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Fritz J, Jochems SHJ, Bjørge T, Wood AM, Häggström C, Ulmer H, Nagel G, Zitt E, Engeland A, Harlid S, Drake I, Stattin P, Stocks T. Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts. Br J Cancer 2024; 130:308-316. [PMID: 38087039 PMCID: PMC10803806 DOI: 10.1038/s41416-023-02526-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Insulin resistance is a hypothesised biological mechanism linking obesity with prostate cancer (PCa) death. Data in support of this hypothesis is limited. METHODS We included 259,884 men from eight European cohorts, with 11,760 incident PCa's and 1784 PCa deaths during follow-up. We used the triglyceride-glucose (TyG) index as indicator of insulin resistance. We analysed PCa cases with follow-up from PCa diagnosis, and the full cohort with follow-up from the baseline cancer-free state, thus incorporating both PCa incidence and death. We calculated hazard ratios (HR) and the proportion of the total effect of body mass index (BMI) on PCa death mediated through TyG index. RESULTS In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01-1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HRtotal effect per 5-kg/m2 BMI: 1.24; 1.14-1.35, of which 28%; 4%-52%, mediated). In contrast, in the full cohort, the TyG index was not associated with PCa death (HR: 1.03; 0.94-1.13), hence did not substantially mediate the effect of BMI on PCa death. CONCLUSIONS Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.
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Affiliation(s)
- Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
| | | | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Isabel Drake
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Fritz J, Belovari K, Ulmer H, Zaruba MM, Messner M, Ungericht M, Siebert U, Ruschitzka F, Bauer A, Poelzl G. Aetiology, ejection fraction and mortality in chronic heart failure: a mediation analysis. Heart 2024; 110:290-298. [PMID: 37722825 DOI: 10.1136/heartjnl-2023-322803] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Clinical decision making in chronic heart failure (CHF) is based primarily on left ventricular ejection fraction (LVEF), and only secondarily on aetiology of the underlying disease. Our aim was to investigate the mediating role of LVEF in the relationship between aetiology and mortality. METHODS Using data of 2056 Austrian patients with CHF (mean age 57.2 years; mean follow-up 8.8 years), effects of aetiology on LVEF and overall mortality were estimated using multivariable-adjusted linear and Cox regression models. In causal mediation analyses, we decomposed the total effect of aetiology on mortality into direct and indirect (mediated through LVEF) effects. RESULTS For the analysed aetiologies (dilated (DCM, n=1009) and hypertrophic (HCM, n=89) cardiomyopathy; ischaemic (IHD, n=529) and hypertensive (HHD, n=320) heart disease; cardiac amyloidosis (CA, n=109)), the effect of LVEF on mortality was similar (HR5%-points lower LVEF=1.07, 95% CI 1.04 to 1.10; pinteraction=0.718). HCM and CA were associated with significantly higher, and IHD and DCM with significantly lower LVEF compared with other aetiologies. Compared with respective other aetiologies, the corresponding total effect HRs for mortality were 0.77 (95% CI 0.67 to 0.89), 0.47 (95% CI 0.25 to 0.88), 1.40 (95% CI 1.21 to 1.62), 0.79 (95% CI 0.67 to 0.95) and 2.36 (95% CI 1.81 to 3.08) for DCM, HCM, IHD, HHD and CA, respectively. CA had the highest mortality despite a HRindirect effect of 0.74 (95% CI 0.65 to 0.83). For all other aetiologies, <20% of the total mortality effects were mediated through LVEF. CONCLUSIONS The direct effect of aetiology on mortality dominates the indirect effect through LVEF. Therefore, clarification of aetiology is as important as measurement of LVEF.
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Affiliation(s)
- Josef Fritz
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Katrin Belovari
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Marc-Michael Zaruba
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Moritz Messner
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Ungericht
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Axel Bauer
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Poelzl
- Department of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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Mayr R, Iltchev A, Bonatti A, Forstner B, Fritz J, Gassner E, Arora R. [Trauma emergency room cases before and during the COVID-19 pandemic : Data from an alpine trauma center]. Unfallchirurgie (Heidelb) 2023; 126:960-966. [PMID: 36534361 PMCID: PMC9761024 DOI: 10.1007/s00113-022-01268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The COVID-19 pandemic had a strong impact on the work of trauma medical teams. The aim of the study was to compare the trauma emergency room (TER) incidence and trauma mechanisms before and during the pandemic at a level I trauma center. OBJECTIVE The TER incidence before and during the pandemic should be assessed to be prepared for future pandemics or new COVID-19 outbreaks. MATERIAL AND METHODS Medical charts from all TER patients from March 2019 to February 2021 were analyzed. The incidence and trauma mechanisms of the 12 months before and the 12 months during the pandemic were compared. The trauma distribution and severity were described by the AIS and ISS, and the patients' country of residency was noted. RESULTS The TER cases decreased from 694 before the COVID-19 pandemic to 477 cases during the pandemic (Incidence rate 0.69). The strongest decrease in trauma cases was noted in sports injuries (0.55), followed by suicide attempts (0.63), traffic accidents (0.71) and leisure accidents (0.76). The rate of patients with severe injuries (ISS ≥ 16) was comparable with 40% before the pandemic and 44% during the pandemic. Foreign residency of TER patients shifted from 37% before the pandemic to 16% during the pandemic. The number of foreign patients was significantly reduced during the pandemic (257 vs. 77). DISCUSSION The TER incidence significantly decreased during the pandemic due to the imposed lockdowns during the peak winter tourism season. The rate of foreign TER patients changed during the pandemic, while the rate of severely injured patients remained stable.
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Affiliation(s)
- R Mayr
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - A Iltchev
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - A Bonatti
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - B Forstner
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - J Fritz
- Department für Medizinische Statistik, Informatik und Gesundheitsökonomie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - E Gassner
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - R Arora
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
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Kafka M, Burtscher T, Fritz J, Schmitz M, Bektic J, Ladurner M, Horninger W, Heidegger I. Real-world comparison of Docetaxel versus new hormonal agents in combination with androgen-deprivation therapy in metastatic hormone-sensitive prostate cancer descrying PSA Nadir ≤ 0.05 ng/ml as marker for treatment response. World J Urol 2023; 41:2043-2050. [PMID: 36287244 PMCID: PMC10415491 DOI: 10.1007/s00345-022-04189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022] Open
Abstract
PROPOSE Using Docetaxel chemotherapy or new hormonal agents (NHT) to intensify upfront systemic therapy resulted in improved survival rates compared to androgen deprivation monotherapy (ADT). Hence, combination therapies have become the new standard of care (SOC) in metastatic hormone-sensitive prostate cancer (mHSPC). However, head-to-head trails comparing different therapies as well as treatment-guiding biomarkers are still lacking. Thus, the aim of the present study was to compare clinical outcomes of Docetaxel versus NHT therapy in the real-world setting as well as to elaborate biomarkers predicting clinical outcome. METHODS We retrospectively assessed overall-survival (OS), progression-free survival 1 and 2 (PFS1/2) and time to progression (TTP) in 42 patients treated by either ADT + NHT or ADT + Docetaxel. In addition, we investigated clinical prognostic biomarkers. RESULTS Our survival analysis revealed 3-year OS of 89.4% in the NHT group compared to 82.4% in the Docetaxel group. 3-year PFS1 was 59.6% in the NHT group compared to 32.2% in the Docetaxel group and the TTP was 53.8% vs 32.2% (pOS = 0.189; pPFS1 = 0.082; pTTP = 0.055). In addition, castration-resistance occurred more often in the Docetaxel group (78.6% vs 25%, p = 0.004). Interestingly, a PSA-Nadir ≤ 0.05 ng/ml during therapy was associated with increased survival rates (p < 0.001) while PSA levels at primary diagnosis had no influence on therapy outcome. Furthermore, a thyroid-stimulating hormone (TSH) increase during therapy was associated with improved clinical outcome (p = 0.06). CONCLUSION We observed a trend towards a higher benefit of NHT as first-line treatment compared to Docetaxel in men with mHSPC. Of note, a PSA-Nadir ≤ 0.05 ng/ml or a TSH-increase during therapy were predictors for therapy response.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Burtscher
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Jasmin Bektic
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Ladurner
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Jochems SHJ, Fritz J, Häggström C, Stattin P, Stocks T. Prediagnostic markers of insulin resistance and prostate cancer risk and death: A pooled study. Cancer Med 2023. [PMID: 37102250 DOI: 10.1002/cam4.6004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Insulin resistance has been shown to be related to a higher risk of several cancers, but the association with prostate cancer (PCa) has been inconsistent. METHODS We investigated prediagnostic markers of insulin resistance in men in four cohorts in Sweden, in relation to PCa risk (total, non-aggressive and aggressive) and PCa death using multivariable-adjusted Cox regression. The number of men, PCa cases and PCa deaths was up to 66,668, 3940 and 473 for plasma glucose and the triglyceride-glucose (TyG) index, and up to 3898, 586 and 102 for plasma insulin, glycated haemoglobin (HbA1c) and leptin. RESULTS Higher HbA1c was related to a lower risk of non-aggressive PCa but no significant associations were found for insulin resistance markers with the risk of aggressive or total PCa. In PCa cases, higher glucose and TyG index were related to a higher risk of PCa death (hazard ratio [HR] per higher standard deviation, 1.22, 95% CI 1.00-1.49 and 1.24, 95% CI 1.00-1.55), which further increased when restricting the analyses to glucose and TyG index measures taken <10 years before the PCa diagnosis (HR, 1.70, 95% CI 1.09-2.70 and 1.66, 95% CI 1.12-2.51). No associations were observed for other markers in relation to PCa death. CONCLUSIONS The results of this study showed no associations of insulin resistance markers with the risk of clinically relevant PCa, but higher glucose and TyG index were associated with poorer survival from PCa. The lack of association for other insulin resistance markers may be due to their smaller sample size.
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Affiliation(s)
- Sylvia H J Jochems
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Sun M, Fritz J, Häggström C, Bjørge T, Nagel G, Manjer J, Engeland A, Zitt E, van Guelpen B, Stattin P, Ulmer H, Stocks T. Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study. J Natl Cancer Inst 2023; 115:456-467. [PMID: 36647199 PMCID: PMC10086630 DOI: 10.1093/jnci/djad008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Studies of obesity with or without metabolic aberrations, commonly termed metabolically unhealthy or healthy obesity, in relation to cancer risk are scarce. METHODS We investigated body mass index (BMI, normal weight/overweight/obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n = 23,630) among 797,193 European individuals. A metabolic score comprising mid-blood pressure, plasma glucose and triglycerides was used to define metabolically healthy and unhealthy status. Hazard ratios (HRs) and multiplicative interactions were assessed using Cox regression, and additive interactions were assessed using the relative excess risk for interaction. All statistical tests were two-sided. RESULTS Metabolically unhealthy obesity, with a baseline prevalence of 7%, was, compared to metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and of colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer (p < 0.05), with the highest risk estimates for endometrial, liver, and renal cell cancer (HRs, 2.55 to 3.00). Metabolically healthy obesity showed a higher relative risk for any obesity-related cancer and colon (in men), endometrial, renal cell, liver, and gallbladder cancer, though the risk relationships were weaker. There were no multiplicative interactions, but there were additive, positive interactions between BMI and metabolic health status on obesity-related and rectal cancer among men, and on endometrial cancer (p < 0.05). CONCLUSIONS This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, metabolic aberrations further increased the obesity-induced cancer risk, suggesting that both obesity and metabolic aberrations are useful targets for prevention.
