1
|
Zarski AC, Weisel KK, Berger T, Krieger T, Schaub MP, Berking M, Görlich D, Jacobi C, Ebert DD. Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial. Psychother Psychosom 2024:1-14. [PMID: 38688243 DOI: 10.1159/000536149] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/29/2023] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms. OBJECTIVE This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC). METHODS Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported. RESULTS Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI. CONCLUSIONS A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.
Collapse
Affiliation(s)
- Anna-Carlotta Zarski
- Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated to the University of Zurich, Zurich, Switzerland
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Corinna Jacobi
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - David D Ebert
- Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Ohlenburg H, Arnemann PH, Hessler M, Görlich D, Zarbock A, Friederichs H. Flipped Classroom: Improved team performance during resuscitation training through interactive pre-course content - a cluster-randomised controlled study. BMC Med Educ 2024; 24:459. [PMID: 38671434 PMCID: PMC11046966 DOI: 10.1186/s12909-024-05438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Resuscitation is a team effort, and it is increasingly acknowledged that team cooperation requires training. Staff shortages in many healthcare systems worldwide, as well as recent pandemic restrictions, limit opportunities for collaborative team training. To address this challenge, a learner-centred approach known as flipped learning has been successfully implemented. This model comprises self-directed, asynchronous pre-course learning, followed by knowledge application and skill training during in-class sessions. The existing evidence supports the effectiveness of this approach for the acquisition of cognitive skills, but it is uncertain whether the flipped classroom model is suitable for the acquisition of team skills. The objective of this study was to determine if a flipped classroom approach, with an online workshop prior to an instructor-led course could improve team performance and key resuscitation variables during classroom training. METHODS A single-centre, cluster-randomised, rater-blinded study was conducted on 114 final year medical students at a University Hospital in Germany. The study randomly assigned students to either the intervention or control group using a computer script. Each team, regardless of group, performed two advanced life support (ALS) scenarios on a simulator. The two groups differed in the order in which they completed the flipped e-learning curriculum. The intervention group started with the e-learning component, and the control group started with an ALS scenario. Simulators were used for recording and analysing resuscitation performance indicators, while professionals assessed team performance as a primary outcome. RESULTS The analysis was conducted on the data of 96 participants in 21 teams, comprising of 11 intervention groups and 10 control groups. The intervention teams achieved higher team performance ratings during the first scenario compared to the control teams (Estimated marginal mean of global rating: 7.5 vs 5.6, p < 0.01; performance score: 4.4 vs 3.8, p < 0.05; global score: 4.4 vs 3.7, p < 0.001). However, these differences were not observed in the second scenario, where both study groups had used the e-learning tool. CONCLUSION Flipped classroom approaches using learner-paced e-learning prior to hands-on training can improve team performance. TRIAL REGISTRATION German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00013096 ).
Collapse
Affiliation(s)
- Hendrik Ohlenburg
- Institute of Education and Student Affairs, Studienhospital Münster, University of Münster, 48149, Münster, Germany.
| | - Philip-Helge Arnemann
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Michael Hessler
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany
| | - Hendrik Friederichs
- Medical Education Research Group, Medical School OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
3
|
Liu C, Görlich D, Lowell CA, Italiano JE, Rossaint J, Bender M, Zarbock A, Margraf A. Thrombopoietin levels in sepsis and septic shock - a systematic review and meta-analysis. Clin Chem Lab Med 2024; 62:999-1010. [PMID: 38037809 DOI: 10.1515/cclm-2023-0792] [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: 07/25/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Sepsis is a life-threatening condition implicating an inadequate activation of the immune system. Platelets act as modulators and contributors to immune processes. Indeed, altered platelet turnover, thrombotic events, and changes in thrombopoietin levels in systemic inflammation have been reported, but thrombopoietin-levels in sepsis and septic-shock have not yet been systematically evaluated. We therefore performed a meta-analysis of thrombopoietin (TPO)-levels in patients with sepsis. METHODS Two independent reviewers screened records and full-text articles for inclusion. Scientific databases were searched for studies examining thrombopoietin levels in adult sepsis and septic-shock patients until August 1st 2022. RESULTS Of 95 items screened, six studies met the inclusion criteria, including 598 subjects. Both sepsis and severe sepsis were associated with increased levels of thrombopoietin (sepsis vs. control: standardized mean difference 3.06, 95 % CI 1.35-4.77; Z=3.50, p=0.0005) (sepsis vs. severe sepsis: standardized mean difference -1.67, 95 % CI -2.46 to -0.88; Z=4.14, p<0.0001). TPO-levels did not show significant differences between severe sepsis and septic shock patients but differed between sepsis and inflammation-associated non-septic controls. Overall, high heterogeneity and low sample size could be noted. CONCLUSIONS Concluding, increased levels of thrombopoietin appear to be present both in sepsis and severe sepsis with high heterogeneity but thrombopoietin does not allow to differentiate between severe sepsis and septic-shock. TPO may potentially serve to differentiate sepsis from non-septic trauma and/or tissue damage related (systemic) inflammation. Usage of different assays and high heterogeneity demand standardization of methods and further large multicenter trials.
Collapse
Affiliation(s)
- Chang Liu
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Clifford A Lowell
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joseph E Italiano
- Department of Surgery, Harvard Medical School and Vascular Biology Program, Boston Children's Hospital, Boston, MA, USA
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Markus Bender
- Institute of Experimental Biomedicine - Chair I, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Margraf
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
4
|
Fischer-Riepe L, Kailayangiri S, Zimmermann K, Pfeifer R, Aigner M, Altvater B, Kretschmann S, Völkl S, Hartley J, Dreger C, Petry K, Bosio A, von Döllen A, Hartmann W, Lode H, Görlich D, Mackensen A, Jungblut M, Schambach A, Abken H, Rossig C. Preclinical Development of CAR T Cells with Antigen-Inducible IL18 Enforcement to Treat GD2-Positive Solid Cancers. Clin Cancer Res 2024:OF1-OF14. [PMID: 38593230 DOI: 10.1158/1078-0432.ccr-23-3157] [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: 10/27/2023] [Revised: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Cytokine-engineering of chimeric antigen receptor-redirected T cells (CAR T cells) is a promising principle to overcome the limited activity of canonical CAR T cells against solid cancers. EXPERIMENTAL DESIGN We developed an investigational medicinal product, GD2IL18CART, consisting of CAR T cells directed against ganglioside GD2 with CAR-inducible IL18 to enhance their activation response and cytolytic effector functions in the tumor microenvironment. To allow stratification of patients according to tumor GD2 expression, we established and validated immunofluorescence detection of GD2 on paraffin-embedded tumor tissues. RESULTS Lentiviral all-in-one vector engineering of human T cells with the GD2-specific CAR with and without inducible IL18 resulted in cell products with comparable proportions of CAR-expressing central memory T cells. Production of IL18 strictly depends on GD2 antigen engagement. GD2IL18CART respond to interaction with GD2-positive tumor cells with higher IFNγ and TNFα cytokine release and more effective target cytolysis compared with CAR T cells without inducible IL18. GD2IL18CART further have superior in vivo antitumor activity, with eradication of GD2-positive tumor xenografts. Finally, we established GMP-compliant manufacturing of GD2IL18CART and found it to be feasible and efficient at clinical scale. CONCLUSIONS These results pave the way for clinical investigation of GD2IL18CART in pediatric and adult patients with neuroblastoma and other GD2-positive cancers (EU CT 2022-501725-21-00).
Collapse
Affiliation(s)
- Lena Fischer-Riepe
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Sareetha Kailayangiri
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Katharina Zimmermann
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Rita Pfeifer
- Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany
| | - Michael Aigner
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bianca Altvater
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Sascha Kretschmann
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Simon Völkl
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jordan Hartley
- Division of Genetic Immunotherapy, Leibniz Institute for Immunotherapy (LIT) and University of Regensburg, Regensburg, Germany
| | - Celine Dreger
- Division of Genetic Immunotherapy, Leibniz Institute for Immunotherapy (LIT) and University of Regensburg, Regensburg, Germany
| | - Katja Petry
- Miltenyi Biomedicine GmbH, Bergisch Gladbach, Germany
| | - Andreas Bosio
- Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany
| | - Angelika von Döllen
- Institute of Transfusion Medicine and Cell Therapy, University Hospital Muenster, Muenster, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Muenster, Germany
| | - Holger Lode
- Pediatric Hematology-Oncology Department, University Medicine Greifswald, Greifswald, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster
| | - Andreas Mackensen
- Department of Internal Medicine 5 - Hematology and Oncology, Friedrich Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
- REBIRTH Research Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
| | - Hinrich Abken
- Division of Genetic Immunotherapy, Leibniz Institute for Immunotherapy (LIT) and University of Regensburg, Regensburg, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Institute of Transfusion Medicine and Cell Therapy, University Hospital Muenster, Muenster, Germany
- Cells-in-Motion Cluster of Excellence (EXC 1003 - CiM), University of Muenster, Muenster, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| |
Collapse
|
5
|
Vollert B, Yim SH, Görlich D, Beintner I, Gordon G, Musiat P, Schmidt U, Jacobi C. Using web-based, guided self-help to bridge the waiting time for face-to-face out-patient treatment for bulimic-spectrum disorders: randomised controlled trial. BJPsych Open 2024; 10:e53. [PMID: 38404025 PMCID: PMC10897701 DOI: 10.1192/bjo.2023.629] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps. AIMS This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment. METHOD A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention 'everyBody Plus' or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology. RESULTS At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09-3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high. CONCLUSIONS The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.
Collapse
Affiliation(s)
- Bianka Vollert
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - See Heng Yim
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Germany
| | - Ina Beintner
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Gemma Gordon
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK; and Forward College, Lisbon, Portugal
| | - Peter Musiat
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| |
Collapse
|
6
|
Rausch C, Arnreich C, Rothenberg-Thurley M, Dufour A, Schneider S, Gittinger H, Bücklein V, Subklewe M, Sauerland C, Görlich D, Krug U, Berdel WE, Wörmann BJ, Hiddemann W, Braess J, von Bergwelt-Baildon M, Spiekermann K, Metzeler KH, Herold T. Friday Leukemia-a Structural Phenomenon. Dtsch Arztebl Int 2024; 121:94-95. [PMID: 38471183 PMCID: PMC11002436 DOI: 10.3238/arztebl.m2023.0260] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 03/14/2024]
Affiliation(s)
| | - Chiara Arnreich
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg
| | | | - Annika Dufour
- Department of Medicine III, LMU Hospital, LMU Munich
| | - Stephanie Schneider
- Department of Medicine III, LMU Hospital, LMU Munich
- Institute for Human Genetics, LMU Hospital, LMU Munich
| | | | - Veit Bücklein
- Department of Medicine III, LMU Hospital, LMU Munich
- Laboratory for Translational Cancer Immunology, LMU Gene Center, LMU Munich
- Bavarian Cancer Research Center (BZKF)
| | - Marion Subklewe
- Department of Medicine III, LMU Hospital, LMU Munich
- Laboratory for Translational Cancer Immunology, LMU Gene Center, LMU Munich
- German Cancer Research Center (DKFZ), Heidelberg
- Bavarian Cancer Research Center (BZKF)
| | - Cristina Sauerland
- Institute für Biometrics and Clinical Research, Faculty of Medicine, University of Münster
| | - Dennis Görlich
- Institute für Biometrics and Clinical Research, Faculty of Medicine, University of Münster
| | - Utz Krug
- Department of Medicine 3, Leverkusen Hospitals GmbH
| | | | | | - Wolfgang Hiddemann
- Department of Medicine III, LMU Hospital, LMU Munich
- German Cancer Research Center (DKFZ), Heidelberg
- German Cancer Consortium (DKTK)
| | - Jan Braess
- Department of Oncology and Hematology, Barmherzige Brüder Hospital, Regensburg
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, LMU Hospital, LMU Munich
- German Cancer Research Center (DKFZ), Heidelberg
- German Cancer Consortium (DKTK)
- Bavarian Cancer Research Center (BZKF)
| | - Karsten Spiekermann
- Department of Medicine III, LMU Hospital, LMU Munich
- German Cancer Research Center (DKFZ), Heidelberg
- German Cancer Consortium (DKTK)
- Bavarian Cancer Research Center (BZKF)
| | - Klaus H. Metzeler
- Department of Hematology, Cell Therapy, Hemostasiology, and Infectology, University Hospital Leipzig
| | - Tobias Herold
- Department of Medicine III, LMU Hospital, LMU Munich
- German Cancer Research Center (DKFZ), Heidelberg
- German Cancer Consortium (DKTK)
| |
Collapse
|
7
|
Danzer MF, Eveslage M, Görlich D, Noto B. A statistical framework for planning and analysing test-retest studies of repeatability. Stat Methods Med Res 2024; 33:295-308. [PMID: 38298010 DOI: 10.1177/09622802241227959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
There is an increasing number of potential quantitative biomarkers that could allow for early assessment of treatment response or disease progression. However, measurements of such biomarkers are subject to random variability. Hence, differences of a biomarker in longitudinal measurements do not necessarily represent real change but might be caused by this random measurement variability. Before utilizing a quantitative biomarker in longitudinal studies, it is therefore essential to assess the measurement repeatability. Measurement repeatability obtained from test-retest studies can be quantified by the repeatability coefficient, which is then used in the subsequent longitudinal study to determine if a measured difference represents real change or is within the range of expected random measurement variability. The quality of the point estimate of the repeatability coefficient, therefore, directly governs the assessment quality of the longitudinal study. Repeatability coefficient estimation accuracy depends on the case number in the test-retest study, but despite its pivotal role, no comprehensive framework for sample size calculation of test-retest studies exists. To address this issue, we have established such a framework, which allows for flexible sample size calculation of test-retest studies, based upon newly introduced criteria concerning assessment quality in the longitudinal study. This also permits retrospective assessment of prior test-retest studies.
