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Gonzalez‐Molina J, Hahn P, Falcão RM, Gultekin O, Kokaraki G, Zanfagnin V, Braz Petta T, Lehti K, Carlson JW. MMP14 expression and collagen remodelling support uterine leiomyosarcoma aggressiveness. Mol Oncol 2024; 18:850-865. [PMID: 37078535 PMCID: PMC10994236 DOI: 10.1002/1878-0261.13440] [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: 08/09/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 04/21/2023] Open
Abstract
Fibrillar collagen deposition, stiffness and downstream signalling support the development of leiomyomas (LMs), common benign mesenchymal tumours of the uterus, and are associated with aggressiveness in multiple carcinomas. Compared with epithelial carcinomas, however, the impact of fibrillar collagens on malignant mesenchymal tumours, including uterine leiomyosarcoma (uLMS), remains elusive. In this study, we analyse the network morphology and density of fibrillar collagens combined with the gene expression within uLMS, LM and normal myometrium (MM). We find that, in contrast to LM, uLMS tumours present low collagen density and increased expression of collagen-remodelling genes, features associated with tumour aggressiveness. Using collagen-based 3D matrices, we show that matrix metalloproteinase-14 (MMP14), a central protein with collagen-remodelling functions that is particularly overexpressed in uLMS, supports uLMS cell proliferation. In addition, we find that, unlike MM and LM cells, uLMS proliferation and migration are less sensitive to changes in collagen substrate stiffness. We demonstrate that uLMS cell growth in low-stiffness substrates is sustained by an enhanced basal yes-associated protein 1 (YAP) activity. Altogether, our results indicate that uLMS cells acquire increased collagen remodelling capabilities and are adapted to grow and migrate in low collagen and soft microenvironments. These results further suggest that matrix remodelling and YAP are potential therapeutic targets for this deadly disease.
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Affiliation(s)
- Jordi Gonzalez‐Molina
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Paula Hahn
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Raul Maia Falcão
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of Cellular Biology and GeneticsFederal University of Rio Grande do NorteNatalBrazil
| | - Okan Gultekin
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Georgia Kokaraki
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Tirzah Braz Petta
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of Cellular Biology and GeneticsFederal University of Rio Grande do NorteNatalBrazil
| | - Kaisa Lehti
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
- Department of Biomedical Laboratory ScienceNorwegian University of Science and TechnologyTrondheimNorway
| | - Joseph W. Carlson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
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Richter FC, Friedrich M, Kampschulte N, Piletic K, Alsaleh G, Zummach R, Hecker J, Pohin M, Ilott N, Guschina I, Wideman SK, Johnson E, Borsa M, Hahn P, Morriseau C, Hammock BD, Schipper HS, Edwards CM, Zechner R, Siegmund B, Weidinger C, Schebb NH, Powrie F, Simon AK. Adipocyte autophagy limits gut inflammation by controlling oxylipin and IL-10. EMBO J 2023; 42:e112202. [PMID: 36795015 PMCID: PMC10015370 DOI: 10.15252/embj.2022112202] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 07/26/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Lipids play a major role in inflammatory diseases by altering inflammatory cell functions, either through their function as energy substrates or as lipid mediators such as oxylipins. Autophagy, a lysosomal degradation pathway that limits inflammation, is known to impact on lipid availability, however, whether this controls inflammation remains unexplored. We found that upon intestinal inflammation visceral adipocytes upregulate autophagy and that adipocyte-specific loss of the autophagy gene Atg7 exacerbates inflammation. While autophagy decreased lipolytic release of free fatty acids, loss of the major lipolytic enzyme Pnpla2/Atgl in adipocytes did not alter intestinal inflammation, ruling out free fatty acids as anti-inflammatory energy substrates. Instead, Atg7-deficient adipose tissues exhibited an oxylipin imbalance, driven through an NRF2-mediated upregulation of Ephx1. This shift reduced secretion of IL-10 from adipose tissues, which was dependent on the cytochrome P450-EPHX pathway, and lowered circulating levels of IL-10 to exacerbate intestinal inflammation. These results suggest an underappreciated fat-gut crosstalk through an autophagy-dependent regulation of anti-inflammatory oxylipins via the cytochrome P450-EPHX pathway, indicating a protective effect of adipose tissues for distant inflammation.