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Affiliation(s)
- Ming Sun
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria.,Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Fritz J, Huang T, Depner CM, Zeleznik OA, Cespedes Feliciano EM, Li W, Stone KL, Manson JE, Clish C, Sofer T, Schernhammer E, Rexrode K, Redline S, Wright KP, Vetter C. Sleep duration, plasma metabolites, and obesity and diabetes: a metabolome-wide association study in US women. Sleep 2023; 46:zsac226. [PMID: 36130143 PMCID: PMC9832513 DOI: 10.1093/sleep/zsac226] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/25/2022] [Revised: 08/08/2022] [Indexed: 01/16/2023] Open
Abstract
Short and long sleep duration are associated with adverse metabolic outcomes, such as obesity and diabetes. We evaluated cross-sectional differences in metabolite levels between women with self-reported habitual short (<7 h), medium (7-8 h), and long (≥9 h) sleep duration to delineate potential underlying biological mechanisms. In total, 210 metabolites were measured via liquid chromatography-mass spectrometry in 9207 women from the Nurses' Health Study (NHS; N = 5027), the NHSII (N = 2368), and the Women's Health Initiative (WHI; N = 2287). Twenty metabolites were consistently (i.e. praw < .05 in ≥2 cohorts) and/or strongly (pFDR < .05 in at least one cohort) associated with short sleep duration after multi-variable adjustment. Specifically, levels of two lysophosphatidylethanolamines, four lysophosphatidylcholines, hydroxyproline and phenylacetylglutamine were higher compared to medium sleep duration, while levels of one diacylglycerol and eleven triacylglycerols (TAGs; all with ≥3 double bonds) were lower. Moreover, enrichment analysis assessing associations of metabolites with short sleep based on biological categories demonstrated significantly increased acylcarnitine levels for short sleep. A metabolite score for short sleep duration based on 12 LASSO-regression selected metabolites was not significantly associated with prevalent and incident obesity and diabetes. Associations of single metabolites with long sleep duration were less robust. However, enrichment analysis demonstrated significant enrichment scores for four lipid classes, all of which (most markedly TAGs) were of opposite sign than the scores for short sleep. Habitual short sleep exhibits a signature on the human plasma metabolome which is different from medium and long sleep. However, we could not detect a direct link of this signature with obesity and diabetes risk.
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Affiliation(s)
- Josef Fritz
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher M Depner
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Oana A Zeleznik
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Wenjun Li
- Department of Public Health, School of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Clary Clish
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Eva Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kathryn Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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Amprosi M, Indelicato E, Eigentler A, Fritz J, Nachbauer W, Boesch S. Toward the Definition of Patient-Reported Outcome Measurements in Hereditary Spastic Paraplegia. Neurol Genet 2023; 9:e200052. [PMID: 36636734 PMCID: PMC9832334 DOI: 10.1212/nxg.0000000000200052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023]
Abstract
Background and Objectives Hereditary spastic paraplegias (HSPs) are a heterogeneous group of rare neurodegenerative diseases, characterized by a progressive spastic paraparesis. Currently, there is a HSP-specific clinician-reported outcome measure (CROM) called Spastic Paraplegia Rating Scale (SPRS). There are, however, no specific patient-reported outcome measures (PROMs) for HSP. In the present cohort study, we prospectively follow up a well-examined Austrian HSP cohort using validated rating scales and compared PROM with disease-specific and non-disease-specific CROM. Methods Patients were recruited and followed up at the Center for Rare Movement Disorders, Innsbruck, Austria. CROM included the SPRS, Scale for the Assessment and Rating of Ataxia (SARA), Barthel Index (BI), and Mini-Mental State Examination (MMSE). PROM included the EQ-5D questionnaire and the Patient Health Questionnaire 9 (PHQ-9). Standardized response means (SRMs) were calculated for all scales at follow-up (FU) after 1 year. Results A total of 55 patients (36 males) with HSP were included in the study. FU was performed for 30 patients (21 males). Apart from females reporting more problems in the EQ-5D domain of anxiety and depression (p = 0.008), other clinician-reported outcomes (CROs) or patient-reported outcomes (PROs) did not differ significantly across sex. SPRS showed significant correlations with SARA (p < 0.001), mainly driven by the gait item, as well as the BI. Although SPRS did not correlate with EQ-5D visual analogue scale and PHQ-9 scores, several EQ-5D domains correlated significantly with SPRS. At FU, SPRS showed the highest responsiveness (SRM 1.11), followed by SARA (SRM 0.47). Neither MMSE nor PRO significantly increased at FU. Discussion In this study, we present an Austrian cohort of patients with HSP and a prospective study evaluating correlations of CRO and PRO as well as their progression. Demographics from our cohort are comparable with several other European cohort studies. Our data highlight the capabilities of the SPRS to show clinical progression and warrant consideration of ataxia rating scales such as SARA in HSP cohorts. We also show that the generic PROMs are not suitable to detect change in HSP, and thus, we propose to create a disease-specific PROM fully depicting the effect of HSP on the patients' lives.
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Affiliation(s)
- Matthias Amprosi
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabetta Indelicato
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Eigentler
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Nachbauer
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sylvia Boesch
- Centre for Rare Neurological Diseases (M.A., E.I., A.E., W.N., S.B.), Department of Neurology, Medical University of Innsbruck; and Department of Medical Statistics (J.F.), Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
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9
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Sviridenko A, Boehm A, di Santo G, Uprimny C, Nilica B, Fritz J, Giesel FL, Haberkorn U, Sahanic S, Decristoforo C, Tancevski I, Widmann G, Loeffler-Ragg J, Virgolini I. Enhancing Clinical Diagnosis for Patients With Persistent Pulmonary Abnormalities After COVID-19 Infection: The Potential Benefit of 68 Ga-FAPI PET/CT. Clin Nucl Med 2022; 47:1026-1029. [PMID: 36257062 PMCID: PMC9653058 DOI: 10.1097/rlu.0000000000004437] [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] [Indexed: 02/04/2023]
Abstract
PATIENTS AND METHODS Six post COVID-19 patients suspected for pulmonary fibrosis were scheduled for dual-tracer PET/CT with 18 F-FDG and 68 Ga-fibroblast activation protein inhibitor (FAPI)-46. The uptake of 68 Ga-FAPI-46 in the involved lung was compared with a control group of 9 non-COVID-19 patients. Clinical data and PET/CT imaging were collected and analyzed. RESULTS PET/CT revealed in all 6 pulmonary impaired patients the reduced glucose avidity on 18 F-FDG and clear positivity on 68 Ga-FAPI-46 PET/CT in comparison to the control group. CONCLUSIONS Enhancing fibrotic repair mechanisms, 68 Ga-FAPI PET/CT may improve noninvasive clinical diagnostic performance in patients with long-term CT abnormalities after severe COVID-19. Although this study shows promising results, additional studies in larger populations are required to establish a general diagnostic guideline.
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Affiliation(s)
| | | | | | | | | | - Josef Fritz
- Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Frederik L. Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg,Department of Nuclear Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg
| | | | | | | | - Gerlig Widmann
- Department of Medical Statistic and Informatics, Medical University of Innsbruck, Innsbruck, Austria
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10
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Lindner AK, Luger AK, Fritz J, Stäblein J, Radmayr C, Aigner F, Rehder P, Tulchiner G, Horninger W, Pichler R. Do we need repeated CT imaging in uncomplicated blunt renal injuries? Experiences of a high-volume urological trauma centre. World J Emerg Surg 2022; 17:38. [PMID: 35799209 PMCID: PMC9264658 DOI: 10.1186/s13017-022-00445-9] [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: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Current guidelines recommend repeat computed tomography (CT) imaging in high-grade blunt renal injury within 48–96 h, yet diagnostic value and clinical significance remain controversial. The aim of this work was to determine the possible gain of CT re-imaging in uncomplicated patients with blunt renal trauma at 48 h after injury, presenting one of the largest case series. Methods A retrospective database of patients admitted to our centre with isolated blunt renal trauma due to sporting injuries was analysed for a period of 20 years (2000–2020). We included only patients who underwent repeat imaging at 48 h after trauma irrespective of AAST renal injury grading (grade 1–5) and initial management. The primary outcome was intervention rates after CT imaging at 48 h in uncomplicated patients versus CT scan at the time of clinical symptoms. Results A total of 280 patients (mean age: 37.8 years; 244 (87.1%) male) with repeat CT after 48 h were included. 150 (53.6%) patients were classified as low-grade (grade 1–3) and 130 (46.4%) as high-grade (grade 4–5) trauma. Immediate intervention at trauma was necessary in 59 (21.1%) patients with high-grade injuries: minimally invasive therapy in 48 (81.4%) and open surgery in 11 (18.6%) patients, respectively. In only 16 (5.7%) cases, intervention was performed based on CT re-imaging at 48 h (low-grade vs. high-grade: 3.3% vs. 8.5%; p = 0.075). On the contrary, intervention rate due to clinical symptoms was 12.5% (n = 35). Onset of clinical progress was on average (range) 5.3 (1–17) days post trauma. High-grade trauma (odds ratio [OR]grade 4 vs. grade 3, 14.62; p < 0.001; ORgrade 5 vs. grade 3, 22.88, p = 0.004) and intervention performed at the day of trauma (OR 3.22; p = 0.014) were powerful predictors of occurrence of clinical progress. Conclusion Our data suggest that routine CT imaging 48 h post trauma can be safely omitted for patients with low- and high-grade blunt renal injury as long as they remain clinically stable. Patients with high-grade renal injury have the highest risk for clinical progress; thus, close surveillance should be considered especially in this group.
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Affiliation(s)
- Andrea Katharina Lindner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | | | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Stäblein
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Friedrich Aigner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Rehder
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Gennadi Tulchiner
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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11
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Jochems SHJ, Fritz J, Häggström C, Järvholm B, Stattin P, Stocks T. Smoking and Risk of Prostate Cancer and Prostate Cancer Death: A Pooled Study. Eur Urol 2022; 83:422-431. [PMID: 35523620 DOI: 10.1016/j.eururo.2022.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/24/2022] [Accepted: 03/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Prospective and detailed investigations of smoking and prostate cancer (PCa) risk and death are lacking. OBJECTIVE To investigate prediagnosis smoking habit (status, intensity, duration, and cessation) as a risk factor, on its own and combined with body mass index (BMI), for PCa incidence and death. DESIGN, SETTING, AND PARTICIPANTS We included 351448 men with smoking information from five Swedish cohorts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used Cox regression to calculate hazard ratios (HRs) and confidence intervals (CIs) for PCa incidence (n = 24731) and death (n = 4322). RESULTS AND LIMITATIONS Smoking was associated with a lower risk of any PCa (HR 0.89, 95% CI 0.86-0.92), which was most pronounced for low-risk PCa (HR 0.74, 95% CI 0.69-0.79) and was restricted to PCa cases diagnosed in the prostate-specific antigen (PSA) era. Smoking was associated with a higher risk of PCa death in the full cohort (HR 1.10, 95% CI 1.02-1.18) and in case-only analysis adjusted for clinical characteristics (HR 1.20, 95% CI 1.11-1.31), which was a consistent finding across case groups (p = 0.8 for heterogeneity). Associations by smoking intensity and, to lesser degree, smoking duration and cessation, supported the associations for smoking status. Smoking in combination with obesity (BMI ≥30 kg/m2) further decreased the risk of low-risk PCa incidence (HR 0.40, 95% CI 0.30-0.53 compared to never smokers with BMI <25 kg/m2) and further increased the risk of PCa death (HR 1.49, 95% CI 1.21-1.84). A limitation of the study is that only a subgroup of men had information on smoking habit around the time of their PCa diagnosis. CONCLUSIONS The lower PCa risk for smokers in the PSA era, particularly for low-risk PCa, can probably be attributed to low uptake of PSA testing by smokers. Poor survival for smokers, particularly obese smokers, requires further study to clarify the underlying causes and the preventive potential of smoking intervention for PCa death. PATIENT SUMMARY Smokers have a higher risk of dying from prostate cancer, which further increases with obesity.
