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Ryba A, Özdemir Z, Nissimov N, Hönikl L, Neidert N, Jakobs M, Kalasauskas D, Krigers A, Thomé C, Freyschlag CF, Ringel F, Unterberg A, Dao Trong P, Beck J, Heiland DH, Meyer B, Vajkoczy P, Onken J, Stummer W, Suero Molina E, Gempt J, Westphal M, Schüller U, Mohme M. Insights from a Multicenter Study on Adult H3 K27M-Mutated Glioma: Surgical Resection's Limited Influence on Overall Survival, ATRX as Molecular Prognosticator. Neuro Oncol 2024:noae061. [PMID: 38507506 DOI: 10.1093/neuonc/noae061] [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: 11/04/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 WHO classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic factors and impact of surgery on adults. Here, we report a multicentric study of this entity in adults. METHODS We included molecularly confirmed H3 K27M-mutated glioma cases in patients >18 years diagnosed between 2016 and 2022. Clinical, radiological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Among 70 patients with a mean age of 36.1 years, the median overall survival (OS) was 13.6 + 14 months. Gross-total resection was achieved in 14.3% of patients, whereas 30% had a subtotal resection and 54.3% a biopsy.Tumors located in telencephalon/diencephalon/myelencephalon were associated with a poorer OS, while a location in the mesencephalon/metencephalon showed a significantly longer OS (8.7 vs. 25.0 months, p=0.007). Preoperative Karnofsky Performance Score (KPS) < 80 showed a reduced OS (4.2 vs. 18 months, p=0.02). Furthermore, ATRX loss, found in 25.7%, was independently associated with an increased OS (31 vs. 8.3 months, p=0.0029). Notably, patients undergoing resection showed no survival benefit over biopsy (12 vs. 11 months, p=0.4006). CONCLUSION The present study describes surgical features of H3 K27M-mutated glioma in adulthood in a large multicentric study. Our data reveal that ATRX status, location and KPS significantly impact OS in H3 K27M-mutated glioma. Importantly, our dataset indicates that resection does not offer a survival advantage over biopsy.
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Affiliation(s)
- A Ryba
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Germany
| | - Z Özdemir
- Department of Neurosurgery, University Hospital of Münster, Germany
| | - N Nissimov
- Department of Neurosurgery, Charité University Hospital Berlin, Germany
| | - L Hönikl
- Department of Neurosurgery, Technical University Munich, Germany
| | - N Neidert
- Department of Neurosurgery, Medical Center - University of Freiburg, Germany
| | - M Jakobs
- Department of Neurosurgery, Heidelberg University Hospital, Germany
- Department of Neurosurgery, Division of Stereotactic Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - D Kalasauskas
- Department of Neurosurgery, University Medical Center Mainz, Germany
| | - A Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Austria
| | - C Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Austria
| | - C F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Austria
| | - F Ringel
- Department of Neurosurgery, University Medical Center Mainz, Germany
| | - A Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - P Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - J Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Germany
| | - D H Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Germany
| | - B Meyer
- Department of Neurosurgery, Technical University Munich, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité University Hospital Berlin, Germany
| | - J Onken
- Department of Neurosurgery, Charité University Hospital Berlin, Germany
| | - W Stummer
- Department of Neurosurgery, University Hospital of Münster, Germany
| | - E Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Germany
| | - J Gempt
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Germany
| | - M Westphal
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Germany
| | - U Schüller
- Institute of Neuropathology, Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Hematology and Oncology, Medical Center Hamburg-Eppendorf, Germany
- Research Institute Children's Cancer Center Hamburg, Germany
| | - M Mohme
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Germany
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Früh A, Zdunczyk A, Wolf S, Mertens R, Spindler P, Wasilewski D, Hecht N, Bayerl S, Onken J, Wessels L, Faust K, Vajkoczy P, Truckenmueller P. Craniectomy size and decompression of the temporal base using the altered posterior question-mark incision for decompressive hemicraniectomy. Sci Rep 2023; 13:11419. [PMID: 37452076 PMCID: PMC10349086 DOI: 10.1038/s41598-023-37689-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