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Affiliation(s)
| | - Matthias Friedrich
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Nadja Kampschulte
- Faculty of Mathematics and Natural SciencesUniversity of WuppertalWuppertalGermany
| | - Klara Piletic
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | - Ghada Alsaleh
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | | | - Julia Hecker
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- Department of Gastroenterology, Infectious Diseases and RheumatologyCampus Benjamin FranklinBerlinGermany
| | - Mathilde Pohin
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | - Nicholas Ilott
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | | | - Sarah Karin Wideman
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Errin Johnson
- The Dunn School of PathologyUniversity of OxfordOxfordUK
| | - Mariana Borsa
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | - Paula Hahn
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | - Christophe Morriseau
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer CenterUniversity of CaliforniaDavisCAUSA
| | - Bruce D Hammock
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer CenterUniversity of CaliforniaDavisCAUSA
| | - Henk Simon Schipper
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
- Center for Translational ImmunologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Claire M Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research CentreUniversity of OxfordOxfordUK
- Nuffield Department of Surgical Sciences, Botnar Research CentreUniversity of OxfordOxfordUK
| | - Rudolf Zechner
- Institute of Molecular BiosciencesUniversity of GrazGrazAustria
| | - Britta Siegmund
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- Department of Gastroenterology, Infectious Diseases and RheumatologyCampus Benjamin FranklinBerlinGermany
| | - Carl Weidinger
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- Department of Gastroenterology, Infectious Diseases and RheumatologyCampus Benjamin FranklinBerlinGermany
| | - Nils Helge Schebb
- Faculty of Mathematics and Natural SciencesUniversity of WuppertalWuppertalGermany
| | - Fiona Powrie
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
| | - Anna Katharina Simon
- Kennedy Institute of RheumatologyUniversity of OxfordOxfordUK
- Max Delbrück CenterBerlinGermany
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O'Hagan D, Shandilya S, Hahn P, Gardner M, Farzan M, Ardeshir A. OP 6.8 – 00102 In vivo evolution of env in SHIV-AD8-infected rhesus macaques after AAV-eCD4-Ig therapy. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100253] [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: 12/24/2022] Open
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Schoutrop E, Renken S, Micallef Nilsson I, Hahn P, Poiret T, Kiessling R, Wickström SL, Mattsson J, Magalhaes I. Trogocytosis and fratricide killing impede MSLN-directed CAR T cell functionality. Oncoimmunology 2022; 11:2093426. [PMID: 35898704 PMCID: PMC9313125 DOI: 10.1080/2162402x.2022.2093426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Successful translation of chimeric antigen receptor (CAR) T cell therapy for the treatment of solid tumors has proved to be troublesome, mainly due to the complex tumor microenvironment promoting T cell dysfunction and antigen heterogeneity. Mesothelin (MSLN) has emerged as an attractive target for CAR T cell therapy of several solid malignancies, including ovarian cancer. To improve clinical response rates with MSLN-CAR T cells, a better understanding of the mechanisms impacting CAR T cell functionality in vitro is crucial. Here, we demonstrated superior cytolytic capacity of CD28-costimulated MSLN-CAR T cells (M28z) relative to 4–1BB-costimulated MSLN-CAR T cells (MBBz). Furthermore, CD28-costimulated MSLN CAR T cells displayed enhanced cytolytic capacity against tumor spheroids with heterogeneous MSLN expression compared to MBBz CAR T cells. In this study, we identified CAR-mediated trogocytosis as a potential impeding factor for successful MSLN-CAR T cell therapy due to fratricide killing and contributing to tumor antigen heterogeneity. Moreover, we link antigen-dependent upregulation of LAG-3 with reduced CAR T cell functionality. Taken together, our study highlights the therapeutic potential and bottlenecks of MSLN-CAR T cells, providing a rationale for combinatorial treatment strategies.