Collapse
Affiliation(s)
- Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Benjamin Noto
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
- Clinic for Radiology, University Hospital Münster, Münster, Germany
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| |
Collapse
|
8
|
Hessler M, Arnemann PH, Jentzsch I, Görlich D, Morelli A, Rehberg SW, Ertmer C, Kampmeier TG. Adjusting Acute Kidney Injury Kidney Disease: Improving Global Outcomes Urine Output Criterion for Predicted Body Weight Improves Prediction of Hospital Mortality. Anesth Analg 2024; 138:134-140. [PMID: 37851903 DOI: 10.1213/ane.0000000000006695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Based on the Kidney Disease: Improving Global Outcomes (KDIGO) definitions, urine output, serum creatinine, and need for kidney replacement therapy are used for staging acute kidney injury (AKI). Currently, AKI staging correlates strongly with mortality and can be used as a predictive tool. However, factors associated with the development of AKI may affect its predictive ability. We tested whether adjustment for predicted (versus actual) body weight improved the ability of AKI staging to predict hospital mortality. METHODS A total of 3279 patients who had undergone cardiac surgery in a university hospital were retrospectively analyzed. AKI was staged according to KDIGO criteria (standard staging) and after adjustment for hourly urine output adjusted by predicted body weight for each patient and each day of their hospital stay. RESULTS The incidence of AKI (all stages) was 43% (predicted body weight adjusted) and 50% (standard staging), respectively ( P < .001). In sensitivity-specificity analyses for predicting hospital mortality, the area under the curve was significantly higher after adjustment for predicted body weight than with standard staging ( P = .002). CONCLUSIONS Compared to standard staging, adjustment of urine output for predicted body weight increases the specificity and improves prediction of hospital mortality in patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Michael Hessler
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Philip-Helge Arnemann
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Imke Jentzsch
- Department of Anesthesiology, Hospital of the University of Munich-Campus Großhadern, Munich, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andrea Morelli
- Department of Anesthesiology and Intensive Care, University of Rome "La Sapienza," Rome, Italy
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital of the Bethel Foundation, Bielefeld, Germany
| | - Christian Ertmer
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| | - Tim-Gerald Kampmeier
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
| |
Collapse
|
9
|
Ozga M, Nicolet D, Mrózek K, Yilmaz AS, Kohlschmidt J, Larkin KT, Blachly JS, Oakes CC, Buss J, Walker CJ, Orwick S, Jurinovic V, Rothenberg-Thurley M, Dufour A, Schneider S, Sauerland MC, Görlich D, Krug U, Berdel WE, Woermann BJ, Hiddemann W, Braess J, Subklewe M, Spiekermann K, Carroll AJ, Blum WG, Powell BL, Kolitz JE, Moore JO, Mayer RJ, Larson RA, Uy GL, Stock W, Metzeler KH, Grimes HL, Byrd JC, Salomonis N, Herold T, Mims AS, Eisfeld AK. Sex-associated differences in frequencies and prognostic impact of recurrent genetic alterations in adult acute myeloid leukemia (Alliance, AMLCG). Leukemia 2024; 38:45-57. [PMID: 38017103 PMCID: PMC10776397 DOI: 10.1038/s41375-023-02068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
Clinical outcome of patients with acute myeloid leukemia (AML) is associated with demographic and genetic features. Although the associations of acquired genetic alterations with patients' sex have been recently analyzed, their impact on outcome of female and male patients has not yet been comprehensively assessed. We performed mutational profiling, cytogenetic and outcome analyses in 1726 adults with AML (749 female and 977 male) treated on frontline Alliance for Clinical Trials in Oncology protocols. A validation cohort comprised 465 women and 489 men treated on frontline protocols of the German AML Cooperative Group. Compared with men, women more often had normal karyotype, FLT3-ITD, DNMT3A, NPM1 and WT1 mutations and less often complex karyotype, ASXL1, SRSF2, U2AF1, RUNX1, or KIT mutations. More women were in the 2022 European LeukemiaNet intermediate-risk group and more men in adverse-risk group. We found sex differences in co-occurring mutation patterns and prognostic impact of select genetic alterations. The mutation-associated splicing events and gene-expression profiles also differed between sexes. In patients aged <60 years, SF3B1 mutations were male-specific adverse outcome prognosticators. We conclude that sex differences in AML-associated genetic alterations and mutation-specific differential splicing events highlight the importance of patients' sex in analyses of AML biology and prognostication.
Collapse
Affiliation(s)
- Michael Ozga
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Deedra Nicolet
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Krzysztof Mrózek
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA.
| | - Ayse S Yilmaz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Jessica Kohlschmidt
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
- Alliance Statistics and Data Management Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Karilyn T Larkin
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Christopher C Oakes
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Jill Buss
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Christopher J Walker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Shelley Orwick
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Vindi Jurinovic
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Annika Dufour
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute of Human Genetics, University Hospital, LMU Munich, Munich, Germany
| | | | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Utz Krug
- Department of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Wolfgang E Berdel
- Department of Medicine, Hematology and Oncology, University of Münster, Münster, Germany
| | | | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Marion Subklewe
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Andrew J Carroll
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Bayard L Powell
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Jonathan E Kolitz
- Monter Cancer Center, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Joseph O Moore
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | | | - Geoffrey L Uy
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Wendy Stock
- University of Chicago Medical Center, Chicago, IL, USA
| | - Klaus H Metzeler
- Department of Hematology, Cellular Therapy, and Hemostaseology, Leipzig University Hospital, Leipzig, Germany
| | - H Leighton Grimes
- Division of Immunobiology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - John C Byrd
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nathan Salomonis
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Alice S Mims
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA
| | - Ann-Kathrin Eisfeld
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, Clara D. Bloomfield Center for Leukemia Outcomes Research, Columbus, OH, USA.
| |
Collapse
|
10
|
Pollmann NS, Vogel T, Pongs C, Katou S, Morgül H, Houben P, Görlich D, Kneifel F, Reuter S, Pollmann L, Pascher A, Becker F. Donor Proteinuria and Allograft Function in Kidney Transplantation: Short- and Long-Term Results From a Retrospective Cohort Study. Transpl Int 2023; 36:11953. [PMID: 38156296 PMCID: PMC10754218 DOI: 10.3389/ti.2023.11953] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023]
Abstract
Donor proteinuria (DP) is a common but rarely evaluated aspect of today's kidney transplant allocation process. While proteinuria after kidney transplantation is a risk factor for impaired graft function and survival, the long-term effects of DP in kidney transplantation have not yet been evaluated. Therefore, this study aims to investigate the impact of DP on the long-term outcome after kidney transplantation. A total of 587 patients were found to be eligible and were stratified into two groups: (1) those receiving a graft from a donor without proteinuria (DP-) and (2) those receiving a graft from a donor with proteinuria (DP+). At 36 months, there was no difference in the primary composite endpoint including graft loss and patient survival (log-rank test, p = 0.377). However, the analysis of DP+ subgroups showed a significant decrease in overall patient survival in the group with high DP (p = 0.017). DP did not adversely affect patient or graft survival over 36 months. Nevertheless, this work revealed a trend towards decreased overall survival of patients with severe proteinuria in the subgroup analysis. Therefore, the underlying results suggest caution in allocating kidneys from donors with high levels of proteinuria.
Collapse
Affiliation(s)
- Nicola Sariye Pollmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Thomas Vogel
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Caroline Pongs
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Shadi Katou
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Haluk Morgül
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp Houben
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Muenster, Muenster, Germany
| | - Felicia Kneifel
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Lukas Pollmann
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
11
|
Eckardt JN, Bill M, Rausch C, Metzeler K, Spiekermann K, Stasik S, Sauer T, Scholl S, Hochhaus A, Crysandt M, Brümmendorf TH, Krug U, Wörmann B, Hiddemann W, Görlich D, Sauerland C, Steffen B, Einsele H, Neubauer A, Burchert A, Schäfer-Eckart K, Berdel WE, Schliemann C, Krause SW, Hänel M, Hanoun M, Kaufmann M, Fransecky L, Braess J, Ruhnke L, Schetelig J, Middeke JM, Serve H, Baldus CD, Platzbecker U, Müller-Tidow C, Bornhäuser M, Herold T, Thiede C, Röllig C. Secondary-type mutations do not impact outcome in NPM1-mutated acute myeloid leukemia - implications for the European LeukemiaNet risk classification. Leukemia 2023; 37:2282-2285. [PMID: 37679502 PMCID: PMC10624615 DOI: 10.1038/s41375-023-02016-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Marius Bill
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Mildred Scheel Early Career Center, Medical Clinic and Policlinic I, University Hospital of the Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - Christian Rausch
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Klaus Metzeler
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Tim Sauer
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Utz Krug
- Department of Medicine III, Hospital Leverkusen, Leverkusen, Germany
| | - Bernhard Wörmann
- Department of Hematology, Oncology and Tumor Immunology, Charité, Berlin, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Dennis Görlich
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Cristina Sauerland
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Björn Steffen
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Hermann Einsele
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine V, Paracelsus Medizinische Privatuniversität and University Hospital Nuremberg, Nuremberg, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | | | | | - Mathias Hänel
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Maher Hanoun
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lars Fransecky
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Jan Braess
- Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Leo Ruhnke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Hubert Serve
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Claudia D Baldus
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Carsten Müller-Tidow
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Mildred Scheel Early Career Center, Medical Clinic and Policlinic I, University Hospital of the Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
| |
Collapse
|
12
|
Vaseekaran M, Kaese S, Görlich D, Wiemer M, Samol A. WATCH-BPM-Comparison of a WATCH-Type Blood Pressure Monitor with a Conventional Ambulatory Blood Pressure Monitor and Auscultatory Sphygmomanometry. Sensors (Basel) 2023; 23:8877. [PMID: 37960576 PMCID: PMC10650650 DOI: 10.3390/s23218877] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. METHODS Therefore, 159 consecutive patients (84 male, 75 female, mean age 64.33 ± 16.14 years) performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. RESULTS The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was "bad" for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. CONCLUSION The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data.
Collapse
Affiliation(s)
- Mathini Vaseekaran
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Sven Kaese
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Münster, 48149 Muenster, Germany;
| | - Marcus Wiemer
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Alexander Samol
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
- Department of Cardiology and Angiology, St. Antonius-Hospital Gronau GmbH, Möllenweg 22, 48599 Gronau, Germany
| |
Collapse
|
13
|
Altvater B, Kailayangiri S, Spurny C, Flügge M, Meltzer J, Greune L, Urban K, Schwöppe C, Brand C, Schliemann C, Hintelmann H, Harrach S, Hartmann W, Abken H, Kuehle J, Schambach A, Görlich D, Berdel WE, Rossig C. CAR T cells as micropharmacies against solid cancers: Combining effector T-cell mediated cell death with vascular targeting in a one-step engineering process. Cancer Gene Ther 2023; 30:1355-1368. [PMID: 37391502 PMCID: PMC10581901 DOI: 10.1038/s41417-023-00642-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
To enhance the potency of chimeric antigen receptor (CAR) engineered T cells in solid cancers, we designed a novel cell-based combination strategy with an additional therapeutic mode of action. CAR T cells are used as micropharmacies to produce a targeted pro-coagulatory fusion protein, truncated tissue factor (tTF)-NGR, which exerts pro-coagulatory activity and hypoxia upon relocalization to the vascular endothelial cells that invade tumor tissues. Delivery by CAR T cells aimed to induce locoregional tumor vascular infarction for combined immune-mediated and hypoxic tumor cell death. Human T cells that were one-vector gene-modified to express a GD2-specific CAR along with CAR-inducible tTF-NGR exerted potent GD2-specific effector functions while secreting tTF-NGR that activates the extrinsic coagulation pathway in a strictly GD2-dependent manner. In murine models, the CAR T cells infiltrated GD2-positive tumor xenografts, secreted tTF-NGR into the tumor microenvironment and showed a trend towards superior therapeutic activity compared with control cells producing functionally inactive tTF-NGR. In vitro evidence supports a mechanism of hypoxia-mediated enhancement of T cell cytolytic activity. We conclude that combined CAR T cell targeting with an additional mechanism of antitumor action in a one-vector engineering strategy is a promising approach to be further developed for targeted treatment of solid cancers.
