival and FVC decline in patients from the European MultiPartner IPF registry (EMPIRE). METHODS The study included 612 patients who discontinued the first antifibrotic therapy. Patients were grouped and analysed from two perspectives: (1) whether they had received a second antifibrotic treatment after the discontinuation of the first therapy, and (2) a reason for discontinuation of the first AF - "lack of efficacy" (LE) and "intolerance" (INT). RESULTS While 263 (43%) of 612 patients received no second AF ("non-switched"), 349 (57%) patients switched. Overall survival was higher in patients who received a second AF (median 50 vs. 29 months; adjusted HR 0.64, P=0.023). Similarly, the annual FVC decline was significantly reduced in switched patients: -98ml/y in switched and -172ml/y in non-switched patients (P=0.023), respectively. The switched patients had similar risk for mortality in both LE and INT groups (adjusted HR 0.95, P=0.85). The high impact of switching on survival was demonstrated in LE patients (adjusted HR 0.27, P<0.001). CONCLUSION The patients without a second AF had significantly shorter overall survival. Our analysis suggests the importance of switching patients with an ineffective first AF therapy to a second AF therapy.
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Affiliation(s)
- Jakub Gregor
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Martina Šterclová
- Department of Respiratory Medicine, Thomayer University Hospital, Prague, Czech Republic
| | - Nesrin Mogulkoc
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Martina Doubková
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
| | - Martina Plačková
- Department of Pneumology, University Hospital Ostrava, Czech Republic
| | - Veronika Müller
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Michael Studnicka
- Department of Respiratory Medicine, Paracelsus Medical University Salzburg, Austria
| | - Monika Žurková
- Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic
| | - Ladislav Lacina
- Department of Pneumology and Thoracic Surgery, Hospital Na Bulovce, Prague, Czech Republic
| | - Katarzyna Lewandowska
- First Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Vladimír Bartoš
- Department of Pneumology, University Hospital Hradec Králové, Czech Republic
| | - Petra Ovesná
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Schneider MF, Vogt M, Scheuermann J, Müller V, Fischer-Hentrich AHL, Kremer T, Lugert S, Metzger F, Kudernatsch M, Kluger G, Hartlieb T, Noachtar S, Vollmar C, Kunz M, Tonn JC, Coras R, Blümcke I, Pace C, Heinen F, Klein C, Potschka H, Borggraefe I. Brain expression profiles of two SCN1A antisense RNAs in children and adolescents with epilepsy. Transl Neurosci 2024; 15:20220330. [PMID: 38283997 PMCID: PMC10811528 DOI: 10.1515/tnsci-2022-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Objective Heterozygous mutations within the voltage-gated sodium channel α subunit (SCN1A) are responsible for the majority of cases of Dravet syndrome (DS), a severe developmental and epileptic encephalopathy. Development of novel therapeutic approaches is mandatory in order to directly target the molecular consequences of the genetic defect. The aim of the present study was to investigate whether cis-acting long non-coding RNAs (lncRNAs) of SCN1A are expressed in brain specimens of children and adolescent with epilepsy as these molecules comprise possible targets for precision-based therapy approaches. Methods We investigated SCN1A mRNA expression and expression of two SCN1A related antisense RNAs in brain tissues in different age groups of pediatric non-Dravet patients who underwent surgery for drug resistant epilepsy. The effect of different antisense oligonucleotides (ASOs) directed against SCN1A specific antisense RNAs on SCN1A expression was tested. Results The SCN1A related antisense RNAs SCN1A-dsAS (downstream antisense, RefSeq identifier: NR_110598) and SCN1A-usAS (upstream AS, SCN1A-AS, RefSeq identifier: NR_110260) were widely expressed in the brain of pediatric patients. Expression patterns revealed a negative correlation of SCN1A-dsAS and a positive correlation of lncRNA SCN1A-usAS with SCN1A mRNA expression. Transfection of SK-N-AS cells with an ASO targeted against SCN1A-dsAS was associated with a significant enhancement of SCN1A mRNA expression and reduction in SCN1A-dsAS transcripts. Conclusion These findings support the role of SCN1A-dsAS in the suppression of SCN1A mRNA generation. Considering the haploinsufficiency in genetic SCN1A related DS, SCN1A-dsAS is an interesting target candidate for the development of ASOs (AntagoNATs) based precision medicine therapeutic approaches aiming to enhance SCN1A expression in DS.
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Affiliation(s)
- Marius Frederik Schneider
- Division of Molecular Biology, Biomedical Center Munich, Ludwig Maximilians University, Munich, Germany
- International Max Planck Research School (IMPRS) for Molecular Life Sciences, Planegg-Martinsried, Germany
| | | | - Johanna Scheuermann
- Division of Molecular Biology, Biomedical Center Munich, Ludwig Maximilians University, Munich, Germany
| | - Veronika Müller
- Division of Molecular Biology, Biomedical Center Munich, Ludwig Maximilians University, Munich, Germany
| | | | - Thomas Kremer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Sebastian Lugert
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Manfred Kudernatsch
- Clinic for Neurosurgery, Schoen-Klinik Vogtareuth, Germany
- Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Kluger
- Paracelsus Medical University, Salzburg, Austria
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Germany
| | - Till Hartlieb
- Paracelsus Medical University, Salzburg, Austria
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Germany
| | - Soheyl Noachtar
- Department of Neurology, Comprehensive Epilepsy Center, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Comprehensive Epilepsy Center, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
- Comprehensive Epilepsy Center, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Jörg Christian Tonn
- Department of Neurosurgery, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Claudia Pace
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilians University, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilians University, Munich, Germany
| | - Ingo Borggraefe
- Comprehensive Epilepsy Center, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, University Hospital of Munich, Ludwig Maximilians University, Munich, Germany
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Csósza G, Szűcs G, Rozgonyi Z, Csoma B, Losonczy G, Müller V, Karlócai K, Lázár Z. Circulating apelin, IL22RA2 and VEGF in pre-capillary pulmonary hypertension. Physiol Int 2023; 110:356-370. [PMID: 37975916 DOI: 10.1556/2060.2023.00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
Cytokines can modulate vascular remodelling and the adaptation of the right ventricle in pre-capillary pulmonary hypertension (PH). However, detailed data on the circulating levels of cytokines in patients are limited. We measured blood cytokine concentration in 39 treatment-naïve patients (pulmonary arterial hypertension: N = 16, chronic thromboembolic PH: N = 15, PH due to lung disease: N = 8) and 12 control subjects using enzyme-linked immunoassays. Apelin concentration >1,261 ng/mL identified patients with PH (66% sensitivity and 82% specificity), and in patients it was related to systolic pulmonary arterial pressure (PAP) (r = 0.33, P = 0.04), right atrial pressure (r = 0.38, P = 0.02), cardiac index (r = -0.34, P = 0.04), and right ventricular stroke work index (r = -0.47, P = 0.003). IL22RA2 concentration correlated with mean PAP (r = -0.32, P = 0.04) and serum N-terminal pro B-type natriuretic peptide level (r = -0.42, P = 0.01). VEGF concentration increased in patients upon clinical improvement (N = 16, P = 0.02). Circulating apelin is a novel biomarker of pre-capillary PH. Apelin and IL22RA2 levels are related to right ventricular function upon diagnosis of PH.
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Affiliation(s)
- Györgyi Csósza
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gergő Szűcs
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsolt Rozgonyi
- 2Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Balázs Csoma
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - György Losonczy
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kristóf Karlócai
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsófia Lázár
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Polivka L, Valyi-Nagy I, Szekanecz Z, Bogos K, Vago H, Kamondi A, Fekete F, Szlavik J, Surjan G, Surjan O, Nagy P, Schaff Z, Kiss Z, Müller C, Kasler M, Müller V. Waning of SARS-CoV-2 Vaccine Effectiveness in COPD Patients: Lessons from the Delta Variant. Vaccines (Basel) 2023; 11:1786. [PMID: 38140190 PMCID: PMC10747394 DOI: 10.3390/vaccines11121786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Although the COVID-19 pandemic is profoundly changing, data on the effect of vaccination and duration of protection against infection and severe disease can still be advantageous, especially for patients with COPD, who are more vulnerable to respiratory infections. The Hungarian COVID-19 registry was retrospectively investigated for risk of infection and hospitalization by time since the last vaccination, and vaccine effectiveness (VE) was calculated in adults with COPD diagnosis and an exact-matched control group during the Delta variant of concern (VOC) wave in Hungary (September-December 2021). For the matching, sex, age, major co-morbidities, vaccination status, and prior infection data were obtained on 23 August 2021. The study population included 373,962 cases divided into COPD patients (age: 66.67 ± 12.66) and a 1:1 matched group (age: 66.73 ± 12.67). In both groups, the female/male ratio was 52.2:47.7, respectively. Among the unvaccinated, there was no difference between groups in risk for infection or hospitalization. Regarding vaccinated cases, in the COPD group, a slightly faster decline in effectiveness was noted for hospitalization prevention, although in both groups, the vaccine lost its significant effect between 215 and 240 days after the last dose of vaccination. Based on a time-stratified multivariate Cox analysis of the vaccinated cases, the hazard was constantly higher in the COPD group, with an HR of 1.09 (95%: 1.05-1.14) for infection and 1.87 (95% CI: 1.59-2.19) for hospitalization. In our study, COPD patients displayed lower vaccine effectiveness against SARS-CoV-2 infection and hospitalization but a similar waning trajectory, as vaccines lost their preventive effect after 215 days. These data emphasize revaccination measures in the COPD patient population.
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Affiliation(s)
- Lörinc Polivka
- Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary;
| | - Istvan Valyi-Nagy
- South-Pest Hospital Centre, National Institute for Infectiology and Hematology, 1097 Budapest, Hungary (J.S.)
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen, 4032 Debrecen, Hungary;
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, 1122 Budapest, Hungary;
| | - Hajnalka Vago
- Heart and Vascular Centre, Semmelweis University, 1122 Budapest, Hungary;
| | - Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, 1145 Budapest, Hungary;
| | - Ferenc Fekete
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
| | - Janos Szlavik
- South-Pest Hospital Centre, National Institute for Infectiology and Hematology, 1097 Budapest, Hungary (J.S.)
| | - György Surjan
- National Public Health Center, 1097 Budapest, Hungary; (G.S.); (O.S.); (C.M.)
| | - Orsolya Surjan
- National Public Health Center, 1097 Budapest, Hungary; (G.S.); (O.S.); (C.M.)
| | - Peter Nagy
- National Institute of Oncology, 1122 Budapest, Hungary;
| | - Zsuzsa Schaff
- Department of Pathology and Forensic Medicine, Semmelweis University, 1091 Budapest, Hungary;
| | - Zoltan Kiss
- 2nd Department of Internal Medicine and Nephrological Center, University of Pécs, 7624 Pécs, Hungary;
| | - Cecilia Müller
- National Public Health Center, 1097 Budapest, Hungary; (G.S.); (O.S.); (C.M.)
| | | | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary;
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8
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Kerpel-Fronius A, Megyesfalvi Z, Markóczy Z, Solymosi D, Csányi P, Tisza J, Kecskés A, Baranyi B, Csánky E, Dóka A, Gálffy G, Göcző K, Győry C, Horváth Z, Juhász T, Kállai Á, Kincses ZT, Király Z, Király-Incze E, Kostyál L, Kovács A, Kovács A, Kuczkó É, Makra Z, Maurovich Horvát P, Merth G, Moldoványi I, Müller V, Pápai-Székely Z, Papp D, Polgár C, Rózsa P, Sárosi V, Szalai Z, Székely A, Szuhács M, Tárnoki D, Tavaszi G, Turóczi-Kirizs R, Tóth L, Urbán L, Vaskó A, Vigh É, Dome B, Bogos K. HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. Eur Radiol 2023:10.1007/s00330-023-10379-8. [PMID: 37921926 DOI: 10.1007/s00330-023-10379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. METHODS A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. RESULTS The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). CONCLUSIONS HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. CLINICAL RELEVANCE STATEMENT HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. KEY POINTS • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.
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Affiliation(s)
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Zsolt Markóczy
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Péter Csányi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Tisza
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anita Kecskés
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | | | - Eszter Csánky
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Adrienn Dóka
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | | | - Katalin Göcző
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Csilla Győry
- Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Zsolt Horváth
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tünde Juhász
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | - Árpád Kállai
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | - Zsigmond T Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Király
- Pulmonological Institute of Veszprém County, Farkasgyepű, Hungary
| | - Enikő Király-Incze
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - László Kostyál
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Anita Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Kovács
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | - Éva Kuczkó
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsuzsanna Makra
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | | | | | | | | | - Zsolt Pápai-Székely
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Dávid Papp
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Budapest, Hungary
| | - Péter Rózsa
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
- MediConcept, Budapest, Hungary
| | - Veronika Sárosi
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | | | | | - Marianna Szuhács
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | | | - Gábor Tavaszi
- Törökbálint Institute of Pulmonology, Törökbálint, Hungary
| | | | | | | | | | - Éva Vigh
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Translational Medicine, Lund University, Lund, Sweden.
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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9
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Kiss Z, Gálffy G, Müller V, Moldvay J, Sárosi V, Pápai-Székely Z, Csada E, Kerpel-Fronius A, Király Z, Szász Z, Hódi G, Polányi Z, Kovács K, Karamousouli E, Knollmajer K, Szabó TG, Berta A, Vokó Z, Rokszin G, Abonyi-Tóth Z, Barcza Z, Tamási L, Bogos K. Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic. Front Oncol 2023; 13:1207295. [PMID: 37860193 PMCID: PMC10584310 DOI: 10.3389/fonc.2023.1207295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Objective The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database. Methods This retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology. Results In total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7% [95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%) and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was statistically significant. Compared to 2011-2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018, and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period. Conclusion 3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic.