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Affiliation(s)
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Christel Häggström
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Bengt Järvholm
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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12
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Fritz J, Brozek W, Concin H, Nagel G, Kerschbaum J, Lhotta K, Ulmer H, Zitt E. The Association of Excess Body Weight with Risk of ESKD Is Mediated Through Insulin Resistance, Hypertension, and Hyperuricemia. J Am Soc Nephrol 2022; 33:1377-1389. [PMID: 35500938 PMCID: PMC9257805 DOI: 10.1681/asn.2021091263] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/24/2022] [Indexed: 01/02/2023] Open
Abstract
BackgroundInsulin resistance, hypertension, hyperuricemia, and hypercholesterolemia are hypothesized to be important intermediates in the relationship between excess body weight and CKD risk. However, the magnitude of the total effect of excess body weight on ESKD mediated through these four pathways remains to be quantified.MethodsWe applied a model for analysis of correlated mediators to population-based data from 100,269 Austrian individuals (mean age 46.4 years). Association of body mass index (BMI) was coalesced with ESKD risk into direct association. Indirect associations were mediated through the triglyceride-glucose (TyG) index (as an indicator of insulin resistance), mean arterial pressure (MAP), uric acid (UA), and total cholesterol (TC).ResultsMean follow-up was 23.1 years with 463 (0.5%) incident ESKD cases. An unhealthy metabolic profile (prevalence 32.4%) was associated with a markedly increased ESKD risk (multivariably adjusted hazard ratio (aHR), 3.57; 95% CI, 2.89 to 4.40), independent of BMI. A 5-kg/m2 higher BMI was associated with a 57% increased ESKD risk (aHRtotal association, 1.57; 1.38 to 1.77). Of this association, 99% (76% to 140%) arose from all mediators jointly; 33% (22% to 49%) through TyG index; 34% (24% to 50%) through MAP; 30% (21% to 45%) through UA; and 2% (−1% to 4%) through TC. The remaining direct association was nonsignificant (aHRdirect association, 1.01; 0.88 to 1.14).ConclusionsTyG index, MAP, and UA, but not TC, mediate the association of BMI with ESKD in middle-aged adults. Our findings highlight that in addition to weight reduction, the control of metabolic risk factors might be essential in mitigating the adverse effects of BMI on kidney function.
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Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Julia Kerschbaum
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
- Austrian Dialysis and Transplant Registry (OEDTR), Medical University of Innsbruck, Innsbruck, Austria
| | - Karl Lhotta
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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13
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Fritz B, Fritz J, Fucentese SF, Pfirrmann CWA, Sutter R. Three-dimensional analysis for quantification of knee joint space width with weight-bearing CT: comparison with non-weight-bearing CT and weight-bearing radiography. Osteoarthritis Cartilage 2022; 30:671-680. [PMID: 34883245 DOI: 10.1016/j.joca.2021.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare computer-based 3D-analysis for quantification of the femorotibial joint space width (JSW) using weight-bearing cone beam CT (WB-CT), non-weight-bearing multi-detector CT (NWB-CT), and weight-bearing conventional radiographs (WB-XR). DESIGN Twenty-six participants prospectively underwent NWB-CT, WB-CT, and WB-XR of the knee. For WB-CT and NWB-CT, the average and minimal JSW was quantified by 3D-analysis of the minimal distance of any point of the subchondral tibial bone surface and the femur. Associations with mechanical leg axes and osteoarthritis were evaluated. Minimal JSW of WB-CT was further compared to WB-XR. Two-tailed p-values of <0.05 were considered significant. RESULTS Significant differences existed of the average medial and lateral JSW between WB-CT and NWB-CT (medial: 4.7 vs 5.1 mm [P = 0.028], lateral: 6.3 vs 6.8 mm [P = 0.008]). The minimal JSW on WB-XR (medial:3.1 mm, lateral:5.8 mm) were significantly wider compared to WB-CT and NWB-CT (both medial:1.8 mm, lateral:2.9 mm, all p < 0.001), but not significantly different between WB-CT and NWB-CT (all p ≥ 0.869). Significant differences between WB-CT and NWB-CT existed in participants with varus knee alignment for the average and the minimal medial JSW (p = 0.004 and p = 0.011) and for participants with valgus alignment for the average lateral JSW (p = 0.013). On WB-CT, 25% of the femorotibial compartments showed bone-on-bone apposition, which was significantly higher when compared to NWB-CT (10%,P = 0.008) and WB-XR (8%,P = 0.012). CONCLUSION Combining WB-CT with 3D-based assessment allows detailed quantification of the femorotibial joint space and the effect of knee alignment on JSW. WB-CT demonstrates significantly more bone-on-bone appositions, which are underestimated or even undetectable on NWB-CT and WB-XR.
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Affiliation(s)
- B Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - J Fritz
- New York University Grossman School of Medicine, New York University, New York, USA.
| | - S F Fucentese
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - C W A Pfirrmann
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - R Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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14
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Perlow H, Yang M, Siedow M, Boulter D, Fritz J, Miller E, Blakaj D, Zoller W, Cadieux C, Eiler D, Addington M, DiCostanzo D, Beyer S, Arnett A, Grecula J, Chakravarti A, Palmer J. 68(GA)DOTATATE PET-Based Radiation Volumes Demonstrate Increased Precision Compared to MRI Based Volumes for Meningioma Patients. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Tulchiner G, Staudacher N, Fritz J, Hackl M, Pichler M, Seles M, Shariat SF, D'Andrea D, Gust K, Albrecht W, Grubmüller K, Madersbacher S, Graf S, Lusuardi L, Augustin H, Berger A, Loidl W, Horninger W, Pichler R. Seasonal Variations in the Diagnosis of Testicular Germ Cell Tumors: A National Cancer Registry Study in Austria. Cancers (Basel) 2021; 13:cancers13215377. [PMID: 34771540 PMCID: PMC8582382 DOI: 10.3390/cancers13215377] [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: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Seasonal variations in cancer diagnosis could already be demonstrated in prostate and breast cancer. The reasons for this observed seasonal pattern are still unclear. The health care system or other determinants such as the protective function of vitamin D3 in carcinogenesis could be assumed as one explanation. Testicular germ cell tumors are the most common developed malignancy among young men. The aim of our study was to investigate, for the first time, the seasonal variations in the clinical diagnosis of testicular germ cell tumors. We have been able to confirm that the frequency of monthly newly diagnosed cases of testicular cell tumors in Austria has a strong seasonality, with a significant reduction in the tumor incidence during the summer months and an increase during the winter months. Abstract We conducted a retrospective National Cancer Registry study in Austria to assess a possible seasonal variation in the clinical diagnosis of testicular germ cell tumors (TGCT). In total, 3615 testicular cancer diagnoses were identified during an 11-year period from 2008 to 2018. Rate ratios for the monthly number of TGCT diagnoses, as well as of seasons and half-years, were assessed using a quasi-Poisson model. We identified, for the first time, a statistically significant seasonal trend (p < 0.001) in the frequency of monthly newly diagnosed cases of TGCT. In detail, clear seasonal variations with a reduction in the tumor incidence during the summer months (Apr–Sep) and an increase during the winter months (Oct–Mar) were observed (p < 0.001). Focusing on seasonality, the incidence during the months of Oct–Dec (p = 0.008) and Jan–Mar (p < 0.001) was significantly higher compared to the months of Jul–Sep, respectively. Regarding histopathological features, there is a predominating incidence in the winter months compared to summer months, mainly concerning pure seminomas (p < 0.001), but not the non-seminoma or mixed TGCT groups. In conclusion, the incidence of TGCT diagnoses in Austria has a strong seasonal pattern, with the highest rate during the winter months. These findings may be explained by a delay of self-referral during the summer months. However, the hypothetical influence of vitamin D3 in testicular carcinogenesis underlying seasonal changes in TGCT diagnosis should be the focus of further research.
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Affiliation(s)
- Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schöpfstraße 41, 6020 Innsbruck, Austria
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, 1110 Vienna, Austria
| | - Martin Pichler
- Research Unit of Non-Coding RNAs and Genome Editing in Cancer, Comprehensive Cancer Center Graz, Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Maximilian Seles
- Department of Urology, Medical University of Graz, 8036 Graz, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Kilian Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Albrecht
- Department of Urology, Austria and Public Health Agency of Lower Austria, 2130 Mistelbach, Austria
| | - Karl Grubmüller
- Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Stephan Madersbacher
- Department of Urology and Andrology, Kaiser-Franz-Josef Spital, 1100 Vienna, Austria
| | - Sebastian Graf
- Department of Urology, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Herbert Augustin
- Department of Urology, General Hospital of the City of Klagenfurt, 9020 Klagenfurt, Austria
| | - Andreas Berger
- Department of Urology, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Wolfgang Loidl
- Department of Urology, Ordensklinikum Linz GmbH Elisabethinen, 4020 Linz, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Velik‐Salchner C, Tauber H, Rastner V, Pajk W, Mittermayr M, Wally D, Kilo J, Vondrys D, Fries D, Fritz J, Streif W. Administration of fibrinogen concentrate combined with prothrombin complex maintains hemostasis in children undergoing congenital heart repair (a long-term propensity score-matched study). Acta Anaesthesiol Scand 2021; 65:1178-1186. [PMID: 34152599 PMCID: PMC8518112 DOI: 10.1111/aas.13945] [Citation(s) in RCA: 4] [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: 01/30/2021] [Revised: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/28/2022]
Abstract
Background Bleeding is a common problem in children with congenital heart disease undergoing major cardiac surgery requiring cardiopulmonary bypass (CPB). Little is known about optimal management with blood products. Objective To investigate clinical outcome and hemostatic effects of fibrinogen concentrate (FC) in combination with prothrombin complex concentrate (PCC) versus standard treatment with fresh frozen plasma (FFP) in children undergoing cardiac surgery. Methods For this single‐institution cohort study, data on 525 children were analyzed. Propensity score matching in 210 children was applied to reduce the impact of various baseline characteristics. Results Three children treated with FC/PCC developed surgical site bleeding requiring surgical revision. One child developed central venous line‐related thrombosis. Blood loss through chest tube drainage was independent of FC/PCC. Coagulation abnormalities were not present in any of these children. Time to extubation and ICU stay did not differ. In the FC/PCC group, children received (median, Q1, Q3) 52 mg/kg (32, 83) FC and 28IU/kg (13, 44) PCC. Fibrinogen concentration was comparable at baseline. On admission to the ICU, fibrinogen was higher in children receiving FC/PCC, namely, 232 mg/dL (196, 280), than in children receiving FFP (186 mg/dL, 149, 224; P < .001). On discharge from the ICU, values did not differ ((FC/PCC 416 mg/dL (288, 501)), non‐FC/PCC 418 mg/dL (272, 585; P = 1.000)). Conclusion FC/PCC was well tolerated and permitted hemostasis to be maintained, even in the very young. We were not able to detect a signal for inferiority of this treatment. We conclude that FC/PCC can safely replace FFP.
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Affiliation(s)
- Corinna Velik‐Salchner
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Helmuth Tauber
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Verena Rastner
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Werner Pajk
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Markus Mittermayr
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Dieter Wally
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Juliane Kilo
- Department of Cardiac Surgery Medical University of Innsbruck Innsbruck Austria
| | - David Vondrys
- Department of Cardiac Surgery Medical University of Innsbruck Innsbruck Austria
| | - Dietmar Fries
- Department of Anaesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Josef Fritz
- Department of Medical Statistics Informatics and Health Economics Medical University of Innsbruck Innsbruck Austria
| | - Werner Streif
- Department of Paediatrics Medical University of Innsbruck Innsbruck Austria
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Nilica B, Svirydenka A, Fritz J, Bayerschmidt S, Kroiss AS, Gruber L, Virgolini IJ. Nephrotoxicity and hematotoxicity one year after four cycles of peptide receptor radionuclide therapy (PRRT) and its impact on future treatment planning. A retrospective analysis. Rev Esp Med Nucl Imagen Mol 2021; 41:S2253-654X(21)00062-7. [PMID: 34384731 DOI: 10.1016/j.remn.2021.03.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Nephro- and hematotoxicity after peptide receptor radionuclide therapy (PRRT) have been described in multiple studies with heterogeneous cumulative activities, number of cycles or radiolabelled peptides. Though highly differentiated metastasized neuroendocrine tumours (NET) have long progression free survival, they may progress. We analysed long-term side effects in a homogenous treatment schedule in PRRT-patients and their impact on future oncologic treatment in case of progression. METHODS From our database 89/384 patients receiving the same PRRT (Lu-177-DOTATATE or Y-90-DOTATOC) 4 times every 10 to 12 weeks and a follow-up at 12 months were analysed. One patient had three and 11 patients had two times four PRRT-cycles resulting in 102 cases. eGFR, Hb, WBC and platelets before the first and one year after the fourth therapy cycle were compared. eGFR-Grading was done according to chronic kidney disease classification (CKD) and grading of hematotoxicity according to Common Terminology Criteria for Adverse Events (CTCAE). Impact of age, gender, cumulative activity, type of PRRT on long-term-toxicity was also assessed. RESULTS eGFR grade 1-2 dropped from 87/102 at the baseline to 71 cases at follow-up (p<0.001). Before treatment grade 3a was found in 13, grade 3b in 2 cases, and at follow-up grade 3a in 25, grade 3b in 5, and grade 4 in 1 case. Anaemia prior to PRRT and at follow-up was grade 0 in 63 versus 48 (p<0.001), grade 1 in 36 versus 48, and grade 2 in three versus six cases. In white blood cell count and platelets, there were no significant changes in grading occurring. Subgroup analysis revealed that only in the age group 65 and older was there a higher incidence for anaemia (p=0.006). CONCLUSIóN: In roughly 20% of cases an increase in grading of nephro- or hematotoxicity is observed. In those patients, except in one, toxicity findings were mild or moderate one year after completion of four cycles of PRRT with either Y-90- or Lu-177-SST-analogues. In terms of safety, PRRT has no critical impact on further oncologic treatment options in the case of disease progression.
