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Solano A, Klein A, Gonzalez-Guardiola G, Chamseddin K, Prakash V, Shih M, Baig MS, Timaran CH, Kirkwood ML, Siah MC. RevCore thrombectomy system for treatment of chronic left external and common iliac vein stent occlusion. J Vasc Surg Cases Innov Tech 2024; 10:101482. [PMID: 38633580 PMCID: PMC11022097 DOI: 10.1016/j.jvscit.2024.101482] [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: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
In recent years, deep venous stenting has increasingly become a treatment strategy for post-thrombotic syndrome. Stent thrombosis can occur, resulting in symptom recurrence despite medical therapy, and there are few options available for durable stent patency restoration. We present a case of a 50-year-old male with prior iliocaval reconstruction that experienced recurrent left lower extremity swelling secondary to occlusion of left external iliac and common iliac vein stents during follow-up. Mechanical thrombectomy with the RevCore System and angioplasty was performed. One month later, the patient demonstrated widely patent bilateral iliac vein stents and complete symptomatic resolution. The RevCore System is a feasible alternative for treatment of chronic in-stent thrombosis.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - M. Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael C. Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Solano A, Pizano A, Figueroa V, Klein A, Babb J, Prakash V, Chamseddin K, Gonzalez-Guardiola G, Kirkwood ML, Siah MC. Extensive iliofemoral and femoropopliteal venous thrombosis in a young patient with iliocaval atresia. J Vasc Surg Cases Innov Tech 2024; 10:101431. [PMID: 38510086 PMCID: PMC10951498 DOI: 10.1016/j.jvscit.2024.101431] [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: 11/09/2023] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
Inferior vena cava (IVC) atresia is a rare congenital anomaly. Standardized treatment is not well defined due to its uncommon presentation, with this pathology associated with an increased risk of unprovoked lower extremity deep vein thrombosis (DVT). We present a case of a 32-year-old man who was admitted for bilateral lower extremity edema and pain and was found to have bilateral extensive iliofemoral and femoropopliteal DVT, absence of IVC filling, and extensive tortuous collateralization arising from the pelvic veins to the azygos vein. Bilateral mechanical thrombectomy and endovascular iliocaval reconstruction was performed. Three months later, the patient demonstrated widely patent iliocaval stents and the absence of DVT. Endovascular treatment of IVC atresia is feasible and optimizes the reduction of thrombus burden.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alejandro Pizano
- Department of Surgery, Nassau University Medical Center, East Meadow, NY
| | - Valentin Figueroa
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Babb
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael C. Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Breuss A, Strasser M, Nuoffer JM, Klein A, Perret-Hoigné E, Felder C, Stauffer R, Wolf P, Riener R, Gautschi M. Nocturnal vestibular stimulation using a rocking bed improves a severe sleep disorder in a patient with mitochondrial disease. J Sleep Res 2024:e14153. [PMID: 38499951 DOI: 10.1111/jsr.14153] [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: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 03/20/2024]
Abstract
Mitochondrial diseases are rare genetic disorders often accompanied by severe sleep disorders. We present the case of a 12-year-old boy diagnosed with a severe primary mitochondrial disease, exhibiting ataxia, spasticity, progressive external ophthalmoplegia, cardiomyopathy and severely disrupted sleep, but no cognitive impairment. Interestingly, his parents reported improved sleep during night train rides. Based on this observation, we installed a rocking bed in the patient's bedroom and performed different interventions, including immersive multimodal vestibular, kinesthetic and auditory stimuli, reminiscent of the sensory experiences encountered during train rides. Over a 5-month period, we conducted four 2-week nocturnal interventions, separated by 1-week washout phases, to determine the subjectively best-perceived stimulation parameters, followed by a final 4-week intervention using the optimal parameters. We assessed sleep duration and quality using the Mini Sleep Questionnaire, monitored pulse rate changes and used videography to document nocturnal interactions between the patient and caregivers. Patient-reported outcome measures, clinical examinations and personal outcomes of specific interests were used to document daytime sleepiness, restlessness, anxiety, fatigue, cognitive performance and physical posture. In the final 4-week intervention, sleep duration increased by 25%, required caregiver interactions reduced by 75%, and caregiving time decreased by 40%. Subjective fatigue, assessed by the Checklist Individual Strength, decreased by 40%, falling below the threshold of severe fatigue. Our study suggests that rocking beds could provide a promising treatment regime for selected patients with persistent severe sleep disorders. Further research is required to validate these findings in larger patient populations with sleep disorders and other conditions.
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Affiliation(s)
- Alexander Breuss
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
| | - Marco Strasser
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Marc Nuoffer
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, and Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Klein
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eveline Perret-Hoigné
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Felder
- Division of Neuropediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ruth Stauffer
- Institute for Physiotherapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wolf
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
| | - Robert Riener
- ETH Zurich, Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Zurich, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Matthias Gautschi
- Division of Paediatric Endocrinology, Diabetology and Metabolism, Department of Paediatrics, and Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Silber I, Mathimalar S, Mangel I, Nayak AK, Green O, Avraham N, Beidenkopf H, Feldman I, Kanigel A, Klein A, Goldstein M, Banerjee A, Sela E, Dagan Y. Two-component nematic superconductivity in 4Hb-TaS 2. Nat Commun 2024; 15:824. [PMID: 38280890 PMCID: PMC10821864 DOI: 10.1038/s41467-024-45169-3] [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: 09/13/2022] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
Most superconductors have an isotropic, single component order parameter and are well described by the standard (BCS) theory for superconductivity. Unconventional, multiple-component superconductors are exceptionally rare and are much less understood. Here, we combine scanning tunneling microscopy and angle-resolved macroscopic transport for studying the candidate chiral superconductor, 4Hb-TaS2. We reveal quasi-periodic one-dimensional modulations in the tunneling conductance accompanied by two-fold symmetric superconducting critical field. The strong modulation of the in-plane critical field, Hc2, points to a nematic, unconventional order parameter. However, the imaged vortex core is isotropic at low temperatures. We suggest a model that reconciles this apparent discrepancy and takes into account previously observed spontaneous time-reversal symmetry breaking at low temperatures. The model describes a competition between a dominating chiral superconducting order parameter and a nematic one. The latter emerges close to the normal phase. Our results strongly support the existence of two-component superconductivity in 4Hb-TaS2 and can provide valuable insights into other systems with coexistent charge order and superconductivity.
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Affiliation(s)
- I Silber
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - S Mathimalar
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Mangel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A K Nayak
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - O Green
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - N Avraham
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - H Beidenkopf
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Feldman
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Kanigel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Klein
- Department of Physics, Faculty of Natural Sciences, Ariel University, Ariel, 40700, Israel
- Department of Chemical Physics, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - A Banerjee
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - E Sela
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel.
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5
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Zebley JA, Klein A, Wanersdorfer K, Quintana MT, Sarani B, Estroff JM, Kartiko S. 0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study. J Surg Res 2024; 293:427-432. [PMID: 37812876 DOI: 10.1016/j.jss.2023.09.016] [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: 11/30/2022] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Patients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration-approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure. METHODS A retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant. RESULTS Sixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence. CONCLUSIONS In patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.
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Affiliation(s)
- James A Zebley
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Andrea Klein
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Karen Wanersdorfer
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Megan T Quintana
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Jordan M Estroff
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Susan Kartiko
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
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Kerr LM, Ryan ME, Lim M, Hearn S, Klein A, Deiva K, Hopkins SE, Bacchus MK, Sokol EA, Waanders AJ, Mitchell WG, Khakoo Y, Lotze TE, Zhang B, Gorman MP. An International Pediatric-Onset Opsoclonus-Myoclonus Ataxia Syndrome Registry and Clinical Research Network: Development, Progress, and Vision. Pediatr Neurol 2023; 148:145-147. [PMID: 37716108 DOI: 10.1016/j.pediatrneurol.2023.05.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Lauren M Kerr
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Morgan E Ryan
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Lim
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sarah Hearn
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrea Klein
- Department of Neurology, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Kumaran Deiva
- Hôpitaux Universitaires Paris Sud-Bicêtre, Paris, France
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Micky K Bacchus
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth A Sokol
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela J Waanders
- Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wendy G Mitchell
- Division of Neurology, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Yasmin Khakoo
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Timothy E Lotze
- Department of Neurology, Texas Children's Hospital, Houston, Texas
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Golder S, McRobbie-Johnson ACE, Klein A, Polite FG, Gonzalez Hernandez G. Social media and COVID-19 vaccination hesitancy during pregnancy: a mixed methods analysis. BJOG 2023; 130:750-758. [PMID: 37078279 DOI: 10.1111/1471-0528.17481] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/13/2023] [Accepted: 01/28/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy. DESIGN We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine. SETTING Two social media platforms - WhatToExpect and Twitter. SAMPLE A total of 945 pregnant people in WhatToExpect (1017 posts) and 345 pregnant people in Twitter (435 tweets). METHODS Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group's 3Cs vaccine hesitancy model (confidence, complacency and convenience barriers). Within each 3Cs we created subthemes that emerged from the data. MAIN OUTCOME MEASURES Subthemes were derived according to the people's posting own words. RESULTS Safety concerns were most common and largely linked to the perceived speed at which the vaccine was created and the lack of data about its safety in pregnancy. This led to a preference to wait until after the baby was born or to take other precautions instead. Complacency surrounded a belief that they are young and healthy or already had COVID-19. Misinformation led to false safety and efficacy allegations, or even conspiracy theories, and fed into creating confidence and complacency barriers. Convenience barriers (such as availability) were uncommon. CONCLUSION The information in this study can be used to highlight the questions, fears and hesitations pregnant people have about the COVID-19 vaccine. Highlighting these hesitations can help public health campaigns and improve communication between healthcare professionals and patients.
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Affiliation(s)
- S Golder
- Department of Health Sciences, University of York, York, UK
| | - A C E McRobbie-Johnson
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A Klein
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - F G Polite
- Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - G Gonzalez Hernandez
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, California, USA
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Henzi BC, Baumann D, Erni SJ, Lötscher N, Tscherter A, Klein A. Effects of the COVID-19 Pandemic on Access to Education and Social Participation in Children and Adolescents with Duchenne Muscular Dystrophy in Switzerland. Neuropediatrics 2023. [PMID: 36996861 PMCID: PMC10332943 DOI: 10.1055/s-0043-1764434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Two-thirds of patients with Duchenne muscular dystrophy (DMD) have cognitive and neuropsychiatric problems. Concerning their quality of life, negative factors are the lack of qualifying education and social participation in sporting and leisure activities. Adapted assistance in education and participation in social life are thus important. During the coronavirus disease 2019 (COVID-19) pandemic, the pediatric population was less severely impacted by the disease, but by the restrictions associated. AIM The aim of this study was to evaluate the impact of the COVID-19 pandemic regarding access to education and social participation for young patients with DMD in Switzerland. METHODS We conducted a survey study from May to August 2021 assessing the impact of the COVID-19 pandemic on access to education and social participation in 8 to 18 years old patients with DMD in Switzerland. RESULTS Of 60 sent surveys, 40 were returned and included. Mean age of participants was 13.5 years (±3.1 standard deviation); 23/40 of the participants were wheelchair bound, 21/40 attended a special school, and 19/40 a regular school. Of the 22/40 participants receiving assistance at school, 7/40 reported a change caused by the pandemic: for 5/7, the assistance was paused. Of the 12 boys and adolescents attending sporting activities, 10 had to suspend these. Nine attended other leisure activities; for 3/9, these activities were paused. CONCLUSION The COVID-19 pandemic had direct effects on school assistance, sporting, and leisure activities in young patients with DMD in Switzerland. It is important to ensure that school assistance and leisure activities are rapidly resumed.
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Affiliation(s)
- Bettina C Henzi
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Dominique Baumann
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sarah J Erni
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, University Hospital of Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Nadine Lötscher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anne Tscherter
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Klein
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, University Hospital of Bern (Inselspital), University of Bern, Bern, Switzerland
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Shih M, Lee KB, Baig MS, Klein A, Rodriguez A, Kirkwood M. Endovascular repair of traumatic axillary artery transection associated with scapulothoracic dissociation complicated by stent separation. J Vasc Surg Cases Innov Tech 2023; 9:101110. [PMID: 36852318 PMCID: PMC9958072 DOI: 10.1016/j.jvscit.2023.101110] [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: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
We report the case of a 23-year-old female pedestrian who had been struck by a car and had presented with axillary artery transection in the setting of scapulothoracic dissociation. The initial endovascular repair was compromised by her shoulder instability and had required the addition of bridging stent placement. Caution is advised with endovascular repair in this clinical scenario because of possible stent separation.
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Affiliation(s)
- Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - K Benjamin Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Mirza S Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Alejandra Rodriguez
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Melissa Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
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Stettner GM, Hasselmann O, Tscherter A, Galiart E, Jacquier D, Klein A. Treatment of spinal muscular atrophy with Onasemnogene Abeparvovec in Switzerland: a prospective observational case series study. BMC Neurol 2023; 23:88. [PMID: 36855136 PMCID: PMC9971686 DOI: 10.1186/s12883-023-03133-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a rare neuromuscular disorder leading to early death in the majority of affected individuals without treatment. Recently, targeted treatment approaches including Onasemnogene Abeparvovec (OA) were introduced. This study describes the first real-world experience with OA in Switzerland. METHODS Prospective observational case series study using data collected within the Swiss Registry for Neuromuscular Disorders from SMA patients treated with OA. Development of motor, bulbar and respiratory function, appearance of scoliosis, and safety data (platelet count, liver function, and cardiotoxicity) were analyzed. RESULTS Nine individuals were treated with OA and followed for 383 ± 126 days: six SMA type 1 (of which two with nusinersen pretreatment), one SMA type 2, and two pre-symptomatic individuals. In SMA type 1, CHOP Intend score increased by 28.1 from a mean score of 20.5 ± 7.6 at baseline. At end of follow-up, 50% of SMA type 1 patients required nutritional support and 17% night-time ventilation; 67% developed scoliosis. The SMA type 2 patient and two pre-symptomatically treated individuals reached maximum CHOP Intend scores. No patient required adaptation of the concomitant prednisolone treatment, although transient decrease of platelet count and increase of transaminases were observed in all patients. Troponin-T was elevated prior to OA treatment in 100% and showed fluctuations in 57% thereafter. CONCLUSIONS OA is a potent treatment for SMA leading to significant motor function improvements. However, the need for respiratory and especially nutritional support as well as the development of scoliosis must be thoroughly evaluated in SMA type 1 patients even in the short term after OA treatment.