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Affiliation(s)
- Zoltán Kiss
- MSD Pharma Hungary Ltd, Budapest, Hungary
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Gabriella Gálffy
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Pápai-Székely
- Fejér County Szent György, University Teaching Hospital, Székesfehérvár, Hungary
| | - Edit Csada
- Csongrád-Csanád County Hospital for Chest Diseases, Deszk, Hungary
| | - Anna Kerpel-Fronius
- National Korányi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | - Zsolt Király
- Veszprém County Pulmonary Hospital, Farkasgyepű, Hungary
| | - Zoltán Szász
- Department of Pulmonology, Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Gábor Hódi
- MSD Pharma Hungary Ltd, Budapest, Hungary
| | | | | | | | | | | | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | | | - Lilla Tamási
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
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10
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Drácz B, Müller V, Takács I, Hagymási K, Dinya E, Miheller P, Szijártó A, Werling K. Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary. Biomedicines 2023; 11:1541. [PMID: 37371636 DOI: 10.3390/biomedicines11061541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.
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Affiliation(s)
- Bálint Drácz
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Krisztina Hagymási
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Elek Dinya
- Digital Health Department, Semmelweis University, 1083 Budapest, Hungary
| | - Pál Miheller
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Klára Werling
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
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11
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Tóth NM, Müller V, Nagy T, Polivka L, Horváth P, Bohács A, Eszes N. Serum Progranulin Level Might Differentiate Non-IPF ILD from IPF. Int J Mol Sci 2023; 24:ijms24119178. [PMID: 37298130 DOI: 10.3390/ijms24119178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnosing interstitial lung disease (ILD) can be a challenging process. New biomarkers may support diagnostic decisions. Elevated serum progranulin (PGRN) levels have been reported in liver fibrosis and dermatomyositis-associated acute interstitial pneumonia. Our aim was to assess the role of PGRN in the differential diagnosis of idiopathic pulmonary fibrosis (IPF) and other ILDs. Serum levels of PGRN were measured by enzyme-linked immunosorbent assay in stable IPF (n = 40), non-IPF ILD (n = 48) and healthy controls (n = 17). Patient characteristics, lung function, CO diffusion (DLCO), arterial blood gases, 6-min walk test, laboratory parameters and high-resolution (HR)CT pattern were assessed. In stable IPF, PGRN levels did not differ from healthy controls; however, serum PGRN levels were significantly higher in non-IPF ILD patients compared to healthy subjects and IPF (53.47 ± 15.38 vs. 40.99 ± 5.33 vs. 44.66 ± 7.77 ng/mL respectively; p < 0.01). The HRCT pattern of usual interstitial pneumonia (UIP) was associated with normal PGRN level, while for non-UIP patterns, significantly elevated PGRN level was measured. Elevated serum PGRN levels may be associated with non-IPF ILD, especially non-UIP patterns and might be helpful in cases of unclear radiological patterns in the differentiation between IPF and other ILDs.
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Affiliation(s)
- Nóra Melinda Tóth
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Tamás Nagy
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Lőrinc Polivka
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Péter Horváth
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Anikó Bohács
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Noémi Eszes
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
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12
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Erdelyi T, Lazar Z, Farkas Á, Furi P, Nagy A, Müller V. Modeling of pulmonary deposition of agents of open and fixed dose triple combination therapies through two different low-resistance inhalers in COPD: a pilot study. Front Med (Lausanne) 2023; 10:1065072. [PMID: 37215734 PMCID: PMC10196142 DOI: 10.3389/fmed.2023.1065072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Inhalation therapy is a cornerstone of treating patients with chronic obstructive pulmonary disease (COPD). Inhaler devices might influence the effectiveness of inhalation therapy. We aimed to model and compare the deposition of acting agents of an open and a fixed dose combination (FDC) triple therapy and examine their repeatability. Methods We recruited control subjects (Controls, n = 17) and patients with stable COPD (S-COPD, n = 13) and those during an acute exacerbation (AE-COPD, n = 12). Standard spirometry was followed by through-device inhalation maneuvers using a pressurized metered dose inhaler (pMDI) and a soft mist inhaler (SMI) to calculate deposition of fixed dose and open triple combination therapies by numerical modeling. Through-device inspiratory vital capacity (IVCd) and peak inspiratory flow (PIFd), as well as inhalation time (tin) and breath hold time (tbh) were used to calculate pulmonary (PD) and extrathoracic deposition (ETD) values. Deposition was calculated from two different inhalation maneuvers. Results There was no difference in forced expiratory volume in 1 s (FEV1) between patients (S-COPD: 42 ± 5% vs. AE-COPD: 35 ± 5% predicted). Spiriva® Respimat® showed significantly higher PD and lower ETD values in all COPD patients and Controls compared with the two pMDIs. For Foster® pMDI and Trimbow® pMDI similar PD were observed in Controls, while ETD between Controls and AE-COPD patients did significantly differ. There was no difference between COPD groups regarding the repeatability of calculated deposition values. Ranking the different inhalers by differences between the two deposition values calculated from separate maneuvers, Respimat® produced the smallest inter-measurement differences for PD. Discussion Our study is the first to model and compare PD using pMDIs and an SMI as triple combination in COPD. In conclusion, switching from FDC to open triple therapy in cases when adherence to devices is maintanined may contribute to better therapeutic effectiveness in individual cases using low resistance inhalers.
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Affiliation(s)
- Tamas Erdelyi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsofia Lazar
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Árpád Farkas
- Environmental Physics Department, Centre for Energy Research, Budapest, Hungary
| | - Peter Furi
- Environmental Physics Department, Centre for Energy Research, Budapest, Hungary
| | - Attila Nagy
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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13
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Ambrus M, Fodor E, Berki T, Müller V, Uhlár Á, Hornyák I, Lacza Z. Professional Athletes Maintain High TNF-Alpha or IFN-Gamma Related Inflammatory Status after Recovering from COVID-19 Infection without Developing a Neutralizing Antibody Response. Sports (Basel) 2023; 11:sports11050097. [PMID: 37234053 DOI: 10.3390/sports11050097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Professional athletes are endangered by COVID-19 and belong to the high-risk population due to their lifestyle. To obtain information on the behavior of COVID-19 in professional athletes, serological, cytokine, and virus neutralization capacities were analyzed. MATERIALS AND METHODS Hungarian national teams participated in international sports events during the early phases of the COVID-19 epidemic in 2020. Altogether, 29 professional athletes volunteered to donate plasma. Their serological status was evaluated by IgA, IgM, and IgG ELISAs and the highest virus neutralization titer in an in vitro live tissue assay. Plasma cytokine patterns were analyzed with a Bioplex multiplex ELISA system. RESULTS Surprisingly, only one athlete (3%) had anti-SARS-CoV-2 IgG, while IgA was more common (31%). Neither plasma showed direct virus neutralization in a titer over 1:10; hence, they were not suitable for reconvalescent treatment. The 'cytokine storm' markers IL-6 and IL-8 were at baseline levels. In contrast, either the TNF-alpha-related cytokines or the IFN-gamma-associated cytokines were elevated. There was a strong negative correlation between the TNF-alpha- or IFN-gamma-related cytokines. CONCLUSIONS Professional athletes are susceptible to the SARS-CoV-2 infection without developing long-term immunity through neutralizing immunoglobulins. Elevated secretory and cellular immunity markers indicate that these systems are probably responsible for virus elimination in this subpopulation.
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Affiliation(s)
- Mira Ambrus
- Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary
| | - Eszter Fodor
- Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary
| | - Timea Berki
- Department of Immunology and Biotechnology, Faculty of Medicine, University of Pécs, 7624 Pécs, Hungary
| | - Veronika Müller
- Clinic of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - Ádám Uhlár
- Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary
| | - István Hornyák
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary
| | - Zsombor Lacza
- Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary
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14
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Riecke K, Müller V, Neunhöffer T, Park-Simon TW, Weide R, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Wuerstlein R, Denkert C, Decker T, Fehm T, Nekljudova V, Rey J, Loibl S, Laakmann E, Witzel I. Long-term survival of breast cancer patients with brain metastases: subanalysis of the BMBC registry. ESMO Open 2023; 8:101213. [PMID: 37075697 DOI: 10.1016/j.esmoop.2023.101213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Up to 30% of metastatic breast cancer (BC) patients develop brain metastases (BM). Prognosis of patients with BM is poor and long-term survival is rare. Identification of factors associated with long-term survival is important for improving treatment modalities. PATIENTS AND METHODS A total of 2889 patients of the national registry for BM in BC (BMBC) were available for this analysis. Long-term survival was defined as overall survival (OS) in the upper third of the failure curve resulting in a cut-off of 15 months. A total of 887 patients were categorized as long-term survivors. RESULTS Long-term survivors compared to other patients were younger at BC and BM diagnosis (median 48 versus 54 years and 53 versus 59 years), more often had HER2-positive tumors (59.1% versus 36.3%), less frequently luminal-like (29.1% versus 35.7%) or triple-negative breast cancer (TNBC) (11.9% versus 28.1%), showed better Eastern Cooperative Oncology Group (ECOG) performance status (PS) at the time of BM diagnosis (ECOG 0-1, 76.9% versus 51.0%), higher pathological complete remission rates after neoadjuvant chemotherapy (21.6% versus 13.7%) and lower number of BM (n = 1, BM 40.9% versus 25.4%; n = 2-3, BM 26.5% versus 26.7%; n ≥4, BM 32.6% versus 47.9%) (P < 0.001). Long-term survivors had leptomeningeal metastases (10.4% versus 17.5%) and extracranial metastases (ECM, 73.6% versus 82.5%) less frequently, and asymptomatic BM more often at the time of BM diagnosis (26.5% versus 20.1%), (P < 0.001). Median OS in long-term survivors was about two times higher than the cut-off of 15 months: 30.9 months [interquartile range (IQR) 30.3] overall, 33.9 months (IQR 37.1) in HER2-positive, 26.9 months (IQR 22.0) in luminal-like and 26.5 months (IQR 18.2) in TNBC patients. CONCLUSIONS In our analysis, long-term survival of BC patients with BM was associated with better ECOG PS, younger age, HER2-positive subtype, lower number of BM and less extended visceral metastases. Patients with these clinical features might be more eligible for extended local brain and systemic treatment.
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Affiliation(s)
- K Riecke
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Neunhöffer
- Frauenärzte am Dom, Mainz, Germany; HELIOS Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
| | - T-W Park-Simon
- Hanover Medical School (MHH University), Hanover, Germany
| | - R Weide
- Institute for Health Services Research in Oncology, Koblenz, Germany
| | - A Polasik
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - M Schmidt
- The University Medical Center Mainz, Mainz, Germany
| | - J Puppe
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | - C Mundhenke
- Klinikum Bayreuth GmbH/Medizincampus Oberfranken, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - M Thill
- Department of Gynecology and Gyneacological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany
| | - R Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC Munich, LMU University Hospital, Munich, Germany
| | - C Denkert
- Institute of Pathology, Philipps University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - T Decker
- Onkology, Haematology Ravensburg, Ravensburg, Germany
| | - T Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - J Rey
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - E Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Zurich, Zürich, Switzerland.
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15
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Marton N, Gyebnar J, Fritsch K, Majnik J, Nagy G, Simon J, Müller V, Tarnoki AD, Tarnoki DL, Maurovich-Horvat P. Photon-counting computed tomography in the assessment of rheumatoid arthritis-associated interstitial lung disease: an initial experience. Diagn Interv Radiol 2023; 29:291-299. [PMID: 36987949 PMCID: PMC10679703 DOI: 10.4274/dir.2023.221959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/22/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Interstitial lung disease (ILD) accounts for a significant proportion of mortality and morbidity in patients with rheumatoid arthritis (RA). The aim of this cross-sectional study is to evaluate the performance of novel photon-counting detector computed tomography (PCD-CT) in the detection of pulmonary parenchymal involvement. METHODS Sixty-one patients with RA without a previous definitive diagnosis of ILD underwent high-resolution (HR) (0.4 mm slice thickness) and ultra-high-resolution (UHR) (0.2 mm slice thickness) PCDCT examination. The extent of interstitial abnormalities [ground-glass opacity (GGO), reticulation, bronchiectasis, and honeycombing] were scored in each lobe using a Likert-type scale. Total ILD scores were calculated as the sum of scores from all lobes. RESULTS Reticulation and bronchiectasis scores were higher in the UHR measurements taken compared with the HR protocol [median (quartile 1, quartile 3): 2 (0, 3.5) vs. 0 (0, 3), P < 0.001 and 2 (0, 2) vs. 0 (0, 2), P < 0.001, respectively]; however, GGO and honeycombing scores did not differ [2 (2, 4) vs. 2 (2, 4), P = 0.944 and 0 (0, 0) vs. 0 (0, 0), P = 0.641, respectively]. Total ILD scores from both HR and UHR scans showed a mild negative correlation in diffusion capacity for carbon monoxide (HR: r = -0.297, P = 0.034; UHR: r = -0.294, P = 0.036). The pattern of lung parenchymal involvement did not differ significantly between the two protocols. The HR protocol had significantly lower volume CT dose index [0.67 (0.69, 1.06) mGy], total dose length product [29 (24.48, 33.2) mGy*cm] compared with UHR scans [8.18 (6.80, 9.23) mGy, P < 0.001 and 250 (218, 305) mGy*cm, P < 0.001]. CONCLUSION UHR PCD-CT provides more detailed information on ILD in patients with RA than low-dose HR PCDCT. HR PCD-CT image acquisition with a low effective radiation dose may serve as a valuable, low-radiation screening tool in the selection of patients for further, higher-dose UHR PCD-CT screening.