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Affiliation(s)
- B Nilica
- Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria.
| | - A Svirydenka
- Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria
| | - J Fritz
- Medical University Innsbruck, Department of Medical Statistics and Informatics, Innsbruck, Austria
| | - S Bayerschmidt
- Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria
| | - A S Kroiss
- Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria
| | - L Gruber
- Medical University Innsbruck, Department of Radiology, Innsbruck, Austria
| | - I J Virgolini
- Medical University Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria
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Fazzini F, Lamina C, Raftopoulou A, Koller A, Fuchsberger C, Pattaro C, Del Greco FM, Döttelmayer P, Fendt L, Fritz J, Meiselbach H, Schönherr S, Forer L, Weissensteiner H, Pramstaller PP, Eckardt K, Hicks AA, Kronenberg F. Association of mitochondrial DNA copy number with metabolic syndrome and type 2 diabetes in 14 176 individuals. J Intern Med 2021; 290:190-202. [PMID: 33453124 PMCID: PMC8359248 DOI: 10.1111/joim.13242] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mitochondria play an important role in cellular metabolism, and their dysfunction is postulated to be involved in metabolic disturbances. Mitochondrial DNA is present in multiple copies per cell. The quantification of mitochondrial DNA copy number (mtDNA-CN) might be used to assess mitochondrial dysfunction. OBJECTIVES We aimed to investigate the cross-sectional association of mtDNA-CN with type 2 diabetes and the potential mediating role of metabolic syndrome. METHODS We examined 4812 patients from the German Chronic Kidney Disease (GCKD) study and 9364 individuals from the Cooperative Health Research in South Tyrol (CHRIS) study. MtDNA-CN was measured in whole blood using a plasmid-normalized qPCR-based assay. RESULTS In both studies, mtDNA-CN showed a significant correlation with most metabolic syndrome parameters: mtDNA-CN decreased with increasing number of metabolic syndrome components. Furthermore, individuals with low mtDNA-CN had significantly higher odds of metabolic syndrome (OR = 1.025; 95% CI = 1.011-1.039, P = 3.19 × 10-4 , for each decrease of 10 mtDNA copies) and type 2 diabetes (OR = 1.027; 95% CI = 1.012-1.041; P = 2.84 × 10-4 ) in a model adjusted for age, sex, smoking and kidney function in the meta-analysis of both studies. Mediation analysis revealed that the association of mtDNA-CN with type 2 diabetes was mainly mediated by waist circumference in the GCKD study (66%) and by several metabolic syndrome parameters, especially body mass index and triglycerides, in the CHRIS study (41%). CONCLUSIONS Our data show an inverse association of mtDNA-CN with higher risk of metabolic syndrome and type 2 diabetes. A major part of the total effect of mtDNA-CN on type 2 diabetes is mediated by obesity parameters.
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Affiliation(s)
- F. Fazzini
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - C. Lamina
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - A. Raftopoulou
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - A. Koller
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - C. Fuchsberger
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - C. Pattaro
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - F. M. Del Greco
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - P. Döttelmayer
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - L. Fendt
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - J. Fritz
- Department of Medical StatisticsInformatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCOUSA
| | - H. Meiselbach
- Department of Nephrology and HypertensionFriedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - S. Schönherr
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - L. Forer
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - H. Weissensteiner
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
| | - P. P. Pramstaller
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - K.‐U. Eckardt
- Department of Nephrology and HypertensionFriedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin BerlinBerlinGermany
| | - A. A. Hicks
- Eurac ResearchInstitute for BiomedicineAffiliated Institute of the University of LübeckBolzanoItaly
| | - F. Kronenberg
- From theDepartment of Genetics and PharmacologyInstitute of Genetic EpidemiologyMedical University of InnsbruckInnsbruckAustria
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Fritz J, Phillips AJK, Hunt LC, Imam A, Reid KJ, Perreira KM, Mossavar-Rahmani Y, Daviglus ML, Sotres-Alvarez D, Zee PC, Patel SR, Vetter C. Cross-sectional and prospective associations between sleep regularity and metabolic health in the Hispanic Community Health Study/Study of Latinos. Sleep 2021; 44:5937003. [PMID: 33095850 DOI: 10.1093/sleep/zsaa218] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 06/12/2020] [Revised: 09/19/2020] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Sleep is an emergent, multi-dimensional risk factor for diabetes. Sleep duration, timing, quality, and insomnia have been associated with diabetes risk and glycemic biomarkers, but the role of sleep regularity in the development of metabolic disorders is less clear. METHODS We analyzed data from 2107 adults, aged 19-64 years, from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos, followed over a mean of 5.7 years. Multivariable-adjusted complex survey regression methods were used to model cross-sectional and prospective associations between the sleep regularity index (SRI) in quartiles (Q1-least regular, Q4-most regular) and diabetes (either laboratory-confirmed or self-reported antidiabetic medication use), baseline levels of insulin resistance (HOMA-IR), beta-cell function (HOMA-β), hemoglobin A1c (HbA1c), and their changes over time. RESULTS Cross-sectionally, lower SRI was associated with higher odds of diabetes (odds ratio [OR]Q1 vs. Q4 = 1.64, 95% CI: 0.98-2.74, ORQ2 vs. Q4 = 1.12, 95% CI: 0.70-1.81, ORQ3 vs. Q4 = 1.00, 95% CI: 0.62-1.62, ptrend = 0.023). The SRI effect was more pronounced in older (aged ≥ 45 years) adults (ORQ1 vs. Q4 = 1.88, 95% CI: 1.14-3.12, pinteraction = 0.060) compared to younger ones. No statistically significant associations were found between SRI and diabetes incidence, as well as baseline HOMA-IR, HOMA-β, and HbA1c values, or their changes over time among adults not taking antidiabetic medication. CONCLUSIONS Our results suggest that sleep regularity represents another sleep dimension relevant for diabetes risk. Further research is needed to elucidate the relative contribution of sleep regularity to metabolic dysregulation and pathophysiology.
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Affiliation(s)
- Josef Fritz
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Larissa C Hunt
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Akram Imam
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Martha L Daviglus
- College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
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Tauber H, Streif W, Gebetsberger J, Gasteiger L, Pierer E, Knoflach M, Fraedrich G, Gummerer M, Fritz J, Velik-Salchner C. Cardiac output and cerebral blood flow during carotid surgery in regional versus general anesthesia: A prospective randomized controlled study. J Vasc Surg 2021; 74:930-937.e2. [PMID: 33887429 DOI: 10.1016/j.jvs.2021.03.042] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Carotid endarterectomy (CEA) is a preventive procedure aimed at decreasing the subsequent risk of fatal or disabling stroke in patients with significant carotid stenosis. It is well-known that carotid surgery under ultrasound-guided regional anesthesia (US-RA) causes a significant increase in blood pressure, heart rate and stress hormone levels owing to increased sympathetic activity. However, little is known about the effects on cardiac output (CO), cardiac index (CI), and cerebral blood flow (CBF) under US-RA as compared with general anesthesia (GA). METHODS Patients scheduled for CEA were randomized prospectively to receive US-RA (n = 37) or GA (n = 41). The primary end point was the change in CI after induction of anesthesia and the change from baseline over time at four different times during the entire procedure in the respective randomized US-RA and GA groups. In addition to systolic blood pressure and heart rate, we also recorded peak systolic velocity, end-diastolic velocity, and minimum diastolic velocity as seen from transcranial Doppler ultrasound examination, as well as regional cerebral oxygenation (rSO2) as seen from near-infrared refracted spectroscopy to evaluate cerebral blood flow. RESULTS In the US-RA group, the CI increased after induction of anesthesia (3.7 ± 0.8 L/min/m2) and remained constant until the end of the procedure. In the GA group CI was significantly lower (2.4 ± 0.6 L/min/m2; P < .001). After induction of anesthesia, the rSO2 remained constant in the GA group on both the ipsilateral (63 ± 9 rSO2) and the contralateral (65 ± 7 rSO2) sides; in contrast, it significantly increased in the US-RA group (ipsilateral 72 ± 8 rSO2; P < .001; contralateral 72 ± 6 rSO2; P < .001). The transcranial Doppler ultrasound parameters (peak systolic velocity, end-diastolic velocity, and minimum diastolic velocity) did not differ between the US-RA and the GA group. The clinical outcome was similarly favorable for both groups. CONCLUSIONS CI was maintained near baseline values throughout the procedure during US-RA, whereas a significant decrease in CI values was observed during CEA under GA. Near-infrared refracted spectroscopy values, reflecting blood flow in small vessels, were higher in US-RA patients than in those with GA. These differences did not influence clinical outcome.
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Affiliation(s)
- Helmuth Tauber
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Streif
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Lukas Gasteiger
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Eve Pierer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Gummerer
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Corinna Velik-Salchner
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
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Tulchiner G, Staudacher N, Fritz J, Radmayr C, Culig Z, Horninger W, Pichler R. The "COVID-19 Pandemic Gap" and Its Influence on Oncologic Outcomes of Bladder Cancer. Cancers (Basel) 2021; 13:cancers13081754. [PMID: 33916962 PMCID: PMC8067623 DOI: 10.3390/cancers13081754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/17/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary The COVID-19 pandemic has had a major impact on the entire healthcare system, resulting in severe restrictions of nonemergency clinical services, as well as in the clinical practice of uro-oncology. We performed a retrospective analysis to evaluate outcomes of the COVID-19 pandemic resulting from delayed diagnosis, staging, and treatment of bladder cancer. We showed that the COVID-19 pandemic led to a deferred oncological diagnosis and treatment of bladder cancer. More attention is required to avoid adverse outcomes, with increased rates of advanced and aggressive tumors in patients with primary bladder cancer. Moreover, timely treatment is compulsory in those patients. Abstract Coronavirus-19 (COVID-19)-induced effects on deferred diagnosis and treatment of bladder cancer (BC) patients are currently not clarified. The aim of this study was to evaluate outcomes of the COVID-19 pandemic by considering its effects on tumor stage and grade, and to create feasible clinical triage decisions. A retrospective single-center analysis of all patients who underwent diagnostic and surgical procedures due to BC, during January 2019 and December 2020, was performed. Due to COVID-19 lockdowns, significantly fewer (diagnostic and therapeutic) endoscopic procedures were performed in the first 6 months of 2020 compared to 2019 (p = 0.002). In patients with a primary diagnosis of BC, a significant increase of high-grade tumors (p < 0.001), as well as advanced tumor stages (p = 0.014), were noticed during 2020 in comparison to 2019. On the contrary, patients with recurrent BC undergoing risk-adapted surveillance, depending on previous tumor histology, showed no adverse outcomes regarding tumor stage and grade when comparing the pre COVID-19 era with 2020. Thus, more awareness in clinical urologic practice is mandatory to avoid adverse consequences, with increased rates of advanced and aggressive tumors in patients with primary BC. In recurrent BC, an individual risk stratification in order to avoid worse outcomes during the COVID-19 pandemic seems to be justified.
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Affiliation(s)
- Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Nina Staudacher
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Schoepfstraße 41, 6020 Innsbruck, Austria;
| | - Christian Radmayr
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Zoran Culig
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (G.T.); (N.S.); (C.R.); (Z.C.); (W.H.)