Collapse
Affiliation(s)
- Bianca Altvater
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Sareetha Kailayangiri
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Christian Spurny
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Maike Flügge
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Jutta Meltzer
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Lea Greune
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Katja Urban
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | | | - Caroline Brand
- Department of Medicine A, University of Muenster, Muenster, Germany
| | | | - Heike Hintelmann
- Department of Medicine A, University of Muenster, Muenster, Germany
| | - Saliha Harrach
- Department of Medicine A, University of Muenster, Muenster, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, Münster University Hospital, Münster, Germany
| | - Hinrich Abken
- Division of Genetic Immunotherapy, Leibniz Institute for Immunotherapy (LIT), and University of Regensburg, Regensburg, Germany
| | - Johannes Kuehle
- Center for Molecular Medicine Cologne, University of Cologne, 50931, Cologne, Germany
| | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
- REBIRTH Research Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
- Division of Hematology/Oncology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University of Muenster, Muenster, Germany
- Cells-in-Motion Cluster of Excellence (EXC 1003 - CiM), University of Muenster, Muenster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
- Cells-in-Motion Cluster of Excellence (EXC 1003 - CiM), University of Muenster, Muenster, Germany.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| |
Collapse
|
14
|
Pastore F, Gittinger H, Raab S, Tschuri S, Ksienzyk B, Konstandin NP, Schneider S, Rothenberg-Thurley M, Horny HP, Werner M, Sauerland MC, Amler S, Görlich D, Berdel WE, Wörmann B, Braess J, Hiddemann W, Tischer J, Herold T, Metzeler KH, Spiekermann K. Acute megakaryoblastic leukaemia shows high frequency of chromosome 1q aberrations and dismal outcome. Br J Haematol 2023; 202:1165-1177. [PMID: 37455345 DOI: 10.1111/bjh.18982] [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: 04/15/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Acute megakaryoblastic leukaemia (AMKL) is associated with poor prognosis. Limited information is available on its cytogenetics, molecular genetics and clinical outcome. We performed genetic analyses, evaluated prognostic factors and the value of allogeneic haematopoietic stem cell transplantation (allo-HSCT) in a homogenous adult AMKL patient cohort. We retrospectively analysed 38 adult patients with AMKL (median age: 58 years, range: 21-80). Most received intensive treatment in AML Cooperative Group (AMLCG) trials between 2001 and 2016. Cytogenetic data showed an accumulation of adverse risk markers according to ELN 2017 and an unexpected high frequency of structural aberrations on chromosome arm 1q (33%). Most frequently, mutations occurred in TET2 (23%), TP53 (23%), JAK2 (19%), PTPN11 (19%) and RUNX1 (15%). Complete remission rate in 33 patients receiving intensive chemotherapy was 33% and median overall survival (OS) was 33 weeks (95% CI: 21-45). Patients undergoing allo-HSCT (n = 14) had a superior median OS (68 weeks; 95% CI: 11-126) and relapse-free survival (RFS) of 27 weeks (95% CI: 4-50), although cumulative incidence of relapse after allo-HSCT was high (62%). The prognosis of AMKL is determined by adverse genetic risk factors and therapy resistance. So far allo-HSCT is the only potentially curative treatment option in this dismal AML subgroup.
Collapse
Affiliation(s)
- Friederike Pastore
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Hanna Gittinger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Susanne Raab
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Tschuri
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Bianka Ksienzyk
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Nikola P Konstandin
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute of Human Genetics, University Hospital LMU, Munich, Germany
| | - Maja Rothenberg-Thurley
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Martin Werner
- Institute of Surgical Pathology, University of Freiburg, Freiburg, Germany
| | - Maria C Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Susanne Amler
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
- Friedrich-Loeffler-Institute, Greifswald-Insel Riems, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University of Münster, Münster, Germany
| | | | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Johanna Tischer
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Herold
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), Munich, Germany
| | - Klaus H Metzeler
- Department of Hematology and Cell Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
15
|
Spille DC, Kuroczik D, Görlich D, Varghese J, Schwake M, Stummer W, Holling M. Which risk factors significantly influence the outcome of traumatic brain injured patients with alcohol use disorder? Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02346-1. [PMID: 37578515 DOI: 10.1007/s00068-023-02346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Every year, approximately 10 million people worldwide suffer a traumatic brain injury that leads to hospitalization or mortality. Chronic and acute alcohol intoxication increase the risk of developing traumatic brain injury. Alcohol use disorder (AUD) as a predictor of outcome in neurosurgical patients and the definition of risk factors have been sparsely addressed so far. This study aims to improve the understanding of the effects of alcohol use disorder in the context of neurosurgical therapy. METHODS This study included patients admitted to Münster University Hospital with a traumatic brain injury and alcohol use disorder from January 1, 2010, to December 31, 2018. Univariate and multivariate analyses were performed to identify risk factors for a poorer outcome, assessed by the Glasgow Outcome Score. RESULTS Of the 197 patients included, 156 (79%) were male, and 41 (21%) were female, with a median age of 49 years (IQR 38-58 years). In multivariate analyses, age (p < 0.001), the occurrence of a new neurologic deficit (p < 0.001), the development of hydrocephalus (p = 0.005), and CT-graphic midline shift due to intracerebral hemorrhage (p = 0.008) emerged as significant predictors of a worse outcome (GOS 1-3). In addition, the level of blood alcohol concentration correlated significantly with the occurrence of seizures (p = 0.009). CONCLUSIONS Early identification of risk factors in patients with alcohol use disorder and traumatic brain injury is crucial to improve the outcome. In this regard, the occurrence of hydrocephalus or seizures during the inpatient stay should be considered as cause of neurological deterioration in this patient group.
Collapse
Affiliation(s)
| | - David Kuroczik
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Julian Varghese
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany.
| |
Collapse
|
16
|
Eveslage M, Rassek P, Riegel A, Maksoud Z, Bauer J, Görlich D, Noto B. Diffusion-Weighted MRI for Treatment Response Assessment in Osteoblastic Metastases-A Repeatability Study. Cancers (Basel) 2023; 15:3757. [PMID: 37568573 PMCID: PMC10417276 DOI: 10.3390/cancers15153757] [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: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
The apparent diffusion coefficient (ADC) is a candidate marker of treatment response in osteoblastic metastases that are not evaluable by morphologic imaging. However, it is unclear whether the ADC meets the basic requirement for reliable treatment response evaluation, namely a low variance of repeated measurements in relation to the differences found between viable and nonviable metastases. The present study addresses this question by analyzing repeated in vivo ADCmedian measurements of 65 osteoblastic metastases in nine patients, as well as phantom measurements. PSMA-PET served as a surrogate for bone metastasis viability. Measures quantifying repeatability were calculated and differences in mean ADC values according to PSMA-PET status were examined. The relative repeatability coefficient %RC of ADCmedian measurements was 5.8% and 12.9% for phantom and in vivo measurements, respectively. ADCmedian values of bone metastases ranged from 595×10-6mm2/s to 2090×10-6mm2/s with an average of 63% higher values in nonviable metastases compared with viable metastases (p < 0.001). ADC shows a small repeatability coefficient in relation to the difference in ADC values between viable and nonviable metastases. Therefore, ADC measurements fulfill the technical prerequisite for reliable treatment response evaluation in osteoblastic metastases.
Collapse
Affiliation(s)
- Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
| | - Philipp Rassek
- Department of Nuclear Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Arne Riegel
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Ziad Maksoud
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
| | - Benjamin Noto
- Institute of Biostatistics and Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Nuclear Medicine, University Hospital Münster, 48149 Münster, Germany
- Clinic for Radiology, University Hospital Münster, 48149 Münster, Germany
| |
Collapse
|
17
|
Evers G, Mohr M, Sprakel L, Galonska J, Görlich D, Schulze AB. Bronchoscopist-Directed Continuous Flow Propofol Based Analgosedation during Flexible Interventional Bronchoscopy and EBUS. J Clin Med 2023; 12:4223. [PMID: 37445256 DOI: 10.3390/jcm12134223] [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: 05/03/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Sedation techniques in interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) are inconsistent and the evidence for required general anesthesia under full anesthesiologic involvement is scarce. Moreover, we faced the challenge of providing bronchoscopic care with limited personnel. Hence, we retrospectively identified 513 patients that underwent flexible interventional bronchoscopy and/or EBUS-TBNA out of our institution between January 2020 and August 2022 to evaluate our deep analgosedation approach based on pethidine/meperidine bolus plus continuous flow adjusted propofol, the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting. Consequently, 502 out of 513 patients received BDcfP for analgosedation. We identified cardiovascular comorbidities, chronic obstructive pulmonary disease, and arterial hypertension as risk factors for periprocedural hypotension. Propofol flow rate did not correlate with hypotension. Theodrenaline and cafedrine might be used to treat periprocedural hypotension. Moreover, midazolam might be used to support the sedative effect. In conclusion, BDcfP is a safe and feasible sedative approach during interventional flexible bronchoscopy and EBUS-TBNA. In general, after the implementation of safety measures, EBUS-TBNA and interventional flexible bronchoscopy via BDcfP might safely be performed even with limited personnel.
Collapse
Affiliation(s)
- Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lena Sprakel
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jule Galonska
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-University Münster, 48149 Münster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| |
Collapse
|
18
|
Eckardt JN, Röllig C, Metzeler K, Heisig P, Stasik S, Georgi JA, Kroschinsky F, Stölzel F, Platzbecker U, Spiekermann K, Krug U, Braess J, Görlich D, Sauerland C, Woermann B, Herold T, Hiddemann W, Müller-Tidow C, Serve H, Baldus CD, Schäfer-Eckart K, Kaufmann M, Krause SW, Hänel M, Berdel WE, Schliemann C, Mayer J, Hanoun M, Schetelig J, Wendt K, Bornhäuser M, Thiede C, Middeke JM. Unsupervised meta-clustering identifies risk clusters in acute myeloid leukemia based on clinical and genetic profiles. Commun Med (Lond) 2023; 3:68. [PMID: 37198246 DOI: 10.1038/s43856-023-00298-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Increasingly large and complex biomedical data sets challenge conventional hypothesis-driven analytical approaches, however, data-driven unsupervised learning can detect inherent patterns in such data sets. METHODS While unsupervised analysis in the medical literature commonly only utilizes a single clustering algorithm for a given data set, we developed a large-scale model with 605 different combinations of target dimensionalities as well as transformation and clustering algorithms and subsequent meta-clustering of individual results. With this model, we investigated a large cohort of 1383 patients from 59 centers in Germany with newly diagnosed acute myeloid leukemia for whom 212 clinical, laboratory, cytogenetic and molecular genetic parameters were available. RESULTS Unsupervised learning identifies four distinct patient clusters, and statistical analysis shows significant differences in rate of complete remissions, event-free, relapse-free and overall survival between the four clusters. In comparison to the standard-of-care hypothesis-driven European Leukemia Net (ELN2017) risk stratification model, we find all three ELN2017 risk categories being represented in all four clusters in varying proportions indicating unappreciated complexity of AML biology in current established risk stratification models. Further, by using assigned clusters as labels we subsequently train a supervised model to validate cluster assignments on a large external multicenter cohort of 664 intensively treated AML patients. CONCLUSIONS Dynamic data-driven models are likely more suitable for risk stratification in the context of increasingly complex medical data than rigid hypothesis-driven models to allow for a more personalized treatment allocation and gain novel insights into disease biology.
Collapse
Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany.
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus Metzeler
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Peter Heisig
- Department of Software and Multimedia Technology, Technical University Dresden, Dresden, Germany
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Julia-Annabell Georgi
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Utz Krug
- Department of Medicine III, Hospital Leverkusen, Leverkusen, Germany
| | - Jan Braess
- Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Dennis Görlich
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Cristina Sauerland
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Bernhard Woermann
- Department of Hematology, Oncology and Tumor Immunology, Charité, Berlin, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany
| | - Hubert Serve
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Claudia D Baldus
- Department of Hematology and Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch Hospital, Stuttgart, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | - Mathias Hänel
- Department of Internal Medicine 3, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Wolfgang E Berdel
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Maher Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Karsten Wendt
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
- Department of Software and Multimedia Technology, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
| |
Collapse
|
19
|
Ventura D, Schindler P, Masthoff M, Görlich D, Dittmann M, Heindel W, Schäfers M, Lenz G, Wardelmann E, Mohr M, Kies P, Bleckmann A, Roll W, Evers G. Radiomics of Tumor Heterogeneity in 18F-FDG-PET-CT for Predicting Response to Immune Checkpoint Inhibition in Therapy-Naïve Patients with Advanced Non-Small-Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15082297. [PMID: 37190228 DOI: 10.3390/cancers15082297] [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: 02/10/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
We aimed to evaluate the predictive and prognostic value of baseline 18F-FDG-PET-CT (PET-CT) radiomic features (RFs) for immune checkpoint-inhibitor (CKI)-based first-line therapy in advanced non-small-cell lung cancer (NSCLC) patients. In this retrospective study 44 patients were included. Patients were treated with either CKI-monotherapy or combined CKI-based immunotherapy-chemotherapy as first-line treatment. Treatment response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). After a median follow-up of 6.4 months patients were stratified into "responder" (n = 33) and "non-responder" (n = 11). RFs were extracted from baseline PET and CT data after segmenting PET-positive tumor volume of all lesions. A Radiomics-based model was developed based on a Radiomics signature consisting of reliable RFs that allow classification of response and overall progression using multivariate logistic regression. These RF were additionally tested for their prognostic value in all patients by applying a model-derived threshold. Two independent PET-based RFs differentiated well between responders and non-responders. For predicting response, the area under the curve (AUC) was 0.69 for "PET-Skewness" and 0.75 predicting overall progression for "PET-Median". In terms of progression-free survival analysis, patients with a lower value of PET-Skewness (threshold < 0.2014; hazard ratio (HR) 0.17, 95% CI 0.06-0.46; p < 0.001) and higher value of PET-Median (threshold > 0.5233; HR 0.23, 95% CI 0.11-0.49; p < 0.001) had a significantly lower probability of disease progression or death. Our Radiomics-based model might be able to predict response in advanced NSCLC patients treated with CKI-based first-line therapy.