The altered posterior question-mark incision for decompressive hemicraniectomy (DHC) was proposed to reduce the risk of intraoperative injury of the superficial temporal artery (STA) and demonstrated a reduced rate of wound-healing disorders after cranioplasty. However, decompression size during DHC is essential and it remains unclear if the new incision type allows for an equally effective decompression. Therefore, this study evaluated the efficacy of the altered posterior question-mark incision for craniectomy size and decompression of the temporal base and assessed intraoperative complications compared to a modified standard reversed question-mark incision. The authors retrospectively identified 69 patients who underwent DHC from 2019 to 2022. Decompression and preservation of the STA was assessed on postoperative CT scans and CT or MR angiography. Forty-two patients underwent DHC with the standard reversed and 27 patients with the altered posterior question-mark incision. The distance of the margin of the craniectomy to the temporal base was 6.9 mm in the modified standard reversed and 7.2 mm in the altered posterior question-mark group (p = 0.77). There was no difference between the craniectomy sizes of 158.8 mm and 158.2 mm, respectively (p = 0.45), and there was no difference in the rate of accidental opening of the mastoid air cells. In both groups, no transverse/sigmoid sinus was injured. Twenty-four out of 42 patients in the modified standard and 22/27 patients in the altered posterior question-mark group had a postoperative angiography, and the STA was preserved in all cases in both groups. Twelve (29%) and 5 (19%) patients underwent revision due to wound-healing disorders after DHC, respectively (p = 0.34). There was no difference in duration of surgery. Thus, the altered posterior question-mark incision demonstrated technically equivalent and allows for an equally effective craniectomy size and decompression of the temporal base without increasing risks of intraoperative complications. Previously described reduction in wound-healing complications and cranioplasty failures needs to be confirmed in prospective studies to demonstrate the superiority of the altered posterior question-mark incision.
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Affiliation(s)
- A Früh
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, BIH Academy, Junior Digital Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Zdunczyk
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - S Wolf
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - R Mertens
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, BIH Academy, Junior Clinician Scientist Program, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - P Spindler
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - D Wasilewski
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - N Hecht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - S Bayerl
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - J Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - L Wessels
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - K Faust
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - P Truckenmueller
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Münch A, Teichmann D, Kuzman P, Spille D, Perez E, May S, Mueller W, Kombos T, Nazari-Dehkordi S, Onken J, Vajkoczy P, Ntoulias G, Paulus W, Heppner F, Koch A, Capper D, Kaul D, Thomas C, Schweizer L. P05.05.B A new IDH-wildtype glioma subtype characterized by highly diffuse growth pattern, distinct epigenetic profile and relatively favorable prognosis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
DNA methylation profiling has emerges as a powerful approach to CNS tumor classification and the discovery of novel, molecularly distinct entities. With the release of the 12.5 version of the Heidelberg Brain Tumor Classifier, some unclassifiable cases can be assigned to novel methylation classes. We retrospectively reviewed our databases and identified 16 previously unclassifiable cases, all of which belong to the provisional methylation class “adult-type diffuse high-grade glioma, IDH-wildtype, subtype F (HGG_F)”.
Material and Methods
We clinically, radiologically and morphologically characterized 16 HGG_F cases and compared them to 347 glioblastomas. We additionally analyzed copy-number alterations and performed DNA exome sequencing.
Results
Median age at diagnosis of the 12 males and 4 females was 65 years. Upon initial diagnostic workup, specimens were classified as CNS tissue with reactive changes (n=3) or suspicious for the infiltration zone of a diffuse glioma (n = 13). None of the cases demonstrated endothelial proliferation or necrosis and 10/16 tumors had flat copy number profiles. Radiological characteristics were reminiscent of gliomatosis cerebri in eight cases and 9/9 cases had normal FET-PET scans. Whole-exome sequencing revealed genetic alterations frequently found in IDH-wildtype glioblastomas, including TERT promoter mutations in 11/14 (78.6%) and PIK3 mutations (10/14, 71.4%). Outcome was significantly better compared to TCGA IDH-wildtype glioblastomas with a median progression-free survival of 58 months and overall survival of 73 months (both p<0.001).
Conclusion
We provide evidence that TERT promoter mutations in diffusely infiltrating gliomas without further morphological or molecular signs of high-grade glioma should be interpreted in the context of the clinico-radiological presentation as well as epigenetic prolife and may not be suitable as standalone diagnostic marker for glioblastoma, IDH wildtype.