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Affiliation(s)
- Esther Schoutrop
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Stefanie Renken
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Paula Hahn
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Poiret
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Kiessling
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung and Skin, Karolinska University Hospital, Stockholm, Sweden
| | - Stina L Wickström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Patient Area Head and Neck, Lung and Skin, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Princess Margaret Cancer Centre and University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Isabelle Magalhaes
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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Gonzalez-Molina J, Hahn P, Falcão RM, Kokaraki G, de Souza JE, Lajus TBP, Lehti K, Carlson JW. Abstract 6096: The microarchitecture and fibrillar collagen expression of leiomyosarcoma are associated with malignancy. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6096] [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: 11/16/2022]
Abstract
Abstract
The expression, abundance, and microarchitecture of fibrillar collagens are associated with tumor development and aggressiveness in various carcinomas. However, the impact of fibrillar collagens on mesenchymal tumors is less understood. While uterine leiomyomas, also known as fibroids, are characterized by high fibrillar collagen deposition and depend on ECM signaling for cell proliferation, the impact of fibrillar collagens on malignant uterine leiomyosarcomas has not been explored. Thus, identifying malignancy and aggressiveness-associated features of the fibrillar collagen-leiomyosarcoma crosstalk may provide novel biomarkers and therapeutic targets for these aggressive tumors. We used publicly available RNAseq data and performed RNAseq and picrosirius red analysis of fiber microarchitecture in a cohort of normal myometrium (MM; n =68 ), leiomyoma (LM; n = 66), and leiomyosarcoma (LMS; n = 67) tissues. Furthermore, we cultured patient-derived primary cells (4 MM, 3 LM, and 4 LMS) on collagen I-functionalized polyacrylamide gels at stiffness ranging from 0.5 to 115 kPa, covering the physiological and pathological stiffness, to investigate distinct behaviors between cell types, including proliferation, migration, and activity of the ECM stiffness molecular rheostat YAP/TAZ. At the protein level, analysis of fibrillar collagen microarchitecture revealed that LMS tumors present reduced fibrillar collagen density and hyphal growth units and enhanced fiber endpoints compared to both MM and LM. At the gene expression level, however, LMS tumors did not show reduced fibrillar collagen expression, instead they exhibited enhanced matrix metalloproteinase expression, particularly of MMP14. Furthermore, COL11A1 was specifically upregulated in LMS tumors and its expression was associated with poor prognosis. Finally, in vitro response of MM, LM, and LMS cells to collagen I at defined stiffness showed that LMS cell migration, proliferation, and subcellular localization of YAP/TAZ are less sensitive to substrate stiffness than in MM and LM cells, although the response varied between distinct donors. In conclusion, we show that LMS tumors typically present low fibrillar collagen protein expression likely due to enhanced degradation. In addition, collagen I adhesion and stiffness have a lower impact on malignant LMS cells than on MM and LM, which may explain their ability to grow in low-collagen microenvironments. Furthermore, this study shows that COL11A1 is a potential biomarker with prognostic value in leiomyosarcoma.
Citation Format: Jordi Gonzalez-Molina, Paula Hahn, Raul Maia Falcão, Georgia Kokaraki, Jorge Estefano de Souza, Tirzah Braz Petta Lajus, Kaisa Lehti, Joseph W. Carlson. The microarchitecture and fibrillar collagen expression of leiomyosarcoma are associated with malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6096.
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Affiliation(s)
| | | | | | | | | | | | - Kaisa Lehti
- 3Norwegian University of Science and Technology, Trondheim, Norway
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Batzner A, Seggewiss H, Hahn P, Sahiti F, Maack C, Gerull B, Stoerk S, Morbach C. Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.276] [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
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): DFG
Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance.
Purpose
In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM.
Methods
We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient <30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments.
Results
In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p < 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups.
Conclusions
Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.