Collapse
Affiliation(s)
- David Ventura
- Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center (WTZ), 48149 Muenster, Germany
| | - Philipp Schindler
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Clinic for Radiology, University and University Hospital Muenster, 48149 Muenster, Germany
| | - Max Masthoff
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Clinic for Radiology, University and University Hospital Muenster, 48149 Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Matthias Dittmann
- Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center (WTZ), 48149 Muenster, Germany
| | - Walter Heindel
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Clinic for Radiology, University and University Hospital Muenster, 48149 Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center (WTZ), 48149 Muenster, Germany
| | - Georg Lenz
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Department of Medicine A-Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
| | - Eva Wardelmann
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany
| | - Michael Mohr
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Department of Medicine A-Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
| | - Peter Kies
- Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center (WTZ), 48149 Muenster, Germany
| | - Annalen Bleckmann
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Department of Medicine A-Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center (WTZ), 48149 Muenster, Germany
| | - Georg Evers
- West German Cancer Center (WTZ), 48149 Muenster, Germany
- Department of Medicine A-Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Muenster, 48149 Muenster, Germany
| |
Collapse
|
20
|
Rausch C, Rothenberg-Thurley M, Dufour A, Schneider S, Gittinger H, Sauerland C, Görlich D, Krug U, Berdel WE, Woermann BJ, Hiddemann W, Braess J, von Bergwelt-Baildon M, Spiekermann K, Herold T, Metzeler KH. Validation and refinement of the 2022 European LeukemiaNet genetic risk stratification of acute myeloid leukemia. Leukemia 2023:10.1038/s41375-023-01884-2. [PMID: 37041198 DOI: 10.1038/s41375-023-01884-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
The revised 2022 European LeukemiaNet (ELN) AML risk stratification system requires validation in large, homogeneously treated cohorts. We studied 1118 newly diagnosed AML patients (median age, 58 years; range, 18-86 years) who received cytarabine-based induction chemotherapy between 1999 and 2012 and compared ELN-2022 to the previous ELN-2017 risk classification. Key findings were validated in a cohort of 1160 mostly younger patients. ELN-2022 reclassified 15% of patients, 3% into more favorable, and 12% into more adverse risk groups. This was mainly driven by patients reclassified from intermediate- to adverse-risk based on additional myelodysplasia-related mutations being included as adverse-risk markers. These patients (n = 79) had significantly better outcomes than patients with other adverse-risk genotypes (5-year OS, 26% vs. 12%) and resembled the remaining intermediate-risk group. Overall, time-dependent ROC curves and Harrel's C-index controlling for age, sex, and AML type (de novo vs. sAML/tAML) show slightly worse prognostic discrimination of ELN-2022 compared to ELN-2017 for OS. Further refinement of ELN-2022 without including additional genetic markers is possible, in particular by recognizing TP53-mutated patients with complex karyotypes as "very adverse". In summary, the ELN-2022 risk classification identifies a larger group of adverse-risk patients at the cost of slightly reduced prognostic accuracy compared to ELN-2017.
Collapse
Affiliation(s)
- Christian Rausch
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Annika Dufour
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Institute of Human Genetics, University Hospital, LMU Munich, Munich, Germany
| | - Hanna Gittinger
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Utz Krug
- Department of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | | | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Michael von Bergwelt-Baildon
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Klaus H Metzeler
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany.
| |
Collapse
|
21
|
Batcha AMN, Buckup N, Bamopoulos SA, Jurinovic V, Rothenberg-Thurley M, Gittinger H, Ksienzyk B, Dufour A, Schneider S, Kontro M, Saad J, Heckmann CA, Sauerland C, Görlich D, Berdel WE, Wörmann BJ, Krug U, Braess J, Mansmann U, Hiddemann W, Spiekermann K, Metzeler KH, Herold T. Germline SNPs previously implicated as prognostic biomarkers do not associate with outcomes in intensively treated AML. Blood Adv 2023; 7:1040-1044. [PMID: 36149944 PMCID: PMC10036512 DOI: 10.1182/bloodadvances.2022007988] [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] [Received: 05/06/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aarif M N Batcha
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE), LMU Munich, Munich, Germany
| | - Nele Buckup
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Stefanos A Bamopoulos
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
- Department of Hematology, Oncology and Tumor Immunology (Campus Benjamin Franklin), Charité University Medicine Berlin, Berlin, Germany
| | - Vindi Jurinovic
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Hanna Gittinger
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Bianka Ksienzyk
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Annika Dufour
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
- Institute of Human Genetics, University Hospital, LMU Munich, Munich, Germany
| | - Mika Kontro
- Department of Haematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Foundation for the Finnish Cancer Institute, Helsinki, Finland
| | - Joseph Saad
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Caroline A Heckmann
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University of Münster, Münster, Germany
| | | | - Utz Krug
- Department of Medicine III, Hospital Leverkusen, Leverkusen, Germany
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE), LMU Munich, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Karsten Spiekermann
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Klaus H Metzeler
- Department of Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Tobias Herold
- Department of Medicine III, Laboratory for Leukemia Diagnostics, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
22
|
Eckardt JN, Röllig C, Metzeler K, Kramer M, Stasik S, Georgi JA, Heisig P, Spiekermann K, Krug U, Braess J, Görlich D, Sauerland CM, Woermann B, Herold T, Berdel WE, Hiddemann W, Kroschinsky F, Schetelig J, Platzbecker U, Müller-Tidow C, Sauer T, Serve H, Baldus C, Schäfer-Eckart K, Kaufmann M, Krause S, Hänel M, Schliemann C, Hanoun M, Thiede C, Bornhäuser M, Wendt K, Middeke JM. Prediction of complete remission and survival in acute myeloid leukemia using supervised machine learning. Haematologica 2023; 108:690-704. [PMID: 35708137 PMCID: PMC9973482 DOI: 10.3324/haematol.2021.280027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
Achievement of complete remission signifies a crucial milestone in the therapy of acute myeloid leukemia (AML) while refractory disease is associated with dismal outcomes. Hence, accurately identifying patients at risk is essential to tailor treatment concepts individually to disease biology. We used nine machine learning (ML) models to predict complete remission and 2-year overall survival in a large multicenter cohort of 1,383 AML patients who received intensive induction therapy. Clinical, laboratory, cytogenetic and molecular genetic data were incorporated and our results were validated on an external multicenter cohort. Our ML models autonomously selected predictive features including established markers of favorable or adverse risk as well as identifying markers of so-far controversial relevance. De novo AML, extramedullary AML, double-mutated CEBPA, mutations of CEBPA-bZIP, NPM1, FLT3-ITD, ASXL1, RUNX1, SF3B1, IKZF1, TP53, and U2AF1, t(8;21), inv(16)/t(16;16), del(5)/del(5q), del(17)/del(17p), normal or complex karyotypes, age and hemoglobin concentration at initial diagnosis were statistically significant markers predictive of complete remission, while t(8;21), del(5)/del(5q), inv(16)/t(16;16), del(17)/del(17p), double-mutated CEBPA, CEBPA-bZIP, NPM1, FLT3-ITD, DNMT3A, SF3B1, U2AF1, and TP53 mutations, age, white blood cell count, peripheral blast count, serum lactate dehydrogenase level and hemoglobin concentration at initial diagnosis as well as extramedullary manifestations were predictive for 2-year overall survival. For prediction of complete remission and 2-year overall survival areas under the receiver operating characteristic curves ranged between 0.77-0.86 and between 0.63-0.74, respectively in our test set, and between 0.71-0.80 and 0.65-0.75 in the external validation cohort. We demonstrated the feasibility of ML for risk stratification in AML as a model disease for hematologic neoplasms, using a scalable and reusable ML framework. Our study illustrates the clinical applicability of ML as a decision support system in hematology.
Collapse
Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden.
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - Klaus Metzeler
- Medical Clinic and Policlinic I Hematology and Cell Therapy. University Hospital, Leipzig
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | | | - Peter Heisig
- Institute of Software and Multimedia Technology, Technical University Dresden, Dresden
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich
| | - Utz Krug
- Medical Clinic III, Hospital Leverkusen, Leverkusen
| | - Jan Braess
- Hospital Barmherzige Brueder Regensburg, Regensburg
| | - Dennis Görlich
- Institute for Biometrics and Clinical Research, University Muenster, Muenster
| | | | - Bernhard Woermann
- Department of Hematology, Oncology and Tumor Immunology, Charité, Berlin
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich
| | - Wolfgang E Berdel
- Department of Internal Medicine A, University Hospital Muenster, Muenster
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I Hematology and Cell Therapy. University Hospital, Leipzig
| | - Carsten Müller-Tidow
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany; German Consortium for Translational Cancer Research DKFZ, Heidelberg
| | - Tim Sauer
- Department of Medicine V, University Hospital Heidelberg, Heidelberg
| | - Hubert Serve
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt
| | - Claudia Baldus
- Department of Hematology and Oncology, University Hospital Schleswig Holstein, Kiel
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine 5, Paracelsus Medical Private University Nuremberg, Nuremberg
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch Hospital, Stuttgart
| | - Stefan Krause
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen
| | - Mathias Hänel
- Department of Internal Medicine 3, Klinikum Chemnitz GmbH, Chemnitz, Germany; Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen
| | | | - Maher Hanoun
- Department of Internal Medicine 3, Klinikum Chemnitz GmbH, Chemnitz, Germany; Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany; German Consortium for Translational Cancer Research DKFZ, Heidelberg
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany; German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany; National Center for Tumor Diseases (NCT), Dresden
| | - Karsten Wendt
- Medical Clinic and Policlinic I Hematology and Cell Therapy. University Hospital, Leipzig
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden
| |
Collapse
|
23
|
Pastore F, Pastore A, Rothenberg-Thurley M, Metzeler KH, Ksienzyk B, Schneider S, Bohlander SK, Braess J, Sauerland MC, Görlich D, Berdel WE, Wörmann B, von Bergwelt-Baildon MS, Hiddemann W, Spiekermann K. Molecular profiling of patients with cytogenetically normal acute myeloid leukemia and hyperleukocytosis. Cancer 2022; 128:4213-4222. [PMID: 36271776 DOI: 10.1002/cncr.34495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) with initial hyperleukocytosis is associated with high early mortality and a poor prognosis. The aims of this study were to delineate the underlying molecular landscape in the largest cytogenetic risk group, cytogenetically normal acute myeloid leukemia (CN-AML), and to assess the prognostic relevance of recurrent mutations in the context of hyperleukocytosis and clinical risk factors. METHODS The authors performed a targeted sequencing of 49 recurrently mutated genes in 56 patients with newly diagnosed CN-AML and initial hyperleukocytosis of ≥100 G/L treated in the AMLCG99 study. The median number of mutated genes per patient was 5. The most common mutations occurred in FLT3 (73%), NPM1 (75%), and TET2 (45%). RESULTS The predominant pathways affected by mutations were signaling (84% of patients), epigenetic modifiers (75% of patients), and nuclear transport (NPM1; 75%) of patients. AML with hyperleukocytosis was enriched for molecular subtypes that negatively affected the prognosis, including a high percentage of patients presenting with co-occurring mutations in signaling and epigenetic modifiers such as FLT3 internal tandem duplications and TET2 mutations. CONCLUSIONS Despite these unique molecular features, clinical risk factors, including high white blood count, hemoglobin level, and lactate dehydrogenase level at baseline, remained the predictors for overall survival and relapse-free survival in hyperleukocytotic CN-AML.
Collapse
Affiliation(s)
- Friederike Pastore
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Alessandro Pastore
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Klaus H Metzeler
- Department of Hematology and Cell Therapy, University Leipzig, Leipzig, Germany
| | - Bianka Ksienzyk
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany.,Institute of Human Genetics, Ludwig Maximilian University Munich, Munich, Germany
| | - Stefan K Bohlander
- Leukemia and Blood Cancer Research Unit, Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Jan Braess
- Department of Oncology and Hematology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Maria C Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology and Oncology, University of Münster, Münster, Germany
| | - Bernhard Wörmann
- Department of Medicine, Hematology, Oncology, and Tumor Immunology, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael S von Bergwelt-Baildon
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Internal Medicine III, Ludwig Maximilian University Munich, Munich, Germany
| |
Collapse
|
24
|
Guenther M, Görlich D, Bernhardt F, Pogatzki-Zahn E, Dasch B, Krueger J, Lenz P. Virtual reality reduces pain in palliative care-A feasibility trial. BMC Palliat Care 2022; 21:169. [PMID: 36195865 PMCID: PMC9533542 DOI: 10.1186/s12904-022-01058-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.