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Affiliation(s)
- Georg M. Stettner
- grid.7400.30000 0004 1937 0650Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
| | - Oswald Hasselmann
- grid.414079.f0000 0004 0568 6320Department of Neuropediatrics, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Anne Tscherter
- grid.5734.50000 0001 0726 5157Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elea Galiart
- grid.7400.30000 0004 1937 0650Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
| | - David Jacquier
- grid.8515.90000 0001 0423 4662Pediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Klein
- grid.5734.50000 0001 0726 5157Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Meadors S, Klein A, Jeon-Slaughter H, Jawaid O, Armstrong EJ, Banerjee R, Alaiti MA, Ramanan B, Modrall JG, Banerjee S, Tsai S. Short-Term Outcomes After Retrograde Versus Antegrade Crossing Approaches for Femoropopliteal Occlusive Disease. J Invasive Cardiol 2023; 35:E31-E36. [PMID: 36446575] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare short- and mid-term outcomes of patients with femoropopliteal (FP) occlusive disease treated with a retrograde vs antegrade crossing strategy. BACKGROUND Few studies have directly compared procedural details and outcomes after retrograde vs antegrade crossing of FP lesions. METHODS Patients undergoing retrograde approaches to FP lesions were identified from the multicenter Excellence in Peripheral Artery Disease (XLPAD) registry between 2007 and 2015. These patients were matched 1:1 to patients treated with antegrade crossing strategies based on age, gender, comorbidities, indication for procedure, and lesion characteristics. Technical success, major adverse limb events (MALEs), and overall device cost were compared between retrograde and antegrade-only crossing. RESULTS A total of 116 patients (58 antegrade and 58 retrograde) were included. The retrograde group had higher prevalence of coronary artery disease and presence of chronic total occlusions. The retrograde approach was associated with significantly longer procedural time (186 ± 70 minutes vs 124.4 ± 60 minutes; P<.001), but similar technical success (91.4% vs 96.6%; P=.24). There was no significant difference in perioperative morbidity. Patients treated with a retrograde approach had a lower total amputation rate (8.6% vs 22.4%; P=.04) and no difference in overall mortality (8.6% vs 5.2%; P=.47). Mean procedural costs were similar in the antegrade and retrograde groups. CONCLUSION In patients with similar disease characteristics, a retrograde approach to FP occlusive disease was associated with longer procedural time, but improved limb salvage, without significant difference in procedural cost.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Shirling Tsai
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9157, Dallas, TX 75390-9157 USA.
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Abdurajan S, Ågren J, Alt J, Axelin A, Bäcke P, Balashova E, Thernström Blomqvist Y, Burckhard Z, Burnsed J, Cornaz Buros S, Chavez-Valdez R, Chen M, Dickie J, Dietz R, Dingman A, Doucette L, El-Dib M, Shibiny H, Flock D, Ganal S, Gorse K, Guo J, Harrison S, Herrmann J, Ionov O, Jackson T, Janesko-Feldman K, Jantzie L, June A, Kathiresh S, Kirtbaya A, Klein A, Kochanek P, Kuter N, Marlicz M, Martin LJ, Matysik W, Munster C, Northington FJ, Quilinan N, Rais R, Schöberlein A, Sharafutdinova D, Suvorov MSI, Suvorova J, Szakmar E, Tiemeier E, Tran P, Trigo NF, Turnbill V, Ushakova L, Vagni V. Proceedings of the 14th International Newborn Brain Conference: Neuroprotection strategies in the neonate. J Neonatal Perinatal Med 2023; 16:S21-S31. [PMID: 37599541 DOI: 10.3233/npm-239002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
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13
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van den Bersselaar LR, Heytens L, Silva HCA, Reimann J, Tasca G, Díaz‐Cambronero Ó, Løkken N, Hellblom A, Hopkins PM, Rueffert H, Bastian B, Vilchez JJ, Gillies R, Johannsen S, Veyckemans F, Muenster T, Klein A, Litman R, Jungbluth H, Riazi S, Voermans NC, Snoeck MMJ. European Neuromuscular Centre consensus statement on anaesthesia in patients with neuromuscular disorders. Eur J Neurol 2022; 29:3486-3507. [PMID: 35971866 PMCID: PMC9826444 DOI: 10.1111/ene.15526] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/05/2022] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Patients with neuromuscular conditions are at increased risk of suffering perioperative complications related to anaesthesia. There is currently little specific anaesthetic guidance concerning these patients. Here, we present the European Neuromuscular Centre (ENMC) consensus statement on anaesthesia in patients with neuromuscular disorders as formulated during the 259th ENMC Workshop on Anaesthesia in Neuromuscular Disorders. METHODS International experts in the field of (paediatric) anaesthesia, neurology, and genetics were invited to participate in the ENMC workshop. A literature search was conducted in PubMed and Embase, the main findings of which were disseminated to the participants and presented during the workshop. Depending on specific expertise, participants presented the existing evidence and their expert opinion concerning anaesthetic management in six specific groups of myopathies and neuromuscular junction disorders. The consensus statement was prepared according to the AGREE II (Appraisal of Guidelines for Research & Evaluation) reporting checklist. The level of evidence has been adapted according to the SIGN (Scottish Intercollegiate Guidelines Network) grading system. The final consensus statement was subjected to a modified Delphi process. RESULTS A set of general recommendations valid for the anaesthetic management of patients with neuromuscular disorders in general have been formulated. Specific recommendations were formulated for (i) neuromuscular junction disorders, (ii) muscle channelopathies (nondystrophic myotonia and periodic paralysis), (iii) myotonic dystrophy (types 1 and 2), (iv) muscular dystrophies, (v) congenital myopathies and congenital dystrophies, and (vi) mitochondrial and metabolic myopathies. CONCLUSIONS This ENMC consensus statement summarizes the most important considerations for planning and performing anaesthesia in patients with neuromuscular disorders.
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Affiliation(s)
- Luuk R. van den Bersselaar
- Malignant Hyperthermia Investigation Unit, Department of AnaesthesiologyCanisius Wilhelmina Hospital NijmegenNijmegenThe Netherlands,Department of Neurology, Donders Institute for Brain, Cognition, and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Luc Heytens
- Malignant Hyperthermia Research Unit, Departments of Anaesthesiology and NeurologyUniversity Hospital Antwerp, University of Antwerp and Born Bunge InstituteAntwerpBelgium
| | - Helga C. A. Silva
- Malignant Hyperthermia Unit, Department of Surgery, Discipline of Anaesthesia, Pain, and Intensive CareSão Paulo Federal UniversitySão PauloBrazil
| | - Jens Reimann
- Department of NeurologyUniversity of Bonn Medical CentreBonnGermany
| | - Giorgio Tasca
- UOC of NeurologyA. Gemelli University Polyclinic Foundation, Scientific Institute for Research and Health CareRomeItaly
| | - Óscar Díaz‐Cambronero
- Malignant Hyperthermia Unit, Department of AnaesthesiologyPerioperative Medicine Research Group, La Fe University and Polytechnic HospitalValenciaSpain
| | - Nicoline Løkken
- Copenhagen Neuromuscular CentreRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Anna Hellblom
- Department of Intensive and Perioperative CareSkåne University Hospital LundLundSweden
| | - Philip M. Hopkins
- Leeds Institute of Medical Research at St James'sUniversity of Leeds and Malignant Hyperthermia Investigation Unit, St James's University HospitalLeedsUK
| | - Henrik Rueffert
- Schkeuditz Helios Clinic, Malignant Hyperthermia Investigation Unit, Department of Anaesthesiology, Intensive Care, Pain TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Börge Bastian
- Schkeuditz Helios Clinic, Malignant Hyperthermia Investigation Unit, Department of Anaesthesiology, Intensive Care, Pain TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Juan Jesus Vilchez
- Neuromuscular Centre, La Fe Hospital UIP and ERN EURO‐NMDNeuromuscular Research Group at La Fe IIS and CIBERERValenciaSpain
| | - Robyn Gillies
- Malignant Hyperthermia Diagnostic Unit, Department of Anaesthesia and Pain ManagementRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Stephan Johannsen
- Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, Centre for Malignant HyperthermiaUniversity Hospital WürzburgWürzburgGermany
| | - Francis Veyckemans
- Paediatric Anaesthesia ClinicJeanne de Flandre Hospital, Lille University Hospital CentreLilleFrance
| | - Tino Muenster
- Department of Anaesthesia and Intensive Care MedicineHospital of the Order of St John of GodRegensburgGermany
| | - Andrea Klein
- Department of Paediatric NeurologyUniversity Children's Hospital UKBBBaselSwitzerland,Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Ron Litman
- Department of Anaesthesiology and Critical CareChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular ServiceEvelina's Children Hospital, Guy's and St Thomas' Hospital National Health Service Foundation TrustLondonUK,Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - Sheila Riazi
- Malignant Hyperthermia Investigation Unit, Department of Anaesthesiology and Pain MedicineUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition, and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Marc M. J. Snoeck
- Malignant Hyperthermia Investigation Unit, Department of AnaesthesiologyCanisius Wilhelmina Hospital NijmegenNijmegenThe Netherlands
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Klein A, Agarwal S, Cholley B, Fassl J, Griffin M, Kaakinen T, Paulus P, Rex S, Siegemund M, van Saet A. A REVIEW OF EUROPEAN GUIDELINES FOR PATIENT BLOOD MANAGEMENT WITH A PARTICULAR EMPHASIS ON ANTIFIBRINOLYTIC DRUG ADMINISTRATION FOR CARDIAC SURGERY. J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Dratva J, Klein A, Marti S, Wieber F. COVID-19 containment measures impact utilization and provision of healthcare in Europe. Eur J Public Health 2022. [PMCID: PMC9594282 DOI: 10.1093/eurpub/ckac129.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The COVID-19 containment measures, implemented to curb the pandemic, impacted health of children and adolescents by numerous pathways. We present the impact on health care utilization and provision. Methods A systematic review on secondary health impact is ongoing (PubMed, PsychInfo, Embase). Literature is screened (title, abstract, full-text) by 2 researchers, and data of interest extracted systematically.. Inclusion criteria are age (0 - 25 yrs.), exposure: containment measures, outcome: secondary health outcome, and European data origin. Results Jan. 2020 - Aug. 2021 10112 studies were identified, 337 were included. n = 60 were on health care utilization and provision. Utilization studies relied on objective hospital or registry data, care provision studies more often on survey data (professionals, parents). Data yields a large but varying decrease in emergency department visits during the lockdown: Italy ∼75%, Spain ∼65%, France ∼60%, and Germany ∼64%, and a substantial change in case mix and severity compared to comparable pre-COVID. Specialized and primary pediatric practices report that elective interventions were postponed, state of the art diagnostics withheld, and rehabilitation services disrupted. Vaccinations in infants, children, and adolescents dropped during the lockdown inversely proportional to children's age. Studies repeatedly suggest patients’ health services avoidance out of fear of infection and stay-at-home rules.Results on catch-up utilization and provision to follow (ongoing study). Conclusions COVID-19 measures exerted a measurable impact on health utilization and provision in children and adolescents. The utilization was comparatively lower and service provision disrupted across Europe. So far little can be said about a potential recovery in terms of catch-up of visits, diagnostics, or treatments. Analyses of the long-term health impact of the observed effects is recommended and can serve to improve future pandemic preparedness. Key messages • COVID-19 confinement measures had measurable secondary health impact on children and adolescents. • Data on catch-up healthcare is important to establish long term impact and learnings.
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Affiliation(s)
- J Dratva
- Institute of Public Health, Zürich University of Applied Sciences , Winterthur, Switzerland
- Medical Faculty, University of Basel , Basel, Switzerland
| | - A Klein
- Institute of Public Health, Zürich University of Applied Sciences , Winterthur, Switzerland
| | - S Marti
- Institute of Public Health, Zürich University of Applied Sciences , Winterthur, Switzerland
| | - F Wieber
- Institute of Public Health, Zürich University of Applied Sciences , Winterthur, Switzerland
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Lebredonchel E, Riquet A, Neut D, Broly F, Matthijs G, Klein A, Foulquier F. A PMM2-CDG caused by an A108V mutation associated with a heterozygous 70 kilobases deletion case report. Ital J Pediatr 2022; 48:178. [PMID: 36221102 PMCID: PMC9552460 DOI: 10.1186/s13052-022-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background Congenital Disorders of Glycosylation (CDG) are a large group of inborn errors of metabolism with more than 140 different CDG types reported to date (1). The first characterized, PMM2-CDG, with an autosomal recessive transmission, is also the most frequent. The PMM2 gene encodes a phosphomannomutase. Here, a novel genetic variation causing PMM2-CDG is reported. Case presentation We report the case of a French child, from healthy and unrelated parents, presenting congenital ataxia with hypotonia, hyperlaxity, inverted nipples, as well as altered coagulation parameters and liver function. Transferrin isoelectrofocusing revealed a typical type I CDG profile. Direct Sanger sequencing and quantitative PCR of PMM2 revealed a unique and novel genotype. On one allele, the patient was heterozygote with a known missense variant NM_000303.3(PMM2):c.323C > T, p.Ala108Val in exon 4. On the second allele, whole genome sequencing (WGS) indicated the presence of a novel heterozygous 70 kb deletion. Conclusion We report in the present paper the largest known heterozygous deletion of a PMM2 gene. The observation reveals the impact of a precise diagnostic on genetic counselling: by using WGS, an erroneous conclusion of homozygosity in the case of a relatively rare variant could be avoided, and an index patient with healthy and unrelated parents correctly identified.
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Affiliation(s)
- E Lebredonchel
- UMR 8576, Univ. Lille, CNRS, UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France. .,Centre de Biologie Et Pathologie, Lille Medical Center, University of Lille, UAM de glycopathologies, 59000, Lille, France.
| | - A Riquet
- Lille University Hospital Center Paediatrics, 59000, Lille, France
| | - D Neut
- Cabinet de Pédiatrie, 93 Rue de la Paix, 62200, Boulogne-sur-Mer City, France
| | - F Broly
- Centre Hospitalier Régional Universitaire de Lille Centre de Biologie Pathologie, 59000, Lille, France
| | - G Matthijs
- Laboratory for Molecular Diagnosis, Center for Human Genetics, 3000, Leuven, KU, Belgium
| | - A Klein
- UMR 8576, Univ. Lille, CNRS, UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France.,Centre de Biologie Et Pathologie, Lille Medical Center, University of Lille, UAM de glycopathologies, 59000, Lille, France
| | - F Foulquier
- UMR 8576, Univ. Lille, CNRS, UGSF - Unité de Glycobiologie Structurale Et Fonctionnelle, 59000, Lille, France
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Weng W, Birnie D, Sadek M, Ramirez F, Nery P, Nair G, Davis D, Redpath C, Klein A, Green M, Hansom S, Aydin A. CARDIAC IMPLANTABLE ELECTRONIC DEVICE LEAD PERFORATION RATES, MANAGEMENT AND OUTCOMES. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.076] [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: 11/02/2022] Open
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Neuenschwander J, Tenenbaum T, Esposito S, Kaplan S, Motov S, Bachur R, Rothman R, Ryan L, Klein A. 47 A Host Protein Test Based on TRAIL, IP-10 and CRP for Differentiating Between Bacterial and Viral Infection Has Potential to Improve Patient Selection for Blood Culture Utilization. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.070] [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: 11/30/2022]
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Masson R, Mazurkiewicz-Bełdzińska M, Rose K, Servais L, Xiong H, Zanoteli E, Baranello G, Bruno C, Day JW, Deconinck N, Klein A, Mercuri E, Vlodavets D, Wang Y, Dodman A, El-Khairi M, Gorni K, Jaber B, Kletzl H, Gaki E, Fontoura P, Darras BT, Volpe JJ, Posner J, Kellner U, Quinlivan R, Gerber M, Khwaja O, Scalco RS, Seabrook T, Koch A, Balikova I, Joniau I, Accou G, Tahon V, Wittevrongel S, De Vos E, de Holanda Mendonça R, Matsui Jr C, Fornazieri Darcie AL, Machado C, Kiyoko Oyamada M, Martini J, Polido G, Rodrigues Iannicelli J, Caires de Oliveira Achili Ferreira J, Hu C, Zhu X, Qian C, Shen L, Li H, Shi Y, Zhou S, Xiao Y, Zhou Z, Wang S, Sang T, Wei C, Dong H, Cao Y, Wen J, Li W, Qin L, Barisic N, Celovec I, Galiot Delic M, Ivkic PK, Vukojevic N, Kern I, Najdanovic B, Skugor M, Tomas J, Boespflug-Tanguy O, De Lucia S, Seferian A, Barreau E, Mnafek N, Peche H, Grange A, Trang Nguyen D, Milascevic D, Tachibana S, Pagliano E, Bianchi Marzoli S, Santarsiero D, Garcia Sierra M, Tremolada G, Arnoldi MT, Vigano M, Dosi C, Zanin R, Schembri V, Brolatti N, Rao G, Tassara E, Morando S, Tacchetti P, Pedemonte M, Priolo E, Sposetti L, Comi GP, Govoni A, Osnaghi SG, Minorini V, Abbati F, Fassini F, Foa M, Lopopolo A, Pane M, Palermo C, Pera MC, Amorelli GM, Barresi C, D'Amico G, Orazi L, Coratti G, Leone D, Laura A, De Sanctis R, Berti B, Kimura N, Takeshima Y, Shimomura H, Lee T, Gomi F, Morimatsu T, Furukawa T, Stodolska-Koberda U, Waskowska A, Kolendo J, Sobierajska-Rek A, Modrzejewska S, Lemska A, Melnik E, Artemyeva S, Leppenen N, Yupatova N, Monakhova A, Papina Y, Shidlovsckaia O, Litvinova E, Enzmann C, Galiart E, Gugleta K, Wondrusch Haschke C, Topaloglu H, Oncel I, Ertugrul NE, Konuskan B, Eldem B, Kadayifçilar S, Alemdaroglu I, Sari S, Bilgin N, Karaduman AA, Sarikaya FGY, Graham RJ, Ghosh P, Casavant D, Levine A, Titus R, Engelbrekt A, Ambrosio L, Fulton A, Baglieri AM, Dias C, Maczek E, Pasternak A, Beres S, Duong T, Gee R, Young S. Safety and efficacy of risdiplam in patients with type 1 spinal muscular atrophy (FIREFISH part 2): secondary analyses from an open-label trial. Lancet Neurol 2022; 21:1110-1119. [DOI: 10.1016/s1474-4422(22)00339-8] [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] [Received: 04/08/2022] [Revised: 07/12/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
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Ramdas S, Della Marina A, Ryan MM, McWilliam K, Klein A, Jacquier D, Alabaf S, Childs AM, Parasuraman D, Beeson D, Palace J, Jungbluth H. Rituximab in juvenile myasthenia gravis-an international cohort study and literature review. Eur J Paediatr Neurol 2022; 40:5-10. [PMID: 35835035 DOI: 10.1016/j.ejpn.2022.06.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
Juvenile myasthenia gravis (JMG) is a rare, antibody-mediated disorder of the neuromuscular junction. Treatment strategies in JMG are largely informed by adult MG treatments as the pathophysiology is similar. Rituximab is increasingly considered as a treatment option in refractory JMG but has not yet been systematically investigated in this patient group We conducted a retrospective study from five international centres with expertise in paediatric myasthenia. 10 JMG patients treated with rituximab were identified. Following rituximab treatment all patients had a reduction in JMG-related hospital admissions. At 24 month follow up, 6 patients (60%) had achieved complete stable remission or pharmacological remission and 7 patients were able to reduce immunomodulatory treatment(s). The main side-effect was infusion-related reactions (30%) which resolved in all patients with symptomatic treatment. We compared our cohort to previously reported JMG cases treated with rituximab and noted similar response rates but a slightly higher side-effect profile. Rituximab is a safe and effective treatment option in moderate to severe JMG and most patients have an improvement in MG symptoms post treatment.