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Affiliation(s)
- A Batzner
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - H Seggewiss
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - P Hahn
- University Hospital of Wurzburg, Wurzburg, Germany
| | - F Sahiti
- University Hospital of Wurzburg, Wurzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - B Gerull
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - S Stoerk
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
| | - C Morbach
- Comprehensive Heart Failure Center (CHFC), Wurzburg, Germany
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Kasimir-Bauer S, Bittner AK, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, Keup C. Abstract P4-01-10: The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-10] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The detection and characterization of circulating tumor cells (CTCs) as one of the analytes in liquid biopsy has been considered as surrogate marker to improve treatment decisions in metastatic breast cancer (MBC). In addition, cell-free tumor DNA (ctDNA) released by tumor cells and harboring tumor-associated variants is further discussed to give additional information for therapeutic options. Thus, CTC and ctDNA analysis from the same blood tube is desired. To test usability of plasma, generated after CTC isolation from whole blood for ctDNA analysis, we analyzed ctDNA from 42 hormone receptor-positive/HER2-negative MBC patients (pts) for the detection of tumor-associated variants (plasma isolated straight from whole blood) and compared the results for similarities and differences of the detected variants in a subgroup of these pts to those, obtained from plasma generated after CTC selection (taken from a separate tube).
Methods: 4 ml plasma of all MBC pts and 4 ml plasma obtained after immunomagnetic isolation of CTCs from 2x5ml blood [AdnaTest EMT-2/Stem Cell Select (n=17pts) followed by multimarker qPCR] were used for the analysis of cell-free DNA (cfDNA) applying the QIAamp MinElute ccfDNA Kit. A total of 30ng - 60ng cfDNA was applied for library construction using the QIAseq Targeted DNA Panel for Illumina with integrated unique molecular identifiers. Sequencing was executed on the NextSeq® 500 platform (Illumina, US). Data were analyzed using the QIAseq Targeted Sequencing Data Analysis Portal, the Biomedical Genomics Workbench and the Ingenuity Variant Analysis. All materials used were manufactured by QIAGEN, Germany.
Results: In the total cohort of 42 pts, most variants of all analyzed genes were detected in the MUC16 gene (31.2%). ERBB2, EGFR and AR (androgen receptor) also showed high numbers of variants (11.6%, 11.0% and 8.9%, respectively) with a majority detected pathogenic variants (47.7%) in AR. 92% of all detected variants showed an allele frequency of <5% and some of the detected MUC16, ERBB2 and AR mutations significantly correlated with overall survival. Comparing the plasma results from a separate blood draw with the results from plasma samples after CTC selection in a subgroup of 17/42 pts, no significant difference was found for cfDNA concentration but variability within the cohort. Whereas the variant comparison of ctDNA isolated from both plasma sources showed great concordance, additional variants (around 15%) were exclusively found in one of the two matched samples. Interestingly, in the variant population exclusively found in ctDNA isolated after CTC isolation, the relative amount of pathogenic variants was increased compared to the variant fraction only found in ctDNA from plasma of a separate blood tube. Results obtained for frequently overexpressed CTC transcripts in this subgroup included genes involved in the PI3K signaling pathway as well as ERBB2 and ERBB3 in about 30% of the pts.
Conclusion: We here present a feasible workflow for CTC and ctDNA evaluation for expression and mutation analysis from the same blood sample. These data emphasize that the use of different liquid biopsy analytes can empower treatment decisions of MBC pts in the future.
Citation Format: Kasimir-Bauer S, Bittner A-K, Hoffmann O, Hauch S, Sprenger-Haussels M, Storbeck M, Benyaa K, Hahn P, Mach P, Tewes M, Kimmig R, and Keup C. The analysis of cell-free DNA and circulating tumor cells from one blood tube might empower treatment decisions in metastatic breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-10.