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Affiliation(s)
- A Münch
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Teichmann
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - P Kuzman
- Institute of Neuropathology, University Hospital Leipzig , Leipzig , Germany
| | - D Spille
- Department of Neurosurgery, University Hospital Münster , Münster , Germany
| | - E Perez
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - S May
- Klinikum Chemnitz, Department of Neurosurgery , Chemnitz , Germany
| | - W Mueller
- Institute of Neuropathology, University Hospital Leipzig , Leipzig , Germany
| | - T Kombos
- Schlosspark-Klinik Charlottenburg, Department of Neurosurgery , Berlin , Germany
| | - S Nazari-Dehkordi
- Schlosspark-Klinik Charlottenburg, Department of Neurosurgery , Berlin , Germany
| | - J Onken
- Charité - Universitätsmedizin Berlin, Department of Neurosurgery , Berlin , Germany
| | - P Vajkoczy
- Charité - Universitätsmedizin Berlin, Department of Neurosurgery , Berlin , Germany
| | - G Ntoulias
- Vivantes Klinikum Neukölln, Department of Neurosurgery , Berlin , Germany
| | - W Paulus
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - F Heppner
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - A Koch
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Capper
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
| | - D Kaul
- Charité - Universitätsmedizin Berlin, Department of Radiation Oncology and Radiotherapy , Berlin , Germany
| | - C Thomas
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - L Schweizer
- Charité - Universitätsmedizin Berlin, Department of Neuropathology , Berlin , Germany
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Onken J, Goerling U, Heinrich M, Guenes S, Krex D, Vajkoczy P, Misch M. P01.121 Optune treatment does not affect quality of life in treatment of high grade glioma compared to chemo-radiotherapy alone. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Onken
- Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - U Goerling
- Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - M Heinrich
- Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - S Guenes
- MSB Medical School Berlin, Berlin, Germany
| | - D Krex
- Universitaetsklinikum Dresden Carl Gustav Carus, Dresden, Germany
| | - P Vajkoczy
- Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - M Misch
- Charite Universitaetsmedizin Berlin, Berlin, Germany
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Schreiber L, Rapp M, Sabel M, Onken J, Misch M, Kinzel A, Thomé C, Scholz M, Vajkoczy P, Freyschlag CF. P09.07 The use of programmable shunts in patients treated with Tumor Treating Fields: Multicentric Case Series. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Misch M, Onken J. P09.32 High therapy compliance in patients treated with Optune® therapy does not depend on demographic data, stage of disease or treatment duration. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Onken J, Reinke A, Radke J, Finger T, Bayerl S, Vajkoczy P, Meyer B. Revision surgery for cervical artificial disc: Surgical technique and clinical results. Clin Neurol Neurosurg 2016; 152:39-44. [PMID: 27888676 DOI: 10.1016/j.clineuro.2016.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/23/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cervical artificial disc replacement (C-ADR) was developed with the goal of preserving mobility of the cervical segment in patients with degenerative disc disease. So far, little is known about experiences with revision surgery and explantation of C-ADRs. Here, we report our experience with revision the third generation, Galileo-type disc prosthesis from a retrospective study of two institutions. PATIENTS AND METHODS Between November 2008 and July 2016, 16 patients with prior implantation of C-ADR underwent removal of the Galileo-type disc prosthesis (Signus, Medizintechnik, Germany) due to a call back by industry. In 10 patients C-ADR was replaced with an alternative prosthesis, 6 patients received an ACDF. Duration of surgery, time to revision, surgical procedure, complication rate, neurological status, histological findings and outcome were examined in two institutions. RESULTS The C-ADR was successfully revised in all patients. Surgery was performed through the same anterior approach as the initial access. Duration of the procedure varied between 43 and 80min. Access-related complications included irritation of the recurrent nerve in one patient and mal-positioning of the C-ADR in another patient. Follow up revealed two patients with permanent mild/moderate neurologic deficits, NDI (neck disability index) ranged between 10 and 42%. CONCLUSIONS Anterior exposure of the cervical spine for explantation and revision of C-ADR performed through the initial approach has an overall complication rate of 18.75%. Replacements of the Galileo-type disc prosthesis with an alternative prosthesis or conversion to ACDF are both suitable surgical options without significant difference in outcome.