- Correspondence: ; Tel.: +43-512-504-24811; Fax: +43-512-504-28365
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Nilica B, Svirydenka A, Fritz J, Bayerschmidt S, Kroiss A, Gruber L, Virgolini IJ. Nephrotoxicity and hematotoxicity one year after four cycles of peptide receptor radionuclide therapy (PRRT) and its impact on future treatment planning — A retrospective analysis. Rev Esp Med Nucl Imagen Mol 2021; 41:138-145. [DOI: 10.1016/j.remnie.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
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Uprimny C, Bayerschmidt S, Kroiss AS, Fritz J, Nilica B, Svirydenka H, Decristoforo C, von Guggenberg E, Horninger W, Virgolini IJ. Early injection of furosemide increases detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT. J Nucl Med 2021; 62:1550-1557. [PMID: 33712533 DOI: 10.2967/jnumed.120.261866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study was to assess a) the impact of forced diuresis with early furosemide injection on the detection rate of local recurrence (LR) in prostate cancer (PC) patients with biochemical recurrence (BR) referred for 68Ga-labelled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC (68Ga-PSMA-11) Positron Emission Tomography/Computed Tomography (PET/CT) and b) whether intravenous administration of furosemide shortly after tracer injection increases renal wash-out of 68Ga-PSMA-11 before it binds to the PSMA-receptor with possible influence on biodistribution and intensity of tracer uptake in organs with physiologic tracer accumulation. Materials and Methods: In a retrospective analysis two different groups with 220 prostate cancer patients each, referred for 68Ga-PSMA-11 PET/CT because of biochemical recurrence after primary therapy, were compared: patients of group one (median prostate specific antigen (PSA): 1.30 ng/ml) receiving no preparation prior to imaging, whereas patients in group two (median PSA: 0.82 ng/ml) were injected with 20 mg furosemide and 500 ml sodium chloride (NaCl 0.9%) immediately after tracer injection. Presence of local recurrence was assessed visually. In addition, intensity of tracer accumulation in organs with physiologic tracer uptake was evaluated standardized uptake value. Results: The detection rate of lesions judged positive for local recurrence was significantly higher in patients receiving furosemide compared to patients without preparation: 56 cases (25.5%) vs 38 cases (17.3%), respectively (P = 0.048). Median maximum standardized uptake values (SUVmax) of organs with physiologic uptake of 68Ga-PSMA-11 in group one and two were: urinary bladder (63.0 vs 8.9), kidney (55.6 vs 54.5), liver (9.9 vs 9.4), spleen (11.2 vs 11.9), small bowel (16.2 vs 17.1), parotid gland (19.2 vs 19.6), lacrimal gland (8.9 vs 10.9), blood pool activity (2.2 vs 2.3), muscle (1.0 vs 1.1) and bone (1.6 vs 1.6). Apart from bladder activity, no significant reduction of tracer accumulation was found in the patient group receiving furosemide. Conclusion: Injection of 20 mg furosemide at the timepoint of radiotracer administration significantly increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence referred for 68Ga-PSMA-11 PET/CT. As intensity of 68Ga-PSMA-11-uptake in organs with physiologic uptake is not significantly reduced, a negative impact of early furosemide injection on targeting properties and biodistribution of 68Ga-PSMA-11 seems unlikely.
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Affiliation(s)
- Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Austria
| | | | | | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Austria
| | - Hanna Svirydenka
- Department of Nuclear Medicine, Medical University Innsbruck, Austria
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Fritz J, Brozek W, Concin H, Nagel G, Kerschbaum J, Lhotta K, Ulmer H, Zitt E. The Triglyceride-Glucose Index and Obesity-Related Risk of End-Stage Kidney Disease in Austrian Adults. JAMA Netw Open 2021; 4:e212612. [PMID: 33787913 PMCID: PMC8013829 DOI: 10.1001/jamanetworkopen.2021.2612] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE It is unknown whether the triglyceride-glucose (TyG) index as a measure of insulin resistance is associated with the risk of developing end-stage kidney disease (ESKD). Because individuals who are overweight or obese often develop insulin resistance, mediation of the association between body mass index (BMI) and ESKD risk through the TyG index seems plausible but has not been investigated. OBJECTIVE To evaluate whether the TyG index is associated with ESKD risk and, if so, to what extent the TyG index mediates the association between BMI and ESKD. DESIGN, SETTING, AND PARTICIPANTS A total of 176 420 individuals were recruited during routine health examinations to participate in the Austrian Vorarlberg Health Monitoring and Promotion Program (VHM&PP), a prospective, population-based cohort study with participant enrollment between January 1, 1988, and June 30, 2005, and a mean follow-up of 22.7 years. Data analysis was conducted from March 1, 2020, to September 30, 2020. EXPOSURES Body mass index and the logarithmized product of fasting triglyceride and glucose concentrations (TyG index), as determined during the baseline health examination. MAIN OUTCOMES AND MEASURES End-stage kidney disease, as indicated by initiation of kidney replacement therapy, either dialysis or kidney transplantation. RESULTS Of the 176 420 participants, 94 885 were women (53.8%); mean (SD) age was 42.5 (15.4) years. During a mean (SD) follow-up of 22.7 (6.9) years, 454 (0.3%) participants developed ESKD and 35 234 (20.0%) died. In multivariable-adjusted Cox proportional hazards models, the TyG index was significantly associated with the risk of ESKD, both with (hazard ratio [HR] per 1-SD increase, 1.68; 95% CI, 1.56-1.82) and without (HR per 1-SD increase, 1.79; 95% CI, 1.66-1.93) the inclusion of BMI as a covariate. Mediation analysis using a newly proposed 2-stage regression method for survival data showed that a 5-point increase in BMI increased the risk of ESKD by 58% (HR [total association], 1.58; 95% CI, 1.43-1.75), and that 41.7% of the total association (95% CI, 31.6%-51.8%) was mediated through the TyG index (HR [indirect association], 1.21; 95% CI, 1.18-1.25). CONCLUSIONS AND RELEVANCE This study found that the TyG index appeared to be associated with ESKD risk and mediates nearly half of the total association between BMI and ESKD in the general population. Public health efforts aiming at the reduction of body weight might decrease the kidney sequelae of insulin resistance and the burden of ESKD.
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Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | | | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Julia Kerschbaum
- Department of Internal Medicine IV (Nephrology and Hypertension), Innsbruck Medical University, Innsbruck, Austria
| | - Karl Lhotta
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Fritz J, Gaillot H, Ruel Y. Helical computed tomographic-dacryocystography in adult pet dwarf rabbits: procedure and normal appearance. VLAAMS DIERGEN TIJDS 2020. [DOI: 10.21825/vdt.v89i6.17412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Partial or complete nasolacrimal drainage system (NLDS) occlusion is a common clinical concern in rabbits. It can be assumed that computed tomographic-dacryocystography (CTDCG) might be an efficient technique in this indication. In this prospective study, the technique of CT-DCG and the appearance of the NLDS in eight healthy rabbits on CT-DCG images are described. The quality of visualization of bony structures adjacent to the NLDS was good on pre-contrast computed tomographic images. The bony lacrimal canal had a smooth contour, a regular diameter, and its mean dimensions are provided. CT-DCG technique was easy to perform and offered a good visualization of the NLDS including anatomical narrowings and bendings. CT-DCG is a minimally invasive and informative technique for evaluating the NLDS in rabbits. Its diagnostic usefulness in exploring nasolacrimal diseases remains to be specified in this species.
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Krapf J, Schuhbeck A, Wendel T, Fritz J, Scholl-Bürgi S, Bösmüller C, Oberhuber R, Margreiter C, Maglione M, Stättner S, Messner F, Berchtold V, Braunwarth E, Primavesi F, Cardini B, Resch T, Karall D, Öfner D, Margreiter R, Schneeberger S. Assessment of the Clinical Impact of a Liver-Specific, BCAA-Enriched Diet in Major Liver Surgery. Transplant Proc 2020; 53:624-629. [PMID: 33139038 DOI: 10.1016/j.transproceed.2020.09.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relationship between nutrition and liver disease is relevant for the outcome after surgery. Patients with liver cirrhosis characteristically show protein-energy malnutrition with decreased levels of branched-chain amino acids (BCAA) and increased levels of aromatic amino acids. MATERIALS AND METHODS We conducted a prospective controlled clinical trial including 57 patients after liver transplantation or major liver resection surgery in order to test the effect of early postoperative nutrition on the outcome and nutrition profile of these patients. The test group received a dietetic program composed of ingredients naturally rich in BCAA (BCAA group), and the control group received standard hospital meals. Patient survival, liver function tests, subjective well-being, and a nutritional status including amino acid profiles were analyzed immediately and 14 days after major liver surgery (secondary end points). General health and well-being were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (primary end point). RESULTS In-depth analysis of amino acid profiles was performed for patients undergoing liver resection (n = 21) and liver transplantation (n = 36). Interestingly, amino acid profiles did not correlate with body mass index or the Model for End-Stage Liver Disease score. Patients scheduled for liver transplantation showed significantly lower levels of BCAA pretransplant compared to patients undergoing liver resection. Patients in the liver resection subgroup were more likely to benefit from the BCAA cuisine in terms of significantly higher food intake and subjective rating. The clinical liver function tests, however, did not show statistical difference between the BCAA group and the control group in the examination period of 14 days. CONCLUSION Our specifically designed BCAA-enriched diet resulted in greater patient satisfaction and compliance with nutrition. A larger trial or longer-term follow-up may be required to identify an effect on survival, recovery, surgical complications, protein profiles, and amino acid profiles.
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Affiliation(s)
- J Krapf
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University and Tirol Kliniken Medical Center Innsbruck, Innsbruck, Austria
| | | | - T Wendel
- Private Practice, Lindau, Germany
| | - J Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - S Scholl-Bürgi
- Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - C Bösmüller
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - R Oberhuber
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - C Margreiter
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - M Maglione
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - S Stättner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - F Messner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - V Berchtold
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - E Braunwarth
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - F Primavesi
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - B Cardini
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - T Resch
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - D Karall
- Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
| | - D Öfner
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - R Margreiter
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - S Schneeberger
- Department of Surgery, University Hospital for Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Polasik A, De Gregorio A, Fritz J, De Gregorio N, Janni W, Bauer E. Der seltene Fall eines ulzerierenden Hidradenoms der Vulva. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Polasik
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
| | - A De Gregorio
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
| | - J Fritz
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
| | - N De Gregorio
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
| | - W Janni
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
| | - E Bauer
- Universitätsklinikum Ulm, Gynäkologie und Geburtshilfe
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Fritz J, Stuck D, Braun T, De GA, Janni W, Reister F, De Gregorio N. Auswirkung einer verkürzten Antibiotikatherapie bei vorzeitigem Blasensprung vor der 34. Schwangerschaftswoche auf Schwangerschaftsverlängerung und Schwangerschaftsdauer. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Fritz
- Universitätsfrauenklinik Ulm
| | - D Stuck
- Universitätsfrauenklinik Ulm
| | - T Braun
- Universitätsfrauenklinik Ulm
| | | | - W Janni
- Universitätsfrauenklinik Ulm
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Fritz J, Fink V, Sophia H, Kersten M, Braun T, Janni W, Bekes I. 61-jährige Patientin mit intramammärer Absiedelung eines extranodalen Mantelzell-Lymphoms der Tränendrüse – ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Fritz
- Universitätsfrauenklinik Ulm
| | - V Fink
- Universitätsfrauenklinik Ulm
| | | | | | - T Braun
- Universitätsfrauenklinik Ulm
| | - W Janni
- Universitätsfrauenklinik Ulm
| | - I Bekes
- Universitätsfrauenklinik Ulm
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Braun T, Baumann L, Rack B, Fritz J, Fink A, Koretz K, Fink V, Huober J, Janni W, De Gregorio A, De Gregorio N. Myofibroblastom der Brust – eine differentialdiagnostische Herausforderung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T Braun
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - L Baumann
- Universitätsklinikum Ulm, Institut für Pathologie
| | - B Rack
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - J Fritz
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - A Fink
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - K Koretz
- Universitätsklinikum Ulm, Institut für Pathologie
| | - V Fink
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - J Huober
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - W Janni
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - A De Gregorio
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
| | - N De Gregorio
- Universitätsklinikum Ulm, Klinik Für Frauenheilkunde und Geburtshilfe
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Raakow J, Denecke C, Chopra S, Fritz J, Hofmann T, Andreou A, Thuss-Patience P, Pratschke J, Biebl M. [Laparoscopic versus open gastrectomy for advanced gastric cancer : Operative and postoperative results]. Chirurg 2020; 91:252-261. [PMID: 31654103 DOI: 10.1007/s00104-019-01053-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/16/2022]
Abstract
BACKGROUND Minimally invasive gastrectomy is increasingly becoming established worldwide as an alternative to open gastrectomy (OG); however, the majority of available articles in the literature refer to Asian populations and early stages of gastric cancer. This makes an international comparison difficult due to a discrepancy in patient populations and tumor biology as well as Asian and western treatment approaches. Little is known, therefore, whether laparoscopic gastrectomy (LG) can be performed in advanced cancer, in particular with respect to laparoscopic D2 lymphadenectomy, with sufficient radicality and safety in this country. MATERIAL AND METHODS All gastrectomies performed for the treatment of advanced gastric cancer with clinical UICC stages 2 and 3 between 2005 and 2017 were analyzed. A case match by age, gender and UICC stage was performed to compare the operative and early postoperative results of LG and OG. RESULTS A total of 243 patients with advanced gastric cancer were analyzed. Of these 81 patients (33.3%) underwent LG. The operative time for LG was around 74 min longer (279.2 min vs. 353.4 min, OG vs. LG; p < 0.001), the hospital stay after LG was around 4 days shorter (22.9 days vs. 18.4 days, OG vs. LG; p < 0.001). Significantly more lymph nodes were resected by LG (24.1 lymph nodes vs. 28.8 lymph nodes, OG vs. LG; p < 0.001). In terms of morbidity and mortality there were no differences between the groups. CONCLUSION The present study showed that minimally invasive gastrectomy can be performed safely and with comparable histopathological results to open surgery, even in advanced gastric cancer in western populations; however, larger case series and evidence from high-quality studies are urgently needed especially to compare short-term and long-term survival.