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Affiliation(s)
- Sithara Ramdas
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, United Kingdom; Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Adela Della Marina
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany.
| | - Monique M Ryan
- Neurology Department, Royal Children's Hospital, Melbourne, Australia.
| | - Kenneth McWilliam
- Department of Paediatric Neurology, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
| | - Andrea Klein
- Department of Pediatric Neurology, University Children's Hospital Basel, Basel, Switzerland; University Children's Hospital Bern, Inselspital, Bern, Switzerland.
| | - David Jacquier
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland.
| | - Setareh Alabaf
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Anne-Marie Childs
- Department of Paediatric Neurology, Leeds Teaching Hospitals, United Kingdom.
| | - Deepak Parasuraman
- Department of Paediatrics, Heartlands Hospital, Birmingham, United Kingdom.
| | - David Beeson
- Neurosciences Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, FoLSM, King's College, London, UK.
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Koelen J, Vonk A, Klein A, de Koning L, Vonk P, de Vet S, Wiers R. Man vs. machine: A meta-analysis on the added value of human support in text-based internet treatments (“e-therapy”) for mental disorders. Clin Psychol Rev 2022; 96:102179. [DOI: 10.1016/j.cpr.2022.102179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/28/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
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Horneff G, Dressler F, Windschall D, Mrusek S, Hospach T, Kühn A, Haller M, Von Bismarck P, Emminger W, Ruehmer P, Hufnagel M, Klein A. POS0170 EXPERIENCES WITH COVID-19 INFECTIONS IN GERMAN PEDIATRIC RHEUMATOLOGY CENTERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1881] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAlthough the risk for severe COVID-19 progression in children is low, this may be aggravated by the underlying disease and/or immunosuppressive drugs.ObjectivesWe analyzed clinical data of COVID-19 cases among paediatric patients with rheumatic diseases reported to the BIKER registry.MethodsThe main task of the German BIKER (Biologics in Pediatric Rheumatology) registry is to monitor the safety of biologics therapies in JIA. After the onset of the COVID-19 pandemic, the survey was expanded with a standardized form to proactively interview all participating centers about the occurrence, presentation, and outcome of SARS-CoV-2- infections in children with rheumatic diseases. Interviews were conducted with 68 centers initially weekly and later biweekly.ResultsA total of 68 centres participated in the survey. Clinical data from 194 COVID-19 cases reported to the BIKER registry from 41 German and 1 Austrian pediatric rheumatology institutions between February 2020 and December 2021 were analyzed. Juvenile idiopathic arthritis (JIA, n=144) was the most common diagnosis followed by genetic autoinflammation (n=18; i.e. FMF, TRAPS, CAPS, HIDS, DADA2), systemic autoimmune diseases (n=11; i.e. SLE, dermatomyositis, vasculitis) and 16 with other rheumatic diseases (i.e. CRMO, Uveitis). 5 patients with no rheumatic disease were excluded. 104 (54%) patients were receiving conventional DMARDs, 81 (43%) received biologics, mainly TNF inhibitors (n=66 (35%)).Of the 189 rheumatic patients with SARS-CoV2 infection, 123 (63%) were female. The mean age was 12.4+/-4.4 years in females and 13.2+/-4.1 in males. The duration of SARS-Co2 infection associated symptoms was 13.8+/-15.3 days (max. 113 days), in 35 (43%) patients they lasted for > 12 days. 46 (24%) were asymptomatic. Patients with autoinflammation and systemic autoimmunopathies reported more symptoms such as fever, head and throat ache. 4 patients only complained about dyspnea.Only 3 patients were hospitalized and received Oxygen-supplementation. The only patients admitted to ICU, received ventilation but succumbed. This 3½-year-old patient, initially diagnosed with systemic JIA, developed fatal disease with intracranial edema and respiratory failure, as well as typical pulmonary texture changes. Prior to her SARS-CoV-2 infection, the patient was treated with MTX and low-dose steroids. Genetic testing revealed a so far unrecognized congenital immunodeficiency.In the total JIA cohort, treatment with corticosteroids, conventional DMARDs, biologics or combinations did not influence the number of reported symptoms or the favorable outcome of the cohort. However, the duration of symptoms was lower in the TNF-treated cohort (10.4+/-6.4 days vs. 15.7 +/- 19.7 days). In the cohort with autoinflammation, fever was observed in 11 (61%). Those 6 who received IL-1-inhibitors did not show a different outcome than those 12 who did not. No case of PIMS/MISC in children with rheumatic diseases was reported.ConclusionExcept for one patient with congenital immunodeficiency who died from her COVID-19 infection, no case of severe COVID-19 was reported in our cohort. At the time of infection, over 80% of patients in our cohort had been treated with conventional DMARDs and/or biologics. This did not appear to have a negative impact on the severity or outcome of SARS-CoV2 infection. Interestingly, no case of PIMS/MISC was observed.Disclosure of InterestsGerd Horneff Speakers bureau: Novartis, Pfizer, Janssen, Grant/research support from: Pfizer, Novartis, Roche, MSD, Frank Dressler Speakers bureau: Pfizer, Novartis, Abbvie, Paid instructor for: Advisory boards Novartis, Mylan, Daniel Windschall Speakers bureau: Pfizer, Novartis, Abbvie, MEDAC, Canon, Grant/research support from: Novartis, Pfizer, Sonja Mrusek: None declared, Toni Hospach: None declared, Alexander Kühn: None declared, Maria Haller: None declared, Philipp von Bismarck: None declared, Wolfgang Emminger: None declared, Peggy Ruehmer: None declared, Markus Hufnagel: None declared, Ariane Klein Speakers bureau: Novartis
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Klein A, Zimmer A, Hospach T, Weller-Heinemann F, Hansmann S, Kuemmerle-Deschner J, Fasshauer M, Minden K, Foeldvari I, Rietschel C, Windschall D, Trauzeddel R, Hufnagel M, Foell D, Berendes R, Boeschow G, Oommen P, Dressler F, Horneff G. OP0217 EFFECTIVENESS AND SAFETY OF IL-6 INHIBITION (TOCILIZUMAB) VERSUS TUMOUR NECROSIS FACTOR INHIBITION IN POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS: RESULTS FROM THE OBSERVATIONAL BIKER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1774] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTocilizumab (TCZ) has been approved for treatment of juvenile idiopathic arthritis (JIA) for 10 years.ObjectivesEvaluation of 12-month efficacy and safety of TCZ compared to TNF inhibitors (TNFi).MethodsBIKER WA 29358 is a 5-year multi-centre prospective, observational cohort study including polyarticular JIA patients in Germany starting treatment between 2015 and 2020 with TCZ and matched 1:1 by date of treatment start and region to patients starting an approved TNFi. Clinical disease activity (JADAS10), JADAS MDA (≦3.8)/remission (≦1.0), safety and drug adherence at 12 months were assessed and compared between cohorts.ResultsThe analysis included 342 participants with 12-month treatment data (TCZ n=171; TNFi n=171). TCZ was used as 2nd line biologic in the majority of patients (84%) while TNFi were mostly 1st line biologics (86%). Patients starting TCZ had a longer disease duration. Efficacy was demonstrated by a marked decrease in JADAS10 in both cohorts (TCZ vs. TNFi at baseline: 15.0+/-6.7 vs. 14.6+/-6.3; at month 12: 3.8+/-5.1 vs. 3.4+/-4.5). Proportions of patients in TCZ/TNFi cohorts achieving JADAS remission at 12 months were 48%/41% in 1st line biologic users and 32%/33% in 2nd line biologic users. JADAS MDA was achieved in 64%/69% in 1st line and 52%/58% in 2nd line users of TCZ/TNFi.After 12 months of treatment JADAS10 (mean +/SD) was higher in the 2nd line TNFi cohort compared to the 1st line (4.5+/-5.6 vs. 3.2+/-4.3), similar to patients receiving 2nd or 1st line TCZ (4.0+/-5.2 vs. 2.9+/-4.4). Patients receiving TCZ or TNFi as first biologic reached JADAS10 remission and MDA numerically more frequently but not statistically significant compared to 2nd line users.Safety was assessed based on adverse event (AE) reporting. 57 (33%) patients in the TCZ cohort and 43 (25%) patients in the TNFi cohort reported AE. The AE rate was significantly higher in the TCZ cohort (69 vs. 44.8/100 patient years, RR 1.5 [95%CI 1.1-2.0], p=0.006, Wald-test). There were 6 serious AE in the TCZ and 3 in the TNFi cohort. Injection site reactions were more common in the TNFi cohort (9 vs. 1, p=0.043). No further differences were identified to date. There was no death and no opportunistic infection.In the TCZ cohort, 32 patients discontinued treatment, 27 due to lack of efficacy, while in the TNFi cohort only 6 patients discontinued treatment. Treatment discontinuation was more frequent among the 2nd biologic users (n=29; 17.4%) than in first line users (n= 9; 5.1%).ConclusionIn this first interim analysis, treatment targets were reached with similar frequency after 12 months of treatment with TCZ or TNFi. TCZ was used predominantly as 2nd line biologic. Higher rates of remission /MDA were observed in 1st line compared to 2nd line biologic users. Although more AE were reported in the TCZ cohort, the occurrence of serious AE and infections was comparable in both cohorts. No new safety signals were identified. Observation is ongoing.Table 1.Baseline characteristics and discontinuations with reasons.Number, nTNFi 1st 147TNFi 2nd 24TNFi total 171TCZ 1st 27TCZ 2nd 144TCZ total 171Female, %119(81%)20 (83%)139(81%)20(74%)123(85%)143(84%)Disease duration, years2.7+/-2.76.5+/-3.33.2+/-3.12.5+/-2.75.9+/-4.15.4+/-4.1Pre-treatmentn.a.None=147 (86%)n.a.None=27 (16%)1 biologic14 (58%)14 (8%)80 (56%)80 (47%)2 biologics7 (29%)7 (4%)54 (38%)54 (32%)≥ 3 biologics3 (13%)3 (2%)10 (7%)10 (6%)CHAQ-DI, mean +/- SD0.67+/-0.640.31+/-0.450.63+/-0,630.43+/-0.440.65+/-0.650.61+/-0.62JADAS 10, mean +/- SD14.8+/-6.313.4+/-6.814.6+/-6.313.3+/-6.015.3+/-7.015.0+/-6.7ConcomitantMTX, n (%)120 (82%)13 (54%)133 (78%)17 (63%)75 (52%)92 (54%)Steroid, n (%)37 (25%)4 (17%)41 (24%)8 (30%)35 (24%)43 (25%)Discontinuations, n (%)5 (3.4%)1 (4.2%)6 (3.5%)4 (16%)28 (19%)32 (19%)-Inefficacy1 (0.7%)2 (1.2%)3 (12%)24 (17%)27 (16%)-Intolerance2 (1.4%)1 (4.2%)2 (1.2%)2 (1.4%)2 (1.2%)-Other2 (1.4%)2 (1.2%)1 (4%)4 (2.8%)5 (3.0%)Disclosure of InterestsAriane Klein Speakers bureau: Novartis fee chairing a lunch symposium, Angela Zimmer: None declared, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Sandra Hansmann: None declared, Jasmin Kuemmerle-Deschner: None declared, Maria Fasshauer: None declared, Kirsten Minden Speakers bureau: Honoraries from Novartis, Pfizer, Medac, Ivan Foeldvari: None declared, Christoph Rietschel: None declared, Daniel Windschall Speakers bureau: Pfizer, Novartis, Abbvie, MEDAC, Canon, Grant/research support from: Novartis, Pfizer, Ralf Trauzeddel: None declared, Markus Hufnagel: None declared, Dirk Foell: None declared, Rainer Berendes: None declared, Gundula Boeschow: None declared, Prasad Oommen: None declared, Frank Dressler Speakers bureau: Honoraries from Novartis, Pfizer, Abbvie, Consultant of: Advisory board Novartis, Mylan, Gerd Horneff Speakers bureau: Novartis, Pfizer, Janssen, Grant/research support from: Pfizer, Novartis, Roche, MSD
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Eulert S, Vollbach K, Tenbrock K, Klotsche J, Foell D, Haas JP, Weller-Heinemann F, Mrusek S, Oommen P, Windschall D, Moenkemoeller K, Kallinich T, Hufnagel M, Foeldvari I, Hospach T, Klaas M, Rühlmann M, Trauzeddel R, Brueck N, Schütz C, Kuemmerle-Deschner JB, Klein A, Minden K, Horneff G. POS0171 A STANDARDIZED ASSESSMENT OF TREATMENT AND OUTCOME OF NEWLY DIAGNOSED PATIENTS WITH JIA WITHIN THE PROKIND PROJECT – PATHWAYS FOR POLYARTICULAR JIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2008] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe ProKind Commission of the Society for Paediatric and Adolescent Rheumatology (GKJR) has developed evidence- and consensus-based protocols for the diagnosis and therapy of children and adolescents with defined rheumatic diseases (e.g., [1]). In the ProKind-Rheuma project, it is now investigated whether the protocols are followed in everyday clinical practice and what the treatment-associated outcomes are.ObjectivesTo investigate the mode of treatment and treatment response in patients with polyarticular juvenile idiopathic arthritis (pJIA).MethodsProKind-Rheuma is a multicenter prospective non-interventional observational study. Patients with pJIA enrolled until 17/1/2022 were included into this analysis. Treatments and outcomes up to the 3-month follow-up visit (3FU) were analyzed. Disease states were categorized based on the 2021 cJADAS10 cutoffs [2].ResultsTo date, 18 pediatric rheumatology facilities have participated in ProKind-Rheuma. Data from 203 patients with JIA are available. Of those, 44% have oligoarthritis, 36% polyarthritis, 9% systemic JIA, 6% enthesitis-related arthritis and 3% psoriatic arthritis.In total, 76 patients were diagnosed with pJIA, 38 with already completed 3FU:For 23 patients with pJIA and completed 3FU, we were able to analyze the protocol-defined [1] treatment goal of at least “minimal improvement”. In total, 18 (78%) achieved minimal improvement, 5 (22%) missed it. For 4 of those 5 patients, the underlying MTX therapy was escalated to a bDMARD (3 changed to MTX+bDMARD-combi, 1 to bDMARD-mono). In 3 other patients, therapy was also escalated to an MTX+bDMARD-combi.Between baseline and 3FU, 72% achieved cJADAS10-disease state improvement (Table 1) by at least one category (range 1 - 2), 0% decreased.Table 1.