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Affiliation(s)
- J Onken
- Department of Neurosurgery, Charité, Berlin, Germany
| | - A Reinke
- Department of Neurosurgery, TMU, Munich, Germany
| | - J Radke
- Department of Neuropathology, Charité, Berlin, Germany
| | - T Finger
- Department of Neurosurgery, Charité, Berlin, Germany
| | - S Bayerl
- Department of Neurosurgery, Charité, Berlin, Germany
| | - P Vajkoczy
- Department of Neurosurgery, Charité, Berlin, Germany.
| | - B Meyer
- Department of Neurosurgery, TMU, Munich, Germany
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Sandborn WJ, Bhandari BR, Fogel R, Onken J, Yen E, Zhao X, Jiang Z, Ge D, Xin Y, Ye Z, French D, Silverman JA, Kanwar B, Subramanian GM, McHutchison JG, Lee SD, Shackelton LM, Pai RK, Levesque BG, Feagan BG. Randomised clinical trial: a phase 1, dose-ranging study of the anti-matrix metalloproteinase-9 monoclonal antibody GS-5745 versus placebo for ulcerative colitis. Aliment Pharmacol Ther 2016; 44:157-69. [PMID: 27218676 PMCID: PMC5089609 DOI: 10.1111/apt.13653] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/26/2016] [Accepted: 04/16/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Matrix metalloproteinase-9 is a proteolytic enzyme whose expression is increased in ulcerative colitis. AIM To evaluate the safety and efficacy of GS-5745, a fully humanised anti-matrix metalloproteinase-9 monoclonal antibody, in moderately-to-severely active ulcerative colitis. METHODS We randomised 74 patients with ulcerative colitis to treatment with single or multiple ascending intravenous or subcutaneous doses of GS-5745 or placebo. Multiple-dose cohorts received either IV infusions (0.3, 1.0, 2.5 or 5.0 mg/kg GS-5745 or placebo) every 2 weeks (three total IV infusions) or five weekly SC injections (150 mg GS-5745 or placebo). The primary outcomes were the safety, tolerability and pharmacokinetics of escalating single and multiple doses of GS-5745. Exploratory analyses in the multiple-dose cohorts included clinical response (≥3 points or 30% decrease from baseline in Mayo Clinic score and ≥1 point decrease in the rectal bleeding subscore or a rectal bleeding subscore ≤1) and clinical remission (a complete Mayo Clinic score ≤2 with no subscore >1) at Day 36. Biological effects associated with a clinical response to GS-5745 were explored using histological and molecular approaches. RESULTS Twenty-three of the 42 patients (55%) receiving multiple doses of GS-5745 had adverse events, compared with 5/8 patients (63%) receiving placebo. GS-5745 showed target-mediated drug disposition, approximately dose-proportional increases in maximum plasma concentration and more than dose-proportional increases in the area under the plasma drug concentration-time curve. Clinical response occurred in 18/42 patients (43%) receiving GS-5745 compared with 1/8 patients (13%) receiving placebo. Clinical remission occurred in 6/42 patients (14%) receiving GS-5745 and 0/8 (0%) receiving placebo. Patients with a clinical response to GS-5745 had reductions in matrix metalloproteinase-9 tissue levels (mean 48.9% decrease from baseline compared with a mean 18.5% increase in nonresponders, P = 0.008) significant improvements in histopathology scores (confirmed with three separate histological disease activity indices), as well as changes in colonic gene expression that were consistent with reduced inflammation. CONCLUSION This phase 1 trial provides preliminary evidence for the safety and therapeutic potential of GS-5745 in the treatment of ulcerative colitis.