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Affiliation(s)
- Nikolett Marton
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Janos Gyebnar
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Kinga Fritsch
- Department of Rheumatology, Buda Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
| | - Judit Majnik
- Department of Rheumatology, Buda Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
| | - Gyorgy Nagy
- Department of Rheumatology, Buda Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Adam Domonkos Tarnoki
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Department of Oncologic Imaging and Invasive Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary
| | - David Laszlo Tarnoki
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Department of Oncologic Imaging and Invasive Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary
| | - Pal Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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16
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Hurler L, Szilágyi Á, Mescia F, Bergamaschi L, Mező B, Sinkovits G, Réti M, Müller V, Iványi Z, Gál J, Gopcsa L, Reményi P, Szathmáry B, Lakatos B, Szlávik J, Bobek I, Prohászka ZZ, Förhécz Z, Csuka D, Kajdácsi E, Cervenak L, Kiszel P, Masszi T, Vályi-Nagy I, Würzner R, Lyons PA, Toonen EJM, Prohászka Z. Complement lectin pathway activation is associated with COVID-19 disease severity, independent of MBL2 genotype subgroups. Front Immunol 2023; 14:1162171. [PMID: 37051252 PMCID: PMC10084477 DOI: 10.3389/fimmu.2023.1162171] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionWhile complement is a contributor to disease severity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, all three complement pathways might be activated by the virus. Lectin pathway activation occurs through different pattern recognition molecules, including mannan binding lectin (MBL), a protein shown to interact with SARS-CoV-2 proteins. However, the exact role of lectin pathway activation and its key pattern recognition molecule MBL in COVID-19 is still not fully understood.MethodsWe therefore investigated activation of the lectin pathway in two independent cohorts of SARS-CoV-2 infected patients, while also analysing MBL protein levels and potential effects of the six major single nucleotide polymorphisms (SNPs) found in the MBL2 gene on COVID-19 severity and outcome.ResultsWe show that the lectin pathway is activated in acute COVID-19, indicated by the correlation between complement activation product levels of the MASP-1/C1-INH complex (p=0.0011) and C4d (p<0.0001) and COVID-19 severity. Despite this, genetic variations in MBL2 are not associated with susceptibility to SARS-CoV-2 infection or disease outcomes such as mortality and the development of Long COVID.ConclusionIn conclusion, activation of the MBL-LP only plays a minor role in COVID-19 pathogenesis, since no clinically meaningful, consistent associations with disease outcomes were noted.
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Affiliation(s)
- Lisa Hurler
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Ágnes Szilágyi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Federica Mescia
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Laura Bergamaschi
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Blanka Mező
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - György Sinkovits
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Marienn Réti
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsolt Iványi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - László Gopcsa
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Beáta Szathmáry
- Department of Infectology, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectology, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - János Szlávik
- Department of Infectology, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Ilona Bobek
- Department of Anaesthesiology and Intensive Therapy, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zita Z. Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsolt Förhécz
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Erika Kajdácsi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - László Cervenak
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Petra Kiszel
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - István Vályi-Nagy
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Reinhard Würzner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Paul A. Lyons
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Erik J. M. Toonen
- Research and Development Department, Hycult Biotech, Uden, Netherlands
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
- *Correspondence: Zoltán Prohászka,
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Groma V, Kugler S, Farkas Á, Füri P, Madas B, Nagy A, Erdélyi T, Horváth A, Müller V, Szántó-Egész R, Micsinai A, Gálffy G, Osán J. Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments. Sci Rep 2023; 13:3566. [PMID: 36864124 PMCID: PMC9980870 DOI: 10.1038/s41598-023-30702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70-10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5-4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.
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Affiliation(s)
- V Groma
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Sz Kugler
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Á Farkas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - P Füri
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - B Madas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - A Nagy
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Budapest, 1121, Hungary
| | - T Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | - A Horváth
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - V Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | | | | | - G Gálffy
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - J Osán
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary.
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18
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Drácz B, Müller V, Takács I, Hagymási K, Dinya E, Miheller P, Szijártó A, Werling K. Effectiveness of COVID-19 Vaccination with mRNA Vaccines for Patients with Cirrhosis in Hungary: Multicentre Matched Cohort Study. Vaccines (Basel) 2022; 11:vaccines11010050. [PMID: 36679899 PMCID: PMC9861308 DOI: 10.3390/vaccines11010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Patients with cirrhosis are vulnerable to hepatic decompensation events and death following COVID-19 infection. Therefore, primary vaccination with COVID-19 vaccines is fundamental to reducing the risk of COVID-19 related deaths in patients with cirrhosis. However, limited data are available about the effectiveness of mRNA vaccines compared to other vaccines. The aim of our study was to investigate the efficacy of mRNA vaccines versus other vaccines in cirrhosis. In this retrospective study, we compared clinical characteristics and vaccine effectiveness of 399 COVID-19 patients without cirrhosis (GROUP A) to 52 COVID-19 patients with cirrhosis (GROUP B). 54 hospitalised cirrhosis controls without COVID-19 (GROUP C) were randomly sampled 1:1 and matched by gender and age. Of the cirrhosis cases, we found no difference (p = 0.76) in mortality rates in controls without COVID-19 (11.8%) compared to those with COVID-19 (9.6%). However, COVID-19 patients with cirrhosis were associated with higher rates of worsening hepatic encephalopathy, ascites and esophageal varices. Patients with cirrhosis receiving mRNA vaccines had significantly better survival rates compared to viral vector or inactivated vaccines. Primary vaccination with the BNT162b2 vaccine was the most effective in preventing acute hepatic decompensating events, COVID-19 infection requiring hospital admission and in-hospital mortality.
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Affiliation(s)
- Bálint Drácz
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
- Correspondence:
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Krisztina Hagymási
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Elek Dinya
- Digital Health Department, Semmelweis University, 1083 Budapest, Hungary
| | - Pál Miheller
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
| | - Klára Werling
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary
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Kiss Z, Bogos K, Tamási L, Ostoros G, Müller V, Bittner N, Sárosi V, Vastag A, Knollmajer K, Várnai M, Kovács K, Berta A, Köveskuti I, Karamousouli E, Rokszin G, Abonyi-Tóth Z, Barcza Z, Kenessey I, Weber A, Nagy P, Freyler-Fadgyas P, Szócska M, Szegner P, Hilbert L, Géczy GB, Surján G, Moldvay J, Vokó Z, Gálffy G, Polányi Z. Underlying reasons for post-mortem diagnosed lung cancer cases - A robust retrospective comparative study from Hungary (HULC study). Front Oncol 2022; 12:1032366. [PMID: 36505881 PMCID: PMC9732724 DOI: 10.3389/fonc.2022.1032366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The Hungarian Undiagnosed Lung Cancer (HULC) study aimed to explore the potential reasons for missed LC (lung cancer) diagnosis by comparing healthcare and socio-economic data among patients with post-mortem diagnosed LC with those who were diagnosed with LC during their lives. Methods This nationwide, retrospective study used the databases of the Hungarian Central Statistical Office (HCSO) and National Health Insurance Fund (NHIF) to identify patients who died between January 1, 2019 and December 31, 2019 and were diagnosed with lung cancer post-mortem (population A) or during their lifetime (population B). Patient characteristics, socio-economic factors, and healthcare resource utilization (HCRU) data were compared between the diagnosed and undiagnosed patient population. Results During the study period, 8,435 patients were identified from the HCSO database with LC as the cause of death, of whom 1,203 (14.24%) had no LC-related ICD (International Classification of Diseases) code records in the NHIF database during their lives (post-mortem diagnosed LC population). Post-mortem diagnosed LC patients were significantly older than patients diagnosed while still alive (mean age 71.20 vs. 68.69 years, p<0.001), with a more pronounced age difference among female patients (difference: 4.57 years, p<0.001), and had significantly fewer GP (General Practitioner) and specialist visits, X-ray and CT scans within 7 to 24 months and 6 months before death, although the differences in GP and specialist visits within 7-24 months did not seem clinically relevant. Patients diagnosed with LC while still alive were more likely to be married (47.62% vs. 33.49%), had higher educational attainment, and had more children, than patients diagnosed with LC post-mortem. Conclusions Post-mortem diagnosed lung cancer accounts for 14.24% of total lung cancer mortality in Hungary. This study provides valuable insights into patient characteristics, socio-economic factors, and HCRU data potentially associated with a high risk of lung cancer misdiagnosis.
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Affiliation(s)
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Directorate of Institution, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Directorate of Institution, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nóra Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine Budapest, Department of Biostatistics, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd, Budapest, Hungary
| | - István Kenessey
- 1 Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Weber
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Péter Nagy
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Department of Anatomy and Histology, University of Veterinary Medicine, Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, Debrecen, Hungary
| | - Petra Freyler-Fadgyas
- National Health Insurance Fund, Department of Project Management and Data Services, Budapest, Hungary
| | - Miklós Szócska
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Péter Szegner
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Lászlóné Hilbert
- Hungarian Central Statistical Office, Department of Population Statistics, Budapest, Hungary
| | | | - György Surján
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- 2 Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Gabriella Gálffy
- Pulmonology Hospital Törökbálint, 6th Department, Törökbálint, Hungary
- Department of Thoracic Surgery, Semmelweis University, Budapest, Hungary
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20
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Schmidt M, Lübbe K, Decker T, Thill M, Bauer L, Müller V, Link T, Furlanetto J, Reinisch M, Mundhenke C, Hoffmann O, Zahn MO, Müller L, Denkert C, van Mackelenbergh M, Fasching P, Burchardi N, Nekljudova V, Loibl S. A multicentre, randomised, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (DESIREE). ESMO Open 2022; 7:100601. [PMID: 36356410 PMCID: PMC9832733 DOI: 10.1016/j.esmoop.2022.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Stomatitis is one of the main reasons to discontinue everolimus in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC). To decrease stomatitis and subsequently early treatment discontinuations or dose reductions, the DESIREE trial investigated the use of a stepwise dose-escalation schedule of everolimus (EVE esc). PATIENTS AND METHODS DESIREE is a phase II, multicentre, randomised, double-blind, placebo-controlled trial in patients with HR+/HER2- mBC and progression/relapse after nonsteroidal aromatase inhibitor treatment. Patients were randomised to EVE esc (2.5 mg/day, week 1; 5 mg/day, week 2; 7.5 mg/day, week 3; 10 mg/day, weeks 4-24) or everolimus 10 mg/day (EVE 10mg) for 24 weeks plus exemestane. The primary endpoint was the incidence of stomatitis episodes grade ≥2 within 12 weeks of treatment. The secondary endpoints included toxicity, relative total dose intensity (RTDI) and quality of life (QoL). RESULTS A total of 160 patients were randomised and 156 started treatment (EVE esc: 80; EVE 10mg: 76). The median age of patients was 64 years (range 33-85), 56.3% patients in the EVE esc arm versus 42.1% in the EVE 10mg arm had liver metastasis (P = 0.081) and 62.5% versus 51.3% received over one metastatic therapy line (P = 0.196). Within 12 weeks, the incidence of stomatitis episodes grade ≥2 was significantly lower in the EVE esc arm compared with the EVE 10mg arm (28.8% versus 46.1%; odds ratio 0.47, 95% confidence interval 0.24-0.92; P = 0.026). Toxicity was in line with the known safety profile without new safety concerns. The median RTDI was 91.1% in the EVE esc arm versus 80.0% in the EVE 10mg arm (P = 0.329). Discontinuation rate in the first 3 weeks was 6.3% versus 15.8%, respectively (P = 0.073). QoL was comparable between the two treatment arms. CONCLUSIONS A dose-escalation schema of everolimus over 3 weeks can be successfully used to reduce the incidence of high-grade stomatitis in the first 12 weeks of treatment in patients with HR+/HER2- mBC. TRIAL REGISTRATION ClinicalTrials.govNCT02387099; https://clinicaltrials.gov/ct2/show/NCT02387099.
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Affiliation(s)
- M. Schmidt
- Universitätsmedizin Mainz, Mainz, Germany
| | - K. Lübbe
- Diakovere Henriettenstift Hannover, Hanover, Germany
| | - T. Decker
- Onkologie und Hämatologie Ravensburg, Ravensburg, Germany
| | - M. Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - L. Bauer
- GRN gGmbH Klinik Weinheim, Weinheim, Germany
| | - V. Müller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - T. Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | | | - M. Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C. Mundhenke
- Brustzentrum, Gynäkologisches Krebszentrum, Perinatalzentrum Level I, Klinikum Bayreuth, Bayreuth, Germany
| | | | - M.-O. Zahn
- MVZ Onkologische Kooperation Harz Dres./Zahn Fachärzte für Innere Medizin, Goslar, Germany
| | | | - C. Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - M. van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Kiel, Germany
| | | | | | | | - S. Loibl
- German Breast Group, Neu-Isenburg, Germany,Correspondence to: Prof. Sibylle Loibl, German Breast Group, Dornhofstr. 10, 63263 Neu-Isenburg, Germany. Tel: +49 6102 7480 335 @GBG_Forschunghttps://twitter.com/GBG_Forschung
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Seres É, Vincze K, Tóth VVM, Tremmel A, Pápay J, Rényi-Vámos F, Müller V, Bohács A. Post-COVID Subacute Thyroiditis and Bronchiolitis in a Lung Transplant Recipient: A Case Report. Transplant Proc 2022; 54:2608-2611. [PMID: 36411095 PMCID: PMC9674305 DOI: 10.1016/j.transproceed.2022.10.050] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lung transplant recipients are at risk for life-threatening infections including severe acute respiratory syndrome coronavirus 2-associated COVID-19. Several viral infections have been associated with the development of chronic lung allograft dysfunction. Long-term outcomes of COVID-19 on graft function are not known. A 53-year-old female patient, who underwent bilateral lung transplantation 3 years before because of stage IV sarcoidosis and secondary pulmonary hypertension was admitted in the second wave of the pandemic because of COVID-19 with symptoms including dry cough. Chest computed tomography showed ground glass opacities affecting 25% to 50% of the lung parenchyma. She was admitted to the COVID-19 Unit of our clinic. She received oxygen via nasal cannula, remdesivir, and low-dose methylprednisolone while mycofenolate acid administration was stopped. Her clinical condition improved. The first follow-up visit 1 month after the infection demonstrated deterioration in lung function. Computed tomography scan showed almost complete resolution; transbronchial biopsy was performed and proved acute allograft rejection. During the hospitalization a new onset atrial fibrillation was confirmed. In the background of atrial fibrillation and simultaneous neck pain, severe hyperthyroidism was proven. Because of thyroiditis and lung allograft rejection, high-dose steroid treatment was initiated and everolimus was added to the immunosuppressive therapy. Donor specific antibodies were also detected, hence plasmapheresis was indicated and continued with photoferesis. On the follow-up spirometry the values were stable; however, they did not reach pre-COVID levels. In lung transplant recipients COVID-19 might trigger allograft rejection in addition to virus-related thyroid disease.