*based on non-missing valuesAt Baseline allAt Baseline with 3FUAt 3FUTotal7638Female, n (%)58 (76)30 (79)Age (years), Mdn (IQR)9 (3-12)7 (2-12)7.5 (3-12)Time since diagnosis (months), Mdn (IQR)0 (0-1)0 (0-1)4 (3-4)RF-positivity, n (%)8 (11)3 (8)Number of active joints (arthritis), Mdn (IQR)7 (4-12)7 (5-12)2 (0-4)JADAS10 (0-40), Mean (SD) (NBL+3FU= 23)18.6 (7.4)19.6 (7.6)7.2 (4.2)cJADAS10 (0-30), Mean (SD) (NBL+3FU= 29)16.3 (5.9)16.7 (6.1)7.1 (4.1)State of inactive disease (cJADAS10≤2.5), n (%*)0 (0)0 (0)4 (13)State of minimal disease activity (2.5<cJADAS10≤5), n (%*)1 (2)1 (3)9 (28)State of moderate disease activity (5<cJADAS10 ≤16), n (%*)33 (54)17 (50)18 (56)State of high disease activity (cJADAS10>16), n (%*)27 (44)16 (47)1 (3)CHAQ (0-3), Mean (SD)0.8 (0.8)0.9 (0.8)0.3 (0.5)Pain (NRS 0 - 10), Mean (SD)4.3 (3)4.7 (3)2.2 (2.7)PedsQL 4.0 total score, Mean (SD)66.3 (22.2)65.4 (21.8)78.4 (17.6)Intraarticular glucocorticoids > 4 joints (ever), n (%)12 (16)5 (13)7 (18)Glucocorticoid pulses (ever), n (%)22 (29)12 (32)13 (34)Methotrexate, n (%)56 (74)31 (82)34 (90)bDMARDs, n (%)7 (9)2 (5)9 (24)Within the first 3 months after diagnosis, the treatment pathways proposed by the ProKind Commission [1] were followed in about three-quarters of patients: i) 5 (13%) received MTX and intra-articular glucocorticoid injections in more than 4 joints (IAGC), but no high-dose intravenous glucocorticoid pulse (HDGC) or bDMARD; ii) 8 (21%) received MTX and HDGC (no bDMARD, no IAGC); iii) 16 (42%) patients received MTX, of whom 4 received a bDMARD up to or at the 3FU (no HDGC, no IAGC). Nine (24%) patients were not treated with MTX or did not fit any of these categories, mostly due to starting bDMARD therapy in conjunction with HDGC or IAGC.ConclusionIn the routine care of JIA patients with polyarthritis, the proposed treatment protocol and treat-to-target strategy are followed in most patients. At 3FU, improvements of JADAS10 and other outcomes were evident, with 41% having achieved inactive or minimal active disease.ProKind is funded by the Innovation Fund “Gemeinsamer Bundesausschuss”, FKZ: 01VSF18031References[1]Horneff et al. Pediatric Rheumatology 2017; 15:78[2]Trincianti et al. Arthritis Rheumatol. 2021 Nov; 73(11):1966-1975AcknowledgementsWe are grateful to all physicians, medical professionals and everyone else who has so far contributed and supported the ProKind-Rheuma project.Moreover, we want to express special gratitude to all patients and their parents for their participation.Disclosure of InterestsSascha Eulert: None declared, Kristina Vollbach: None declared, Klaus Tenbrock: None declared, Jens Klotsche: None declared, Dirk Foell Speakers bureau: Speaker fees/honoraria from Boehringer, Novartis, Werfen and Sobi, Grant/research support from: Novartis and Sobi, Johannes-Peter Haas: None declared, Frank Weller-Heinemann: None declared, Sonja Mrusek: None declared, Prasad Oommen: None declared, Daniel Windschall Speakers bureau: Research support and speakers fee: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Grant/research support from: Research support and speakers fee: Pfizer, Novartis, Abbvie, Medac, Sobi, Canon, Kirsten Moenkemoeller: None declared, Tilmann Kallinich: None declared, Markus Hufnagel: None declared, Ivan Foeldvari Consultant of: Addvisory board: Hexal, Novartis, Pfizer, Toni Hospach Consultant of: Advisory board: Sobi, Novartis, Moritz Klaas: None declared, Michael Rühlmann: None declared, Ralf Trauzeddel: None declared, Normi Brueck: None declared, Catharina Schütz: None declared, J. B. Kuemmerle-Deschner: None declared, Ariane Klein: None declared, Kirsten Minden Speakers bureau: Speaker: Pfizer, Novartis, Gerd Horneff: None declared
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Rossor T, Yeh EA, Khakoo Y, Angelini P, Hemingway C, Irani SR, Schleiermacher G, Santosh P, Lotze T, Dale RC, Deiva K, Hero B, Klein A, de Alarcon P, Gorman MP, Mitchell WG, Lim M. Diagnosis and Management of Opsoclonus-Myoclonus-Ataxia Syndrome in Children: An International Perspective. Neurol Neuroimmunol Neuroinflamm 2022; 9:e1153. [PMID: 35260471 PMCID: PMC8906188 DOI: 10.1212/nxi.0000000000001153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare disorder of the nervous system that classically presents with a combination of characteristic eye movement disorder and myoclonus, in addition to ataxia, irritability, and sleep disturbance. There is good evidence that OMAS is an immune-mediated condition that may be paraneoplastic in the context of neuroblastoma. This syndrome may be associated with long-term cognitive impairment, yet it remains unclear how this is influenced by disease course and treatment. Treatment is largely predicated on immune suppression, but there is limited evidence to indicate an optimal regimen. METHODS Following an international multiprofessional workshop in 2004, a body of clinicians and scientists comprising the International OMS Study group continued to meet biennially in a joint professionals and family workshop focusing on pediatric OMAS. Seventeen years after publication of the first report, a writing group was convened to provide a clinical update on the definitions and clinical presentation of OMAS, biomarkers and the role of investigations in a child presenting with OMAS, treatment and management strategies including identification and support of long-term sequelae. RESULTS The clinical criteria for diagnosis were reviewed, with a proposed approach to laboratory and radiologic investigation of a child presenting with possible OMAS. The evidence for an upfront vs escalating treatment regimen was reviewed, and a treatment algorithm proposed to recognize both these approaches. Importantly, recommendations on monitoring of immunotherapy response and longer-term follow-up based on an expert consensus are provided. DISCUSSION OMAS is a rare neurologic condition that can be associated with poor cognitive outcomes. This report proposes an approach to investigation and treatment of children presenting with OMAS, based on expert international opinion recognizing the limited data available.
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Affiliation(s)
- Thomas Rossor
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - E. Ann Yeh
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Yasmin Khakoo
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Paola Angelini
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Cheryl Hemingway
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Sarosh R. Irani
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Gudrun Schleiermacher
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Paramala Santosh
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Tim Lotze
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Russell C. Dale
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Kumaran Deiva
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Barbara Hero
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Andrea Klein
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Pedro de Alarcon
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Mark P. Gorman
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Wendy G. Mitchell
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
| | - Ming Lim
- From the Children's Neurosciences (T.R., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Department Women and Children's Health (T.R., M.L.), School of Life Course Sciences (SoLCS), King's College London, UK; Division of Neurology (E.A.Y.), Department of Pediatrics, Neurosciences and Mental Health (RI), The Hospital for Sick Children; Faculty of Medicine (E.A.Y.), The University of Toronto, Ontario, Canada; Department of Pediatrics (Y.K.) and Department of Neurology (Y.K.), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pediatrics (Y.K.), Weill Medical College of Cornell University, New York; Children and Young People's Unit (Paola Angelini), The Royal Marsden, Downs Road, Sutton, Surrey; UCL Great Ormond Street Institute of Child Health (C.H.), Department of Neurology, Great Ormond Street Hospital for Children, London; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.R.I.), Oxford University Hospitals NHS Foundation Trust, UK; SiRIC RTOP (G.S.), Translational Research Department, PSL Research University, Institut Curie Research Center; INSERM U830 (G.S.), PSL Research University, Institut Curie Research Center; SIREDO Center: Care (G.S.), Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Child and Adolescent Psychiatry (P.S.), King's College London; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD) Research Team (P.S.), South London and Maudsley NHS Foundation Trust, London, UK; Baylor College of Medicine (T.L.), Texas Children's Hospital, Houston; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery (R.C.D.), The Children's Hospital at Westmead; The Children's Hospital at Westmead Clinical School (R.C.D.), Faculty of Medicine, University of Sydney, NSW, Australia; Pediatric Neurology Department (K.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Bicêtre Hospital; National Referral Center for Rare Inflammatory and Auto-Immune Brain and Spinal Diseases (K.D.); Inserm UMR 1184 (K.D.), Immunology of Viral Infections and Autoimmune Diseases, CEA, IDMIT, Le Kremlin Bicêtre, France; Department of Pediatric Hematology and Oncology (B.H.), University Children's Hospital, Koln; Division of Child Neurology (A.K.), University Children's Hospital Bern Inselspital, University of Bern; Department of Pediatric Neurology (A.K.), University Children's Hospital Basel, Switzerland; Department of Pediatrics (Pedro de Alarcon), University of Illinois College of Medicine at Peoria, Peoria IL; Department of Neurology (M.P.G.), Boston Children's Hospital, Harvard Medical School, MA; Division of Neurology (W.G.M.), Department of Pediatrics, Children's Hospital Los Angeles; and Department of Neurology (W.G.M.), Keck School of Medicine at the University of Southern California, Los Angeles
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26
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Casaulta C, Messerli F, Rodriguez R, Klein A, Riedel T. Changes in ventilation distribution in children with neuromuscular disease using the insufflator/exsufflator technique: an observational study. Sci Rep 2022; 12:7009. [PMID: 35488044 PMCID: PMC9054802 DOI: 10.1038/s41598-022-11190-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with neuromuscular disease often suffer from weak and ineffective cough resulting in mucus retention and increased risk for chest infections. Different airway clearance techniques have been proposed, one of them being the insufflator/exsufflator technique. So far, the immediate physiological effects of the insufflator/exsufflator technique on ventilation distribution and lung volumes are not known. We aimed to describe the immediate effects of the insufflator/exsufflator technique on different lung volumes, forced flows and ventilation distribution. Eight subjects (age 5.8–15.2 years) performed lung function tests including spirometry, multiple breath washout and electrical impedance tomography before and after a regular a chest physiotherapy session with an insufflator/exsufflator device. Forced lung volumes and flows as well as parameters of ventilation distribution derived from multiple breath washout and electrical impedance tomography were compared to assess the short-term effect of the therapy. In this small group of stable paediatric subjects with neuromuscular disease we could not demonstrate any short-term effects of insufflation/exsufflation manoeuvres on lung volumes, expiratory flows and ventilation distribution. With the currently used protocol of the insufflation/exsufflation manoeuvre, we cannot demonstrate any immediate changes in lung function.
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Affiliation(s)
- Carmen Casaulta
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.,Division of Paediatric Intensive Care, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Florence Messerli
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Romy Rodriguez
- Division of Paediatric Pulmonology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Andrea Klein
- Division of Paediatric Neurology, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.,Paediatric Neurology, University Childrens Hospital Basel, UKBB, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Thomas Riedel
- Division of Paediatric Intensive Care, Department of Paediatrics, Inselspital, Bern University Hospital, Univeristy of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland. .,Department of Paediatrics, Cantonal Hospital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland.
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27
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Kim HJ, Mohassel P, Donkervoort S, Guo L, O'Donovan K, Coughlin M, Lornage X, Foulds N, Hammans SR, Foley AR, Fare CM, Ford AF, Ogasawara M, Sato A, Iida A, Munot P, Ambegaonkar G, Phadke R, O'Donovan DG, Buchert R, Grimmel M, Töpf A, Zaharieva IT, Brady L, Hu Y, Lloyd TE, Klein A, Steinlin M, Kuster A, Mercier S, Marcorelles P, Péréon Y, Fleurence E, Manzur A, Ennis S, Upstill-Goddard R, Bello L, Bertolin C, Pegoraro E, Salviati L, French CE, Shatillo A, Raymond FL, Haack TB, Quijano-Roy S, Böhm J, Nelson I, Stojkovic T, Evangelista T, Straub V, Romero NB, Laporte J, Muntoni F, Nishino I, Tarnopolsky MA, Shorter J, Bönnemann CG, Taylor JP. Heterozygous frameshift variants in HNRNPA2B1 cause early-onset oculopharyngeal muscular dystrophy. Nat Commun 2022; 13:2306. [PMID: 35484142 PMCID: PMC9050844 DOI: 10.1038/s41467-022-30015-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/25/2022] [Indexed: 01/05/2023] Open
Abstract
Missense variants in RNA-binding proteins (RBPs) underlie a spectrum of disease phenotypes, including amyotrophic lateral sclerosis, frontotemporal dementia, and inclusion body myopathy. Here, we present ten independent families with a severe, progressive muscular dystrophy, reminiscent of oculopharyngeal muscular dystrophy (OPMD) but of much earlier onset, caused by heterozygous frameshift variants in the RBP hnRNPA2/B1. All disease-causing frameshift mutations abolish the native stop codon and extend the reading frame, creating novel transcripts that escape nonsense-mediated decay and are translated to produce hnRNPA2/B1 protein with the same neomorphic C-terminal sequence. In contrast to previously reported disease-causing missense variants in HNRNPA2B1, these frameshift variants do not increase the propensity of hnRNPA2 protein to fibrillize. Rather, the frameshift variants have reduced affinity for the nuclear import receptor karyopherin β2, resulting in cytoplasmic accumulation of hnRNPA2 protein in cells and in animal models that recapitulate the human pathology. Thus, we expand the phenotypes associated with HNRNPA2B1 to include an early-onset form of OPMD caused by frameshift variants that alter its nucleocytoplasmic transport dynamics. Missense variants in RNA-binding proteins underlie many diseases. Here the authors report an oculopharyngeal muscular dystrophy caused by heterozygous frameshift mutations in HNRNPA2B1 that alter its nucleocytoplasmic transport dynamics and result in cytoplasmic accumulation of hnRNPA2 protein.