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Affiliation(s)
- W. J. Sandborn
- Robarts Clinical TrialsUniversity of Western OntarioLondonONCanada,University of CaliforniaSan DiegoCAUSA
| | | | - R. Fogel
- Clinical Research Institute of MichiganLLCChesterfieldMIUSA
| | - J. Onken
- Duke University Medical CenterDurhamNCUSA
| | - E. Yen
- Gilead Sciences, Inc.Foster CityCAUSA
| | - X. Zhao
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Z. Jiang
- Gilead Sciences, Inc.Foster CityCAUSA
| | - D. Ge
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Y. Xin
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Z. Ye
- Gilead Sciences, Inc.Foster CityCAUSA
| | - D. French
- Gilead Sciences, Inc.Foster CityCAUSA
| | | | - B. Kanwar
- Gilead Sciences, Inc.Foster CityCAUSA
| | | | | | - S. D. Lee
- University of WashingtonSeattleWAUSA
| | - L. M. Shackelton
- Robarts Clinical TrialsUniversity of Western OntarioLondonONCanada
| | | | - B. G. Levesque
- Robarts Clinical TrialsUniversity of Western OntarioLondonONCanada
| | - B. G. Feagan
- Robarts Clinical TrialsUniversity of Western OntarioLondonONCanada,Department of MedicineUniversity of Western OntarioLondonONCanada,Department of Epidemiology and BiostatisticsUniversity of Western OntarioLondonONCanada
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Finger T, Bayerl S, Onken J, Czabanka M, Woitzik J, Vajkoczy P. Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative spine disease. Eur Spine J 2014; 23:1013-20. [PMID: 24448893 DOI: 10.1007/s00586-014-3165-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative spine disease. METHODS A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. RESULTS The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). CONCLUSION The surgical treatment of multilevel degenerative spine disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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Affiliation(s)
- T Finger
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Frömke C, Hothorn L, Sczesny F, Onken J, Schneider M. Analytical method transfer: Improving interpretability with ratio-based statistical approaches. J Pharm Biomed Anal 2013; 74:186-93. [DOI: 10.1016/j.jpba.2012.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/20/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
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Abstract
This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.
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Affiliation(s)
- D Provenzale
- Division of Gastroenterology, Duke University Medical Center, Durham VA Medical Center, North Carolina 27710, USA
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Abstract
The biotransformation of limonene by the basidiomycete Pleurotus sapidus yielded cis/trans-carveol and carvone as the main products. The transformation period was extended from 4 days after direct addition to 12 days by gas phase addition of the substrate. After 2 days of transformation, 97% of the substrate had accumulated in the mycelium, while only 3% were present in the culture medium. Substrate toxicity led to a decrease of dry matter. Adaptation of the precultures with small amounts of substrate doubled the concentration of carveol and increased the concentration of carvone by a factor of 3-4. Total product concentrations of > 100 mg l-1 were reached.
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Affiliation(s)
- J Onken
- Institut für Lebensmittelchemie, Universität Hannover, Germany
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13
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Schlenger WE, Etheridge RM, Hansen DJ, Fairbank DW, Onken J. Evaluation of state efforts to improve systems of care for children and adolescents with severe emotional disturbances: the CASSP (Child and Adolescent Service System Program) initial cohort study. J Ment Health Adm 1999; 19:131-42. [PMID: 10121506 DOI: 10.1007/bf02521314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 1984, the National Institute of Mental Health (NIMH) began funding its Child and Adolescent Service System Program (CASSP). In this paper, we present findings from a descriptive study of the experiences of the initial cohort of states to receive CASSP grants, conceived and conducted when the projects were approaching the end of their fifth and final year of NIMH funding. Detailed case studies were conducted of each of the 10 initial cohort projects, and the findings analyzed across projects. Data were collected from three major sources: (1) existing documentation about the projects, (2) site visits to each of the projects, and (3) information from relevant secondary sources. Findings suggest that the initial cohort projects utilized a variety of strategies and encountered a variety of barriers and facilitating factors. The projects generally implemented the intended CASSP program and did so by using a variety of strategies. The projects were judged by stakeholders in their states to have influenced the service systems in their states in the intended directions: toward a more comprehensive system of care that emphasizes community-based treatment; toward better integrated, more collaborative efforts among the state agencies involved; toward a more detailed understanding on the part of system stakeholders of the mental health problems of children and adolescents who have severe emotional disturbances, and of the influence of those problems on the lives of the children and their families; and toward increased involvement by parents and other family members in the care of these children and adolescents.