Collapse
Affiliation(s)
- Miriam Guenther
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Burkhard Dasch
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Janina Krueger
- Specialized Outpatient Palliative Care Service Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany. .,Department of Palliative Care, University of Muenster, Albert-Schweitzer-Campus 1, Building W 30, D-48149, Muenster, Germany.
| |
Collapse
|
25
|
Kunadt D, Stasik S, Metzeler KH, Röllig C, Schliemann C, Greif PA, Spiekermann K, Rothenberg-Thurley M, Krug U, Braess J, Krämer A, Hochhaus A, Scholl S, Hilgendorf I, Brümmendorf TH, Jost E, Steffen B, Bug G, Einsele H, Görlich D, Sauerland C, Schäfer-Eckart K, Krause SW, Hänel M, Hanoun M, Kaufmann M, Wörmann B, Kramer M, Sockel K, Egger-Heidrich K, Herold T, Ehninger G, Burchert A, Platzbecker U, Berdel WE, Müller-Tidow C, Hiddemann W, Serve H, Stelljes M, Baldus CD, Neubauer A, Schetelig J, Thiede C, Bornhäuser M, Middeke JM, Stölzel F. Impact of IDH1 and IDH2 mutational subgroups in AML patients after allogeneic stem cell transplantation. J Hematol Oncol 2022; 15:126. [PMID: 36064577 PMCID: PMC9442956 DOI: 10.1186/s13045-022-01339-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background The role of allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML) with mutated IDH1/2 has not been defined. Therefore, we analyzed a large cohort of 3234 AML patients in first complete remission (CR1) undergoing alloHCT or conventional chemo-consolidation and investigated outcome in respect to IDH1/2 mutational subgroups (IDH1 R132C, R132H and IDH2 R140Q, R172K). Methods Genomic DNA was extracted from bone marrow or peripheral blood samples at diagnosis and analyzed for IDH mutations with denaturing high-performance liquid chromatography, Sanger sequencing and targeted myeloid panel next-generation sequencing, respectively. Statistical as-treated analyses were performed using R and standard statistical methods (Kruskal–Wallis test for continuous variables, Chi-square test for categorical variables, Cox regression for univariate and multivariable models), incorporating alloHCT as a time-dependent covariate. Results Among 3234 patients achieving CR1, 7.8% harbored IDH1 mutations (36% R132C and 47% R132H) and 10.9% carried IDH2 mutations (77% R140Q and 19% R172K). 852 patients underwent alloHCT in CR1. Within the alloHCT group, 6.2% had an IDH1 mutation (43.4% R132C and 41.4% R132H) and 10% were characterized by an IDH2 mutation (71.8% R140Q and 24.7% R172K). Variants IDH1 R132C and IDH2 R172K showed a significant benefit from alloHCT for OS (p = .017 and p = .049) and RFS (HR = 0.42, p = .048 and p = .009) compared with chemotherapy only. AlloHCT in IDH2 R140Q mutated AML resulted in longer RFS (HR = 0.4, p = .002). Conclusion In this large as-treated analysis, we showed that alloHCT is able to overcome the negative prognostic impact of certain IDH mutational subclasses in first-line consolidation treatment and could pending prognostic validation, provide prognostic value for AML risk stratification and therapeutic decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01339-8.
Collapse
Affiliation(s)
- Desiree Kunadt
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
| | - Sebastian Stasik
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Klaus H Metzeler
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Philipp A Greif
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Utz Krug
- Medizinische Klinik III, Klinikum Leverkusen, Leverkusen, Germany
| | - Jan Braess
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Alwin Krämer
- Medizinische Klinik Und Poliklinik, Abteilung Innere Medizin V, Universität Heidelberg, Heidelberg, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Edgar Jost
- Medizinische Klinik IV, Uniklinik RWTH Aachen, Aachen, Germany
| | - Björn Steffen
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Gesine Bug
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Dennis Görlich
- Institut für Biometrie und Klinische Forschung, Universität Münster, Münster, Germany
| | - Cristina Sauerland
- Institut für Biometrie und Klinische Forschung, Universität Münster, Münster, Germany
| | - Kerstin Schäfer-Eckart
- Klinik für Innere Medizin 5, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nuremberg, Germany
| | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mathias Hänel
- Medizinische Klinik III, Klinikum Chemnitz, Chemnitz, Germany
| | - Maher Hanoun
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Martin Kaufmann
- Abteilung für Hämatologie, Onkologie und Palliativmedizin, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Bernhard Wörmann
- Abteilung für Hämatologie, Onkologie und Palliativmedizin, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Michael Kramer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Katja Sockel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Andreas Burchert
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Uwe Platzbecker
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Wolfgang E Berdel
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Carsten Müller-Tidow
- Medizinische Klinik Und Poliklinik, Abteilung Innere Medizin V, Universität Heidelberg, Heidelberg, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Hubert Serve
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Matthias Stelljes
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Claudia D Baldus
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Andreas Neubauer
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Johannes Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Christian Thiede
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases, Dresden (NCT/UCC), Dresden, Germany.,German Consortium for Translational Cancer Research (DKTK), DKFZ, Heidelberg, Germany
| | - Jan M Middeke
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Friedrich Stölzel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | |
Collapse
|
26
|
Noto B, Asmus I, Schäfers M, Görlich D, Riemann B. Predictors of Anxiety and Depression in Differentiated Thyroid Cancer Survivors: Results of a Cross-Sectional Study. Thyroid 2022; 32:1077-1085. [PMID: 35734910 DOI: 10.1089/thy.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Despite an excellent survival rate, impairments are recognized in the quality of life and emotional well-being of differentiated thyroid cancer (DTC) survivors. Predictors for anxiety and depression in DTC patients are not well characterized. Objective: To identify predictors for anxiety and depression in DTC survivors. Methods: In this cross-sectional study, all DTC survivors presenting for follow-up between 2014 and 2019 in a tertiary referral hospital were asked to complete the "Hospital Anxiety and Depression Scale" (HADS). Depression (HADS-D) and anxiety (HADS-A) subscores were dichotomized for analysis. Univariate and multivariable logistic regression analyses were performed to identify predictors of anxiety and depression. Inverse probability weighting was applied to correct for bias due to nonresponse. Results: Six hundred forty patients meeting study inclusion criteria completed the HADS questionnaire (73% female, mean age 50 years). Of these, 37.6% and 15.7% of patients demonstrated HADS-A and HADS-D scores ≥8. Female sex, elevated body mass index (BMI), permanent recurrent laryngeal nerve damage (RLND), permanent hypoparathyroidism (PH), comorbidities classified in chapter XIX of the International Classification of Diseases, 10th Revision (ICD-10; external causes of morbidity and mortality), and comorbidities in chapter XXI of ICD-10 (factors influencing health status and contact with health services) were independent predictors for elevated anxiety scores with adjusted odds ratios of 1.9 ([CI 1.2-3.2], p < 0.01), 1.0 ([CI 1.0-1.1], p = 0.02), 2.6 ([CI 1.0-6.3], p = 0.04), 2.0 ([CI 1.1-3.5], p = 0.02), 5.5 ([CI 1.0-29.6], p < 0.05), and 1.7 ([CI 1.1-2.6], p = 0.03). PH, elevated anti-Tg titer, comorbidities of the digestive system (chapter XI of ICD-10), and comorbidities of the genitourinary system (chapter XIV of ICD-10) were independent predictors for depression with adjusted odds ratios of 2.2 ([CI 1.2-4.2], p = 0.01), 1.0 ([CI 1.0-1.0], p = 0.04), 3.0 ([CI 1.5-6.1], p < 0.01), and 2.4 ([CI 1.0-5.7], p = 0.04). Conclusions: Female sex, elevated BMI, RLND, PH, and comorbidities classified in chapter XIX and chapter XXI of ICD-10 are predictors for anxiety in DTC patients. PH, elevated anti-Tg titer, comorbidities of the digestive system, and comorbidities of the genitourinary system are predictors for depression in DTC patients. Physicians involved in the follow-up of DTC patients should devote particular attention to the emotional well-being in DTC patients with PH or permanent RLND.
Collapse
Affiliation(s)
- Benjamin Noto
- Clinic for Radiology, University Hospital Münster, Münster, Germany
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
- West German Cancer Center; University Hospital Münster, Münster, Germany
| | - Inga Asmus
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center; University Hospital Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center; University Hospital Münster, Münster, Germany
- European Institute for Molecular Imaging; University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Burkhard Riemann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
- West German Cancer Center; University Hospital Münster, Münster, Germany
| |
Collapse
|
27
|
Schulze AB, Evers G, Tenk FS, Schliemann C, Schmidt LH, Görlich D, Mohr M. Central airway obstruction treatment with self-expanding covered Y-carina nitinol stents: A single center retrospective analysis. Thorac Cancer 2022; 13:1040-1049. [PMID: 35199949 PMCID: PMC8977163 DOI: 10.1111/1759-7714.14359] [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: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background Central airway obstruction (CAO) is one of the most challenging, potentially lethal complications in malignant and benign respiratory diseases. Worsening dyspnea is also a relevant cause for reduced quality of life in such patients. Here, we present our data on the application of covered, self‐expanding Y‐carina nitinol stents due to benign and malignant diseases. Methods We retrospectively identified 27 patients who had undergone 31 rigid bronchoscopies with implantation of covered Y‐carina nitinol stents over a period of 10 years in order to evaluate indication, clinical course, and outcome. Results Short‐term survival of successfully stented patients with palliative and curative treatment goal did not differ, allowing for diagnosis independent indication. With respect to overall survival, patients with endoluminal obstruction benefited most compared to patients with fistula and/or external compression. Granulation tissue formation (61.3%) and mucus plugging (80.6%) were the most frequent complications. Material defect (6.5%) and migration (3.2%) were rare complications that could be handled by revisional rigid bronchoscopy and stent exchange in some cases. Conclusions Implantation of self‐expanding covered Y‐carina nitinol stents via rigid bronchoscopy is a feasible and safe treatment option for benign and malignant central airway obstruction. Especially in palliative, malignant airway stenosis, stenting might facilitate additional treatment options and optimize dyspnea and eventually quality of life.
Collapse
Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Friederike Sophia Tenk
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pulmonary Medicine and Thoracic Oncology, Klinikum Ingolstadt, Ingolstadt, Germany.,Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische-Wilhelms University Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
28
|
Westphal F, Jehn U, Görlich D, Reuter S. iPTH is not a significant factor influencing the tacrolimus C/D ratio. Clin Transl Sci 2022; 15:805-806. [PMID: 35157352 PMCID: PMC9010258 DOI: 10.1111/cts.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Florian Westphal
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| |
Collapse
|
29
|
Klar K, Knaack D, Kampmeier S, Hein AK, Görlich D, Steltenkamp S, Weyland U, Becker K. Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany. Children 2022; 9:children9020190. [PMID: 35204911 PMCID: PMC8870042 DOI: 10.3390/children9020190] [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] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
Abstract
Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8–11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child’s perspective should be given more consideration in the design and maintenance of sanitary facilities.
Collapse
Affiliation(s)
- Kristin Klar
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (K.K.); (D.K.)
| | - Dennis Knaack
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (K.K.); (D.K.)
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, 48149 Münster, Germany;
| | - Anna Katharina Hein
- Institute of Education, Westphalian Wilhelms-University of Münster, 48143 Münster, Germany; (A.K.H.); (U.W.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westphalian Wilhelms-University of Münster, 48149 Münster, Germany;
| | | | - Ulrike Weyland
- Institute of Education, Westphalian Wilhelms-University of Münster, 48143 Münster, Germany; (A.K.H.); (U.W.)
| | - Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-5560
| |
Collapse
|
30
|
Jehn U, Kortenhorn A, Schütte-Nütgen K, Thölking G, Westphal F, Strauss M, Wennmann DO, Pavenstädt H, Suwelack B, Görlich D, Reuter S. The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial. J Clin Med 2022; 11:jcm11030654. [PMID: 35160109 PMCID: PMC8836679 DOI: 10.3390/jcm11030654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients' electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018-0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards.