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Affiliation(s)
- Hong Joo Kim
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Payam Mohassel
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Sandra Donkervoort
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Lin Guo
- Department of Biochemistry & Biophysics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kevin O'Donovan
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Maura Coughlin
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Xaviere Lornage
- Département Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Médicale U1258, Centre National de la Recherche Scientifique UMR7104, Université de Strasbourg, Illkirch, France
| | - Nicola Foulds
- Wessex Clinical Genetics Services, Princess Anne Hospital, Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, England
| | - Simon R Hammans
- Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
| | - A Reghan Foley
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Charlotte M Fare
- Department of Biochemistry & Biophysics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Alice F Ford
- Department of Biochemistry & Biophysics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Masashi Ogasawara
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.,Medical Genome Center, NCNP, Kodaira, Tokyo, Japan
| | - Aki Sato
- Department of Neurology, Niigata City General Hospital, Niigata, Japan
| | | | - Pinki Munot
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Gautam Ambegaonkar
- Department of Paediatric Neurology, Cambridge University Hospital NHS Trust, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK
| | - Rahul Phadke
- Division of Neuropathology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery London, UK and Division of Neuropathology, UCL Institute of Neurology, Dubowitz Neuromuscular Centre, London, UK
| | - Dominic G O'Donovan
- Department of Histopathology Box 235, Level 5 John Bonnett Clinical Laboratories Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca Buchert
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Mona Grimmel
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Irina T Zaharieva
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Lauren Brady
- Division of Neuromuscular & Neurometabolic Disorders, Department of Pediatrics, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Ying Hu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrea Klein
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Pediatric Neurology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alice Kuster
- Department of Neurometabolism, University Hospital of Nantes, Nantes, France
| | - Sandra Mercier
- CHU Nantes, Service de génétique médicale, Centre de Référence des Maladies Neuromusculaires AOC, 44000, Nantes, France.,Université de Nantes, CNRS, INSERM, l'institut du thorax, 44000, Nantes, France
| | - Pascale Marcorelles
- Service d'anatomopathologie, CHU Brest and EA 4685 LIEN, Université de Bretagne Occidentale, Brest, France
| | - Yann Péréon
- CHU de Nantes, Centre de Référence des Maladies Neuromusculaires, Filnemus, Euro-NMD, Hôtel-Dieu, Nantes, France
| | - Emmanuelle Fleurence
- Etablissement de Santé pour Enfants et Adolescents de la région Nantaise, Nantes, France
| | - Adnan Manzur
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Sarah Ennis
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rosanna Upstill-Goddard
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Luca Bello
- Department of Neurosciences, DNS, University of Padova, Padova, Italy
| | - Cinzia Bertolin
- Clinical Genetics Unit, Department of Women and Children's Health, University of Padova, IRP Città della Speranza, Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences, DNS, University of Padova, Padova, Italy
| | - Leonardo Salviati
- Clinical Genetics Unit, Department of Women and Children's Health, CIR-Myo Myology Center, University of Padova, IRP Città della Speranza, Padova, Italy
| | | | - Andriy Shatillo
- Institute of Neurology, Psychiatry and Narcology of NAMS of Ukraine, Kharkiv, Ukraine
| | - F Lucy Raymond
- Cambridge Institute of Medical Research, University of Cambridge, Cambridge, UK
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Susana Quijano-Roy
- Neuromuscular Unit, Pediatric Neurology and ICU Department, Raymond Poincaré Hospital (UVSQ), AP-HP Université Paris-Saclay, Garches, France
| | - Johann Böhm
- Département Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Médicale U1258, Centre National de la Recherche Scientifique UMR7104, Université de Strasbourg, Illkirch, France
| | - Isabelle Nelson
- Sorbonne Université, INSERM, Centre of Research in Myology, UMRS974, Paris, France
| | - Tanya Stojkovic
- APHP, Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile de France, Institut de Myologie, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Teresinha Evangelista
- Unité de Morphologie Neuromusculaire, Institut de Myologie, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Norma B Romero
- APHP, Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile de France, Institut de Myologie, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Unité de Morphologie Neuromusculaire, Institut de Myologie, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jocelyn Laporte
- Département Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Médicale U1258, Centre National de la Recherche Scientifique UMR7104, Université de Strasbourg, Illkirch, France
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.,Medical Genome Center, NCNP, Kodaira, Tokyo, Japan
| | - Mark A Tarnopolsky
- Division of Neuromuscular & Neurometabolic Disorders, Department of Pediatrics, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - James Shorter
- Department of Biochemistry & Biophysics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carsten G Bönnemann
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
| | - J Paul Taylor
- Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, United States. .,Howard Hughes Medical Institute, Chevy Chase, MD, United States.
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Hameed S, Pelc D, Anderson ZW, Klein A, Spieker RJ, Yue L, Das B, Ramberger J, Lukas M, Liu Y, Krogstad MJ, Osborn R, Li Y, Leighton C, Fernandes RM, Greven M. Enhanced superconductivity and ferroelectric quantum criticality in plastically deformed strontium titanate. Nat Mater 2022; 21:54-61. [PMID: 34608284 DOI: 10.1038/s41563-021-01102-3] [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] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
The properties of quantum materials are commonly tuned using experimental variables such as pressure, magnetic field and doping. Here we explore a different approach using irreversible, plastic deformation of single crystals. We show that compressive plastic deformation induces low-dimensional superconductivity well above the superconducting transition temperature (Tc) of undeformed SrTiO3, with evidence of possible superconducting correlations at temperatures two orders of magnitude above the bulk Tc. The enhanced superconductivity is correlated with the appearance of self-organized dislocation structures, as revealed by diffuse neutron and X-ray scattering. We also observe deformation-induced signatures of quantum-critical ferroelectric fluctuations and inhomogeneous ferroelectric order using Raman scattering. Our results suggest that strain surrounding the self-organized dislocation structures induces local ferroelectricity and quantum-critical dynamics that strongly influence Tc, consistent with a theory of superconductivity enhanced by soft polar fluctuations. Our results demonstrate the potential of plastic deformation and dislocation engineering for the manipulation of electronic properties of quantum materials.
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Affiliation(s)
- S Hameed
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - D Pelc
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA.
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, Croatia.
| | - Z W Anderson
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - A Klein
- Department of Physics, Faculty of Natural Sciences, Ariel University, Ariel, Israel
| | - R J Spieker
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - L Yue
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - B Das
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, USA
| | - J Ramberger
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, USA
| | - M Lukas
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Y Liu
- Neutron Scattering Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - M J Krogstad
- Materials Science Division, Argonne National Laboratory, Lemont, IL, USA
| | - R Osborn
- Materials Science Division, Argonne National Laboratory, Lemont, IL, USA
| | - Y Li
- International Center for Quantum Materials, School of Physics, Peking University, Beijing, China
| | - C Leighton
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, USA
| | - R M Fernandes
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - M Greven
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA.
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30
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Franco-Valencia K, Nóbrega I, Cantaruti T, Barra A, Klein A, Azevedo-Jr G, Costa R, Carvalho C. Subcutaneous injection of an immunologically tolerated protein up to 5 days before skin injuries improves wound healing. Braz J Med Biol Res 2022; 55:e11735. [PMID: 35170683 PMCID: PMC8851940 DOI: 10.1590/1414-431x2021e11735] [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: 07/26/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
Oral tolerance blocks the development of specific immune responses to proteins ingested by the oral route. One of the first registries of oral tolerance showed that guinea pigs fed corn became refractory to hypersensitivity to corn proteins. Mice fed with chow containing corn are tolerant to zein, and parenteral injection of zein plus adjuvant blocks immunization to unrelated proteins injected concomitantly and reduces unspecific inflammation. Extensive and prolonged inflammatory infiltrate in the wound bed is one of the causes of pathological wound healing. Previous research shows that intraperitoneal injection of zein concomitant with skin injuries reduces the inflammatory infiltrate in the wound bed and improves wound healing. Herein, we tested if one subcutaneous injection of zein before skin injury improves wound healing. We also investigated how long the effects triggered by zein could improve skin wound healing. Mice fed zein received two excisional wounds on the interscapular skin under anesthesia. Zein plus Al(OH)3 was injected at the tail base at 10 min, or 3, 5, or 7 days before skin injuries. Wound healing was analyzed at days 7 and 40 after injury. Our results showed that a zein injection up to 5 days before skin injury reduced the inflammatory infiltrate, increased the number of T-cells in the wound bed, and improved the pattern of collagen deposition in the neodermis. These findings could promote the development of new strategies for the treatment and prevention of pathological healing using proteins normally found in the common diet.
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Affiliation(s)
| | | | | | - A. Barra
- Universidade Federal de Minas Gerais, Brasil
| | - A. Klein
- Universidade Federal de Minas Gerais, Brasil
| | | | - R.A. Costa
- Universidade Federal de São João del Rei, Brasil
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31
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Kirkwood ML, Klein A, Timaran C, Siah M, Shih M, Baig S, Xi Y, Guild J. Disposable, Lightweight Shield Decreases Operator Eye and Brain Radiation Dose When Attached to Safety Eyewear During Fluoroscopically-Guided-Interventions. J Vasc Surg 2021; 75:2047-2053. [PMID: 34923065 DOI: 10.1016/j.jvs.2021.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Long-term radiation exposure from fluoroscopically-guided-interventions (FGIs) can cause cataracts and brain tumors in the operator. We have previously demonstrated that leaded eyewear does not decrease operator eye dose unless lead shielding is added to the lateral and inferior portions. Therefore, we developed a disposable, lightweight, lead-equivalent shield that can be attached to the operator's eyewear, conforming around the face and adhering to the surgical mask. This study evaluates the efficacy of our new prototype in lowering operator brain and eye dose when added to both leaded and non-leaded eyewear. METHODS The attenuating efficacy of leaded eyewear alone, leaded eyewear + prototype and non-leaded eyewear + prototype were compared to no eyewear protection in both a simulated setting and clinical practice. In the simulation, optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, II) were placed inside the ocular, temporal lobe, and midbrain spaces of a head phantom (ATOM model-701: CIRS, Norfolk, VA). The phantom was positioned to represent a primary operator performing right femoral access. Fluorography was performed on a plastic scatter phantom at 80kVp for an exposure of 3 Gy RAK. In the clinical setting, nanoDots were placed below the operator's eye both inside and outside the prototype during FGIs. Median and interquartile ranges were calculated for the dose at each nanoDot location for both the phantom and clinical study, with average dose reduction also reported. RESULTS Wearing standard leaded eyewear alone did not decrease operator ocular or brain dose. In the phantom experiment, the leaded glasses + prototype reduced dose to the lens, temporal lobe and midbrain by 83% (p<0.001), 78% (p<0.001), and 75% (p<0.001), respectively. The non-leaded glasses + prototype also reduced dose to the lens, temporal lobe and midbrain by 85% (p<0.001), 81% (p<0.001), and 71% (p<0.001). In the clinical setting, 15 FGIs were included, with median RAK of 98.4 mGy. Our prototype led to an average operator eye dose reduction of 89% (p<0.001). CONCLUSIONS Attaching our prototype to both leaded and non-leaded glasses significantly decreased eye and brain radiation dose to the operator. This face shield attachment provides meaningful radiation protection and should be considered as either a replacement or adjunct to routine eyewear.
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Affiliation(s)
- Melissa L Kirkwood
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX.
| | - Andrea Klein
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Carlos Timaran
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Shadman Baig
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey Guild
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
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32
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Klein A, Guild J, Xi Y, Chamseddin K, Shih M, Siah M, Timaran C, Kirkwood M. Use of a 2 Dimensional Vessel Navigator Roadmap Decreases Patient Radiation Dose Compared to Standard 3D Mapping for Fenestrated Endovascular Aneurysm Repair. Ann Vasc Surg 2021; 80:250-255. [PMID: 34748947 DOI: 10.1016/j.avsg.2021.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE For fenestrated endovascular aneurysm repair (FEVAR), the implementation of the VesselNavigator (Philips Healthcare, Best, The Netherlands) to provide a 3-dimensional vessel roadmap has been shown to reduce patient radiation exposure. Unfortunately, FEVAR radiation doses remain substantial despite utilization of this technology. Traditionally, registration of the live fluoroscopy with the pre-operative CTA is performed via the acquisition of a low-dose cone-beam CT scan. However, this registration can also be accomplished with the acquisition of 2D X-rays using the c-arm in 2 different projection angles. We hypothesized that the 2D image acquisition for vessel roadmap development would result in a significant reduction in patient radiation dose in comparison to the 3D CT registration without compromising image quality or increasing procedural length. METHODS This single-center, retrospective study included FEVARs performed from January 2015 to May 2019. For patient data, the cumulative reference air kerma (RAK) was presented as geometric mean and standard deviation. A general linear model with log-normal distribution was used to test the difference in patient RAK between 2D X-ray and 3D CT VesselNavigator registration after adjusting for BMI and the number of vessel fenestrations (1 to 2 vs. 3 to 4). Fluoroscopy time was recorded and used as a surrogate for case complexity. All analyses were done in SAS 9.4 (SAS Institute, Inc., Cary, North Carolina). RESULTS One hundred and sixty four FEVARs were performed on a Philips Allura Xper FD 20 fluoroscopy system equipped with clarity technology. The VesselNavigator registration was completed using 3D CT mapping in 99 cases and 2D X-rays in 65 procedures. On average, utilization of 2D mapping versus 3D mapping for the VesselNavigator resulted in a 20.4% reduction in patient RAK after controlling for BMI and number of vessel fenestrations, P = 0.0135. There was no significant difference in fluoroscopy time between the 2 study groups (P= 0.81) suggesting that image quality was not compromised by the use of 2D mapping leading to the need for additional fluoroscopy. CONCLUSION Acquisition of 2D films rather than a 3D CT scan for VesselNavigator registration allows for a significant reduction in patient radiation dose during FEVAR without increasing the case complexity or compromising image quality.
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Affiliation(s)
- Andrea Klein
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX.
| | - Jeffrey Guild
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Khalil Chamseddin
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Michael Siah
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Carlos Timaran
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Melissa Kirkwood
- Department of Surgery, Division of Vascular and Endovascular Surgery, UT Southwestern Medical Center, Dallas, TX
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33
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Kölbel H, Vill K, Schwartz O, Blaschek A, Nennstiel U, Schara-Schmidt U, Hoffmann GF, Gläser D, Röschinger W, Bernert G, Klein A, Müller-Felber W. [Newborn screening program for spinal muscular atrophy]. Nervenarzt 2021; 93:135-141. [PMID: 34652481 DOI: 10.1007/s00115-021-01204-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The introduction of a comprehensive newborn screening program for spinal muscular atrophy (SMA), specifically for 5q-SMA, is planned for the end of 2021 in Germany. Several targeted treatment options have become available for all patients with SMA. MATERIAL AND METHODS Newborn screening for 5q-SMA is based on the detection of a homozygous deletion of exon 7 in the SMN1 gene by molecular genetic analysis from the dried blood card. In all cases a second blood sample must be drawn as a part of confirmation diagnostics including the determination of the SMN2 copy numbers. RESULTS Insights from pilot projects performed in parts of Germany are presented. Advantages and disadvantages of the screening project are discussed. CONCLUSION Consultation and treatment should be carried out in a department of neuropediatrics with experience in the treatment of children with 5q-SMA, which is able to provide all current treatment options for the child, so that, when necessary, the treatment can be started within the first month of life.