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Affiliation(s)
- Éva Seres
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztina Vincze
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Anna Tremmel
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Judit Pápay
- Department of I. Pathology, Semmelweis University, Budapest, Hungary
| | | | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Anikó Bohács
- Department of Pulmonology, Semmelweis University, Budapest, Hungary,Address correspondence to Anikó Bohács, MD, PhD, Department of Pulmonology, Semmelweis University, Budapest, 1083, Tömő u. 25-29, Hungary. Tel: +3613559733; Fax: +361 214-2498
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22
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Hannemann J, Oliveira-Ferrer L, Goele A, Witzel I, Müller V, Böger R. Plasma L-arginine metabolic profiling in breast cancer patients reflects differences in cellular gene expression and metabolic activities according to subtype – A translational study in human breast cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01575-1] [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: 11/19/2022]
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23
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Schneider MF, Müller V, Müller SA, Lichtenthaler SF, Becker PB, Scheuermann JC. LncRNA RUS shapes the gene expression program towards neurogenesis. Life Sci Alliance 2022; 5:5/10/e202201504. [PMID: 35688487 PMCID: PMC9187872 DOI: 10.26508/lsa.202201504] [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: 04/25/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
The chromatin-associated lncRNA RUS binds in the vicinity to neural differentiation-associated genes and regulates them in a context-dependent manner to enable proper neuron development. The evolution of brain complexity correlates with an increased expression of long, noncoding (lnc) RNAs in neural tissues. Although prominent examples illustrate the potential of lncRNAs to scaffold and target epigenetic regulators to chromatin loci, only few cases have been described to function during brain development. We present a first functional characterization of the lncRNA LINC01322, which we term RUS for “RNA upstream of Slitrk3.” The RUS gene is well conserved in mammals by sequence and synteny next to the neurodevelopmental gene Slitrk3. RUS is exclusively expressed in neural cells and its expression increases during neuronal differentiation of mouse embryonic cortical neural stem cells. Depletion of RUS locks neuronal precursors in an intermediate state towards neuronal differentiation resulting in arrested cell cycle and increased apoptosis. RUS associates with chromatin in the vicinity of genes involved in neurogenesis, most of which change their expression upon RUS depletion. The identification of a range of epigenetic regulators as specific RUS interactors suggests that the lncRNA may mediate gene activation and repression in a highly context-dependent manner.
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Affiliation(s)
- Marius F Schneider
- Division of Molecular Biology, Biomedical Center Munich, Ludwig-Maximilians-University, Munich, Germany.,Division of Metabolic Biochemistry, Faculty of Medicine, Biomedical Center Munich (BMC), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Veronika Müller
- Division of Metabolic Biochemistry, Faculty of Medicine, Biomedical Center Munich (BMC), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan A Müller
- Neuroproteomics, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) Munich and Neuroproteomics Unit, Technical University, Munich, Germany
| | - Stefan F Lichtenthaler
- Neuroproteomics, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) Munich and Neuroproteomics Unit, Technical University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Peter B Becker
- Division of Molecular Biology, Biomedical Center Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Johanna C Scheuermann
- Division of Metabolic Biochemistry, Faculty of Medicine, Biomedical Center Munich (BMC), Ludwig-Maximilians-Universität München, Munich, Germany
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24
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Májek O, Gregor J, Mogulkoć N, Lewandowska K, Šterclová M, Müller V, Hájková M, Kramer MR, Tekavec-Trkanjec J, Jovanović D, Studnicka M, Stoeva N, Kirchgässler KU, Littnerová S, Dušek L, Vašáková MK. Survival and lung function decline in patients with definite, probable and possible idiopathic pulmonary fibrosis treated with pirfenidone. PLoS One 2022; 17:e0273854. [PMID: 36048805 PMCID: PMC9436039 DOI: 10.1371/journal.pone.0273854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is no clear evidence whether pirfenidone has a benefit in patients with probable or possible UIP, i.e. when idiopathic pulmonary fibrosis (IPF) is diagnosed with a lower degree of diagnostic certainty. We report on outcomes of treatment with pirfenidone in IPF patients diagnosed with various degrees of certainty. Methods and findings We followed patients in the multi-national European MultiPartner IPF Registry (EMPIRE) first seen between 2015 and 2018. Patients were assessed with HRCT, histopathology and received a multi-disciplinary team (MDT) IPF diagnosis. Endpoints of interest were overall survival (OS), progression-free survival (PFS) and lung function decline. Results A total of 1626 patients were analysed, treated with either pirfenidone (N = 808) or receiving no antifibrotic treatment (N = 818). When patients treated with pirfenidone were compared to patients not receiving antifibrotic treatment, OS (one-, two- and three-year probability of survival 0.871 vs 0.798; 0.728 vs 0.632; 0.579 vs 0.556, P = 0.002), and PFS (one-, two- and three-year probability of survival 0.597 vs 0.536; 0.309 vs 0.281; 0.158 vs 0.148, P = 0.043) was higher, and FVC decline smaller (-0.073 l/yr vs -0.169 l/yr, P = 0.017). The benefit of pirfenidone on OS and PFS was also seen in patients with probable or possible IPF. Conclusions This EMPIRE analysis confirms the favourable outcomes observed for pirfenidone treatment in patients with definitive IPF and indicates benefits also for patients with probable or possible IPF.
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Affiliation(s)
- Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jakub Gregor
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nesrin Mogulkoć
- Department of Pulmonary Medicine, Ege University Medical School, Izmir, Turkey
| | - Katarzyna Lewandowska
- 1st Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Martina Šterclová
- Department of Respiratory Diseases of the First Faculty of Medicine Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Marta Hájková
- Clinic of Pneumology and Phthisiology, University Hospital Bratislava, Bratislava, Slovakia
| | | | | | | | | | - Natalia Stoeva
- Pulmonary Department, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | | | - Simona Littnerová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Koziar Vašáková
- Department of Respiratory Diseases of the First Faculty of Medicine Charles University, Thomayer University Hospital, Prague, Czech Republic
- * E-mail:
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25
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Vereckei A, Katona G, Révész K, Vágó H, Müller V, Nagy B, Nagy P, Sepp R, Suvarna K. Cardiac sarcoidosis completely mimicking biventricular arrhythmogenic cardiomyopathy. ESC Heart Fail 2022; 9:4304-4314. [PMID: 36045019 PMCID: PMC9773774 DOI: 10.1002/ehf2.14123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/16/2022] [Accepted: 08/15/2022] [Indexed: 01/19/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a chameleon of cardiology, and it can mimic different cardiac diseases; among them is arrhythmogenic cardiomyopathy (ACM). We admitted a 70-year-old female patient with heart failure symptoms in 2015, who fulfilled all major ECG and non-invasive imaging criteria of biventricular ACM. She was well with the recommended medications for 3 years, showing only isolated cardiac involvement, but in 2018, cervical and mediastinal lymphadenopathy appeared and cervical lymph node core biopsy histology, bronchoalveolar lavage flow cytometry strongly suggested extracardiac sarcoidosis. Therefore, our suspicion was that sarcoidosis is responsible for the cardiac involvement, which was not confirmed by PET-CT and gallium scintigraphy examinations. At the end of 2018, she died in septicaemia with multiorgan failure, and only autopsy verified her CS. A new ECG algorithm published in 2021 for the differential diagnosis of CS and biventricular ACM, when applied on her ECGs recorded in 2015, suggested the diagnosis of CS.
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Affiliation(s)
- András Vereckei
- Department of Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Gábor Katona
- Department of Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Katalin Révész
- Department of Medicine and HematologySemmelweis UniversityBudapestHungary
| | - Hajnalka Vágó
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Veronika Müller
- Department of PulmonologySemmelweis UniversityBudapestHungary
| | - Beáta Nagy
- 1st Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Péter Nagy
- 1st Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Róbert Sepp
- Department of Medicine, Division of Non‐Invasive CardiologyUniversity of SzegedSzegedHungary
| | - Kim Suvarna
- Department of HistopathologySheffield Teaching Hospitals, NHS Foundation Trust, Northern General HospitalSheffieldUK
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26
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Polivka L, Gajdacsi J, Fazekas L, Sebok S, Barczi E, Hidvegi E, Sutto Z, Dinya E, Maurovich-Horvat P, Szabo AJ, Merkely B, Müller V. Long-term survival benefit of male and multimorbid COVID-19 patients with 5-day remdesivir treatment. J Glob Health 2022; 12:05031. [PMID: 36040909 PMCID: PMC9428504 DOI: 10.7189/jogh.12.05031] [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] [Indexed: 11/23/2022] Open
Abstract
Background Treatment of the coronavirus disease (COVID-19) is still challenging due to the lack of evidence-based treatment protocols and continuously changing epidemiological situations and vaccinations. Remdesivir (RDV) is among the few antiviral medications with confirmed efficacy for specific patient groups. However, real-world data on long-term outcomes for a short treatment course are scarce. Methods This retrospective observational cohort study included real-life data collected during the second and third wave of the COVID-19 pandemic in Hungary (September 1, 2020-April 30, 2021) from inpatients at a University Center (n = 947). Participants consisted of two propensity score-matched cohorts (370/370 cases): Group RDV including patients receiving RDV and supplementary oxygen and Group standard of care (SOC) as control. The primary outcome was the effect of 5-day RDV treatment on 30- and 60-day all-cause mortality. Multivariate analyses were performed to assess the effect of RDV by different covariates. Results Group RDV included significantly more patients from the alpha variant wave, with greater frequency of comorbidities diabetes and anemia, and larger degree of parenchymal involvement. All-cause mortality at 30- and 60-day were significantly lower in Group RDV compared to Group SOC. Significant risk reduction of 60-day all-cause mortality was observed for RDV treatment in men and patients with COPD or multiple comorbidities. Conclusions Hospitalized COVID-19 patients with 5-day RDV treatment had significantly lower 30- and 60-day all-cause mortality, despite their more severe clinical condition. Men and patients with multiple comorbidities, including COPD, profited the most from RDV treatment in the long term. Due to the ongoing COVID-19 pandemic, effective treatment regimens are needed for hospitalized patients.
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Affiliation(s)
- Lorinc Polivka
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Levente Fazekas
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Szilvia Sebok
- University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary
| | - Eniko Barczi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Edit Hidvegi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zoltan Sutto
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Elek Dinya
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | | | - Attila J Szabo
- Clinical Center, Semmelweis University, Budapest, Hungary.,1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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27
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Bárczi E, Varga V, Nagy A, Eszes N, Jáky‐Kováts Z, Müller V, Bohács A. Serological findings following the second and third SARS‐CoV‐2 vaccines in lung transplant recipients. Immun Inflamm Dis 2022; 10:e646. [PMID: 35894705 PMCID: PMC9311263 DOI: 10.1002/iid3.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Enikő Bárczi
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Viktória Varga
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Alexandra Nagy
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Noémi Eszes
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | | | - Veronika Müller
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Anikó Bohács
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
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28
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Jáky‐Kováts Z, Vámos M, Komlósi ZI, Bikov A, Madurka I, Szűcs G, Müller V, Bohács A. Peripheral blood and bronchoalveolar leukocyte profile in lung transplant recipients and their changes according to immunosuppressive regimen: A single‐center experience. Immun Inflamm Dis 2022; 10:e673. [PMID: 35894710 PMCID: PMC9274796 DOI: 10.1002/iid3.673] [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: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background After lung transplantation (LuTX), lower respiratory tract infections (LRTI) and acute cellular rejection (ACR) are associated with changes in peripheral blood and bronchoalveolar lavage fluid mononuclear cell profile (PBMC and BALIC). PBMC is also influenced by immunosuppressive regimen and its changes with postoperative time. First‐year PBMC and BALIC changes were evaluated in this study with rabbit anti‐thymocyte globulin (ATG) and alemtuzumab (AL) induction therapy. Methods In total, 64 LuTX recipients were included, 53 of them received AL and 11 ATG as induction therapy. PBMC and BALIC were examined routinely and in cases suspicious of infection and/or rejection. A PBMC‐ and BALIC‐based algorithm for infection and rejection prediction was also tested. Results In the AL group, peripheral blood lymphocyte and basophil cell numbers were significantly reduced, while the neutrophil cell number elevation during LRTI was significantly higher compared to the control. Early postoperative measurements showed a lower BALIC lymphocyte count. The algorithm had 17% sensitivity and 94% specificity for ACR in all patients and 33% sensitivity and 95% specificity for ACR with coexisting LRTI. Conclusion BALIC is not significantly influenced by the immunosuppressive regimen. PBMC‐ and BALIC‐based algorithm may improve the differential diagnosis of ACR.