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Affiliation(s)
- J Raakow
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - C Denecke
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - S Chopra
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Fritz
- Department für Medizinische Statistik, Informatik und Gesundheitsökonomie, Medizinische Universität Innsbruck, Schöpfstraße 41/1, 6020, Innsbruck, Österreich
| | - T Hofmann
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - A Andreou
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - P Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - J Pratschke
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Biebl
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland.
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Fritz J, Stochl J, Goodyer IM, van Harmelen AL, Wilkinson PO. Embracing the positive: an examination of how well resilience factors at age 14 can predict distress at age 17. Transl Psychiatry 2020; 10:272. [PMID: 32759937 PMCID: PMC7406495 DOI: 10.1038/s41398-020-00944-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
One-in-two people suffering from mental health problems develop such distress before or during adolescence. Research has shown that distress can predict itself well over time. Yet, little is known about how well resilience factors (RFs), i.e. those factors that decrease mental health problems, predict subsequent distress. Therefore, we investigated which RFs are the best indicators for subsequent distress and with what accuracy RFs predict subsequent distress. We examined three interpersonal (e.g. friendships) and seven intrapersonal RFs (e.g. self-esteem) and distress in 1130 adolescents, at age 14 and 17. We estimated the RFs and a continuous distress-index using factor analyses, and ordinal distress-classes using factor mixture models. We then examined how well age-14 RFs and age-14 distress predict age-17 distress, using stepwise linear regressions, relative importance analyses, as well as ordinal and linear prediction models. Low brooding, low negative and high positive self-esteem RFs were the most important indicators for age-17 distress. RFs and age-14 distress predicted age-17 distress similarly. The accuracy was acceptable for ordinal (low/moderate/high age-17 distress-classes: 62-64%), but low for linear models (37-41%). Crucially, the accuracy remained similar when only self-esteem and brooding RFs were used instead of all ten RFs (ordinal = 62%; linear = 37%); correctly predicting for about two-in-three adolescents whether they have low, moderate or high distress 3 years later. RFs, and particularly brooding and self-esteem, seem to predict subsequent distress similarly well as distress can predict itself. As assessing brooding and self-esteem can be strength-focussed and is time-efficient, those RFs may be promising for risk-detection and translational intervention research.
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Affiliation(s)
- J. Fritz
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - J. Stochl
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.4491.80000 0004 1937 116XDepartment of Kinanthropology, Charles University, Charles, Czech Republic
| | - I. M. Goodyer
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A.-L. van Harmelen
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P. O. Wilkinson
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
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Meryk A, Kropshofer G, Hutter J, Fritz J, Salvador C, Lass-Flörl C, Crazzolara R. Benefits of risk-adapted and mould-specific antifungal prophylaxis in childhood leukaemia. Br J Haematol 2020; 191:816-824. [PMID: 32621534 PMCID: PMC7754307 DOI: 10.1111/bjh.16931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
Fluconazole is one of the most commonly used drugs for antifungal prophylaxis in childhood leukaemia. However, its interaction with vincristine may induce neuropathy and the emergence of antifungal drug resistance contributes to substantial mortality caused by invasive fungal infections (IFIs). In a retrospective single‐centre study, we compared tolerability and outcome of different antifungal prophylaxis strategies in 198 children with acute leukaemia (median age 5·3 years). Until 2010, antifungal prophylaxis with fluconazole was offered to most of the patients and thereafter was replaced by liposomal amphotericin‐B (L‐AMB) and restricted to high‐risk patients only. Vincristine‐induced neurotoxicity was significantly reduced under L‐AMB, as the percentage of patients with severe constipation decreased (15·4% vs. 3·7%, before vs. after 31 December·2010, P = 0·01) and stool frequency increased by up to 38% in polyene‐treated patients (P = 0·005). Before 2011, 10 patients developed confirmed IFIs, most of them were infected with Aspergillus species. After risk adaption in 2011, IFIs were completely prevented (P = 0·007). L‐AMB prophylaxis is beneficial in childhood leukaemia patients, as it offers effective antifungal activity with improved tolerability as compared to fluconazole. The potential impact of our risk‐adapted antifungal treatment should be included in current prophylaxis guidelines for childhood leukaemia.
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Affiliation(s)
- Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Hutter
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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Polasik A, Otto S, Schumann U, Hüner B, Fritz J, Ebner F, Janni W, Reister F, Andres S. Auswirkung einer moderaten körperlichen Belastung in der Schwangerschaft auf den Feten sowie die feto- und uteroplazentare Durchblutung. Eine prospektive Pilot-Studie auf dem Fahrradergometer. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Polasik
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
| | - S Otto
- 2 Universitätsklinikum Ulm, Klinik für Innere Medizin II, Sektion Sport- und Rehabilitationsmedizin
| | - U Schumann
- 2 Universitätsklinikum Ulm, Klinik für Innere Medizin II, Sektion Sport- und Rehabilitationsmedizin
| | - B Hüner
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
| | - J Fritz
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
| | - F Ebner
- 2 Universitätsklinikum Ulm, Klinik für Innere Medizin II, Sektion Sport- und Rehabilitationsmedizin
| | - W Janni
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
| | - F Reister
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
| | - S Andres
- 1 Universitätsklinikum Ulm, Klinik für Gynäkologie und Geburtshilfe
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35
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Fritz J, Stuck D, Braun T, deGregorio A, Janni W, Reister F, deGregorio N. Auswirkung einer verkürzten Antibiotikatherapie bei vorzeitigem Blasensprung vor der 34. Schwangerschaftswoche auf Schwangerschaftsverlängerung und Schwangerschaftsdauer. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Fritz
- Universitätsfrauenklinik Ulm
| | - D Stuck
- Universitätsfrauenklinik Ulm
| | - T Braun
- Universitätsfrauenklinik Ulm
| | | | - W Janni
- Universitätsfrauenklinik Ulm
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36
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Fritz J, Bjørge T, Nagel G, Manjer J, Engeland A, Häggström C, Concin H, Teleka S, Tretli S, Gylling B, Lang A, Stattin P, Stocks T, Ulmer H. The triglyceride-glucose index as a measure of insulin resistance and risk of obesity-related cancers. Int J Epidemiol 2020; 49:193-204. [PMID: 30945727 DOI: 10.1093/ije/dyz053] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. METHODS Altogether 510 471 individuals from six European cohorts, with a mean age of 43.1 years, were included. We used the triglyceride glucose product (TyG index) as a surrogate measure for insulin resistance. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with 10 common obesity-related cancers, and quantified the proportion of the effect of BMI mediated through TyG index on the log-transformed hazard ratio (HR) scale. RESULTS During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney HR per one standard deviation increase 1.13, 95% confidence interval: 1.07 to 1.20], liver (1.13, 1.04 to 1.23), pancreas (1.12, 1.06 to 1.19), colon (1.07, 1.03 to 1.10) and rectum (1.09, 1.04 to 1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%) and colon (20%); smaller proportions for kidney (15%) and liver (11%). Little or no mediation was observed for breast (postmenopausal), endometrial and ovarian cancer. Results were similar for males and females, except for pancreatic cancer where the proportions mediated were 20% and 91%, respectively. CONCLUSIONS The TyG index was associated with increased risk of cancers of the digestive system and substantially mediated the effect of BMI, suggesting that insulin resistance plays a promoting role in the pathogenesis of gastrointestinal cancers.
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Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Stanley Teleka
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Björn Gylling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
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Uprimny C, Bayerschmidt S, Kroiss AS, Fritz J, Nilica B, Svirydenka A, Decristoforo C, di Santo G, von Guggenberg E, Horninger W, Virgolini IJ. Impact of forced diuresis with furosemide and hydration on the halo artefact and intensity of tracer accumulation in the urinary bladder and kidneys on [ 68Ga]Ga-PSMA-11-PET/CT in the evaluation of prostate cancer patients. Eur J Nucl Med Mol Imaging 2020; 48:123-133. [PMID: 32385647 DOI: 10.1007/s00259-020-04846-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE to assess the influence of intravenous hydration and forced diuresis with furosemide in two different dosages (20 vs 40 mg) on the intensity of tracer accumulation in the urinary collection system and on the occurrence of halo artefact surrounding the urinary bladder and kidneys in [68Ga]Ga-PSMA-11-PET/CT scans. MATERIALS AND METHODS Comparison of four groups with 50 patients each, receiving different preparation prior to [68Ga]Ga-PSMA-11-PET/CT. Group one, no preparation. Group two, 500 ml sodium chloride administered immediately after tracer injection. Group three, 500 ml sodium chloride and injection of 20 mg furosemide immediately after tracer administration. Group four, 500 ml sodium chloride and injection of 40 mg furosemide immediately after tracer injection. Images were judged visually whether halo artefact was present; semiquantitative measurements were performed with standardised uptake value (SUV). RESULTS Halo artefact of the urinary bladder was present in twelve patients without preparation, in eight patients receiving only sodium chloride, in one patient injected with 20 mg furosemide/sodium chloride and in two patients receiving 40 mg furosemide/sodium chloride, showing a median SUVmean in the bladder of 45.8, 14.4, 4.6 and 5.8, respectively. Differences between patient group without preparation and the two groups with furosemide/sodium chloride were statistically significant. Patient groups receiving 20 mg furosemide and 40 mg furosemide did not differ significantly. Renal halo artefacts were observed in 15 patients of group one, in ten patients of group two, in 14 patients of group three and in 14 patients of group four, with corresponding median SUVmean values of 33.9, 32.0, 37.8 and 30.4 (no statistically significant differences). CONCLUSION Performing [68Ga]Ga-PSMA-11-PET/CT, intravenous injection of 20-mg furosemide and 500-ml sodium chloride significantly reduces the number of bladder halo artefacts and intensity of tracer accumulation in the urinary bladder. A total of 40 mg furosemide does not further improve results.