Collapse
Affiliation(s)
- Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
- Correspondence: ; Tel.: +49-251-83-47540; Fax: +49-251-83-56973
| | - Anja Kortenhorn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Katharina Schütte-Nütgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Florian Westphal
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Markus Strauss
- Department of Medicine C, Division of Cardiology and Angiology, University Hospital of Muenster, 48149 Muenster, Germany;
| | - Dirk-Oliver Wennmann
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany;
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster, 48149 Muenster, Germany; (A.K.); (K.S.-N.); (G.T.); (F.W.); (D.-O.W.); (H.P.); (B.S.); (S.R.)
| |
Collapse
|
31
|
Jacobi C, Vollert B, Hütter K, von Bloh P, Eiterich N, Görlich D, Taylor CB. Indicated, Web-based Prevention for Women With Anorexia Nervosa Symptoms: A Randomised Controlled Efficacy Trial (Preprint). J Med Internet Res 2021; 24:e35947. [PMID: 35653174 PMCID: PMC9204567 DOI: 10.2196/35947] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although preventive interventions for eating disorders in general have shown promise, interventions specifically targeting individuals at risk for anorexia nervosa (AN) are lacking. Objective The aim of this study was to determine the efficacy of a guided, indicated web-based prevention program for women at risk for AN. Methods We conducted a randomized controlled efficacy trial for women at risk for AN. Assessments were carried out at baseline (before the intervention), after the intervention (10 weeks after baseline), and at 6- and 12-month follow-ups (FUs). A total of 168 women with low body weight (17.5 kg/m2≤BMI≤19 kg/m2) and high weight concerns or with normal body weight (19 kg/m2<BMI≤25 kg/m2), high weight concerns, and high restrained eating were recruited from 3 German universities as well as on the web and randomized to Student Bodies-AN (SB-AN; intervention group [IG]) or a wait-list control group (CG). The exclusion criteria were current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–based full-syndrome eating disorders and serious medical or mental problems. The interventions were a cognitive-behavioral guided web-based prevention program (SB-AN) over 10 weeks (IG) and a wait-list CG. The primary outcomes were clinically significant changes in disordered eating attitudes and behaviors and change in BMI at 12-month FU in the group of participants who were underweight. The secondary outcomes were new onset of eating disorders, symptoms of disordered eating, and associated psychopathology. Results Data were available for 81.5% (137/168) of the women after the intervention and for 69% (116/168) of the women at 12-month FU. At 12-month FU, the IG participants showed larger decreases in Eating Disorder Examination total scores (38/48, 79% vs 33/58, 57%) than the CG participants and the IG participants who were underweight also showed larger clinically relevant increases in BMI (15/31, 49% vs 10/32, 32%) than the CG participants, but these differences were not significant. In addition, after the intervention and at 12-month FU, we found a significant increase in continuously measured BMI for the participants who were underweight and significant improvements in disordered eating attitudes and behaviors (eg, restrained eating as well as weight and shape concerns). At all time points, the rates of new-onset eating disorder cases were (nonsignificantly) lower in the IG than in the CG and the reductions in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition–based eating disorder syndromes were (nonsignificantly) higher in the IG than in the CG. Conclusions SB-AN is the first preventive intervention shown to significantly reduce specific risk factors for, and symptoms of, AN and shows promise for reducing full-syndrome AN onset. Trial Registration ISRCTN Registry ISRCTN70380261; https://www.isrctn.com/ISRCTN70380261
Collapse
Affiliation(s)
- Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Kristian Hütter
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Paula von Bloh
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Nadine Eiterich
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - C Barr Taylor
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
32
|
Görlich D, Friederichs H. Using longitudinal progress test data to determine the effect size of learning in undergraduate medical education - a retrospective, single-center, mixed model analysis of progress testing results. Med Educ Online 2021; 26:1972505. [PMID: 34459724 PMCID: PMC8409971 DOI: 10.1080/10872981.2021.1972505] [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: 03/05/2021] [Revised: 06/10/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
Medical education research focuses on the development of efficient learning methods promoting the acquisition of student's knowledge and competencies. Evaluation of any modification of educational approaches needs to be evaluated accordingly and a reliable effect size needs to be reached. Our aim is to provide a methodological basis to calculate effect sizes from longitudinal progress test data that can be used as reference values in further research. We used longitudinally collected progress test data and evaluated the increasing knowledge of medical students from the first to the fifth academic year. Students were asked to participate in the progress test, which consists of 200 multiple-choice questions in single best answer format with an additional 'don't know' option. All available individual test scores of all progress tests (n = 10) administered between April 2012 and October 2017 were analyzed. Due to the large amount of missing test results, e.g., from students at the beginning of their studies, a linear mixed model was fitted to include all collected data. In total, we analyzed 6324 test scores provided by 2587 medical students. Mean score for medical knowledge (% correct answers) increases from 16.6% (SD: 10.8%) to 51.0% (SD: 15.7%, overall effects size using linear mixed models d = 1.55). Medical students showed a learning effect of d = 0.54 (total gain: 6.9%) between the 1st and 2nd, d = 0.88 (total gain: 12.0%) between the 2nd and 3rd, d = 0.60 (total gain: 7.9%) between the 3rd and 4th and d = 0.58 (total gain: 7.9%) between the 4th and 5th study year. We demonstrated that incomplete data from longitudinally collected progress tests can be used to acquire reliable effect size estimates. The demonstrated effects size between d = 0.53-0.9 by study year may help researchers to design studies in medical education.
Collapse
Affiliation(s)
- Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Germany
| | - Hendrik Friederichs
- Medical Education Research Group, Medical School OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
33
|
Spiesshoefer J, Lutter R, Kabitz HJ, Henke C, Herkenrath S, Randerath W, Young P, Dreher M, Görlich D, Boentert M. Respiratory Muscle Function Tests and Diaphragm Ultrasound Predict Nocturnal Hypoventilation in Slowly Progressive Myopathies. Front Neurol 2021; 12:731865. [PMID: 34721265 PMCID: PMC8551547 DOI: 10.3389/fneur.2021.731865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: In slowly progressive myopathies, diaphragm weakness early manifests through sleep-related hypoventilation as reflected by nocturnal hypercapnia. This study investigated whether daytime tests of respiratory muscle function and diaphragm ultrasound predict hypercapnia during sleep. Methods: Twenty-seven patients with genetic myopathies (myotonic dystrophy type 1 and 2, late-onset Pompe disease, facioscapulohumeral dystrophy; 48 ± 11 years) underwent overnight transcutaneous capnometry, spirometry, measurement of mouth occlusion pressures, and diaphragm ultrasound. Results: Sixteen out of 27 patients showed nocturnal hypercapnia (peak ptcCO2 ≥ 50 mmHg for ≥ 30 min or increase in ptcCO2 by 10 mmHg or more from the baseline value). In these patients, forced vital capacity (FVC; % predicted) and maximum inspiratory pressure (MIP; % of lower limit or normal or LLN) were significantly reduced compared to normocapnic individuals. Nocturnal hypercapnia was predicted by reduction in FVC of <60% [sensitivity, 1.0; area under the curve (AUC), 0.82] and MIP (%LLN) <120% (sensitivity, 0.83; AUC, 0.84), the latter reflecting that in patients with neuromuscular disease, pretest likelihood of abnormality is per se higher than in healthy subjects. Diaphragm excursion velocity during a sniff maneuver excluded nocturnal hypercapnia with high sensitivity (0.90) using a cutoff of 8.0 cm/s. Conclusion: In slowly progressive myopathies, nocturnal hypercapnia is predicted by FVC <60% or MIP <120% (LLN). As a novelty, nocturnal hypercapnia can be excluded with acceptable sensitivity by diaphragm excursion velocity >8.0 cm/s on diaphragm ultrasound.
Collapse
Affiliation(s)
- Jens Spiesshoefer
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany.,Department of Pneumology and Intensive Care Medicine, Aachen University Hospital, Aachen, Germany
| | - Riccarda Lutter
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology, Cardiology, and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Carolin Henke
- Department of Neurology, Herz-Jesu-Krankenhaus Münster-Hiltrup, Münster, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, Aachen University Hospital, Aachen, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Matthias Boentert
- Department of Neurology With Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany.,Department of Medicine, Universitätsklinikum Münster (UKM) Marienhospital, Steinfurt, Germany
| |
Collapse
|
34
|
Langenbruch L, Strippel C, Görlich D, Elger CE, Möddel G, Meuth SG, Kellinghaus C, Wiendl H, Kovac S. Occurrence of status epilepticus in persons with epilepsy is determined by sex, epilepsy classification, and etiology: a single center cohort study. J Neurol 2021; 268:4816-4823. [PMID: 34021409 PMCID: PMC8563665 DOI: 10.1007/s00415-021-10600-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
Background Status epilepticus (SE) can occur in persons with or without epilepsy and is associated with high morbidity and mortality. Methods This survey aimed to record self-reported frequency of SE in persons with epilepsy, its association with clinical characteristics and patient level of information on SE and rescue medication. 251 persons with epilepsy at a tertiary epilepsy center were included in the study. Results 87 (35%) had a history of SE defined as seizure duration of more than 5 min. These patients were less likely to be seizure-free, and had a higher number of present and past anti-seizure medication. Female sex, cognitive disability, younger age at epilepsy onset, defined epilepsy etiology, and focal epilepsy were associated with a history of SE. On Cox regression analysis, female sex, defined etiology and focal classification remained significant. 67% stated that they had information about prolonged seizures, and 75% knew about rescue medication. 85% found it desirable to receive information about SE at the time of initial diagnosis of epilepsy, but only 16% had been offered such information at the time. Conclusion SE is frequent among persons with epilepsy and there remain unmet needs regarding patient education.
Collapse
Affiliation(s)
- Lisa Langenbruch
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Christine Strippel
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Christian E Elger
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Gabriel Möddel
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| |
Collapse
|
35
|
Wächter H, Yörük E, Becker K, Görlich D, Kahl BC. Correlations of Host and Bacterial Characteristics with Clinical Parameters and Survival in Staphylococcus aureus Bacteremia. J Clin Med 2021; 10:1371. [PMID: 33800644 PMCID: PMC8037130 DOI: 10.3390/jcm10071371] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 01/14/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is a frequent, severe condition that occurs in patients of all age groups and affects clinical departments of all medical fields. It is associated with a high mortality rate of 20-30%. In this study, we analyzed patient mortality associated with SAB at our tertiary care university hospital, assessed the clinical management in terms of administered antimicrobial therapy, and determined which factors have an impact on the clinical course and outcome of patients with this disease. We collected clinical data and blood culture isolates of 178 patients diagnosed with SAB between May 2013 and July 2015. For this study, bacteria were cultured and analyzed concerning their phenotype, hemolysis activity, biofilm formation, nuclease activity, prevalence of toxin genes, spa and agr type. Overall mortality was 24.2% and 30-day mortality was 14.6%. Inadequate initial therapy was administered to 26.2% of patients and was associated with decreased survival (p = 0.041). Other factors associated with poor survival were patient age (p = 0.003), agr type 4 (p ≤ 0.001) and pathological leukocyte counts (p = 0.029 if elevated and p = 0.003 if lowered). The type of infection focus, spa clonal complex and enterotoxin genes seg and sei had an impact on severity of inflammation. Our results indicate that mortality and burden of disease posed by SAB are high at our university hospital.
Collapse
Affiliation(s)
- Hannah Wächter
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (H.W.); (E.Y.); (K.B.)
| | - Erdal Yörük
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (H.W.); (E.Y.); (K.B.)
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (H.W.); (E.Y.); (K.B.)
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, 48149 Münster, Germany;
| | - Barbara C. Kahl
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (H.W.); (E.Y.); (K.B.)
| |
Collapse
|
36
|
Weisel KK, Zarski AC, Berger T, Krieger T, Moser CT, Schaub MP, Görlich D, Berking M, Ebert DD. User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study. J Med Internet Res 2020; 22:e16450. [PMID: 32936085 PMCID: PMC7527916 DOI: 10.2196/16450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities. OBJECTIVE The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders. METHODS This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder-7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire-9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d. RESULTS Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace. CONCLUSIONS The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
Collapse
Affiliation(s)
- Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P Schaub
- Swiss Research Institute of Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Clinical, Neuro- & Development Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
37
|
Engel PT, Thavayogarajah T, Görlich D, Lenz P. Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting. Int J Environ Res Public Health 2020; 17:ijerph17144977. [PMID: 32664314 PMCID: PMC7400707 DOI: 10.3390/ijerph17144977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/16/2022]
Abstract
Background and study aims: Acute health service requires focused palliative care (PC). This study was performed to provide guidance for the establishment of a palliative care consultation service (PCCS). Patients and methods: This study was conceived as a retrospective single-center study for observing, analyzing and evaluating the initial setup of a PCCS from 1 May 2015 to 31 May 2018. Patients from Muenster University Hospital with advanced life-limiting diseases, identified to require PC, were included. Results: PCCS was requested from various departments, for between 20 and 80 patients per month, corresponding to a total of 2359 for the study period. Requests were highest in internal medicine (27.3%), gynecology (18.1%) and radiotherapy (17.6%). Time to referral was significantly shorter in departments with special PCCS ward rounds (6 ± 9 vs. 12 ± 22 days, p < 0.001). The most frequently reported symptoms were fatigue, pain and loss of appetite. Pain was frequently localized in the stomach (20.4%), back (17.1%), or in the head and neck area (14.9%). After the first PCCS consultation, 254 patients (90%) reported sufficient pain relief after 48 h. An introduction/modification of painkiller medication, which was recommended for 142 inpatients, was implemented in 57.0% of cases by the respective departments. Overall, the direct realization of PCCS recommendations reached only 50% on average. Conclusions: Besides an analysis of the ability to address the symptoms of the referred patients by the PCCS, this study highlights the importance of the interaction between PCCS and other departments. It further elucidates the role and possibilities of this service both in regular ward rounds and individual staff contacts.