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Affiliation(s)
- Heike Kölbel
- Klinik für Kinderheilkunde, Kinderklinik 1/Neuropädiatrie, Universitätsmedizin Essen (UME), Hufelandstr. 55, Essen, Deutschland.
| | - Katharina Vill
- Dr. v. Haunersches Kinderspital, Ludwig-Maximilians-Universität (LMU), München, Deutschland
| | - Oliver Schwartz
- Klinik für Kinder- und Jugendmedizin, UKM, Münster, Deutschland
| | - Astrid Blaschek
- Dr. v. Haunersches Kinderspital, Ludwig-Maximilians-Universität (LMU), München, Deutschland
| | - Uta Nennstiel
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim, Deutschland
| | - Ulrike Schara-Schmidt
- Klinik für Kinderheilkunde, Kinderklinik 1/Neuropädiatrie, Universitätsmedizin Essen (UME), Hufelandstr. 55, Essen, Deutschland
| | - Georg F Hoffmann
- Zentrum für Kinder- und Jugendmedizin, UKHD, Heidelberg, Deutschland
| | | | | | | | - Andrea Klein
- Universitäts-Kinderspital beider Basel, UKBB, Basel, Schweiz.,Inselspital, Universitäts-Kinderklinik Bern, Bern, Schweiz
| | - Wolfgang Müller-Felber
- Dr. v. Haunersches Kinderspital, Ludwig-Maximilians-Universität (LMU), München, Deutschland
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34
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Brucato A, Lim-Watson MZ, Imazio M, Klein A, Andreis A, Andreis A, Cella D, Cremer P, Lewinter M, Luis SA, Lin D, Lotan D, Trotta L, Zou L, Wheeler A, Paolini JF. Health-related quality of life in patients with recurrent pericarditis: results from RHAPSODY, a phase 3 study of rilonacept. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recurrent pericarditis (RP) patients report that painful, debilitating flares negatively impact their health-related quality of life (HRQoL). RHAPSODY, the Phase 3 trial of rilonacept (IL-1α/IL-1β cytokine trap), included a daily pain diary and patient-reported outcome SF-36v2 to measure HRQoL throughout the trial.
Purpose
The purpose of this research is to evaluate the effect of rilonacept on HRQoL in relation to changes in pain for RP patients who have a recurrence.
Methods
RHAPSODY enrolled 86 patients with acute symptomatic RP to receive weekly rilonacept for a 12-week run-in (RI) period and randomized 61 patients (1:1) to receive placebo (n=31) or continue rilonacept (n=30) for the event-driven randomized-withdrawal (RW) period. Patients on placebo who experienced a qualifying recurrence during RW (return of pericarditis pain and increase in C-reactive protein) were rescued with bailout rilonacept. Patients reported daily pericarditis pain electronically, using a 0–10 numeric rating scale (NRS), and completed the SF-36v2 at study visits prior to clinician interaction. Scores from RI Baseline (BL), RI Week 12 (RW BL), Recurrence visit, and RW up to Week 24 (or end of study; EOS) were evaluated for patients who experienced recurrence in RW. Analyses exclude one patient randomized to placebo who had a recurrence after Week 24 of the RW period.
Results
Analyses focused on the 22 of 30 patients (73%) in the placebo group who experienced a recurrence before Week 24 of RW (median time from RW BL to recurrence: 8.6 weeks). During RI, daily pain scores decreased while on rilonacept (Cohen's effect size [ES] d=−2.0), and SF-36v2 scores improved, with scores at RI BL (Fig. 1 red line) below the general population average of 50 and near or above average at RI Week 12 (Fig. 1 blue line); ES were all large (d>0.8), ranging from 0.917 (Mental Component Summary) to 2.021 (Bodily Pain). At recurrence, pain scores increased (d=6.5; Fig. 2) and SF-36v2 scores were below the population average (Fig. 1 orange line), with largest reductions between RI Week 12 (RW BL) and recurrence for Bodily Pain (−13.4) and Physical Component Summary (−10.6). Following rilonacept bailout, average pain decreased (d=−2.1; Fig. 2), and by RW Week 24/EOS, SF-36v2 scores returned to similar levels as at the end of the RI period (Fig. 1 green line).
Conclusion
Impaired RI BL SF-36v2 scores indicate negative impact of RP on HRQOL in RP patients. While receiving rilonacept, HRQoL scores improved to near or above population averages, in conjunction with patient-reported pain. After discontinuing rilonacept during RW, HRQoL scores worsened at recurrence and improved upon receipt of bail-out rilonacept, similar to pain. These results provide support for the broader benefit of rilonacept treatment beyond pain, when administered on top of conventional therapies and as mono-therapy, providing evidence of its potential to improve HRQoL in this patient population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Kiniksa Pharmaceuticals, Ltd.
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Affiliation(s)
- A Brucato
- Fatebenefratelli Hospital, Milan, Italy
| | - M Z Lim-Watson
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - M Imazio
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - D Cella
- Northwestern University, Evanston, Illinois, United States of America
| | - P Cremer
- Cleveland Clinic, Cleveland, United States of America
| | - M Lewinter
- The University of Vermont Medical Center, Burlington, United States of America
| | - S A Luis
- Mayo Clinic, Rochester, United States of America
| | - D Lin
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - D Lotan
- Sheba Medical Center, Tel Aviv, Israel
| | - L Trotta
- Fatebenefratelli Hospital, Milan, Italy
| | - L Zou
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - A Wheeler
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
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Lo Presti S, Chan N, Saijo Y, Wang T, Klein A. Left atrial strain evaluation and prognostic value in constrictive pericarditis patients undergoing pericardiectomy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left Atrial (LA) phasic volumes analyses is flawed with geometrical assumption requiring high endocardial border definition. LA strain analysis is an emergent technique that overcome some of these technical limitations. Prior studies of LA mechanics in pericardiectomy patients found improvement in LA strain at follow-up and manifested as symptomatic improvement, however their relationships with survival have not been investigated.
Purpose
We assessed LA strain before and after pericardiectomy and its association with all- cause mortality.
Methods
Consecutive patients with constrictive pericarditis who underwent pericardiectomy from 2000–2017 were retrospectively analyzed, analyzing pre-operative and post-operative (at 12 months) echocardiography. Exclusion criteria included atrial fibrillation, previous left sided valve surgery, concomitant valvular surgery at the index pericardiectomy, more than mild left sided valvulopathy and poor echocardiographic windows. Strain analyses was performed with Vector velocity imaging independent software. Univariate and multivariable analyses were utilized to identify factors associated with reduced survival.
Results
Amongst 190 patients included in the analyses, mean age was 58.5±12.7 years and 37 (19.5%) were female. The etiology of constriction was deemed idiopathic in 61.6% of the cases, median time interval surgery-postoperative echo was 67 days (IQR 6, 312 days). During median follow up of 3.3 years (IQR 0.73, 5.9 years) there were 37 deaths. After surgery, there was a significant decrease in LA reservoir, conduit and regional wall strains. (Table 1). Multivariable analysis demonstrated that postoperative 4C AL strain reservoir was independently associated with all-cause mortality (Table 2).
Conclusions
In pericardiectomy patients, postoperative 4C LA strain reservoir is independently associated with all-cause mortality. Perhaps, compensatory changes of septal and antero-posterior walls during constriction explain why after surgery these walls become less dynamic, negatively impacting the overall function. Overall, LA quantification and strains may become a useful clinical tool for risk stratification in pericardiectomy patients
Funding Acknowledgement
Type of funding sources: None. Table 1. Left atrial variables.Table 2. All-cause mortality predictors
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Affiliation(s)
- S Lo Presti
- Cleveland Clinic Foundation, Advanced Cardiac Imaging, Cleveland, United States of America
| | - N Chan
- Cleveland Clinic Foundation, Internal Medicine, Cleveland, United States of America
| | - Y Saijo
- Cleveland Clinic Foundation, Cardiovascular reserach department, Cleveland, United States of America
| | - T Wang
- Cleveland Clinic Foundation, Advanced Cardiac Imaging, Cleveland, United States of America
| | - A Klein
- Cleveland Clinic Foundation, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Cleveland, United States of America
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Reid A, Klein A, Lin D, Abbate A, Luis SA, Petersen J, Portman M, Winnowski D, Malinowski A, Marden L, Paolini JF, Martin D. RESONANCE Registry: rationale and design of the retrospective and prospective longitudinal, observational registry in pediatric and adult patients with recurrent pericarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Annually in the United States (US), an estimated 80–90,000 patients are diagnosed with acute pericarditis and 15–30% experience recurrent pericarditis (RP), resulting in increased morbidity and reduced health-related quality of life (HRQoL). Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Corticosteroids (CS) are often added to the treatment plan in RP despite CS-associated adverse events and inherent potentiation of recurrence with long-term treatment. A recent Phase 3 clinical trial RHAPSODY (NCT03737110) demonstrated efficacy and safety of rilonacept, an interleukin-1 α and β cytokine trap, in patients with RP. RHAPSODY data helped support FDA approval of the first therapy for RP. With the emergence of this targeted therapy, there is increased interest to learn more about this disease with the goal to better inform treatment and management decisions and improve long-term outcomes.
Purpose
RESONANCE Registry aims to evaluate the natural history of RP by collecting retrospective and prospective, longitudinal physician- and patient-reported outcomes data in real-world clinical practice across the US.
Methods
RP patients with active disease (recurrence within 3 years) will have both retrospective and prospective data collected (Figure 1) for as long as their RP is managed up to 5 years. For patients with inactive disease (no recurrence within 3 years), data collection will be retrospective (Figure 2). Up to 500 patients in the US are planned for enrollment at pediatric and adult medical centers, with the potential for expansion to European sites. Additionally, patients will be recruited through a novel, internet-based technology platform and screened for eligibility at a “decentralized” trial site. The registry will include variables obtained from health records, including baseline characteristics and medical history, as well as patient reported outcome (PRO) measures collected every 3 months. The RESONANCE protocol is designed to include a broad population of pediatric and adult patients, regardless of etiology or treatment course, including patients treated with rilonacept. Data will be analyzed to understand disease heterogeneity, variability in treatment and management, and impact on HRQoL. The protocol and Case Report Forms (CRFs) were developed in collaboration with physicians, patients, and patient advocates.
Conclusions
Registries utilize real-world data to fill knowledge gaps in the management of less common diseases such as RP. The RESONANCE Registry is the first RP registry designed to collect data across a broad range of patients regardless of treatment. The registry will also serve as a connection point for physicians to further educate and empower patients with information about their disease. In addition, PRO data may enable greater insights into the understanding of the burden of RP from the patient's perspective.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Kiniksa Pharmaceuticals
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Affiliation(s)
- A Reid
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - A Klein
- Cleveland Clinic, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Cleveland, United States of America
| | - D Lin
- Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, United States of America
| | - A Abbate
- Virginia Commonwealth University, VCU Pauley Heart Center, Richmond, United States of America
| | - S A Luis
- Mayo Clinic, Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J Petersen
- Swedish Medical Center, Seattle, United States of America
| | - M Portman
- Seattle Children's Hospital, Seattle, United States of America
| | - D Winnowski
- Pericarditis Alliance, Albany, United States of America
| | - A Malinowski
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - L Marden
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
| | - D Martin
- Kiniksa Pharmaceuticals Corp., Lexington, United States of America
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Abstract
Abstract
Background
Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition.
Purpose
This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.
Results
The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.
Conclusions
In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - F Piroli
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - G Lazaros
- Hippokration General Hospital, University Cardiology, Athens, Greece
| | - M Lewinter
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, United States of America
| | - A Klein
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - A Brucato
- Fatebenefratelli Hospital, Department of Biomedical and Clinical Sciences, Milan, Italy
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Nasser R, Fisher Y, Klein A. Gastrointestinal: Severe gastritis with complete gastric mucosal sloughing. J Gastroenterol Hepatol 2021; 36:2639. [PMID: 33624341 DOI: 10.1111/jgh.15427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 12/09/2022]
Affiliation(s)
- R Nasser
- Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Y Fisher
- Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - A Klein
- Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Masson R, Boespflug-Tanguy O, Darras B, Day J, Deconinck N, Klein A, Mazurkiewicz-Bełdzińska M, Mercuri E, Rose K, Servais L, Vlodavets D, Xiong H, Zanoteli E, Dodman A, El-Khairi M, Gaki E, Gerber M, Gorni K, Kletzl H, Baranello G. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Weng W, Theriault-Lauzier P, Birnie D, Nair G, Nery P, Sadek M, Golian M, Klein A, Redpath C, Ramirez F, Davis D, Green M, Aydin A. LONG TERM SAFETY OF ABANDONED CARDIAC IMPLANTABLE ELECTRONIC DEVICES. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.090] [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: 11/29/2022] Open
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Study A, Rothman R, Kaplan S, Arias C, Motov S, Weissman A, Halabi S, Ryan L, Klein A, Bachur R. 120 A Rapid Host-Protein Signature Based on TRAIL, IP-10 and CRP Permits Accurate Differentiation of Bacterial and Viral Infection in Febrile Patients Presenting to the Emergency Department: Apollo Sub-study. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karmali R, Donovan A, Wagner‐Johntson N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Lansigan F, Kaplan JB, Caimi PB, Rajguru S, Evens A, Klein A, Umyarova E, Amengual JE, Lue JK, Diefenbach C, Epperla N, Barta SK, Hernandez‐Ilizaliturri FJ, Handorf E, Villa D, Gerrie AS, Li S, Mederios J, Wang M, Cohen J, Calzada O, Churnetski M, Hill B, Sawalha Y, Gerson JN, Kothari S, Vose JM, Bast M, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B. SURVIVAL FOLLOWING FIRST RELAPSE IN YOUNGER PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.60_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - A. Donovan
- Dartmouth Hitchcock, Hem Onc Lebanon USA
| | | | - M. Messmer
- Johns Hopkins University, Hem Onc Baltimore USA
| | - A. Mehta
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - J. K. Anderson
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - N. Reddy
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - A. E. Kovach
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - D. J. Landsburg
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | - M. Glenn
- Huntsman Cancer Institute, Hem Onc Salt Lake City USA
| | | | | | | | | | - P. B. Caimi
- Case Western Reserve University, Hem Onc Cleveland USA
| | - S. Rajguru
- University of Wisconsin, Hem Onc Madison USA
| | - A. Evens
- Rutgers, Hem Onc New Brunswick USA
| | | | - E. Umyarova
- University of Vermont, Hem Onc Burlington USA
| | | | | | | | - N. Epperla
- Ohio State University, Hem Onc Columbus USA
| | - S. K. Barta
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - E. Handorf
- Fox Chase Cancer Center, Hematology Oncology Philadelphia USA
| | - D. Villa
- BC Cancer, Hem Onc Vancouver Canada
| | | | - S. Li
- MD Anderson, Hem Onc Houstin USA
| | | | - M. Wang
- MD Anderson, Hem Onc Houstin USA
| | | | | | | | | | | | - J. N. Gerson
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - J. M. Vose
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - M. Bast
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - T. S. Fenske
- Medical College of Wisconsin, Hem Onc Milwaukee USA
| | | | | | - D. Bond
- Ohio State University, Hem Onc Columbus USA
| | - V. Bachanova
- University of Minnesota , Hem Onc Minneapolis USA
| | - B. Kolla
- University of Minnesota , Hem Onc Minneapolis USA
| | - J. Chavez
- Moffitt Cancer Center, Hem Onc Tampa USA
| | - B. Shah
- Moffitt Cancer Center, Hem Onc Tampa USA
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Klein A, Windschall D, Emminger W, Berendes R, Kuemmerle-Deschner J, Trauzeddel R, Rietschel C, Kühn A, Hufnagel M, Sailer-Hoeck M, Hospach T, Haller M, Mrusek S, Sengler C, Minden K, Horneff G. POS1202 EXPERIENCE WITH COVID-19 IN GERMAN PAEDIATRIC RHEUMATOLOGY CENTRES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2045] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:COVID-19 is a major challenge worldwide. Although the risk for a severe disease course is low among children with COVID-19, symptoms may be exacerbated by underlying disease and/or immunosuppressive medication. We analysed clinical data from COVID-19 cases in among pediatric patients with juvenile idiopathic arthritis (JIA) in Germany reported to the BIKER registry.Objectives:This is an analysis of clinical data for 56 COVID-19 cases reported to the German BIKER registry from 29 German pediatric rheumatology centers and clinics from February 2020 to January 2021.Methods:The major task of the German BIKER (Biologics in Paediatric Rheumatology) Registry is surveillance of biologics used in pediatric rheumatology patients. Following the start of the COVID-19 pandemic in Germany, a survey was established to proactively interview all participating centers regarding the occurrence, presentation and outcome of SARS-CoV-2-infected children with rheumatic diseases. Initially, the interviews were conducted in weekly intervals, later bi-weekly.A standardized Adverse Event of Special Interest form was developed requesting biographic data, pre-treatment, current medication, data on clinical presentation, course, treatment and outcome of COVID-19 pediatric rheumatology patients.Results:In all, 56 patients with JIA and SARS-CoV-2 infection were reported (Table 1). Of these patients, 71% were 12 or more years old.Table 1.Patient characteristics. COVID-19 positive patients.JIA patients, n=56n (%)Age 0-5 years / 6-11years / 12-18years3 (5.4) / 13 (23.2) / 40 (71.4)JIA category•Systemic JIA5 (8.9)•Oligoarthritis JIA9 (16)•Polyarticular JIA32 (57)•Enthesitis-related JIA2 (3.6)•Psoriatic JIA1 (1.8)•Unknown7 (12.5)Uveitis (concomitant)4 (7.1)Treatment•DMARD / MTX23/ 22 (41/39)•Biologics29 (52)•TNF inhibitors20 (36)•Tocilizumab5 (8.9)•Abatacept1 (1.8)•Anakinra1 (1.8)•Ustekinumab1 (1.8)•JAK inhibitors1 (1.8)•Steroids5 (8.9)Asymptomatic13 (23.2)Hospitalized/ICU/Ventilation/Death1/1/1/1 (1.8)At the time of infection, 41% of the patients received conventional DMARDs and 52% received biologics (Table 1). Forty-four patients (79%) received either a conventional DMARD or a biologic. Most patients had a polyarticular course of their JIA (57%).In 49 of the 56 cases (88%) COVID-19 was detected directly by PCR (n=46), by antigen test only (n=1) or an undisclosed method (n= 2). Six patients had detectable SARS-CoV2 antibodies and reported to have had typical symptoms. One patient tested negative but developed typical symptoms at approximately the same time a positive SARS-CoV-2 test was returned for a family member.Symptoms were reported in 43 of the 56 patients (77%): fever n=15, rhinitis n=14, cough n=12, headache n=10, loss of sense of taste and/or smell n=9, pharyngitis n=8, fatigue n=5, musculoskeletal pain n=5, GI symptoms n=2 (abdominal pain n=1, diarrhoea n=1), dizziness n=3, encephalitis/seizure/respiratory failure/death n=1. Thirteen patients (23%) were asymptomatic.A 3½ -year-old female patient initially diagnosed with systemic JIA developed intracranial oedema and respiratory failure. Her SARS-CoV2 PCR test was positive and pulmonary imaging displayed typical changes in lung texture. Before her SARS-CoV-2 infection, the patient was treated with methotrexate and low-dose steroids. Unfortunately, she died three days following hospital admission. Genetic testing revealed an inborn immunodeficiency. Except for this one patient, all other cases were treated as outpatients and no deaths were reported.Conclusion:Apart from one patient with an inborn immunodeficiency who died from her COVID-19 infection, no case of hospitalization or severe COVID-19 was reported in our cohort of JIA patients. At the time of COVID-19 diagnosis, nearly 80% of patients in our cohort had been treated with conventional DMARD and/or biologics. This seemed not to have a negative effect on severity or outcome of SARS-CoV2 infection.Acknowledgements:Thanks also for contributing Reports for this analysis to: Normi Brück, Frank Dressler, Ivan Foeldvari, Tilman Geikowski, Hermann Girschick, Johannes-Peter Haas, Tilmann Kallinich, Bernd-Ulrich Keck, Eggert Lilienthal, Anna-Hedrich Müller, Ulrich Neudorf, Nils Onken, Peggy Rühmer.Disclosure of Interests:None declared.