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Abstract
The basidiomycete Cystoderma carcharias transformed citronellol into 3,7-dimethyl-1,6,7-octanetriol as the main product. 3,7-Dimethyl-6,7-epoxy-1-octanol was identified as important intermediary product of the biotransformation, and the allylic diols 2,6-dimethyl-2-octene-1,8-diol, 3,7-dimethyl-5-octene-1,7-diol and 3,7-dimethyl-7-octene-1,6-diol were found to be minor products. Microbial formation of rose oxide, a flavour-impact component, was observed for the first time. The formation of the main products was inhibited by 70% after addition of 0.1 mmol l-1 cytochrome monooxygenase inhibitors. Formation of 3,7-dimethyl-1,6,7-octanetriol was effective in a bioreactor with aeration over a coil of a hydrophobic microporous polypropene capillary membrane. Production rates of up to 150 mg l-1 day-1 were reached and led to a product concentration of 866 mg l-1 (conversion rate: 52%). The total loss of the added volatile substrate via the exhaust air was 4.5% when this aeration method was used.
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Affiliation(s)
- J Onken
- Institut für Lebensmittelchemie, Universität Hannover, Germany
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15
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Jowell PS, Eisen G, Onken J, Bute BP, Ginsberg B. Patient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial. Gastrointest Endosc 1996; 43:490-4. [PMID: 8726764 DOI: 10.1016/s0016-5107(96)70292-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adequate comfort is essential to patients undergoing invasive procedures. This study was designed to evaluate whether patient-controlled analgesia could improve sedation for ERCP. METHODS Patients were randomized to receive standard sedation (n = 31) or patient-controlled analgesia (n = 31). The patients were blinded to the randomization. After the procedure the patient, physician, and nurse each rated their satisfaction with sedation using a verbal rating scale. RESULTS There was no significant difference between the patient's mean satisfaction score for the conventional and patient-controlled analgesia groups (9.3 and 9.6, respectively, p = 0.5). The physicians rated sedation higher in the conventional group compared with the patient-controlled analgesia group (8.6 and 8.2, respectively, p = 0.02). Physicians and nurses' scores correlated (r = 0.53, p = 0.0001), but there was no correlation between scores reported by either physicians or nurses and the patients' scores (r = 0.2 and r = 0.05, respectively). Oxygen saturation less than 90% occurred for more than 1 minute in three patients who received standard sedation but in none who used patient-controlled analgesia. CONCLUSION This trial demonstrates that patient-controlled analgesia during ERCP is as effective as standard sedation with respect to patient satisfaction. Physicians and nurses, however, are not good proxies for assessing patient satisfaction.
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Affiliation(s)
- P S Jowell
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710
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Onken J, Hastie R, Revelle W. Individual differences in the use of simplification strategies in a complex decision-making task. J Exp Psychol Hum Percept Perform 1985. [PMID: 3156956 DOI: 10.1037//0096-1523.11.1.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decision time results were used to assess the strategies that 90 college undergraduates used in a complex decision-making task. Trend analyses revealed that the functions relating choice time to the number of choice alternatives in a set and the number of attributes comprising those alternatives contained linear (increasing) components. In addition, for a portion of the subjects, there was a quadratic effect of the number of attributes available to the decision maker on choice time, suggesting that these subjects adopted simplification strategies at high levels of task complexity. Reliable individual differences in these trend components were observed, consistent with individual differences in motivation and/or processing capacities. These individual differences were included in an information-processing model of decision behavior that captured the choice time data observed in this study. Subjects' ratings of apartments were used as a basis to assess the extent to which the use of simplification strategies resulted in preference reversals. Contrary to expectation, subjects whose choice times contained quadratic components demonstrated fewer preference reversals at high levels of information load.
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Abstract
Decision time results were used to assess the strategies that 90 college undergraduates used in a complex decision-making task. Trend analyses revealed that the functions relating choice time to the number of choice alternatives in a set and the number of attributes comprising those alternatives contained linear (increasing) components. In addition, for a portion of the subjects, there was a quadratic effect of the number of attributes available to the decision maker on choice time, suggesting that these subjects adopted simplification strategies at high levels of task complexity. Reliable individual differences in these trend components were observed, consistent with individual differences in motivation and/or processing capacities. These individual differences were included in an information-processing model of decision behavior that captured the choice time data observed in this study. Subjects' ratings of apartments were used as a basis to assess the extent to which the use of simplification strategies resulted in preference reversals. Contrary to expectation, subjects whose choice times contained quadratic components demonstrated fewer preference reversals at high levels of information load.
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