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Affiliation(s)
- Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Steffen Bayerschmidt
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Stephan Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna Svirydenka
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gianpaolo di Santo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Irene Johanna Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Ruttmann E, Abfalterer H, Dietl M, Wagner J, Kilo J, Grimm M, Bates K, Fritz J, Ulmer H. Positive family history of cardiovascular disease and long-term outcomes after coronary artery bypass grafting: a genetic paradox? Eur J Cardiothorac Surg 2020; 57:986-993. [PMID: 31819982 DOI: 10.1093/ejcts/ezz333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Parental cardiovascular disease (CVD) is a known risk factor for premature CVD. It is unknown whether a positive family history (PFH) affects outcomes after coronary artery bypass grafting (CABG). METHODS Data come from a retrospective longitudinal study of CABG patients consecutively recruited from 2001 to 2018 (n = 5389). From this study, 2535 patients with premature CVD undergoing CABG under the age of 60 years and information on parental CVD were identified. The Framingham offspring study criteria were used to identify PFH of CVD. Multivariable Cox proportional hazards regression models were used to assess the effect of PFH on overall and major adverse cardiovascular and cerebrovascular event-free survival. RESULTS A total of 273 deaths and 428 major adverse cardiovascular and cerebrovascular events occurred during follow-up. PFH of CVD was found in 54.2% of patients (n = 1375). Within these patients, 66.1% had a father who experienced a premature cardiovascular event (n = 909), 27.8% a mother (n = 382) and 6.1% both a mother and a father (n = 84). In the majority of cases, the patient's parent had experienced a cardiac event (85.9%, n = 1181) and 14.1% of patients with PFH reported parental stroke (n = 194). Following CABG, PFH was associated with improved overall [adjusted hazards ratio (HR) 0.67, 95% confidence interval (CI) 0.50-0.90; P = 0.008] and major adverse cardiovascular and cerebrovascular event-free survival (adjusted HR 0.73, 95% CI 0.68-0.89; P = 0.01). Among the covariates adjusted for age, diabetes, renal insufficiency, peripheral arterial disease, ejection fraction, previous cerebrovascular events and previous mediastinal radiation were all associated with poorer outcomes. CONCLUSIONS Although it is well established that a PFH increases the risk of requiring CABG at younger ages, this study shows that, paradoxically, PFH is also protective regarding long-term outcomes. REGISTRATION NUMBER LOCAL IRB UN4232 297/4.3 (retrospective study).
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Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Hannes Abfalterer
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Marion Dietl
- Department of Plastic and Reconstructive Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Julian Wagner
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Juliane Kilo
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Katie Bates
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
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Fritz J, VoPham T, Wright KP, Vetter C. A Chronobiological Evaluation of the Acute Effects of Daylight Saving Time on Traffic Accident Risk. Curr Biol 2020; 30:729-735.e2. [PMID: 32008905 DOI: 10.1016/j.cub.2019.12.045] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/31/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022]
Abstract
There is evidence that the spring Daylight Saving Time (DST) transition acutely increases motor vehicle accident (MVA) risk ("DST effect"), which has been partly attributed to sleep deprivation and circadian misalignment [1-6]. Because spring DST also shifts clock time 1 h later, mornings are darker and evenings brighter, changing illumination conditions for peak traffic density. This daytime-dependent illumination change ("time of day effect") is hypothesized to result in DST-associated afternoon and evening accident risk reductions [2, 5, 7]. Furthermore, sunrise and local photoperiod timing depend on position in time zone. The sun rises at an earlier clock time in the eastern regions of a given time zone than in the western regions, which is thought to induce higher levels of circadian misalignment in the west than in the east ("time zone effect") [8, 9]. This study evaluated the acute consequences of the DST transition on MVAs in a chronobiological context, quantifying DST, time of day, and time zone effects. We used large US registry data, including 732,835 fatal MVAs recorded across all states (1996-2017), and observed that spring DST significantly increased fatal MVA risk by 6%, which was more pronounced in the morning and in locations further west within a time zone. DST-associated MVA risk increased even in the afternoon hours, despite longer daylight hours. The MVA risk increase waned in the week subsequent to DST, and there were no effects of the fall-back transition to Standard Time (ST) on MVA risk, further supporting the hypothesis that DST-transition-associated, preventable circadian misalignment and sleep deprivation might underlie MVA risk increases.
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Affiliation(s)
- Josef Fritz
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Trang VoPham
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Kenneth P Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
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Andexlinger S, Fritz J, Edlinger M, Concin H, Nagel G, Brozek W, Ruttmann E, Foeger B, Ulmer H. P3402Validation of the SCORE O.P. for prediction of cardiovascular disease mortality in a large population of elderly individuals. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Estimation of absolute cardiovascular risk in apparently healthy individuals, using SCORE (Systematic COronary Risk Evaluation) is recommended by the ESC guidelines on cardiovascular disease (CVD) prevention in clinical practice. Recently, the SCORE system has been extended by the SCORE O.P. aiming to improve estimates of cardiovascular risk specifically in older persons (65 years and older).
Purpose
The aim of this study was to validate the SCORE O.P. in an Austrian population of 34,909 healthy individuals aged between 65 and 80 years which were prospectively followed for a minimum of 10 years.
Methods
Predicted fatal CVD and coronary heart disease (CHD) event rates within 10 years were calculated using the “SCORE O.P. risk function for low risk regions” and compared to the actually observed rates, thereby assessing calibration. In addition, predicted probabilities were plotted against observed mortality by deciles of predicted risk. Regarding discrimination, receiver operating characteristics (ROC) analysis and corresponding c-statistics were used.
Results
In 14,586 males, 1,509 deaths from CVD (10.4%) and 847 deaths from CHD (5.8%) occurred within 10 years of follow-up. SCORE O.P. predicted 1,699 fatal CVD (11.7%) and 872 CHD (6.0%) events. In male high risk individuals (10th decile), SCORE O.P. overestimated mortality from CVD and CHD. C-statistics were 0.68 (95% CI 0.67–0.70) for CVD and 0.67 (0.65–0.69) for CHD.
In 20,323 females, 1,340 deaths from CVD (6.6%) and 672 deaths from CHD (3.3%) were observed. SCORE O.P. predicted 1,232 fatal CVD (6.1%) and 539 CHD events (2.7%). In female high risk individuals (8–10th deciles), SCORE O.P. underestimated mortality from CVD and CHD. C-statistics were 0.77 (0.75–0.78) for CVD and 0.77 (0.75–0.79) for CHD.
Conclusion
With regard to overall accuracy, the SCORE O.P. performed considerably well in this elderly Austrian population. However, in high-risk individuals, cardiovascular risk was overestimated for males and underestimated for females. SCORE O.P. was able to discriminate high-risk from low-risk individuals, better in women than in men.
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Affiliation(s)
- S Andexlinger
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - J Fritz
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - M Edlinger
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - G Nagel
- University of Ulm, Institute of Epidemiology and Medical Biometry, Ulm, Germany
| | - W Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - E Ruttmann
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - B Foeger
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - H Ulmer
- Innsbruck Medical University, Medical Statistics, Informatics and Health Economics, Innsbruck, Austria
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Ruttmann-Ulmer E, Abfalterer H, Dietl M, Wagner J, Bates K, Grimm M, Fritz J, Ulmer H. P6427Positive family history of cardiovascular disease and long-term outcomes after coronary artery bypass grafting in younger patients: a genetic paradox? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Parental cardiovascular disease (CVD) is a known risk factor for premature CVD in both men and women. It is unknown whether a positive family history (PFH) of premature CVD also affects long-term outcomes after coronary artery bypass grafting (CABG).
Purpose
We estimated the prevalence of PFH of premature CVD in a large population of CABG patients younger than 60 years of age. We evaluated whether PFH is an independent predictor of survival and freedom from major adverse cardiac and cerebrovascular events (MACCEs) following CABG.
Methods
Data come from a prospective longitudinal study of first, non-emergent, CABG patients consecutively recruited at the Innsbruck Medical University between August 2001 and February 2018 (n=5389). Patients were followed up for a median of 8 years. From this study, 2553 patients with premature CAD undergoing CABG under the age of 60 years were identified. Self-reported PFH data was available for 99.3% of patients; n=2535 patients were eligible for these analyses. In line with the Framingham offspring study, a premature PFH of CVD was defined when a patient's father and/or mother experienced their first CV event at <55 (father) and <65 (mother) years of age, respectively. Adjusted multivariable Cox proportional hazards regression was used to assess the effect of PFH on overall and MACCE-free survival.
Results
Premature PFH was found in 54.2% of patients (n=1375). Within these patients, 66.1% had a father who experienced a premature CV event (n=909), 27.8% a mother (n=382) and 6.1% both a mother and a father (n=84). In the majority of cases the patient's parent had experienced a premature cardiac event (85.9%, n=1181), 14.1% of patients with PFH reported their parent(s) had a premature stroke (n=194). Patients with a PFH had lower rates of smoking, diabetes and renal disease but were more likely to be hypertensive. Following CABG, PFH was associated with improved long-term survival (adjusted HR, 0.66; 95% CI, 0.50–0.91; p=0.011) and MACCE-free survival (adjusted HR, 0.73; 95% CI, 0.68–0.89; p=0.01). Among the covariates adjusted for, age, diabetes, renal insufficiency, peripheral arterial disease, impaired left ventricular function, previous cerebrovascular events and previous mediastinal radiation were associated with poorer outcomes. In contrast, multiple arterial grafting by bilateral internal thoracic arteries improved both survival (adjusted HR, 0.52; 95% CI, 0.36–0.74; p<0.001), and MACCE-free survival (adjusted HR, 0.41; 95% CI, 0.31–0.54; p<0.001).
Conclusion
In this cohort of high-risk patients undergoing CABG under 60 years of age, PFH was highly prevalent. Whilst it is evident that a PFH increases the risk of requiring CABG at younger ages, this study shows that PFH is also, paradoxically, protective regarding long-term outcomes; PFH is associated with both improved overall and MACCE-free survival following CABG.
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Affiliation(s)
| | - H Abfalterer
- Innsbruck Medical University, Innsbruck, Austria
| | - M Dietl
- Innsbruck Medical University, Innsbruck, Austria
| | - J Wagner
- Innsbruck Medical University, Innsbruck, Austria
| | - K Bates
- Innsbruck Medical University, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, Innsbruck, Austria
| | - J Fritz
- Innsbruck Medical University, Innsbruck, Austria
| | - H Ulmer
- Innsbruck Medical University, Innsbruck, Austria
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Brockmann SO, Oehme R, Buckenmaier T, Beer M, Jeffery-Smith A, Spannenkrebs M, Haag-Milz S, Wagner-Wiening C, Schlegel C, Fritz J, Zange S, Bestehorn M, Lindau A, Hoffmann D, Tiberi S, Mackenstedt U, Dobler G. A cluster of two human cases of tick-borne encephalitis (TBE) transmitted by unpasteurised goat milk and cheese in Germany, May 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667575 PMCID: PMC6836198 DOI: 10.2807/1560-7917.es.2018.23.15.17-00336] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 12/17/2022]
Abstract
In May 2016, two cases of tick-borne encephalitis (TBE) were confirmed by serology (positive IgM and IgG antibodies against TBE virus (TBEV) in serum), with a possible link to raw milk and cheese from a goat farm in a region in Baden-Württemberg, Germany not previously known as TBE-endemic. The outbreak investigation identified 32 consumers of goat dairy products (29 consumers, one farm employee, two owners) of whom none had IgM antibodies against TBEV 3–8 weeks after consumption. Of the 27 notified TBE cases in the State, none reported consumption of raw goat milk or cheese from the suspected farm. Five of 22 cheese samples from 18 different batches were RT-qPCR-positive for TBEV -genome, and two of the five samples were confirmed by virus isolation, indicating viability of TBEV in the cheese. Nine of the 45 goats had neutralising TBEV antibodies, two of them with a high titre indicating recent infection. One of 412 Ixodes ricinus was RT-qPCR-positive, and sequencing of the E gene from nucleic acid extracted from the tick confirmed TBEV. Phylogenetic analyses of tick and cheese isolates showed 100% amino acid homology in the E gene and a close relation to TBEV strains from Switzerland and Austria.