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Horneff G, Windschall D, Minden K, Hospach T, Dressler F, Weller-Heinemann F, Huegle B, Foeldvari I, Klein A. POS1301 DRUG SURVIVAL OF BIOLOGICS WITH RESPECT TO COMBINATION WITH METHOTREXATE IN TREATMENT OF POLYARTICULAR JIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.995] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In polyarticular juvenile idiopathic arthritis (pJIA) biologic therapies are often combined with methotrexate (MTX). This combination was shown to increase efficacy in adult rheumatoid arthritis patients. MTX may also have a protective effect on the formation of anti-drug antibodies and thus may prolong drug survival. In pJIA, there are few and sometimes controversial data available.Objectives:To compare the effect of combination treatment with MTX on discontinuation due to inefficacy and on drug survival discontinuation of biologics approved for first line treatment of pJIA.Methods:Patients from the German BIKER registry with their first treatment course with Adalimumab, Etanercept, Golimumab or Tocilizumab were selected. Rates of ineffectiveness-related withdrawal were analysed and compared using χ2-test, Wald-test and Kaplan-Meier analysis of patients receiving biologic monotherapy or concomitant methotrexate. Cases were censored if MTX was discontinued before the biologic.Results:2173 pJIA patients were identified who for the first time received a biologic. Etanercept (ETA) was by far the most frequently used biologic for first line biologic treatment in pJIA (77%) followed by Adalimumab (ADA, 16%). Patients on Golimumab (GOL) received most frequently a combination with MTX (86.5%), while patients on Tocilizumab (TOC) had the lowest rate of combination treatment (53%).ETA/ADA/GOL/TOC was given as monotherapy in 500(30%)/89(26%)/5(13.5%)/46(47%) and combined with MTX in 1179 (70%)/259(74%)/32(86.5%)/51(53%) cases. More patients with rheumatoid-factor negative (54 vs 50%; p=0.04) and rheumatoid-factor positive pJIA (13 vs 10%, p=0.04) received combination with MTX, while more patients in the monotherapy cohort had extended oligoarthritis (40 vs 32%, p<0.001). Patients with MTX had a shorter disease duration (4 vs 5.5years, p<0.001) and received concomitant steroid more often (34 vs 24%), p<0.001). There was no statistical difference regarding disease activity parameters (active joint count, patient assessment and physician assessment of disease activity, ESR, CRP, CHAQ-DI, JADAS10). Discontinuation due to ineffectiveness was reported for ETA/ADA/GOL/TOC in 20%/18%/14%/28% of patients, respectively in 3.7/4.9/6/10.5 patients/100 treatment years. Thus discontinuation due to inefficacy was reported less frequently with ETA compared to ADA (p=0.046) and TOC (p<0.001) and with ADA compared to TOC (p<0.001).Patients on ETA and ADA had a slightly, but not statistically significant lower rate of withdrawal for ineffectiveness if on methotrexate (Figure 1). There was no difference regarding baseline disease activity parameters in patients with ETA/ADA monotherapy compared with combination with MTX, apart from patients with ETA+MTX receiving more often systemic steroids at baseline (36vs 24%,p<0-001). For both GOL and TOC treatment, no baseline differences in disease activity between cohorts with monotherapy and MTX combination could be shown. The combination with MTX led to significantly lower rates of discontinuation due to inefficacy (p<0.05) with GOL and TOC (Figure 1).Conclusion:Patients with pJIA mostly were treated with a combination of the biologic and MTX rather than with biologic monotherapy. Treatment was discontinued due to lack of efficacy in 14% to 28%. No statistically significant effect of combination treatment with MTX versus monotherapy could be observed regarding the rate of treatment failures in patients treated with ETA or ADA. However, combination treatment with MTX significantly prolonged the survival of GOL and TOC in patients with polyarticular JIA. The results are limited by low patient numbers in the GOL cohort and possible bias by JIA category.Figure 1.Kaplan Meier plot of drug survival in patients with monotherapy or with combination with MTX of the indicated biologicDisclosure of Interests:Gerd Horneff Speakers bureau: MSD, Grant/research support from: Pfizer, Roche, Chugai, MSD, Daniel Windschall: None declared, Kirsten Minden Speakers bureau: Pfizer, Abbvie, Grant/research support from: Pfizer, Toni Hospach: None declared, Frank Dressler: None declared, Frank Weller-Heinemann: None declared, Boris Huegle: None declared, Ivan Foeldvari Speakers bureau: Pfizer, Ariane Klein: None declared
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Zimmer A, Klein A, Minden K, Hospach T, Weller-Heinemann F, Kuemmerle-Deschner J, Fasshauer M, Hofmann N, Koessel H, Foeldvari I, Mrusek S, Windschall D, Onken N, Hufnagel M, Foell D, Brueck N, Oommen PT, Dressler F, Helling-Bakki A, Horneff G. POS0075 SAFETY AND EFFICACY OF GOLIMUMAB FOR THE TREATMENT OF POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS - AN UPDATE FROM THE BIKER REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2145] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Golimumab (GOL) is approved for treatment of polyarticular juvenile idiopathic arthritis (pJIA) in patients 2 years and older. Data on long-term safety of GOL in this indication are limited.Objectives:To assess long-term safety and efficacy of GOL in pJIA patients.Methods:In this ongoing non-interventional observational study, clinical characteristics, disease activity and safety parameters were analysed using the German Biologics in Paediatric Rheumatology (BiKeR) registry. 81 pJIA-patients treated with GOL were body weight-matched with 162 patients receiving alt. tumor necrosis factor inhibitors (TNFi) and 81 biologic–naïve patients under methotrexate (MTX)-therapy.Results:Baseline parameters of GOL patients differed from the alternative TNFi and MTX cohorts. In patients starting with GOL treatment, disease duration was longer, corticosteroid use was less and disease activity, measured by the mean number of active joints and the JADAS10, was lower (Table 1).The long-term clinical efficacy of GOL in pJIA is highlighted by a decrease of the mean JADAS 10 from 11.6 (baseline) to 5.2 after 24 months. After 2 years, a JADAS 10 minimal disease activity was reached by 44.4 % of patients, whereas 22.2 % of patients were in remission and the JIA ACR 30/50/70/90 response rates were 77.8/72.2/66.7/55.6% respectively.AE, SAE and infectious AE rates between the three cohorts were comparable (Table 1). In the GOL cohort, 4 SAE (1 uveitis, 1 arthritis flare, 1 fibromyalgia syndrome and 1 abscess) were reported, while in the alt. TNFi group 7 SAEs and in the MTX cohort 1 SAE were noted (Table 1). One serious infectious event (1 abscess) was documented in the GOL cohort, 2 alt. TNFi patients had influenza and no serious infectious events were seen in the MTX control group.Table 1.Baseline parameters and adverse eventsGOLn=81alt. TNFin=162MTXn=81p-value ∞GOL vs alt. TNFip-value∞ GOL vs MTXGender female °67 (83)127 (78)64 (79)0.50.7Disease duration (yrs)7.1±4.34.3±3.71.2±2.1<0.0001<0.0001RF neg. Polyarthritis °40 (49)79 (49)50 (62)1.00.15RF pos. Polyarthritis °8 (10)22 (14)16 (20)0.50.1Extended Oligoarthritis °30 (37)54 (33)13 (16)0.60.004Psoriatic arthritis °3 (4)7 (4)2 (3)1.0/1.01.0Pretreatment bDMARD °68 (84.0)35 (21.6)0<0.0001<0.0001Concomitant systemic steroids, n (%)13 (16)38 (24)39 (48)0.2<0.0001Active joint count #4.6±4.84.9±5.79.6±6.50.4<0.0001CHAQ DI #0.4±0.50.5±0.50.6±0.60.10.02JADAS10 #11.6±6.212.1±6.116.8±5.30.6<0.0001AE *91 (107.4; 88-132)213 (88.7; 78-101)113 (119.8; 100-144)0.10.4SAE *4 (4.7; 2-13)7 (2.9; 1-6)1 (1.1; 0.1-8)0.40.2Serious infections *1 (1.2; 0.2-8.4)2 (0.8; 0.2-3.3)00.7n.a.Autoimmune process (%)2 (2.4)3 (1.9)1 (1.2)1.01.0Patients with uveitis new manifestation after study entry *1 (1.2; 0.2-8)2 (0.8; 0.5-3)00.7n.a.Patients with uveitis flare events with preexisting uveitis at baseline*6 (7.1; 3-16)00n.a.n.a.Rheumatoid factor (RF), biologic disease modifying antirheumatic drug (bDMARD), childhood health assessment questionnaire disability index (CHAQ Di), juvenile arthritis disease activity index (JADAS), adverse event (AE), patient year (PY), ° n (%), # mean (SD), * n (rate/100PY; 95%CI), Golimumab (GOL), alternative tumor necrosis factor inhibitor (alt. TNFi), methotrexate (MTX), ∞ by t-test or χ2-test as appropriate.Few autoimmune processes occurred: 2 incident events in the GOL cohort (1 uveitis, 1 psoriasis), 3 cases in the alt. TNFi group (2 uveitis, 1 psoriasis,) and 1 event in MTX-patients (celiac disease) (Table 1). Out of the 20 GOL patients with preexisting uveitis at baseline, 6 had flare events; there were no reported uveitis flares of the 17 patients in the alt. TNFi group and no patients with preexisting uveitis in the MTX-group. No malignancies or deaths were reported.Conclusion:Our interim results show an acceptable safety profile of GOL therapy, comparable to treatment with alt. TNFi or MTX. No new safety signals occurred. The efficacy outcome data confirm long-term benefits of GOL treatment in pJIA patients.Acknowledgements:We greatly appreciate the kind support of Z. Huang, S. Calhoun.Disclosure of Interests:Angela Zimmer: None declared, Ariane Klein: None declared, Kirsten Minden: None declared, Toni Hospach: None declared, Frank Weller-Heinemann: None declared, Jasmin Kuemmerle-Deschner: None declared, Maria Fasshauer: None declared, Nadja Hofmann: None declared, Hans Koessel: None declared, Ivan Foeldvari: None declared, Sonja Mrusek: None declared, Daniel Windschall: None declared, Nils Onken: None declared, Markus Hufnagel: None declared, Dirk Foell: None declared, Normi Brueck: None declared, Prassad Thomas Oommen: None declared, Frank Dressler: None declared, Astrid Helling-Bakki: None declared, Gerd Horneff Speakers bureau: MSD.