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Affiliation(s)
- Zsuzsanna Jáky‐Kováts
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
| | - Melinda Vámos
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
| | - Zsolt István Komlósi
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
- Department of Genetics, Cell‐ and Immunobiology, Faculty of Medicine Semmelweis University Budapest Hungary
| | - András Bikov
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Ildikó Madurka
- Department of Thoracic Surgery, Faculty of Medicine Semmelweis University Budapest Hungary
- Department of Thoracic Surgery National Institute of Oncology Budapest Hungary
| | - Gergő Szűcs
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
| | - Veronika Müller
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
| | - Anikó Bohács
- Department of Pulmonology, Faculty of Medicine Semmelweis University Budapest Hungary
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29
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Vokó Z, Kiss Z, Surján G, Surján O, Barcza Z, Wittmann I, Molnár GA, Nagy D, Müller V, Bogos K, Nagy P, Kenessey I, Wéber A, Polivka L, Pálosi M, Szlávik J, Rokszin G, Müller C, Szekanecz Z, Kásler M. Effectiveness and Waning of Protection With Different SARS-CoV-2 Primary and Booster Vaccines During the Delta Pandemic Wave in 2021 in Hungary (HUN-VE 3 Study). Front Immunol 2022; 13:919408. [PMID: 35935993 PMCID: PMC9353007 DOI: 10.3389/fimmu.2022.919408] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background In late 2021, the pandemic wave was dominated by the Delta SARS-CoV-2 variant in Hungary. Booster vaccines were offered for the vulnerable population starting from August 2021. Methods The nationwide HUN-VE 3 study examined the effectiveness and durability of primary immunization and single booster vaccinations in the prevention of SARS-CoV-2 infection, Covid-19 related hospitalization and mortality during the Delta wave, compared to an unvaccinated control population without prior SARS-CoV-2 infection. Results The study population included 8,087,988 individuals who were 18-100 years old at the beginning of the pandemic. During the Delta wave, after adjusting for age, sex, calendar day, and chronic diseases, vaccine effectiveness (VE) of primary vaccination against registered SARS-CoV-2 infection was between 11% to 77% and 18% to 79% 14-120 days after primary immunization in the 16-64 and 65-100 years age cohort respectively, while it decreased to close to zero in the younger age group and around 40% or somewhat less in the elderly after 6 months for almost all vaccine types. In the population aged 65-100 years, we found high, 88.1%-92.5% adjusted effectiveness against Covid-19 infection after the Pfizer-BioNTech, and 92.2%-95.6% after the Moderna booster dose, while Sinopharm and Janssen booster doses provided 26.5%-75.3% and 72.9%-100.0% adjusted VE, respectively. Adjusted VE against Covid-19 related hospitalization was high within 14-120 days for Pfizer-BioNTech: 76.6%, Moderna: 83.8%, Sputnik-V: 78.3%, AstraZeneca: 73.8%, while modest for Sinopharm: 45.7% and Janssen: 26.4%. The waning of protection against Covid-19 related hospitalization was modest and booster vaccination with mRNA vaccines or the Janssen vaccine increased adjusted VE up to almost 100%, while the Sinopharm booster dose proved to be less effective. VE against Covid-19 related death after primary immunization was high or moderate: for Pfizer-BioNTech: 81.5%, Moderna: 93.2%, Sputnik-V: 100.0%, AstraZeneca: 84.8%, Sinopharm: 58.6%, Janssen: 53.3%). VE against this outcome also showed a moderate decline over time, while booster vaccine types restored effectiveness up to almost 100%, except for the Sinopharm booster. Conclusions The HUN-VE 3 study demonstrated waning VE with all vaccine types for all examined outcomes during the Delta wave and confirmed the outstanding benefit of booster vaccination with the mRNA or Janssen vaccines, and this is the first study to provide clear and comparable effectiveness results for six different vaccine types after primary immunization against severe during the Delta pandemic wave.
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Affiliation(s)
- Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Zoltán Kiss
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - György Surján
- Ministry of Human Resources, Budapest, Hungary
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - Orsolya Surján
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Gergő Attila Molnár
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Dávid Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztina Bogos
- Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Anatomy and Histology, Laboratory of Redox Biology, University of Veterinary Medicine, Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, Debrecen, Hungary
| | - István Kenessey
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Wéber
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Lőrinc Polivka
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - János Szlávik
- Department of Infectology South-Pest Hospital Centre – National Institute for Infectology and Haematology, Budapest, Hungary
| | - György Rokszin
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
- RxTarget Ltd., Szolnok, Hungary
| | - Cecília Müller
- Department of Chief Medical Officer, National Public Health Center, Budapest, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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30
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Kiss Z, Wittmann I, Polivka L, Surján G, Surján O, Barcza Z, Molnár GA, Nagy D, Müller V, Bogos K, Nagy P, Kenessey I, Wéber A, Pálosi M, Szlávik J, Schaff Z, Szekanecz Z, Müller C, Kásler M, Vokó Z. Nationwide Effectiveness of First and Second SARS-CoV2 Booster Vaccines During the Delta and Omicron Pandemic Waves in Hungary (HUN-VE 2 Study). Front Immunol 2022; 13:905585. [PMID: 35812442 PMCID: PMC9260843 DOI: 10.3389/fimmu.2022.905585] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background In Hungary, the pandemic waves in late 2021 and early 2022 were dominated by the Delta and Omicron SARS-CoV-2 variants, respectively. Booster vaccines were offered with one or two doses for the vulnerable population during these periods. Methods and Findings The nationwide HUN-VE 2 study examined the effectiveness of primary immunization, single booster, and double booster vaccination in the prevention of Covid-19 related mortality during the Delta and Omicron waves, compared to an unvaccinated control population without prior SARS-CoV-2 infection during the same study periods. The risk of Covid-19 related death was 55% lower during the Omicron vs. Delta wave in the whole study population (n=9,569,648 and n=9,581,927, respectively; rate ratio [RR]: 0.45, 95% confidence interval [CI]: 0.44-0.48). During the Delta wave, the risk of Covid-19 related death was 74% lower in the primary immunized population (RR: 0.26; 95% CI: 0.25-0.28) and 96% lower in the booster immunized population (RR: 0.04; 95% CI: 0.04-0.05), vs. the unvaccinated control group. During the Omicron wave, the risk of Covid-19 related death was 40% lower in the primary immunized population (RR: 0.60; 95% CI: 0.55-0.65) and 82% lower in the booster immunized population (RR: 0.18; 95% CI: 0.16-0.2) vs. the unvaccinated control group. The double booster immunized population had a 93% lower risk of Covid-19 related death compared to those with only one booster dose (RR: 0.07; 95% CI. 0.01-0.46). The benefit of the second booster was slightly more pronounced in older age groups. Conclusions The HUN-VE 2 study demonstrated the significantly lower risk of Covid-19 related mortality associated with the Omicron vs. Delta variant and confirmed the benefit of single and double booster vaccination against Covid-19 related death. Furthermore, the results showed the additional benefit of a second booster dose in terms of SARS-CoV-2 infection and Covid-19 related mortality.
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Affiliation(s)
- Zoltán Kiss
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Lőrinc Polivka
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - György Surján
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - Orsolya Surján
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Gergő Attila Molnár
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Dávid Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztina Bogos
- Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Anatomy and Histology, Laboratory of Redox Biology, University of Veterinary Medicine, Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, Debrecen, Hungary
| | - István Kenessey
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Wéber
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Cancer Surveillance Branch, International Agency for Research on Cancer,
Lyon, France
| | | | - János Szlávik
- South-Pest Hospital Centre – National Institute for Infectology and Haematology, Budapest, Hungary
| | - Zsuzsa Schaff
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Cecília Müller
- Department of Chief Medical Officer, National Public Health Center, Budapest, Hungary
| | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Müller V, Polivka L, Valyi-Nagy I, Nagy A, Szekanecz Z, Bogos K, Vago H, Kamondi A, Fekete F, Szlavik J, Elek J, Surján G, Surján O, Nagy P, Schaff Z, Müller C, Kiss Z, Kásler M. Booster Vaccination Decreases 28-Day All-Cause Mortality of the Elderly Hospitalized Due to SARS-CoV-2 Delta Variant. Vaccines (Basel) 2022; 10:vaccines10070986. [PMID: 35891151 PMCID: PMC9321254 DOI: 10.3390/vaccines10070986] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: SARS-CoV-2 infections are associated with an increased risk of hospital admissions especially in the elderly (age ≥ 65 years) and people with multiple comorbid conditions. (2) Methods: We investigated the effect of additional booster vaccinations following the primary vaccination series of mRNA, inactivated whole virus, or vector vaccines on infections with the SARS-CoV-2 delta variant in the total Hungarian elderly population. The infection, hospital admission, and 28-day all-cause mortality of elderly population was assessed. (3) Results: A total of 1,984,176 people fulfilled the criteria of elderly including 299,216 unvaccinated individuals, while 1,037,069 had completed primary vaccination and 587,150 had obtained an additional booster. The primary vaccination series reduced the risk of infection by 48.88%, the risk of hospital admission by 71.55%, and mortality by 79.87%. The booster vaccination had an additional benefit, as the risk of infection, hospital admission, and all-cause mortality were even lower (82.95%; 92.71%; and 94.24%, respectively). Vaccinated patients needing hospitalization suffered significantly more comorbid conditions, indicating a more vulnerable population. (4) Conclusions: Our data confirmed that the primary vaccination series and especially the booster vaccination significantly reduced the risk of the SARS-CoV-2 delta-variant-associated hospital admission and 28-day all-cause mortality in the elderly despite significantly more severe comorbid conditions.
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Affiliation(s)
- Veronika Müller
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (L.P.); (A.N.)
- Correspondence:
| | - Lorinc Polivka
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (L.P.); (A.N.)
| | - Istvan Valyi-Nagy
- South-Pest Hospital Centre, National Institute for Infectiology and Hematology, 1097 Budapest, Hungary; (I.V.-N.); (J.S.)
| | - Alexandra Nagy
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary; (L.P.); (A.N.)
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, 1122 Budapest, Hungary; (K.B.); (J.E.)
| | - Hajnalka Vago
- Department of Cardiology, Department of Sports Medicine, Semmelweis University, 1122 Budapest, Hungary;
| | - Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, 1145 Budapest, Hungary;
| | - Ferenc Fekete
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
| | - Janos Szlavik
- South-Pest Hospital Centre, National Institute for Infectiology and Hematology, 1097 Budapest, Hungary; (I.V.-N.); (J.S.)
| | - Jeno Elek
- National Korányi Institute of Pulmonology, 1122 Budapest, Hungary; (K.B.); (J.E.)
| | - György Surján
- Ministry of Human Resources, 1055 Budapest, Hungary; (G.S.); (M.K.)
- Institute of Digital Health Sciences, Semmelweis University, 1094 Budapest, Hungary
| | - Orsolya Surján
- Department of Deputy Chief Medical Officer II., National Public Health Center, 1097 Budapest, Hungary;
| | - Péter Nagy
- National Institute of Oncology, 1122 Budapest, Hungary;
- Department of Anatomy and Histology, University of Veterinary Medicine, 1078 Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, 4012 Debrecen, Hungary
| | - Zsuzsa Schaff
- Department of Pathology, Semmelweis University, 1085 Budapest, Hungary;
| | | | - Zoltan Kiss
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, 7624 Pécs, Hungary;
| | - Miklós Kásler
- Ministry of Human Resources, 1055 Budapest, Hungary; (G.S.); (M.K.)
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Müller V, Gero D, File B, Widmer J, Thalheimer A, Bueter M. Attitudes of primary care physicians towards bariatric surgery in Switzerland – a free-word association networks analysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac175.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Primary care physicians (PCP) have a major responsibility in identifying patients with obesity eligible for bariatric surgery (BS). The aim was to explore PCPs’ attitudes towards BS in order to map potential barriers of referral.
Methods
3526 PCPs in Switzerland were invited to participate in an online survey. PCPs were asked to write the first 5 words coming to their mind about the term “bariatric surgery”. Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Cognitive representation network was constructed based on co-occurrence of associations, using validated data-driven methodology.
Results
216 PCPs completed the study. Respondents were aged 55±9.8 years, had an equal gender distribution and practiced mainly in urban setting (Table 1). The majority of PCPs refer either often (31%) or sometimes (41%) patients for BS, while 7% never refer patients to BS, even if eligibility criteria are met. The PCPs’ overall satisfaction with BS was high (88.5%)(Fig. 1). PCPs could be categorized in 3 subgroups based on their cognitive representation of BS: a) indication-focused (most frequent associations: “obesity”, ”diabetes”/most frequent emotion: “worrying”), b) treatment-focused (“gastric bypass”, “weight loss”/“interested”), and c) risk vs. benefit-focused (“complications”, “challenging follow-up”, “success”/“alert”) (Fig. 2&3). There were no relevant demographic or practice related differences between PCPs in the 3 cognitive modules. PCPs with a treatment-focused mindset had a significantly better knowledge of current guidelines on indications of BS (χ2=17.1, P=0.029) and referred in average 5 patients/year, x2 more than PCPs belonging to the other cognitive modules.
Conclusion
PCPs in Switzerland approve the efficacy of BS, but show reservation to refer eligible patients systematically. PCPs think about BS along 3 cognitive schemes, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confident knowledge of current indications of BS was the only significant factor that distinguished PCPs with a treatment-focused attitude. Strengthening the collaboration in therapeutic decision-making between PCPs and BS centers has the potential to improve access to optimal care for patients with obesity.