Collapse
Affiliation(s)
- Peter Tom Engel
- Department of Palliative Care, University of Muenster, 48149 Muenster, Germany;
| | - Tharshika Thavayogarajah
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany;
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany;
| | - Philipp Lenz
- Department of Palliative Care, University of Muenster, 48149 Muenster, Germany;
- Correspondence:
| |
Collapse
|
38
|
Jehn U, Görlich D, Reuter S. The Estimation Formula for the Urinary Albumin-Creatinine Ratio Based on the Protein-Creatinine Ratio Are Not Valid for a Kidney Transplant and a Living Donor Cohort. J Am Soc Nephrol 2020; 31:1915-1916. [PMID: 32737207 DOI: 10.1681/asn.2020050545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ulrich Jehn
- Division of General Internal Medicine, Department of Medicine D, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital of Münster, Münster, Germany
| | - Stefan Reuter
- Division of General Internal Medicine, Department of Medicine D, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| |
Collapse
|
39
|
Velasco Gonzalez A, Görlich D, Buerke B, Münnich N, Sauerland C, Rusche T, Faldum A, Heindel W. Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis. Transl Stroke Res 2020; 11:900-909. [PMID: 32447614 PMCID: PMC7496051 DOI: 10.1007/s12975-020-00784-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.
Collapse
Affiliation(s)
- Aglaé Velasco Gonzalez
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Boris Buerke
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Nico Münnich
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Thilo Rusche
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| |
Collapse
|
40
|
Schulze AB, Evers G, Görlich D, Mohr M, Marra A, Hillejan L, Rehkämper J, Schmidt LH, Heitkötter B. Tumor infiltrating T cells influence prognosis in stage I-III non-small cell lung cancer. J Thorac Dis 2020; 12:1824-1842. [PMID: 32642087 PMCID: PMC7330340 DOI: 10.21037/jtd-19-3414a] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 12/24/2022]
Abstract
Background T cell infiltration in non-small cell lung cancer (NSCLC) is essential for the immunological response to malignant tissue, especially in the era of immune-checkpoint inhibition. To investigate the prognostic impact of CD4+ T helper cells (Th), CD8+ cytotoxic (Tc) and FOXP3+ regulatory T (Treg) cells in NSCLC, we performed this analysis. Methods By counterstaining of CD4, CD8 and FOXP3 we used immunohistochemistry on tissue microarrays (TMA) to evaluate peritumoral Th cells, Treg cells and Tc cells in n=294 NSCLC patients with pTNM stage I–III disease. Results Strong CD4+ infiltration was associated with higher tumor stages and lymphonodal spread. However, strong CD4+ infiltration yielded improved overall survival (OS) (P=0.014) in adenocarcinoma (ADC) and large cell carcinoma (LCC) but not in squamous cell carcinoma (SCC). A CD4/CD8 ratio <1 was associated with high grade NSCLC tumors (P=0.020). High CD8+ T cell infiltration was an independent prognostic factor for OS (P=0.040) and progression-free survival (PFS) (P=0.012) in the entire study collective. The OS benefit of high CD8+ infiltration was especially prominent in PD-L1 negative NSCLC (P=0.001) but not in PD-L1 positive tissue (P=0.335). Moreover, positive FOXP3+ expression in tumor infiltrating lymphocytes was associated with increased OS (P=0.007) and PFS (P=0.014) in SCC but not in ADC and LCC (all P>0.05). Here, prognostic effects were prominent in PD-L1 positive SCC (P=0.023) but not in PD-L1 negative SCC (P=0.236). Conclusions High proportion of CD8+ Tc cells correlated with improved prognostic outcome in stage I–III NSCLC. Th cells and Treg cells have implications on outcome with respect to tumor histology and biology.
Collapse
Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische-Wilhelms University Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Alessandro Marra
- Department of Thoracic Surgery, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Niels-Stensen-Kliniken, Ostercappeln, Germany
| | - Jan Rehkämper
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany.,IV. Medical Department, Pulmonary Medicine and Thoracic Oncology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Birthe Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
41
|
Köppe J, Freisinger E, Gerß J, Reinecke H, Görlich D. Re: "Long Term Survival After Femoropopliteal Artery Revascularisation With Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis". Eur J Vasc Endovasc Surg 2020; 60:152. [PMID: 32336619 DOI: 10.1016/j.ejvs.2020.03.048] [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] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jeanette Köppe
- University of Münster, Institute of Biostatistics and Clinical Research, Münster, Germany.
| | - Eva Freisinger
- University Hospital Münster, Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Münster, Germany
| | - Joachim Gerß
- University of Münster, Institute of Biostatistics and Clinical Research, Münster, Germany
| | - Holger Reinecke
- University Hospital Münster, Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Münster, Germany
| | - Dennis Görlich
- University of Münster, Institute of Biostatistics and Clinical Research, Münster, Germany
| |
Collapse
|
42
|
Lange J, Heidenreich K, Higelin K, Dyck K, Marx V, Reichel C, van Wamel W, den Reijer M, Görlich D, Kahl BC. Staphylococcus aureus Pathogenicity in Cystic Fibrosis Patients-Results from an Observational Prospective Multicenter Study Concerning Virulence Genes, Phylogeny, and Gene Plasticity. Toxins (Basel) 2020; 12:toxins12050279. [PMID: 32357453 PMCID: PMC7290773 DOI: 10.3390/toxins12050279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/04/2022] Open
Abstract
Staphylococcus aureus and cystic fibrosis (CF) are closely interlinked. To date, however, the impact of S. aureus culture in CF airways on lung function and disease progression has only been elucidated to a limited degree. This analysis aims to identify bacterial factors associated to clinical deterioration. Data were collected during an observational prospective multi-center study following 195 patients from 17 centers. The average follow-up time was 80 weeks. S. aureus isolates (n = 3180) were scanned for the presence of 25 virulence genes and agr-types using single and multiplex PCR. The presence of specific virulence genes was not associated to clinical deterioration. For the agr-types 1 and 4, however, a link to the subjects’ clinical status became evident. Furthermore, a significant longitudinal decrease in the virulence gene quantity was observed. Analyses of the plasticity of the virulence genes revealed significantly increased plasticity rates in the presence of environmental stress. The results suggest that the phylogenetic background defines S. aureus pathogenicity rather than specific virulence genes. The longitudinal loss of virulence genes most likely reflects the adaptation process directed towards a persistent and colonizing rather than infecting lifestyle.
Collapse
Affiliation(s)
- Jonas Lange
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Kathrin Heidenreich
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Katharina Higelin
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Kristina Dyck
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Vanessa Marx
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Christian Reichel
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
| | - Willem van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center Rotterdam, 3015 CN Rotterdam, The Netherlands; (W.v.W.); (M.d.R.)
| | - Martijn den Reijer
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center Rotterdam, 3015 CN Rotterdam, The Netherlands; (W.v.W.); (M.d.R.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, 48149 Münster, Germany;
| | - Barbara C. Kahl
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (J.L.); (K.H.); (K.H.); (K.D.); (V.M.); (C.R.)
- Correspondence: ; Tel.: +49-251-8355358
| |
Collapse
|
43
|
Westphal C, Görlich D, Kampmeier S, Herzog S, Braun N, Hitschke C, Mellmann A, Peters G, Kahl BC. Antibiotic Treatment and Age Are Associated With Staphylococcus aureus Carriage Profiles During Persistence in the Airways of Cystic Fibrosis Patients. Front Microbiol 2020; 11:230. [PMID: 32174894 PMCID: PMC7055462 DOI: 10.3389/fmicb.2020.00230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/31/2020] [Indexed: 01/14/2023] Open
Abstract
Background Staphylococcus aureus is one of the most isolated pathogens from the airways of cystic fibrosis (CF) patients. There is a lack of information about the clonal nature of S. aureus cultured from CF patients and their impact on disease. We hypothesized that patients would differ in their clinical status depending on S. aureus clonal carriage profiles during persistence. Methods During a 21-months prospective observational multicenter study (Junge et al., 2016), 3893 S. aureus isolates (nose, oropharynx, and sputa) were cultured from 183 CF patients (16 German centers, 1 Austrian center) and subjected to spa-sequence typing to assess clonality. Data were associated to lung function, age, gender, and antibiotic treatment by multivariate regression analysis. Results Two hundred and sixty-five different spa-types were determined with eight prevalent spa-types (isolated from more than 10 patients): t084, t091, t008, t015, t002 t012, t364, and t056. We observed different carriage profiles of spa-types during the study period: patients being positive with a prevalent spa-type, only one, a dominant or related spa-type/s. Patients with more antibiotic cycles were more likely to be positive for only one spa-type (p = 0.005), while older patients were more likely to have related (p = 0.006), or dominant spa-types (p = 0.026). Two percent of isolates were identified as methicillin-resistant S. aureus (MRSA) and evidence of transmission of clones within centers was low. Conclusion There was a significant association of antibiotic therapy and age on S. aureus carriage profiles in CF patients indicating that antibiotic therapy prevents acquisition of new clones, while during aging of patients with persisting S. aureus, dominant clones were selected and mutations in the spa-repeat region accumulated.
Collapse
Affiliation(s)
- Corinna Westphal
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany
| | | | - Susann Herzog
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Nadja Braun
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Carina Hitschke
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | | | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Barbara C Kahl
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | | |
Collapse
|
44
|
Velasco Gonzalez A, Buerke B, Görlich D, Fobker M, Rusche T, Sauerland C, Meier N, Jeibmann A, McCarthy R, Kugel H, Sporns P, Faldum A, Paulus W, Heindel W. Clot Analog Attenuation in Non-contrast CT Predicts Histology: an Experimental Study Using Machine Learning. Transl Stroke Res 2020; 11:940-949. [PMID: 31933117 DOI: 10.1007/s12975-019-00766-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
Exact histological clot composition remains unknown. The purpose of this study was to identify the best imaging variables to be extrapolated on clot composition and clarify variability in the imaging of thrombi by non-contrast CT. Using a CT-phantom and covering a wide range of histologies, we analyzed 80 clot analogs with respect to X-ray attenuation at 24 and 48 h after production. The mean, maximum, and minimum HU values for the axial and coronal reconstructions were recorded. Each thrombus underwent a corresponding histological analysis, together with a laboratory analysis of water and iron contents. Decision trees, a type of supervised machine learning, were used to select the primary variable altering attenuation and the best parameter for predicting histology. The decision trees selected red blood cells (RBCs) for correlation with all attenuation parameters (p < 0.001). Conversely, maximum attenuation on axial CT offered the greatest accuracy for discriminating up to four groups of clot histology (p < 0.001). Similar RBC-rich thrombi displayed variable imaging associated with different iron (p = 0.023) and white blood cell contents (p = 0.019). Water content varied among the different histologies but did not in itself account for the differences in attenuation. Independent factors determining clot attenuation were the RBCs (β = 0.33, CI = 0.219-0.441, p < 0.001) followed by the iron content (β = 0.005, CI = 0.0002-0.009, p = 0.042). Our findings suggest that it is possible to extract more and valuable information from NCCT that can be extrapolated to provide insights into clot histological and chemical composition.
Collapse
Affiliation(s)
- Aglae Velasco Gonzalez
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.
| | - Boris Buerke
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Manfred Fobker
- Center for Laboratory Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Thilo Rusche
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Norbert Meier
- Department of Clinical Radiology, Medical Physics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Astrid Jeibmann
- Institute of Neuropathology, University Hospital Muenster, Pottkamp 2, 48149, Muenster, Germany
| | - Ray McCarthy
- Cerenovus, Galway Neuro Technology Centre, Mervue Business Park, Galway, Ireland
| | - Harald Kugel
- Department of Clinical Radiology, Medical Physics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Peter Sporns
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Muenster, Pottkamp 2, 48149, Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| |
Collapse
|
45
|
Opatz S, Bamopoulos SA, Metzeler KH, Herold T, Ksienzyk B, Bräundl K, Tschuri S, Vosberg S, Konstandin NP, Wang C, Hartmann L, Graf A, Krebs S, Blum H, Schneider S, Thiede C, Middeke JM, Stölzel F, Röllig C, Schetelig J, Ehninger G, Krämer A, Braess J, Görlich D, Sauerland MC, Berdel WE, Wörmann BJ, Hiddemann W, Spiekermann K, Bohlander SK, Greif PA. The clinical mutatome of core binding factor leukemia. Leukemia 2020; 34:1553-1562. [PMID: 31896782 PMCID: PMC7266744 DOI: 10.1038/s41375-019-0697-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 07/23/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022]
Abstract
The fusion genes CBFB/MYH11 and RUNX1/RUNX1T1 block differentiation through disruption of the core binding factor (CBF) complex and are found in 10–15% of adult de novo acute myeloid leukemia (AML) cases. This AML subtype is associated with a favorable prognosis; however, nearly half of CBF-rearranged patients cannot be cured with chemotherapy. This divergent outcome might be due to additional mutations, whose spectrum and prognostic relevance remains hardly defined. Here, we identify nonsilent mutations, which may collaborate with CBF-rearrangements during leukemogenesis by targeted sequencing of 129 genes in 292 adult CBF leukemia patients, and thus provide a comprehensive overview of the mutational spectrum (‘mutatome’) in CBF leukemia. Thereby, we detected fundamental differences between CBFB/MYH11- and RUNX1/RUNX1T1-rearranged patients with ASXL2, JAK2, JAK3, RAD21, TET2, and ZBTB7A being strongly correlated with the latter subgroup. We found prognostic relevance of mutations in genes previously known to be AML-associated such as KIT, SMC1A, and DHX15 and identified novel, recurrent mutations in NFE2 (3%), MN1 (4%), HERC1 (3%), and ZFHX4 (5%). Furthermore, age >60 years, nonprimary AML and loss of the Y-chromosomes are important predictors of survival. These findings are important for refinement of treatment stratification and development of targeted therapy approaches in CBF leukemia.