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Klotsche J, Klein A, Niewerth M, Kallinich T, Windschall D, Haas JP, Weller-Heinemann F, Hospach T, Dressler F, Minden K, Horneff G. OP0165 RISK FOR UVEITIS EVENTS AFTER WITHDRAWAL OF DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN THE TREATMENT OF PATIENTS WITH EXTENDED OLIGOARTHRITIS OR RHEUMATOID FACTOR NEGATIVE POLYARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4014] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Juvenile idiopathic arthritis (JIA) associated uveitis is an extra-articular manifestation of the JIA disease that may cause vision-threatening complications and an uncontrolled uveitis may even lead to blindness. Uveitis occurs in up to 20% of patients with JIA, depending on the JIA category. The majority of patients develop uveitis within the first two years after JIA symptom onset, but uveitis can continue into adulthood.Objectives:The main objective of this study was to analyze the risk for uveitis events after discontinuing disease-modifying antirheumatic drugs (DMARD) in patients with extended oligoarthritis and rheumatoid factor (RF)-negative polyarthritis.Methods:Data of the two ongoing multicenter biologic registers: German Biologics in Pediatric Rheumatology (BiKeR) and the Juvenile arthritis Methotrexate/Biologics long-term Observation (JuMBO) were used to analyze the adverse-event (AE) and events of special interest (ESI) reports about uveitis events during treatment and after discontinuation of DMARDs. Biker started recruitment of children and adolescent patients with JIA exposed to biological (b) or conventional (cs) DMARD’s in 2001. The patients were further followed in JuMBO after reaching the age of 18 or transitioning to an adult rheumatologist. Disease characteristics, treatment data, AE’s and ESI’s were reported by the pediatric or adults rheumatologist, respectively.Results:A total of 2,041 patients with RF-negative polyarthritis (n=1,280) or extended oligoarthritis (n=761) were included into the analyses. The mean follow-up of this study was 7.6 years (SD 5.3). About half of the patients were enrolled in BiKeR with start of etanercept (1,137, 55.7%), followed by 635 (31.1%) patients with start of methotrexate (MTX) monotherapy or adalimumab (ADA, n=198, 9.7%). A history of uveitis was reported for 238 (11.7%) patients at enrolment in BiKeR. More patients with a history of uveitis treated with ADA were included in BiKeR initiating ADA (n=98 of 238, 41.2%). Patients with uveitis had a lower age at JIA onset in comparison to patients without uveitis (mean 3.6 (SD 3.0) versus 7.0 (SD 4.5) years). A total of 142 recurrent (84% of 169) uveitis events were reported in 93 patients and for 27 patients (1.3% of 2,041) was an incident uveitis reported during follow-up. More than one uveitis event was reported for 32 patients with a maximum number of 4 uveitis flares in 3 patients. Nineteen uveitis flares (11.2% of 169) were reported for patients after the age of 18. The longer the time since DMARD discontinuation the fewer uveitis events occurred. Uveitis events were significantly more often reported in the first 24 months after MTX discontinuation (<6 months: OR=3.19, 95%CI: 1.70 to 5.96; 6 to <12 months: OR=2.06, 95%CI: 1.01 to 4.66; 12 to <24 months: OR=2.20, 95%CI: 1.14 to 4.25) and in the first three months after biological DMARD discontinuation (OR=5.4, 95%CI: 1.56 to 18.33). Patients with a MTX dose of ≤ 10 mg/m2 at last MTX intake had a higher likelihood for uveitis events (OR=1.40, 95%CI: 1.02 to 1.92).Conclusion:This is the first study that analyzed the risk of uveitis after DMARD withdrawal. Uveitis relapses are common. Patients who discontinued DMARD therapy were at high risk for uveitis within the first 3 to 24 months after discontinuation. Rheumatologists and ophthalmologists should be aware about this risk which should lead to a regular uveitis screening after DMARD withdrawal.Disclosure of Interests:Jens Klotsche: None declared, Ariane Klein: None declared, Martina Niewerth: None declared, Tilmann Kallinich: None declared, Daniel Windschall: None declared, Johannes-Peter Haas: None declared, Frank Weller-Heinemann Speakers bureau: Pfizer, Abbvie, SOBI, Roche, Novartis, Toni Hospach: None declared, Frank Dressler: None declared, Kirsten Minden: None declared, Gerd Horneff: None declared
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Horneff G, Windschall D, Hospach T, Mrusek S, Rühlmann M, Klein A. OP0163 COMPARATIVE ANALYSIS OF ETANERCEPT BIOSIMILAR AND ORIGINATOR USE IN CLINICAL PRACTICE: DATA FROM THE GERMAN BIKER-REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In 2017, 2 Etanercept biosimilars became approved. Comparative studies performed in adult patients with rheumatoid arthritis, ankylosing spondylitis or psoriasis by extrapolation led to approval for juvenile idiopathic arthritis (JIA).Objectives:So far there is limited experience with Etanercept biosimilars in JIA: The large national data base of the BIKER-registry was used to describe experience with Etanercept biosimilars in clinical practice.Methods:In this retrospective analysis patients exposed to ETA were identified in the German BIKER-registry and grouped into cohorts according to initiation of treatment after 2017, use of the originator and of biosimilars. The course of JADAS10, Physician global assessment VAS 0–100-mm, Parent/patient global assessment VAS 0–100-cm, Active joint count 0-71, truncated at 10, ESR and CHAQ-DI was analyzed. Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESI).Results:Until 31.10.2020, 2917 JIA patients were reported to have received Etanercept. Since January 1 2017, in 39 centres treatment with Etanercept was started in 439 patients (377 (85.9%) started with the originator and 62 (14.1%) started a Biosimilar). Biosimilars were prescribed n 17 centres (44%). In 12 centres (31%), Etanercept biosimilars were used first line in 62 patients. In 17 centres (44%), 63 patients switched for the originator to a biosimilar. 3 patients reswitched from the biosimilar to the originator. 4 patient switched from a biosimilar to the originator). 22 centres (56%) had not prescribed a biosimilars so far.In not a single centre, initiation of a biosimilar was more frequent than of the originator.The patients’ characteristics and disease activity parameters were widely comparanble. Patients receiving biosimilar first line were slightly older at disease onset and had a longer disease duration. Patients receiving biosimilar first line had more often rheumatoid factor (RF) negative polyarthritis while extended oligoarthritis was more frequent in the originator cohort. In the switching cohort, more patients had extended oligoarthritis and fewer had RF negative polyarthritis and ERA JIA.No difference in disease activity parameters was noted, neither at baseline, during the course of treatment nor at last observation upon treatment. A decrease of the JADAS10 indicates improvement in both groups (Figure 1). At the time of switching, 68% had JADAS minimal disease activity (MDA) and 43% were in JASDAS remission. At month 6 and 12 these numbers increased to 74%/65% and 62%/50%.In total, 66 adverse events (AE) were reported in 45 patients upon biosimilar treatment.33 patients had 1, 5 patients 2, 5 patients had 3 and 2 reported 4 events. Adverse event of special interest were hypersensitivity n=1, injection site reaction n=1, new onset of psoriasis n=1, celiac disease n=1, Crohn‘s diesease n=1, elevated transaminases n=2, depression n=1 and disease deterioration (arthritis flare) in n=21. In 20 patients, the etanercept biosimilar was discontinued.Conclusion:This analysis is the first attempt to present a large data sample on JIA patients exposed to Etanercept biosimilars. Biosimilar were used in a minority of patients and by a minority of centers although no difference in efficacy or safety was noted from our analysis. Until today, the use of the originator is by far exceeding the use of biosimilars. The prescription of a biosimilar either first line or by switching from the originator is limited to a part of centres. Differences in efficacy between first line biosimilar users and originator users could not be observed. Also, after switching, no loss of efficacy was observed.Disclosure of Interests:Gerd Horneff Speakers bureau: Pfizer, Daniel Windschall: None declared, Toni Hospach: None declared, Sonja Mrusek: None declared, Michael Rühlmann: None declared, Ariane Klein: None declared
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Horneff G, Dressler F, Rühlmann M, Geikowski T, Mrusek S, Klein A. POS1303 EXPERIENCE WITH ADALIMUMAB BIOSIMILAR USE IN CLINICAL PRACTICE: DATA FROM THE GERMAN BIKER-REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1433] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In 2017, Adalimumab Biosimilars became approved. Comparative studies to the originator have been performed in adult patients with rheumatoid arthritis, ankylosing spondylitis and psoriasis and extrapolation led to approval for juvenile idiopathic arthritis (JIA).Objectives:So far there is limited experience with biosimilars in JIA: The large national data base of the BIKER-registry was used to describe experience with Adalimumab biosimilars in clinical practiceMethods:This retrospective analysis used data of the German BIKER-registry. The data basis war screened for patients exposed to Adalimumab. Subcohorts with initiation of treatment after 2017, use of the originator and of biosimilars were built. The course of JADAS10, Physician global assessment VAS 0–100-mm, Parent/patient global assessment VAS 0–100-cm, Active joint count 0-71, truncated at 10, ESR and CHAQ-DI was analyzed. Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESI).Results:Until 31.10.2020, 1173 JIA patients were reported to have received Adalimumab. 352 treatments have been started after January 1, 2017. A biosimilar was used first line in 44 patients. Further 55 patients switched for the originator to a biosimilar. 2 patient switched from a biosimilar to the originator. 3 patients switched to a second biosimilar while 5 patients who switched from the originator to a biosimilar reswitched back to the originator.After 2017, 33 pediatric rheumatology centres reported initiation of Adalimumab treatment. 17 have used a biosimilar. 15 centres have swichted at least 1 patient from the originator to a biosimilar and 14 have used first line a biosimilar in at least 1 patient. In a single centre, initiation of a biosimilar was used more frequently (8 versus 7).The patients’ characteristics and disease activity parameters were brightly comparable. The JIA category rheumatoid factor (RF) negative polyarthritis was less frequent in the biosimilar first cohort while RF positive polyarthritis and psoriatic arthritis was more frequent. In patients with idiopathic uveitis the originator was used more often. In the switching cohort, more patients had RF negative polyarthritis, persistent oligoarthritis but less had psoriatic arthritis and no had RF positive polyarthritis.No difference in disease activity parameters between patients receiving the originator or biosimilars were noted, neither at baseline, during the course of treatment nor at last observation upon treatment (Figure 1). At the time of switching, 46 (92%) had JADAS minimal disease activity (MDA) and 30 (69%) were in JASDAS remission. At last observation, those numbers were comparable with 42 (86%) with JADAS MDA and 28 (57%) with JADAS remission.In total, 45 adverse events (AE) were reported in 45 patients upon biosimilar treatment. 26 patients had 1, 12 patients had 2 and 6 patients reported 3 and 1 reported 4 events. Adverse event of special interest were Infection associated leukopenia (n=1), COVID 19 infection (n=1), Uveitis flare (n=8), other disease deterioration (arthritis flare) (n=20), injection site reaction n=2. A single serious AE was reported. A 16 year old female adolescent was admitted for unexpected CK elevation. In 10 patients, Adalimumab was discontinued, in 2 it was temporarily paused.Conclusion:This article is the first attempt to present a large sample of data on JIA patients exposed to Adalimumab biosimilars. Since approval of Adalimumab-Biosimilars, limited experience from clinical practice is available. Biosimilars are used in a minority of patients and by a minority of centers although no difference in efficacy or safety was noted from our analysis.Disclosure of Interests:Gerd Horneff Speakers bureau: Novartis, MSD, Sobi, Grant/research support from: MSD, Roche, Frank Dressler: None declared, Michael Rühlmann: None declared, Tilmann Geikowski: None declared, Sonja Mrusek: None declared, Ariane Klein: None declared
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Sengler C, Eulert S, Niewerth M, Kallinich T, Wittkowski H, Girschick H, Haas JP, Horneff G, Hospach T, Armann J, Kuemmerle-Deschner JB, Brunner J, Borte M, Hühn R, Minden K, Klein A. POS1199 CLINICAL MANIFESTATIONS OF SARS-CoV2 INFECTIONS IN CHILDREN AND ADOLESCENTS WITH RHEUMATIC AND MUSCULUSKELETAL DISEASES – SURVEY DATA FROM GERMANY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1875] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Although children and adolescents are less likely to develop COVID-19 and generally show milder disease courses, it is unclear what impact the SARS-CoV2 infection has on children and adolescents with rheumatic and musculoskeletal disease (RMD). Due to their underlying disease as well as therapeutic immunosuppression these patients may be at higher risk of being more severely affected by SARS-CoV2. Furthermore, SARS-CoV2 infection might trigger a flare of the underlying disease.Objectives:To evaluate clinical characteristics and disease course of COVID-19 in children and adolescents with RMD and to analyze possible effects of SARS-CoV2 infection on the underlying disease under different therapeutic regimens.Methods:Data from juvenile patients with RMD recorded via the SARS-CoV2 questionnaire within the National Pediatric Rheumatology Database and the registry for hospitalized children and adolescents with COVID-19 of the German Society for Pediatric Infectious Diseases were analyzed. In addition to age, sex and diagnosis, information was collected about the date and method of a positive SARS-CoV2 testing, reason for testing, on clinical manifestations, disease course, treatment and outcome of COVID-19, on drug therapy at the time of virus detection, on disease activity (NRS 0 – 10, 0 = best) of the underlying disease at the last visit before and after the SARS-CoV2 infection.Results:From April 17th 2020 until January 25th 2021, data of 67 patients with RMD and confirmed SARS-CoV2 infection were collected. Mean age was 13.5 ± 3.9 years with equal sex distribution. The majority of patients were diagnosed with juvenile idiopathic arthritis (JIA, 64%), 12 (18%) patients had an autoinflammatory disease (FMF, CAPS, PFAPA, TRAPS) and 5 (7%) a connective tissue disease. Fifty-two patients (78%) were treated with a disease modifying antirheumatic drug (DMARD), 39% with a biological DMARD and 9% systemic glucocorticoids at the time of SARS-CoV-2 infection. Nineteen patients (28%) were tested for SARS-CoV-2 because of typical symptoms, the majority (67%) because of contact to an infected person. PCR was used most often (in 60 %).52 patients (78%) developed symptoms of COVID-19, 15 patients remained asymptomatic. The most common symptom of COVID-19 was rhinitis (42%) and fever (38%), followed by fatigue (34%), taste/smell disorder (33%), sore throat (27%) and cough (23%).Disease severity was graded as mild in 44 of 52 (85%) symptomatic patients, only two patients were hospitalized, one of whom required intensive care and died of cardiorespiratory failure 3 days after symptom onset. In 22 of 26 (85%) SARS-CoV2-positive patients, no relevant increase in disease activity (difference in NRS ≤ 1 before/after infection) of the underlying disease was observed 31 days after symptom onset (median, IQR 17-52 days). One patient, who had paused tocilizumab for 2 doses, experienced a flare of his seronegative polyarthritis 2 months after asymptomatic SARS-CoV-2 infection.Conclusion:In our cohort, the clinical picture of COVID-19 in children and adolescents with RMD was similar to that of healthy peers. The majority of patients showed mild disease course with good outcome under various medications, however, one patient with a severe course of COVID-19 died. In addition, SARS-CoV2 infection does not appear to have a relevant impact on the underlying disease activity, whereas discontinuation of therapy might pose a risk of flare.Disclosure of Interests:None declared.
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Martinot M, Giacobi C, De Stefano C, Rezzoug D, Baubet T, Klein A. [Age at diagnosis of Autism Spectrum Disorder depending on ethno-cultural background or migratory status: A systematic literature review]. Encephale 2021; 47:157-170. [PMID: 33051084 PMCID: PMC7547827 DOI: 10.1016/j.encep.2020.06.007] [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] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review. METHOD Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles. RESULTS Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion. CONCLUSION Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.
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Affiliation(s)
- M Martinot
- GHU Paris psychiatrie neurosciences, centre médical Marmottan, 17, rue d'Armaillé, 75017 Paris, France.
| | - C Giacobi
- Hôpital Avicenne, AP-HP, Bobigny, France
| | | | - D Rezzoug
- CESP Inserm U1178, université Paris 13 EA 4403, hôpital Avicenne, AP-HP, Bobigny, France; Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France
| | - T Baubet
- CESP Inserm U1178, université Paris 13 EA 4403, hôpital Avicenne, AP-HP, Bobigny, France; Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France
| | - A Klein
- Inserm, CESP, équipe « PsyDev », université Paris-Saclay, UVSQ, Villejuif, France; Université Paris 13, hôpital Avicenne, AP-HP, Bobigny, 129, rue de Stalingrad, 93009 Bobigny, France
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