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Affiliation(s)
- V Müller
- Faculty of Medicine, University of Zurich , Zurich, Switzerland
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
| | - D Gero
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
| | - B File
- Department of Physics, Wigner Research Center of Physics , Budapest, Hungary
| | - J Widmer
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
| | - M Bueter
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
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Müller V, Pikó B. Depression and other correlates of adult Attention Deficit Hyperactivity Disorder (ADHD) symptoms among Hungarian university students. Eur Psychiatry 2022. [PMCID: PMC9565616 DOI: 10.1192/j.eurpsy.2022.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity. It is one of the most common disabilities in college populations and comorbidity with depression is frequently reported. Objectives The aim of the study is to shed light on depression as comorbidity and other intrapersonal correlates of ADHD in young adults. Methods Participants were Hungarian university students (N=420; M=24.5, SD=5.0 years). Criteria of the ADHD group were based on the Adult ADHD Self Report Scale V1.1 (ASRS-V.1.1) screening tool. The participants filled in the Beck’s Depression Inventory, the Hyperfocus Scale, Flow State Scale, Academic Persistence Scale, Satisfaction With Life Scale, General Self-Efficacy Scale, and the Connor-Davidson Resilience Scale. Results We found that in the group of students who had ADHD symptoms, depression score was significantly (p<.001) higher (M=18.38, SD=5.87) than the control group’s scores (M=14.56, SD=4.45). Frequency of severe depression was 13.4% (moderate: 33.5%) while in the control group: 1.6% and 17.6% respectively. Participants reporting ADHD symptoms (N=164, 39%) also reported lower levels of resilience (M=23.40, SD=6.96), relative to their non-ADHD peers (M=27.69, SD=6.48). Significant differences were found in the areas of self-efficacy, depression, flow and hyperfocus as well, and ADHD symptoms contributed to lower level of life satisfaction (β=-0.24, p<.001). Conclusions Our findings suggest that university students reporting symptoms of ADHD may be assisted with strategies that are focused on increasing protective factors (i.e., resilience, self-efficacy, flow) to prevent depression and improve their life satisfaction and quality of life. Disclosure No significant relationships.
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Laakmann E, Witzel I, Neunhöffer T, Park-Simon TW, Weide R, Riecke K, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V. Characteristics of patients with brain metastases from human epidermal growth factor receptor 2-positive breast cancer: subanalysis of Brain Metastases in Breast Cancer Registry. ESMO Open 2022; 7:100495. [PMID: 35653983 PMCID: PMC9271494 DOI: 10.1016/j.esmoop.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Up to 40% of patients with metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer develop brain metastases (BMs). Understanding of clinical features of these patients with HER2-positive breast cancer and BMs is vital. Patients and methods A total of 2948 patients from the Brain Metastases in Breast Cancer registry were available for this analysis, of whom 1311 had primary tumors with the HER2-positive subtype. Results Patients with HER2-positive breast cancer and BMs were—when compared with HER2-negative patients—slightly younger at the time of breast cancer and BM diagnosis, had a higher pathologic complete response rate after neoadjuvant chemotherapy and a higher tumor grade. Furthermore, extracranial metastases at the time of BM diagnosis were less common in HER2-positive patients, when compared with HER2-negative patients. HER2-positive patients had more often BMs in the posterior fossa, but less commonly leptomeningeal metastases. The median overall survival (OS) in all HER2-positive patients was 13.2 months (95% confidence interval 11.4-14.4). The following factors were associated with shorter OS (multivariate analysis): older age at BM diagnosis [≥60 versus <60 years: hazard ratio (HR) 1.63, P < 0.001], lower Eastern Cooperative Oncology Group status (2-4 versus 0-1: HR 1.59, P < 0.001), higher number of BMs (2-3 versus 1: HR 1.30, P = 0.082; ≥4 versus 1: HR 1.51, P = 0.004; global P = 0.015), BMs in the fossa anterior (HR 1.71, P < 0.001), leptomeningeal metastases (HR 1.63, P = 0.012), symptomatic BMs at diagnosis (HR 1.35, P = 0.033) and extracranial metastases at diagnosis of BMs (HR 1.43, P = 0.020). The application of targeted therapy after the BM diagnosis (HR 0.62, P < 0.001) was associated with longer OS. HER2-positive/hormone receptor-positive patients showed longer OS than HER2-positive/hormone receptor-negative patients (median 14.3 versus 10.9 months; HR 0.86, P = 0.03), but no differences in progression-free survival were seen between both groups. Conclusions We identified factors associated with the prognosis of HER2-positive patients with BMs. Further research is needed to understand the factors determining the longer survival of HER2-positive/hormone receptor-positive patients. Patients with HER2-positive BMs from breast cancer have the best prognosis compared with other tumor subtypes. Among HER2-positive patients, hormone receptor-positive patients have the longest survival. HER2-targeted therapy is significantly associated with a better prognosis in patients with BMs. On average, two HER2-targeted therapy lines were administered prior to the development of BMs. New compounds are urgently needed to improve the outcome of this subgroup of patients.
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Affiliation(s)
- E Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Neunhöffer
- Frauenärzte am Dom, Mainz, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | | | - R Weide
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - K Riecke
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Polasik
- Universitätsklinikum Ulm, Ulm, Germany
| | - M Schmidt
- Universitätsmedizin Mainz, Mainz, Germany
| | - J Puppe
- Universitätsfrauenklinik Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Germany
| | - C Mundhenke
- Frauenklinik, Klinikum Bayreuth, Bayreuth, Germany
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - M Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - D-M Zahm
- Department of Gynecology, SRH Wald-Klinikum Gera GmbH, Gera, Germany
| | - C Denkert
- Institut für Pathologie UKGM - Universitätsklinikum Marburg, Marburg, Germany
| | - T Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - J Rey
- GBG Forschungs GmbH, Germany
| | - S Loibl
- GBG Forschungs GmbH, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Jovanovic DM, Šterclová M, Mogulkoc N, Lewandowska K, Müller V, Hájková M, Studnicka M, Tekavec-Trkanjec J, Littnerová S, Vašáková M. Comorbidity burden and survival in patients with idiopathic pulmonary fibrosis: the EMPIRE registry study. Respir Res 2022; 23:135. [PMID: 35624513 PMCID: PMC9145164 DOI: 10.1186/s12931-022-02033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients with idiopathic pulmonary fibrosis (IPF) frequently have multiple comorbidities, which may influence survival but go under-recognised in clinical practice. We therefore report comorbidity, antifibrotic treatment use and survival of patients with IPF observed in the multi-national EMPIRE registry. Methods For this prospective IPF cohort, demographics, comorbidities, survival and causes of death were analysed. Comorbidities were noted by the treating physician based on the patient’s past medical history or as reported during follow-up. Comorbidities were defined as prevalent when noted at enrolment, or as incident when recorded during follow-up. Survival was analysed by Kaplan–Meier estimates, log-rank test, and Cox proportional hazards models. Hazard ratios (HR) were adjusted for gender, age, smoking status and FVC at enrolment. Results A population of 3,580 patients with IPF from 11 Central and Eastern European countries was followed every 6 months for up to 6 years. At enrolment, 91.3% of patients reported at least one comorbidity, whereas more than one-third (37.8%) reported four or more comorbidities. Five-year survival was 53.7% in patients with no prevalent comorbidities, whereas it was 48.4%, 47.0%, 43.8% and 41.1% in patients with 1, 2, 3 and ≥ 4 comorbidities, respectively. The presence of multiple comorbidities at enrolment was associated with significantly worse survival (log-rank test P = 0.007). Adjusted HRs indicate that risk of death was increased by 44% in patients with IPF reporting ≥ 4 comorbidities at baseline compared with no comorbidity (P = 0.021). The relationship between number of comorbidities and decreased survival was also seen in patients receiving antifibrotic treatment (63% of all patients; log-rank test P < 0.001). Comorbidity as cause of death was identified in at least 26.1% of deaths. Conclusions The majority of patients with IPF demonstrate comorbidities, and many have comorbidity-related deaths. Increasing numbers of comorbidities are associated with worse survival; and this pattern is also present in patients receiving antifibrotic therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02033-6.
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Affiliation(s)
| | - Martina Šterclová
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University, Thomayer Hospital, Prague, Czech Republic
| | - Nesrin Mogulkoc
- Department of Pulmonary Medicine, Ege University Medical School, Izmir, Turkey
| | - Katarzyna Lewandowska
- Department of Pulmonary Diseases, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Marta Hájková
- Clinic of Pneumology and Phthisiology, University Hospital Bratislava, Bratislava, Slovakia
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | | | - Simona Littnerová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martina Vašáková
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University, Thomayer Hospital, Prague, Czech Republic.
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Fodor E, Müller V, Iványi Z, Berki T, Kuten Pella O, Hornyák I, Ambrus M, Sárkány Á, Skázel Á, Madár Á, Kardos D, Kemenesi G, Földes F, Nagy S, Matusovits A, Nacsa J, Tordai A, Jakab F, Lacza Z. Correction to: Early Transfusion of Convalescent Plasma Improves the Clinical Outcome in Severe SARS-CoV2 Infection. Infect Dis Ther 2022; 11:1767-1768. [PMID: 35575975 PMCID: PMC9108689 DOI: 10.1007/s40121-022-00637-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Eszter Fodor
- Orthosera Kft, Budapest, 1149, Hungary. .,Univesity of Physical Education, Budapest, 1223, Hungary.
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1083, Hungary
| | - Zsolt Iványi
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, 1082, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, University of Pécs, Budapest, 7643, Hungary
| | | | - István Hornyák
- Instute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Mira Ambrus
- Univesity of Physical Education, Budapest, 1223, Hungary
| | - Ágnes Sárkány
- Szent György University Teaching Hospital, Székesfehérvár, 8000, Hungary
| | - Árpád Skázel
- Szent György University Teaching Hospital, Székesfehérvár, 8000, Hungary
| | - Ágnes Madár
- Univesity of Physical Education, Budapest, 1223, Hungary
| | | | - Gábor Kemenesi
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622, Hungary
| | - Fanni Földes
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622, Hungary
| | - Sándor Nagy
- Hungarian National Blood Transfusion Service, Budapest, 1113, Hungary
| | - Andrea Matusovits
- Hungarian National Blood Transfusion Service, Budapest, 1113, Hungary
| | - Janos Nacsa
- Hungarian National Blood Transfusion Service, Budapest, 1113, Hungary
| | - Attila Tordai
- Department of Transfusiology, Semmelweis University, Budapest, 1089, Hungary
| | - Ferenc Jakab
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622, Hungary
| | - Zsombor Lacza
- Orthosera Kft, Budapest, 1149, Hungary.,Univesity of Physical Education, Budapest, 1223, Hungary.,Department of Translational Medicine, Semmelweis University, 1085, Budapest, Hungary
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Simon J, Grodecki K, Cadet S, Killekar A, Slomka P, Zara SJ, Zsarnóczay E, Nardocci C, Nagy N, Kristóf K, Vásárhelyi B, Müller V, Merkely B, Dey D, Maurovich-Horvat P. Radiomorphological signs and clinical severity of SARS-CoV-2 lineage B.1.1.7. BJR Open 2022; 4:20220016. [PMID: 36452055 PMCID: PMC9667478 DOI: 10.1259/bjro.20220016] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to assess the differences in the severity and chest-CT radiomorphological signs of SARS-CoV-2 B.1.1.7 and non-B.1.1.7 variants. Methods We collected clinical data of consecutive patients with laboratory-confirmed COVID-19 and chest-CT imaging who were admitted to the Emergency Department between September 1- November 13, 2020 (non-B.1.1.7 cases) and March 1-March 18, 2021 (B.1.1.7 cases). We also examined the differences in the severity and radiomorphological features associated with COVID-19 pneumonia. Total pneumonia burden (%), mean attenuation of ground-glass opacities and consolidation were quantified using deep-learning research software. Results The final population comprised 500 B.1.1.7 and 500 non-B.1.1.7 cases. Patients with B.1.1.7 infection were younger (58.5 ± 15.6 vs 64.8 ± 17.3; p < .001) and had less comorbidities. Total pneumonia burden was higher in the B.1.1.7 patient group (16.1% [interquartile range (IQR):6.0-34.2%] vs 6.6% [IQR:1.2-18.3%]; p < .001). In the age-specific analysis, in patients <60 years B.1.1.7 pneumonia had increased consolidation burden (0.1% [IQR:0.0-0.7%] vs 0.1% [IQR:0.0-0.2%]; p < .001), and severe COVID-19 was more prevalent (11.5% vs 4.9%; p = .032). Mortality rate was similar in all age groups. Conclusion Despite B.1.1.7 patients were younger and had fewer comorbidities, they experienced more severe disease than non-B.1.1.7 patients, however, the risk of death was the same between the two groups. Advances in knowledge Our study provides data on deep-learning based quantitative lung lesion burden and clinical outcomes of patients infected by B.1.1.7 VOC. Our findings might serve as a model for later investigations, as new variants are emerging across the globe.