Collapse
Affiliation(s)
- Sabrina Opatz
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanos A Bamopoulos
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Klaus H Metzeler
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Bianka Ksienzyk
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Kathrin Bräundl
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Tschuri
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Vosberg
- Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Nikola P Konstandin
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Christine Wang
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Luise Hartmann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Graf
- Laboratory for Functional Genome Analysis at the Gene Center, LMU Munich, Munich, Germany
| | - Stefan Krebs
- Laboratory for Functional Genome Analysis at the Gene Center, LMU Munich, Munich, Germany
| | - Helmut Blum
- Laboratory for Functional Genome Analysis at the Gene Center, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Institute of Human Genetics, University Hospital, LMU Munich, Munich, Germany
| | - Christian Thiede
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Moritz Middeke
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Friedrich Stölzel
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Röllig
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Schetelig
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Gerhard Ehninger
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alwin Krämer
- German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Braess
- Oncology and Hematology, St. John of God Hospital, Regensburg, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | | | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - Bernhard J Wörmann
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow, Berlin, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan K Bohlander
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philipp A Greif
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany. .,Experimental Leukemia & Lymphoma Research, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany. .,German Cancer Consortium (DKTK), Heidelberg, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
46
|
Schulze AB, Schmidt LH, Heitkötter B, Huss S, Mohr M, Marra A, Hillejan L, Görlich D, Barth PJ, Rehkämper J, Evers G. Prognostic impact of CD34 and SMA in cancer-associated fibroblasts in stage I-III NSCLC. Thorac Cancer 2019; 11:120-129. [PMID: 31760702 PMCID: PMC6938745 DOI: 10.1111/1759-7714.13248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/06/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Epithelial‐to‐mesenchymal transition (EMT) is a crucial step in lung cancer pathogenesis. Among others, cancer‐associated fibroblasts (CAFs) are reported to regulate this process. Objectives To investigate the prognostic and clinical impact, we analyzed CD34+ and SMA+ CAFs in non‐small cell lung cancer (NSCLC). Methods Retrospectively, immunohistochemistry was performed to study stromal protein expression of both CD34 and SMA in 304 NSCLC patients with pTNM stage I‐III disease. All tissue samples were embedded on tissue microarrays (TMAs). Results Our analysis revealed an association for CD34+ CAFs with G1/2 tumors and adenocarcinoma histology. Moreover CD34+ CAFs were identified as an independent prognostic factor (both for progression free survival [PFS] and overall survival [OS] in stage I‐III NSCLC). Besides, SMA+ expression correlated with higher pTNM‐tumor stages and lymphatic spread (pN stage). In turn, SMA‐negativity was associated with improved PFS, but no prognostic impact was found on OS. Of interest, neither CD34+ CAFs nor SMA+ CAFs were associated with the primary tumor size, localization and depth of infiltration (pT stage). Conclusions CD34 was identified as an independent prognostic marker in pTNM stage I‐III NSCLC. Moreover, loss of CD34+ CAFs might influence the dedifferentiation of the NSCLC tumor from its cell origin. Finally, SMA+ CAFs are more prevalent in NSCLC tumors of higher stages and lymphonodal positive NSCLC. Key points Expression of CD34 on cancer associated fibroblasts (CAFs) is an independent prognostic factor in stage I‐III NSCLC. SMA+ cancer associated fibroblasts are associated with higher tumor stages in NSCLC and might contribute to tumor progression in NSCLC.
Collapse
Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Birthe Heitkötter
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Sebastian Huss
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Alessandro Marra
- Department of Thoracic Surgery, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Niels-Stensen-Kliniken Ostercappeln, Ostercappeln, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-University Muenster, Muenster, Germany
| | - Peter J Barth
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Jan Rehkämper
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
47
|
Henke C, Spiesshoefer J, Kabitz HJ, Herkenrath S, Randerath W, Brix T, Görlich D, Young P, Boentert M. Characteristics of respiratory muscle involvement in myotonic dystrophy type 1. Neuromuscul Disord 2019; 30:17-27. [PMID: 31839403 DOI: 10.1016/j.nmd.2019.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 01/21/2023]
Abstract
The pathophysiology of respiratory muscle weakness in myotonic dystrophy type 1 (DM1) remains incompletely understood. 21 adult patients with DM1 (11 men, 42 ± 13 years) and 21 healthy matched controls underwent spirometry, manometry, and diaphragm ultrasound. In addition, surface electromyography of the diaphragm and the obliquus abdominis muscle was performed following cortical and posterior cervical magnetic stimulation (CMS) of the phrenic nerves or magnetic stimulation of the lower thoracic nerve roots. Magnetic stimulation was combined with invasive recording of the twitch transdiaphragmatic and gastric pressure (twPdi and twPgas) in 10 subjects per group. The following parameters were reduced in DM1 patients compared to control subjects: maximum inspiratory pressure (MIP; 40.3 ± 19.2 vs. 95.8 ± 28.5 cmH2O, p < 0.01), diaphragm thickening ratio (DTR; 2.0 ± 0.4 vs. 2.7 ± 0.6, p < 0.01), twPdi following CMS (10.8 ± 8.3 vs. 21.4 ± 10.1 cmH2O, p = 0.03), and amplitude of diaphragm compound muscle action potentials (0.10 ± 0.25 vs. 0.46 ± 0.35 mV; p = 0.04). MIP and DTR were significantly correlated with the muscular impairment rating scale (MIRS) score. Maximum expiratory pressure (MEP) was reduced in DM1 patients compared to controls (41.3 ± 13.4 vs. 133.8 ± 28.0 cmH2O, p < 0.01) and showed negative correlation with the MIRS score. Pgas following a maximum cough was markedly lower in patients than in controls (71.9 ± 43.2 vs. 102.4 ± 35.5 cmH2O) but without statistical significance (p = 0.06). In DM1, respiratory muscle weakness relates to clinical disease severity and involves inspiratory and probably expiratory muscle strength. Axonal phrenic nerve pathology may contribute to diaphragm dysfunction.
Collapse
Affiliation(s)
- Carolin Henke
- Respiratory Physiology Laboratory, Institute for Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Jens Spiesshoefer
- Respiratory Physiology Laboratory, Institute for Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany; Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany; Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Tobias Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Dennis Görlich
- Insitute for Biostatistics and Clinical Research, University Hospital, Muenster, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Matthias Boentert
- Respiratory Physiology Laboratory, Institute for Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany.
| |
Collapse
|
48
|
Henke C, Spiesshoefer J, Kabitz HJ, Herkenrath S, Randerath W, Brix T, Görlich D, Young P, Boentert M. Respiratory muscle weakness in facioscapulohumeral muscular dystrophy. Muscle Nerve 2019; 60:679-686. [PMID: 31566774 DOI: 10.1002/mus.26717] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/07/2019] [Accepted: 09/11/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The purpose of this study was to comprehensively evaluate respiratory muscle function in adults with facioscapulohumeral muscular dystrophy (FSHD). METHODS Fourteen patients with FSHD (9 men, 53 ± 16 years of age) and 14 matched controls underwent spirometry, diaphragm ultrasound, and measurement of twitch gastric and transdiaphragmatic pressures (twPgas and twPdi; n = 10) after magnetic stimulation of the lower thoracic nerve roots and the phrenic nerves. The latter was combined with recording of diaphragm compound muscle action potentials (CMAPs; n = 14). RESULTS The following parameters were significantly lower in patients vs controls: forced vital capacity (FVC); maximum inspiratory and expiratory pressure; peak cough flow; diaphragm excursion amplitude; and thickening ratio on ultrasound, twPdi (11 ± 5 vs 20 ± 6 cmH2 O) and twPgas (7 ± 3 vs 25 ± 20 cmH2 O). Diaphragm CMAP showed no group differences. FVC correlated inversely with the clinical severity scale score (r = -0.63, P = .02). DISCUSSION In FSHD, respiratory muscle weakness involves both the diaphragm and the expiratory abdominal muscles.
Collapse
Affiliation(s)
- Carolin Henke
- Respiratory Physiology Laboratory, Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Jens Spiesshoefer
- Respiratory Physiology Laboratory, Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Simon Herkenrath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital gGmbH Solingen, Solingen, Germany.,Institute for Pneumology, University of Cologne, Solingen, Germany
| | - Tobias Brix
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Dennis Görlich
- Institute for Biostatistics and Clinical Research, University Hospital, Münster, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Bad Feilnbach, Germany
| | - Matthias Boentert
- Respiratory Physiology Laboratory, Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| |
Collapse
|
49
|
Roden L, Görlich D, Omran H, Peters G, Große-Onnebrink J, Kahl BC. A retrospective analysis of the pathogens in the airways of patients with primary ciliary dyskinesia. Respir Med 2019; 156:69-77. [PMID: 31437650 DOI: 10.1016/j.rmed.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/26/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare genetically heterogeneous disorder of motile cilia, which leads to recurrent and chronic airway infections. Detailed information about infection causing pathogens is scarce. With this study, we aimed to determine the prevalence and susceptibility of the most common respiratory pathogens in PCD patients retrospectively in a cross-sectional and the dynamics of the microbiological diversity in a longitudinal study. METHODS Microbiological and clinical data of 106 patients between 2010 and 2016 were analysed cross-sectionally and of 28 patients longitudinally. Dynamics in microbiological diversity were assessed by calculating the mean rate of alteration (MRA). RESULTS Haemophilus influenzae was the most common pathogen (n = 41; 38.7%) followed by Staphylococcus aureus (n = 36; 34%), Moraxella catarrhalis (n = 18; 17%) and Pseudomonas aeruginosa (n = 16; 15.1%). Nontuberculous mycobacteria were cultured from two patients (1.9%). H. influenzae was the most prevalent pathogen in children (n = 31; 45.6%), S. aureus in adults (n = 15; 39%). Two patients were infected by methicillin-resistant S. aureus. P. aeruginosa was mostly susceptible to standard antibiotics with highest rates of resistance against fosfomycin (63.6%; 7/11). The culture of P. aeruginosa correlated negatively with age adjusted FEV1% predicted (p = 0.04), while the MRA was positively associated with age (rho 0.411, p = 0.032). DISCUSSION In PCD patients, the prevalence of pathogens differed in children and adults with H. influenzae and S. aureus being the most common pathogens in children, S. aureus and P. aeruginosa in adults, respectively. Unexpectedly, the MRA increased by age.
Collapse
Affiliation(s)
- Lukas Roden
- Institute of Medical Microbiology, University Hospital Münster, Germany.
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Hospital Münster, Germany.
| | - Heymut Omran
- Department of General Pediatrics, University Hospital Münster, Germany.
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Germany.
| | | | - Barbara C Kahl
- Institute of Medical Microbiology, University Hospital Münster, Germany.
| |
Collapse
|
50
|
Beintner I, Vollert B, Zarski AC, Bolinski F, Musiat P, Görlich D, Ebert DD, Jacobi C. Adherence Reporting in Randomized Controlled Trials Examining Manualized Multisession Online Interventions: Systematic Review of Practices and Proposal for Reporting Standards. J Med Internet Res 2019; 21:e14181. [PMID: 31414664 PMCID: PMC6713038 DOI: 10.2196/14181] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 03/29/2019] [Revised: 06/07/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023] Open
Abstract
Background Adherence reflects the extent to which individuals experience or engage with the content of online interventions and poses a major challenge. Neglecting to examine and report adherence and its relation to outcomes can compromise the interpretation of research findings. Objective The aim of this systematic review is to analyze how adherence is accounted for in publications and to propose standards for measuring and reporting adherence to online interventions. Methods We performed a systematic review of randomized controlled trials on online interventions for the prevention and treatment of common mental disorders (depression, anxiety disorders, substance related disorders, and eating disorders) published between January 2006 and May 2018 and indexed in Medline and Web of Science. We included primary publications on manualized online treatments (more than 1 session and successive access to content) and examined how adherence was reported in these publications. Results We identified 216 publications that met our inclusion criteria. Adherence was addressed in 85% of full-text manuscripts, but only in 31% of abstracts. A median of three usage metrics were reported; the most frequently reported usage metric (61%) was intervention completion. Manuscripts published in specialized electronic health journals more frequently included information on the relation of adherence and outcomes. Conclusions We found substantial variety in the reporting of adherence and the usage metrics used to operationalize adherence. This limits the comparability of results and impedes the integration of findings from different studies. Based on our findings, we propose reporting standards for future publications on online interventions.
Collapse
Affiliation(s)
- Ina Beintner
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Bianka Vollert
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Anna-Carlotta Zarski
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Felix Bolinski
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter Musiat
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - David Daniel Ebert
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Corinna Jacobi
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|