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Affiliation(s)
- S O Brockmann
- Public Health Office, District of Reutlingen, Reutlingen, Germany
| | - R Oehme
- State Health Office Baden-Württemberg, Stuttgart, Germany
| | - T Buckenmaier
- Veterinary Health Office, District of Reutlingen, Reutlingen, Germany
| | - M Beer
- Friedrich-Loeffler Institute, Federal Institute of Animal Health, Institute of Diagnostic Virology, Greifswald, Insel Riems, Germany
| | | | - M Spannenkrebs
- Public Health Office, District of Biberach, Biberach, Germany
| | - S Haag-Milz
- Public Health Office, District of Sigmaringen, Sigmaringen, Germany
| | | | - C Schlegel
- Public Health Office, District of Reutlingen, Reutlingen, Germany
| | - J Fritz
- Public Health Office, District of Reutlingen, Reutlingen, Germany
| | - S Zange
- Bundeswehr Institute of Microbiology; German Consultant Laboratory of TBE, German Center of Infection Research (DZIF), Munich, Germany
| | - M Bestehorn
- Parasitology Unit, University of Hohenheim, Stuttgart, Germany
| | - A Lindau
- Parasitology Unit, University of Hohenheim, Stuttgart, Germany
| | - D Hoffmann
- Friedrich-Loeffler Institute, Federal Institute of Animal Health, Institute of Diagnostic Virology, Greifswald, Insel Riems, Germany
| | - S Tiberi
- Barts Health NHS Trust, London, United Kingdom
| | - U Mackenstedt
- Parasitology Unit, University of Hohenheim, Stuttgart, Germany
| | - G Dobler
- Parasitology Unit, University of Hohenheim, Stuttgart, Germany.,Bundeswehr Institute of Microbiology; German Consultant Laboratory of TBE, German Center of Infection Research (DZIF), Munich, Germany
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Fritz J, Mahinc M, Rannou B, Cauvin E. Medical management of Echinococcus multilocularis infection mimicking a locally aggressive cavitary tumor with pulmonary metastases in a dog. VLAAMS DIERGEN TIJDS 2019. [DOI: 10.21825/vdt.v88i4.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A two-year-old Labrador retriever living in the French Alps was presented with abdominal distension, lethargy and weight loss but no other specific clinical signs. CT examination revealed a large, cavitary liver mass invading the caudal vena cava, associated with multiple hepatic lesions of similar appearance, lymphadenopathy and pulmonary nodules. The condition was initially mistaken for a malignant neoplasm. However, cytologic and histologic examinations of the largest liver mass were consistent with cestodiasis and PCR testing confirmed infection with Echinococcus multilocularis. Medical treatment with albendazole was initiated. The dog remained clinically well for ten months following the diagnosis, but had to be euthanized because the owners had to return to Great-Britain and the dog could not be legally imported. To the authors’ knowledge, this is the first case report, in which long-term follow-up of Echinococcus sp. infection in a dog, managed medically, is described. This case also shows that medical management may be a viable option in case surgery is not feasible.
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Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, Fritz J, Feurstein B, Popp W, Karam V, Muiesan P, O'Grady J, Jamieson N, Wigmore SJ, Pirenne J, Malek-Hosseini SA, Hidalgo E, Tokat Y, Paul A, Pratschke J, Bartels M, Trunecka P, Settmacher U, Pinzani M, Duvoux C, Newsome PN, Schneeberger S. Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study. J Hepatol 2019; 71:313-322. [PMID: 31071367 PMCID: PMC6656693 DOI: 10.1016/j.jhep.2019.04.011] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/23/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors. METHODS We analysed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other aetiologies. The principle endpoints were patient and overall allograft survival. RESULTS Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH - an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, p <0.001). NASH was not significantly associated with survival of patients (hazard ratio [HR] 1.02, p = 0.713) or grafts (HR 0.99; p = 0.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in patients with NASH without HCC. Increasing recipient age (61-65 years: HR 2.07, p <0.001; >65: HR 1.72, p = 0.017), elevated model for end-stage liver disease score (>23: HR 1.48, p = 0.048) and low (<18.5 kg/m2: HR 4.29, p = 0.048) or high (>40 kg/m2: HR 1.96, p = 0.012) recipient body mass index independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors. CONCLUSIONS The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications. LAY SUMMARY The prevalence of non-alcoholic fatty liver disease has increased dramatically in parallel with the worldwide increase in obesity and diabetes. Its progressive form, non-alcoholic steatohepatitis, is a growing indication for liver transplantation in Europe, with good overall outcomes reported. However, careful risk factor assessment is required to maintain favourable post-transplant outcomes in patients with non-alcoholic steatohepatitis.
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Affiliation(s)
- Debashis Haldar
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK,Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Barbara Kern
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria,Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health (BIH), Berlin, Germany
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Mindelsohn Way, Birmingham, UK
| | - Matthew James Armstrong
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK,Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rene Adam
- Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University of Paris-Sud, Inserm U776, Villejuif, France
| | - Gabriela Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel, Vienna, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Benedikt Feurstein
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Popp
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Vincent Karam
- Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University of Paris-Sud, Inserm U776, Villejuif, France
| | - Paolo Muiesan
- Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John O'Grady
- King’s Liver Transplant Unit, King’s College Hospital NHS Foundation Trust, London, UK
| | - Neville Jamieson
- Cambridge Transplant Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge UK
| | - Stephen J. Wigmore
- MRC Centre for Inflammation Research and Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Jacques Pirenne
- Laboratory of Abdominal Transplantation, Universitaire Zeikenhuizen Leuven, Leuven, Belgium
| | | | | | - Yaman Tokat
- Liver Transplantation Center, Florence Nightingale Hospital, Istanbul, Turkey
| | - Andreas Paul
- Department of Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Bartels
- Universitatsklinikum Leipzig, Chirurgische Klinik Und Poliklinik Ii Visceral, Transplantations, Thorax und Gefabchirurgie, Leipzig, Germany
| | - Pavel Trunecka
- Institute of Clinical and Experimental Medicine, Transplant Center, Prague, Czech Republic
| | - Utz Settmacher
- Universitatsklinikum Jena, Allgemeine, Viszerale und Transplantationschirurgie, Jena, Germany
| | - Massimo Pinzani
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Christophe Duvoux
- Service De Chirurgie Digestive, Hopital Henri Mondor, Creteil, France
| | - Philip Noel Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK; Centre for Liver and Gastroenterology Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
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de Gregorio A, Bauer E, Uhde M, Swerev T, Fritz J, Janni W, Ebner F, de Gregorio N. Akutes Nierenversagen bei Pemphigoid gestationis – ein ungewöhnlicher Krankheitsverlauf. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - E Bauer
- Universitätsfrauenklinik Ulm
| | - M Uhde
- Universitätsfrauenklinik Ulm
| | | | - J Fritz
- Universitätsfrauenklinik Ulm
| | - W Janni
- Universitätsfrauenklinik Ulm
| | - F Ebner
- Klinik für Frauenheilkunde HELIOS Amper Klinik Dachau
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Reinert CP, Federmann B, Hofmann J, Bösmüller H, Wirths S, Fritz J, Horger M. Computed tomography textural analysis for the differentiation of chronic lymphocytic leukemia and diffuse large B cell lymphoma of Richter syndrome. Eur Radiol 2019; 29:6911-6921. [PMID: 31236702 DOI: 10.1007/s00330-019-06291-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/14/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To test the hypothesis that both indolent and aggressive chronic lymphocytic leukemia (CLL) can be differentiated from diffuse large B cell lymphoma (DLBCL) of Richter syndrome (RS) by CT texture analysis (CTTA) of involved lymph nodes. MATERIAL AND METHODS We retrospectively included 52 patients with indolent CLL (26/52), aggressive CLL (8/52), and DLBCL of RS (18/52), who underwent standardized contrast-enhanced CT. In main lymphoma tissue, VOIs were generated from which CTTA features including first-, second-, and higher-order textural features were extracted. CTTA features were compared between the entire CLL group, the indolent CLL subtype, the aggressive CLL subtype, and DLBCL using a Kruskal-Wallis test. All p values were adjusted after the Bonferroni correction. ROC analyses for significant CTTA features were performed to determine cut-off values for differentiation between the groups. RESULTS Compared with DLBCL of RS, CTTA of the entire CLL group showed significant differences of entropy heterogeneity (p < 0.001), mean intensity (p < 0.001), mean average (p = 0.02), and number non-uniformity gray-level dependence matrix (NGLDM) (p = 0.03). Indolent CLL significantly differed for entropy (p < 0.001), uniformity of heterogeneity (p = 0.02), mean intensity (p < 0.001), and mean average (p = 0.01). Aggressive CLL showed significant differences in mean intensity (p = 0.04). For differentiation between CLL and DLBCL of RS, cut-off values for mean intensity and entropy of heterogeneity were defined (e.g., 6.63 for entropy heterogeneity [aggressive CLL vs. DLBCL]; sensitivity 0.78; specificity 0.63). CONCLUSIONS CTTA features of ultrastructure and vascularization significantly differ in CLL compared with that in DLBCL of Richter syndrome, allowing complementary to visual features for noninvasive differentiation by contrast-enhanced CT. KEY POINTS • Richter transformation of CLL into DLBCL results in structural changes in lymph node architecture and vascularization that can be detected by CTTA. • First-order CT textural features including intensity and heterogeneity significantly differ between both indolent CLL and aggressive CLL and DLBCL of Richter syndrome. • CT texture analysis allows for noninvasive detection of Richter syndrome which is of prognostic value.
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Affiliation(s)
- C P Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.
| | - B Federmann
- Department of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - J Hofmann
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - H Bösmüller
- Department of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - S Wirths
- Department of Hematology and Oncology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - J Fritz
- Russell H. Morgan Department of Radiology and Radiological, Johns Hopkins University School of Medicine, Science, 601 N. Caroline Street, JHOC 3142, Baltimore, MD, 21287, USA
| | - M Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
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Perl RM, Risse E, Hetzel J, Bösmüller H, Kloth C, Fritz J, Horger M. The effect of intraparenchymal blood patching on the rate of pneumothorax in patients undergoing percutaneous CT-guided core biopsy of the lung. Eur J Radiol 2019; 116:14-20. [PMID: 31153555 DOI: 10.1016/j.ejrad.2019.04.010] [Citation(s) in RCA: 2] [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: 11/21/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.
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Affiliation(s)
- R M Perl
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany.
| | - E Risse
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - J Hetzel
- Department of Internal Medicine II, Eberhard Karls University, Tübingen, Germany
| | - H Bösmüller
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, Eberhard Karls University, Tübingen, Germany
| | - C Kloth
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - J Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Caroline Street, JHOC 3140A, Baltimore, MD, 21287, United States
| | - M Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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Dalili D, Haberland U, Hodgson D, Khodarahmi I, Fishman EK, Fritz J, Isaac A. A Tale of Twos: Dual-energy CT, an Indispensable Metal Artifact Reduction Tool Around Implants: A Multi-center Experience from Two Primary and Revision Hip Arthroplasty Units. Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Grande FD, Rashidi A, Tanaka M, Fritz J. Next-generation 5-min Knee MRI with Combined Simultaneous Multislice and Parallel Imaging Acceleration: Ready for Prime Time? Semin Musculoskelet Radiol 2019. [DOI: 10.1055/s-0039-1692573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fritz J, Bjorge T, Nagel G, Concin H, Manjer J, Häggström C, Stattin P, Stocks T, Ulmer H. Insulin resistance measured by the triglyceride-glucose index and risk of obesity-related cancers: An epidemiological investigation in more than 500,000 individuals. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1552] [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: 11/20/2022] Open
Abstract
1552 Background: The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. We aimed to determine to what extent insulin resistance measured as the logarithmized triglyceride glucose product (TyG index) mediates the effect of BMI on risk of obesity-related cancers. Methods: A total of 510,471 individuals from six European cohorts with a mean age of 43.1 years were included in the study. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with ten common obesity-related cancer sites, and quantified the proportion of the effect of BMI mediated through TyG index. Results: During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney (hazard ratio (HR) per one standard deviation increase 1.13, 95% confidence interval: 1.07-1.20), liver (1.13, 1.04-1.23), pancreas (1.12, 1.06-1.19), colon (1.07, 1.03-1.10), and rectum (1.09, 1.04-1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%), and colon (20%); smaller proportions for kidney (15%) and liver (11%); none for endometrium, ovary and breast (postmenopausal). Conclusions: In this pooled cohort study including more than 500,000 individuals, insulin resistance measured as the logarithmized triglyceride glucose product significantly mediated the effect of overweight and obesity on risk of cancers of the kidney, liver, pancreas, colon, and rectum. In contrast, insulin resistance did not mediate the risk for cancers of the endometrium, ovary and breast. Our results confirm a promoting role of insulin resistance in the pathogenesis of gastrointestinal cancers. Although often claimed, insulin resistance does not appear to connect excess body weight with cancers of the female reproductive organs.
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Affiliation(s)
| | | | | | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Jonas Manjer
- Lund University, Skane University Hospital, Malmö, Sweden
| | | | | | | | - Hanno Ulmer
- Innsbruck Medical University, Innsbruck, Austria
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