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Affiliation(s)
| | | | - Sebastian Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Aditya Killekar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Piotr Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | | | | | - Chiara Nardocci
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Norbert Nagy
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Kristóf
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
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Riecke K, Laakmann E, Neunhöffer T, Park-Simon TW, Weide R, Schmidt M, Polasik A, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V, Witzel I. 170P Long-term survival of breast cancer patients with brain metastases: Subanalysis of the BMBC registry. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.189] [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: 11/16/2022] Open
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Furlanetto J, Marmé F, Thode C, Nekljudova V, Liu Y, Martin Jimenez M, Reimer T, Knudsen E, Denkert C, Bassy M, Martin LA, Karn T, Sinn B, Filipitis M, van Mackelenbergh M, Fasching P, Müller V, Stickeler E, Schem C, Loibl S. 60MO Ovarian function in young patients (pts) treated with postneoadjuvant palbociclib (PAL) and endocrine therapy (ET) for hormone receptor (HR)-positive, HER2-negative early breast cancer (BC): Explorative analysis in Penelope-B. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.076] [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: 11/15/2022] Open
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Henry BM, Sinkovits G, Szergyuk I, de Oliveira MHS, Lippi G, Benoit JL, Favaloro EJ, Pode-Shakked N, Benoit SW, Cooper DS, Müller V, Iványi Z, Gál J, Réti M, Gopcsa L, Reményi P, Szathmáry B, Lakatos B, Szlávik J, Bobek I, Prohászka ZZ, Förhécz Z, Csuka D, Hurler L, Kajdácsi E, Cervenak L, Mező B, Kiszel P, Masszi T, Vályi-Nagy I, Prohászka Z. Complement Levels at Admission Reflecting Progression to Severe Acute Kidney Injury (AKI) in Coronavirus Disease 2019 (COVID-19): A Multicenter Prospective Cohort Study. Front Med (Lausanne) 2022; 9:796109. [PMID: 35572977 PMCID: PMC9100416 DOI: 10.3389/fmed.2022.796109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Dysregulation of complement system is thought to be a major player in development of multi-organ damage and adverse outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to examine associations between complement system activity and development of severe acute kidney injury (AKI) among hospitalized COVID-19 patients. Materials and Methods In this multicenter, international study, complement as well as inflammatory and thrombotic parameters were analyzed in COVID-19 patients requiring hospitalization at one US and two Hungarian centers. The primary endpoint was development of severe AKI defined by KDIGO stage 2+3 criteria, while the secondary endpoint was need for renal replacement therapy (RRT). Complement markers with significant associations with endpoints were then correlated with a panel of inflammatory and thrombotic biomarkers and assessed for independent association with outcome measures using logistic regression. Results A total of 131 hospitalized COVID-19 patients (median age 66 [IQR, 54–75] years; 54.2% males) were enrolled, 33 from the US, and 98 from Hungary. There was a greater prevalence of complement over-activation and consumption in those who developed severe AKI and need for RRT during hospitalization. C3a/C3 ratio was increased in groups developing severe AKI (3.29 vs. 1.71; p < 0.001) and requiring RRT (3.42 vs. 1.79; p < 0.001) in each cohort. Decrease in alternative and classical pathway activity, and consumption of C4 below reference range, as well as elevation of complement activation marker C3a above the normal was more common in patients progressing to severe AKI. In the Hungarian cohort, each standard deviation increase in C3a (SD = 210.1) was independently associated with 89.7% increased odds of developing severe AKI (95% CI, 7.6–234.5%). Complement was extensively correlated with an array of inflammatory biomarkers and a prothrombotic state. Conclusion Consumption and dysregulation of complement system is associated with development of severe AKI in COVID-19 patients and could represent a promising therapeutic target for reducing thrombotic microangiopathy in SARS-CoV-2 infection.
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Affiliation(s)
- Brandon M. Henry
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Disease Intervention and Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States
- *Correspondence: Brandon M. Henry
| | - György Sinkovits
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Ivan Szergyuk
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Justin L. Benoit
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Emmanuel J. Favaloro
- Haematology, Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead, NSW, Australia
| | - Naomi Pode-Shakked
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Stefanie W. Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David S. Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsolt Iványi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Marienn Réti
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - László Gopcsa
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Beáta Szathmáry
- Department of Infectology, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectology, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - János Szlávik
- Department of Infectology, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Ilona Bobek
- Department of Anaesthesiology and Intensive Therapy, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zita Z. Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsolt Förhécz
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Lisa Hurler
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Erika Kajdácsi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - László Cervenak
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Blanka Mező
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Petra Kiszel
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - István Vályi-Nagy
- Department of Infectology, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Central Hospital of Southern Pest National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
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Jost JT, Gries T, Müller V. Costs and Benefits of a Market-Based Model of Ideological Choice: Responding to Consumers and Critics. Psychological Inquiry 2022. [DOI: 10.1080/1047840x.2022.2065135] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- John T. Jost
- Department of Psychology, New York University, New York, New York
| | - Thomas Gries
- Department of Economics, University of Paderborn, Paderborn, Germany
| | - Veronika Müller
- School of Advanced International Studies, Johns Hopkins University, Washington D.C
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Affiliation(s)
- Thomas Gries
- Department of Economics, University of Paderborn, Paderborn, Germany
| | - Veronika Müller
- School of Advanced International Studies, Johns Hopkins University, Washington, D.C
| | - John T. Jost
- Departments of Psychology, Politics, & Data Science, New York University, New York, New York
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Fodor E, Müller V, Iványi Z, Berki T, Kuten Pella O, Hornyák I, Ambrus M, Sárkány Á, Skázel Á, Madár Á, Kardos D, Kemenesi G, Földes F, Nagy S, Matusovits A, János N, Tordai A, Jakab F, Lacza Z. Early Transfusion of Convalescent Plasma Improves the Clinical Outcome in Severe SARS-CoV2 Infection. Infect Dis Ther 2022; 11:293-304. [PMID: 34817840 PMCID: PMC8611245 DOI: 10.1007/s40121-021-00514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Plasma harvested from convalescent COVID-19 patients (CCP) has been applied as first-line therapy in the early phase of the SARS-CoV2 pandemic through clinical studies using various protocols. METHODS We present data from a cohort of 267 hospitalized severe COVID-19 patients who received CCP. No transfusion-related complications were reported, indicating the overall safety of CCP therapy. RESULTS Patients who eventually died from COVID-19 received CCP significantly later (3.95 versus 5.22 days after hospital admission) and had higher interleukin 6 (IL-6) levels (28.9 pg/ml versus 102.5 pg/ml) than those who survived. In addition, CCP transfusion caused a significant reduction in the overall inflammatory status of the patients regardless of the severity of disease or outcome, as evidenced by decreasing C-reactive protein, IL6 and ferritin levels. CONCLUSION We conclude that CCP transfusion is a safe and effective supplementary treatment modality for hospitalized COVID-19 patients characterized by better expected outcome if applied as early as possible. We also observed that IL-6 may be a suitable laboratory parameter for patient selection and monitoring of CCP therapy effectiveness.
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Affiliation(s)
- Eszter Fodor
- Orthosera Kft, Budapest, 1149 Hungary
- Univesity of Physical Education, Budapest, 1223 Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1083 Hungary
| | - Zsolt Iványi
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, 1082 Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, University of Pécs, Budapest, 7643 Hungary
| | | | - István Hornyák
- Instute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Mira Ambrus
- Univesity of Physical Education, Budapest, 1223 Hungary
| | - Ágnes Sárkány
- Szent György University Teaching Hospital, Székesfehérvár, 8000 Hungary
| | - Árpád Skázel
- Szent György University Teaching Hospital, Székesfehérvár, 8000 Hungary
| | - Ágnes Madár
- Univesity of Physical Education, Budapest, 1223 Hungary
| | | | - Gábor Kemenesi
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Fanni Földes
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Sándor Nagy
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Andrea Matusovits
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Nacsa János
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Attila Tordai
- Department of Transfusiology, Semmelweis University, Budapest, 1089 Hungary
| | - Ferenc Jakab
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Zsombor Lacza
- Orthosera Kft, Budapest, 1149 Hungary
- Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Univesity of Physical Education, Budapest, 1223 Hungary
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Sinkovits G, Réti M, Müller V, Iványi Z, Gál J, Gopcsa L, Reményi P, Szathmáry B, Lakatos B, Szlávik J, Bobek I, Prohászka ZZ, Förhécz Z, Mező B, Csuka D, Hurler L, Kajdácsi E, Cervenak L, Kiszel P, Masszi T, Vályi-Nagy I, Prohászka Z. Associations between the von Willebrand Factor-ADAMTS13 Axis, Complement Activation, and COVID-19 Severity and Mortality. Thromb Haemost 2022; 122:240-256. [PMID: 35062036 PMCID: PMC8820843 DOI: 10.1055/s-0041-1740182] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background
Endothelial and complement activation were both associated with immunothrombosis, a key determinant of COVID-19 severity, but their interrelation has not yet been investigated.
Objectives
We aimed to determine von Willebrand factor (VWF) antigen (VWF:Ag) concentration, VWF collagen binding activity (VWF:CBA), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity (ADAMTS13:Ac), and their ratios in hospitalized COVID-19 patients, and to investigate how these parameters and their constellation with complement activation relate to disease severity and in-hospital mortality in COVID-19.
Methods
Samples of 102 hospitalized patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 positivity were included in our observational cohort study. Patients were stratified according to the peak severity of COVID-19 disease in agreement with the World Health Organization ordinal scale. Twenty-six convalescent plasma donors with previous COVID-19 disease formed the control group. VWF:Ag concentration and VWF:CBA were determined by enzyme-linked immunosorbent assay (ELISA); ADAMTS13:Ac was determined by fluorescence resonance energy transfer. Complement C3 and C3a were measured by turbidimetry and ELISA, respectively. Clinical covariates and markers of inflammation were extracted from hospital records.
Results
VWF:Ag and VWF:CBA were elevated in all groups of hospitalized COVID-19 patients and increased in parallel with disease severity. ADAMTS13:Ac was decreased in patients with severe COVID-19, with the lowest values in nonsurvivors. High (> 300%) VWF:Ag concentrations or decreased (< 67%) ADAMTS13:Ac were associated with higher risk of severe COVID-19 disease or in-hospital mortality. The concomitant presence of decreased ADAMTS13:Ac and increased C3a/C3 ratio—indicating complement overactivation and consumption—was a strong independent predictor of in-hospital mortality.
Conclusion
Our results suggest that an interaction between the VWF-ADAMTS13 axis and complement overactivation and consumption plays an important role in the pathogenesis of COVID-19.
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Affiliation(s)
- György Sinkovits
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Marienn Réti
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsolt Iványi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - László Gopcsa
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Péter Reményi
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Beáta Szathmáry
- Department of Infectology, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Botond Lakatos
- Department of Infectology, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - János Szlávik
- Department of Infectology, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Ilona Bobek
- Department of Anaesthesiology and Intensive Therapy, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zita Z Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zsolt Förhécz
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Blanka Mező
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Lisa Hurler
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Erika Kajdácsi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - László Cervenak
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Petra Kiszel
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - István Vályi-Nagy
- Department of Haematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
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Kolonics-Farkas AM, Šterclová M, Mogulkoc N, Lewandowska K, Müller V, Hájková M, Kramer M, Jovanovic D, Tekavec-Trkanjec J, Studnicka M, Stoeva N, Littnerová S, Vašáková M. Differences in Baseline Characteristics and Access to Treatment of Newly Diagnosed Patients With IPF in the EMPIRE Countries. Front Med (Lausanne) 2022; 8:729203. [PMID: 35004713 PMCID: PMC8733326 DOI: 10.3389/fmed.2021.729203] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare lung disease with poor prognosis. The diagnosis and treatment possibilities are dependent on the health systems of countries. Hence, comparison among countries is difficult due to data heterogeneity. Our aim was to analyse patients with IPF in Central and Eastern Europe using the uniform data from the European Multipartner IPF registry (EMPIRE), which at the time of analysis involved 10 countries. Newly diagnosed IPF patients (N = 2,492, between March 6, 2012 and May 12, 2020) from Czech Republic (N = 971, 39.0%), Turkey (N = 505, 20.3%), Poland (N = 285, 11.4%), Hungary (N = 216, 8.7%), Slovakia (N = 149, 6.0%), Israel (N = 120, 4.8%), Serbia (N = 95, 3.8%), Croatia (N = 87, 3.5%), Austria (N = 55, 2.2%), and Bulgaria (N = 9, 0.4%) were included, and Macedonia, while a member of the registry, was excluded from this analysis due to low number of cases (N = 5) at this timepoint. Baseline characteristics, smoking habit, comorbidities, lung function values, CO diffusion capacity, high-resolution CT (HRCT) pattern, and treatment data were analysed. Patients were significantly older in Austria than in the Czech Republic, Turkey, Hungary, Slovakia, Israel, and Serbia. Ever smokers were most common in Croatia (84.1%) and least frequent in Serbia (39.2%) and Slovakia (42.6%). The baseline forced vital capacity (FVC) was >80% in 44.6% of the patients, between 50 and 80% in 49.3%, and <50% in 6.1%. Most IPF patients with FVC >80% were registered in Poland (63%), while the least in Israel (25%). A typical usual interstitial pneumonia (UIP) pattern was present in 67.6% of all patients, ranging from 43.5% (Austria) to 77.2% (Poland). The majority of patients received antifibrotic therapy (64.5%); 37.4% used pirfenidone (range 7.4–39.8% between countries); and 34.9% nintedanib (range 12.6–56.0% between countries) treatment. In 6.8% of the cases, a therapy switch was initiated between the 2 antifibrotic agents. Significant differences in IPF patient characteristics and access to antifibrotic therapies exist in EMPIRE countries, which needs further investigation and strategies to improve and harmonize patient care and therapy availability in this region.
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Affiliation(s)
| | - Martina Šterclová
- Department of Respiratory Diseases of the First Faculty of Medicine Charles University, University Thomayer Hospital, Prague, Czechia
| | - Nesrin Mogulkoc
- Department of Pulmonary Medicine, Ege University Medical School, Izmir, Turkey
| | - Katarzyna Lewandowska
- First Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Marta Hájková
- Clinic of Pneumology and Phthisiology, University Hospital Bratislava, Bratislava, Slovakia
| | - Mordechai Kramer
- Rabin Medical Center, Institute of Pulmonary Medicine, Petah Tikva, Israel
| | | | | | | | | | - Simona Littnerová
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czechia
| | - Martina Vašáková
- Department of Respiratory Diseases of the First Faculty of Medicine Charles University, University Thomayer Hospital, Prague, Czechia
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Nagy A, Horváth A, Farkas Á, Füri P, Erdélyi T, Madas BG, Czitrovszky A, Merkely B, Szabó A, Ungvári Z, Müller V. Modeling of nursing care-associated airborne transmission of SARS-CoV-2 in a real-world hospital setting. GeroScience 2022; 44:585-595. [PMID: 34985588 PMCID: PMC8729098 DOI: 10.1007/s11357-021-00512-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Abstract
Respiratory transmission of SARS-CoV-2 from one older patient to another by airborne mechanisms in hospital and nursing home settings represents an important health challenge during the COVID-19 pandemic. However, the factors that influence the concentration of respiratory droplets and aerosols that potentially contribute to hospital- and nursing care-associated transmission of SARS-CoV-2 are not well understood. To assess the effect of health care professional (HCP) and patient activity on size and concentration of airborne particles, an optical particle counter was placed (for 24 h) in the head position of an empty bed in the hospital room of a patient admitted from the nursing home with confirmed COVID-19. The type and duration of the activity, as well as the number of HCPs providing patient care, were recorded. Concentration changes associated with specific activities were determined, and airway deposition modeling was performed using these data. Thirty-one activities were recorded, and six representative ones were selected for deposition modeling, including patient's activities (coughing, movements, etc.), diagnostic and therapeutic interventions (e.g., diagnostic tests and drug administration), as well as nursing patient care (e.g., bedding and hygiene). The increase in particle concentration of all sizes was sensitive to the type of activity. Increases in supermicron particle concentration were associated with the number of HCPs (r = 0.66; p < 0.05) and the duration of activity (r = 0.82; p < 0.05), while submicron particles increased with all activities, mainly during the daytime. Based on simulations, the number of particles deposited in unit time was the highest in the acinar region, while deposition density rate (number/cm2/min) was the highest in the upper airways. In conclusion, even short periods of HCP-patient interaction and minimal patient activity in a hospital room or nursing home bedroom may significantly increase the concentration of submicron particles mainly depositing in the acinar regions, while mainly nursing activities increase the concentration of supermicron particles depositing in larger airways of the adjacent bed patient. Our data emphasize the need for effective interventions to limit hospital- and nursing care-associated transmission of SARS-CoV-2 and other respiratory pathogens (including viral pathogens, such as rhinoviruses, respiratory syncytial virus, influenza virus, parainfluenza virus and adenoviruses, and bacterial and fungal pathogens).
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Affiliation(s)
- Attila Nagy
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Konkoly-Thege Miklós st. 29-33, Budapest, Hungary
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Árpád Farkas
- Environmental Physics Department, Centre for Energy Research, Budapest, Hungary
| | - Péter Füri
- Environmental Physics Department, Centre for Energy Research, Budapest, Hungary
| | - Tamás Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Balázs G Madas
- Environmental Physics Department, Centre for Energy Research, Budapest, Hungary
| | - Aladár Czitrovszky
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Konkoly-Thege Miklós st. 29-33, Budapest, Hungary.,Envi-Tech Ltd, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Attila Szabó
- 1st Department of Pediatrics Semmelweis University, Budapest, Hungary.,Clinical Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Ungvári
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry & Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 731042, USA.,Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK, 73104, USA.,Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Kardos AS, Simon J, Nardocci C, Szabó IV, Nagy N, Abdelrahman RH, Zsarnóczay E, Fejér B, Futácsi B, Müller V, Merkely B, Maurovich-Horvat P. The diagnostic performance of deep-learning-based CT severity score to identify COVID-19 pneumonia. Br J Radiol 2022; 95:20210759. [PMID: 34889645 PMCID: PMC8722241 DOI: 10.1259/bjr.20210759] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To determine the diagnostic accuracy of a deep-learning (DL)-based algorithm using chest computed tomography (CT) scans for the rapid diagnosis of coronavirus disease 2019 (COVID-19), as compared to the reference standard reverse-transcription polymerase chain reaction (RT-PCR) test. Methods: In this retrospective analysis, data of COVID-19 suspected patients who underwent RT-PCR and chest CT examination for the diagnosis of COVID-19 were assessed. By quantifying the affected area of the lung parenchyma, severity score was evaluated for each lobe of the lung with the DL-based algorithm. The diagnosis was based on the total lung severity score ranging from 0 to 25. The data were randomly split into a 40% training set and a 60% test set. Optimal cut-off value was determined using Youden-index method on the training cohort. Results: A total of 1259 patients were enrolled in this study. The prevalence of RT-PCR positivity in the overall investigated period was 51.5%. As compared to RT-PCR, sensitivity, specificity, positive predictive value, negative predictive value and accuracy on the test cohort were 39.0%, 80.2%, 68.0%, 55.0% and 58.9%, respectively. Regarding the whole data set, when adding those with positive RT-PCR test at any time during hospital stay or “COVID-19 without virus detection”, as final diagnosis to the true positive cases, specificity increased from 80.3% to 88.1% and the positive predictive value increased from 68.4% to 81.7%. Conclusion: DL-based CT severity score was found to have a good specificity and positive predictive value, as compared to RT-PCR. This standardized scoring system can aid rapid diagnosis and clinical decision making. Advances in knowledge: DL-based CT severity score can detect COVID-19-related lung alterations even at early stages, when RT-PCR is not yet positive.
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Affiliation(s)
- Anna Sára Kardos
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Chiara Nardocci
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | - Norbert Nagy
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | | | - Emese Zsarnóczay
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bence Fejér
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Futácsi
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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48
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Kiss Z, Bogos K, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Knollmajer K, Várnai M, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Moldvay J, Gálffy G, Vokó Z. Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary. Pathol Oncol Res 2021; 27:1610041. [PMID: 35002544 PMCID: PMC8734146 DOI: 10.3389/pore.2021.1610041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
Objective: This study aimed to examine the characteristics of the lung cancer (LC) patient pathway in Hungary during a 6-years period. Methods: This nationwide, retrospective study included patients newly diagnosed with LC (ICD-10 C34) between January 1, 2011, and December 31, 2016, using data from the National Health Insurance Fund (NHIF) of Hungary. The following patient pathway intervals were examined: system, diagnostic and treatment interval by age, gender, tumor type, study year and first-line LC therapy. Results: During the 6-years study period, 17,386 patients had at least one type of imaging (X-ray or CT/MRI) prior to diagnosis, and 12,063 had records of both X-ray and CT/MRI. The median system interval was 64.5 days, and it was 5 days longer among women, than in men (68.0 vs. 63.0 days). The median system interval was significantly longer in patients with adenocarcinoma compared to those with squamous cell carcinoma or small cell lung cancer (70.4 vs. 64.0 vs. 48.0 days, respectively). Patients who received surgery as first-line treatment had significantly longer median system intervals compared to those receiving chemotherapy (81.4 vs. 62.0 days). The median system interval significantly increased from 62.0 to 66.0 days during the 6-years study period. Conclusion: The LC patient pathway significantly increased in Hungary over the 6-years study period. There were no significant differences in the length of the whole LC patient pathway according to age, however, female sex, surgery as first-line treatment, and adenocarcinoma were associated with longer system intervals.
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Affiliation(s)
- Zoltan Kiss
- MSD Pharma Hungary Ltd., Budapest, Hungary
- *Correspondence: Zoltan Kiss,
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary
| | - Nóra Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | - Balázs Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Krisztián Horváth
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biomathematics and Computer Science, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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49
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Nagy A, Nagy T, Kolonics-Farkas AM, Eszes N, Vincze K, Barczi E, Tarnoki AD, Tarnoki DL, Nagy G, Kiss E, Maurovich-Horvat P, Bohacs A, Müller V. Autoimmune Progressive Fibrosing Interstitial Lung Disease: Predictors of Fast Decline. Front Pharmacol 2021; 12:778649. [PMID: 35002713 PMCID: PMC8727590 DOI: 10.3389/fphar.2021.778649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
A subset of interstitial lung diseases (ILDs) with autoimmune traits-including connective tissue disease-associated ILD (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF)-develops progressive fibrosing (PF)-ILD. The aim of our study was to evaluate the clinical characteristics and predictors of longitudinal lung function (LF) changes in autoimmune PF-ILD patients in a real-world setting. All ILD cases with confirmed or suspected autoimmunity discussed by a multidisciplinary team (MDT) between January 2017 and June 2019 (n = 511) were reviewed, including 63 CTD-ILD and 44 IPAF patients. Detailed medical history, LF test, diffusing capacity of the lung for carbon monoxide (DLCO), 6-min walk test (6MWT), blood gas analysis (BGA), and high-resolution computer tomography (HRCT) were performed. Longitudinal follow-up for functional parameters was at least 2 years. Women were overrepresented (70.1%), and the age of the IPAF group was significantly higher as compared to the CTD-ILD group (p < 0.001). Dyspnea, crackles, and weight loss were significantly more common in the IPAF group as compared to the CTD-ILD group (84.1% vs. 58.7%, p = 0.006; 72.7% vs. 49.2%, p = 0.017; 29.6% vs. 4.8%, p = 0.001). Forced vital capacity (FVC) yearly decline was more pronounced in IPAF (53.1 ± 0.3 vs. 16.7 ± 0.2 ml; p = 0.294), while the majority of patients (IPAF: 68% and CTD-ILD 82%) did not deteriorate. Factors influencing progression included malignancy as a comorbidity, anti-SS-A antibodies, and post-exercise pulse increase at 6MWT. Antifibrotic therapy was administered significantly more often in IPAF as compared to CTD-ILD patients (n = 13, 29.5% vs. n = 5, 7.9%; p = 0.007), and importantly, this treatment reduced lung function decline when compared to non-treated patients. Majority of patients improved or were stable regarding lung function, and autoimmune-associated PF-ILD was more common in patients having IPAF. Functional decline predictors were anti-SS-A antibodies and marked post-exercise pulse increase at 6MWT. Antifibrotic treatments reduced progression in progressive fibrosing CTD-ILD and IPAF, emphasizing the need for guidelines including optimal treatment start and combination therapies in this special patient group.
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Affiliation(s)
- Alexandra Nagy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Tamas Nagy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Noemi Eszes
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztina Vincze
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Eniko Barczi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | | | - György Nagy
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
| | - Emese Kiss
- Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
- 3rd Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | | | - Aniko Bohacs
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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50
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Müller V, Banys-Paluchowski M, Friedl TWP, Fasching PA, Schneeweiss A, Hartkopf A, Wallwiener D, Rack B, Meier-Stiegen F, Huober J, Rübner M, Hoffmann O, Müller L, Janni W, Wimberger P, Jäger B, Pantel K, Riethdorf S, Harbeck N, Fehm T. Prognostic relevance of the HER2 status of circulating tumor cells in metastatic breast cancer patients screened for participation in the DETECT study program. ESMO Open 2021; 6:100299. [PMID: 34839105 PMCID: PMC8637493 DOI: 10.1016/j.esmoop.2021.100299] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/11/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) have been reported to predict clinical outcome in metastatic breast cancer (MBC). Biology of CTCs may differ from that of the primary tumor and HER2-positive CTCs are found in some patients with HER2-negative tumors. PATIENTS AND METHODS Patients with HER2-negative MBC were screened for participation in DETECT III and IV trials before the initiation of a new line of therapy. Blood samples were analyzed using CELLSEARCH. CTCs were labeled with an anti-HER2 antibody and classified according to staining intensity (negative, weak, moderate, or strong staining). RESULTS Screening blood samples were analyzed in 1933 patients with HER2-negative MBC. As many as 1217 out of the 1933 screened patients (63.0%) had ≥1 CTC per 7.5 ml blood; ≥5 CTCs were detected in 735 patients (38.0%; range 1-35 078 CTCs, median 8 CTCs). HER2 status of CTCs was assessed in 1159 CTC-positive patients; ≥1 CTC with strong HER2 staining was found in 174 (15.0%) patients. The proportion of CTCs with strong HER2 staining among all CTCs of an individual patient ranged between 0.06% and 100% (mean 15.8%). Patients with estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were more likely to harbor ≥1 CTC with strong HER2 staining. CTC status was significantly associated with overall survival (OS). Detection of ≥1 CTC with strong HER2 staining was associated with shorter OS [9.7 (7.1-12.3) versus 16.5 (14.9-18.1) months in patients with CTCs with negative-to-moderate HER2 staining only, P = 0.013]. In multivariate analysis, age, ER status, PR status, Eastern Cooperative Oncology Group performance status, therapy line, and CTC status independently predicted OS. CONCLUSION CTC detection in patients with HER2-negative disease is a strong prognostic factor. Presence of ≥1 CTC with strong HER2 staining was associated with shorter OS, supporting a biological role of HER2 expression on CTCs.
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Affiliation(s)
- V Müller
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - M Banys-Paluchowski
- Gynecology and Obstetrics Department, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - T W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Schneeweiss
- Division Gynecologic Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - A Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - D Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - B Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - F Meier-Stiegen
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - J Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - M Rübner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - O Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - L Müller
- OnkologieUnterEms, Leer, Germany
| | - W Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus Dresden, TU Dresden, Germany; National Center for Tumor Diseases (NCT), Dresden, Germany
| | - B Jäger
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - K Pantel
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Riethdorf
- Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, Munich, Germany
| | - T Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
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