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Affiliation(s)
- S Kasimir-Bauer
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - A-K Bittner
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - O Hoffmann
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - S Hauch
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Sprenger-Haussels
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Storbeck
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - K Benyaa
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Hahn
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - P Mach
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - M Tewes
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - R Kimmig
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
| | - C Keup
- University Hospital, Essen, Germany; QIAGEN GmbH, Hilden, Germany; Dep. of Int. Med. (Cancer Res), Essen, Germany
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9
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Oezdemir S, Komp M, Hahn P, Ruetten S. Decompression for cervical disc herniation using the full-endoscopic anterior technique. Oper Orthop Traumatol 2018; 31:1-10. [PMID: 29392340 DOI: 10.1007/s00064-018-0531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/30/2017] [Accepted: 02/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach. INDICATION Fresh disc herniation with monoradicular symptoms in the upper extremity. CONTRAINDICATIONS Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity. SURGICAL TECHNIQUE Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space. POSTOPERATIVE MANAGEMENT Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6. RESULTS A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.
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Affiliation(s)
- S Oezdemir
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany.
| | - M Komp
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
| | - P Hahn
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
| | - S Ruetten
- Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe-Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany
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Komp M, Oezdemir S, Hahn P, Ruetten S. Full-endoscopic posterior foraminotomy surgery for cervical disc herniations. Oper Orthop Traumatol 2018; 30:13-24. [DOI: 10.1007/s00064-017-0529-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
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Bittner R, Hahn P, Novak C, Lancaster T, Linden D, Reif A. PB 22 Association between genetic risk for schizophrenia and deactivation of the right temporo-parietal junction during working memory encoding – An imaging genetics study. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bittner R, Seitz A, Hahn P, Raspor E, Novak C, Linden D, Goebel R, Reif A. FV 2 Reduced spatial variability in cortical working memory networks after macro-anatomical alignment – Converging evidence from multiple fMRI studies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Unglaub F, Langer MF, Hohendorff B, Müller LP, Unglaub JM, Hahn P, Krimmer H, Spies CK. [Distal radius fracture of the adult : Diagnostics and therapy]. Orthopade 2017; 46:93-110. [PMID: 27815606 DOI: 10.1007/s00132-016-3347-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fractures of the distal radius are very common. The majority of patients are elderly females. High impact trauma are often responsible for fractures in young men. Clinical and radiological diagnostics, including computer-assisted tomography (CAT) scan, are generally sufficient. The indication for conservative treatment is still recommended for specific fracture patterns. Application of palmar locking plates after open reduction proved to be efficacious for the majority of fracture patterns. Furthermore, precise detection and treatment of concomitant lesions are mandatory in order to prevent complications.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - B Hohendorff
- Hand-, Ästhetische, Plastische Chirurgie, Elbe Kliniken, Stade, Deutschland
| | - L P Müller
- Klinik und Polyklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - J M Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - H Krimmer
- Zentrum für Hand- und Fußchirurgie, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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14
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Olson J, Adamic M, Snyder D, Brookhart J, Hahn P, Watrous M. A comparative study of 129I content in environmental standard materials IAEA-375, NIST SRM 4354 and NIST SRM 4357 by Thermal Ionization Mass Spectrometry and Accelerator Mass Spectrometry. Appl Radiat Isot 2017; 126:54-57. [DOI: 10.1016/j.apradiso.2017.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/29/2016] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
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15
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Rüttermann S, Sobotta A, Hahn P, Kiessling C, Härtl A. Teaching and assessment of communication skills in undergraduate dental education - a survey in German-speaking countries. Eur J Dent Educ 2017; 21:151-158. [PMID: 26960532 DOI: 10.1111/eje.12194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Teaching communication is perceived to be of importance in dental education. Several reports have been published worldwide in the educational literature describing modifications of the dental curriculum by implementing the teaching of communication skills. Surveys which evaluate the current state of training and assessment of communication skills in dental education in different countries exist already in some countries, but little information is available about German-speaking countries. MATERIAL AND METHODS In a cross-sectional study with the aim of a census, all 36 dental schools in Germany (30), Austria (3), and Switzerland (3) were surveyed. RESULTS The present survey revealed that at 26 of the 34 dental schools (76%), communication skills training has been implemented. Training of communication skills mainly takes place between the 6th and the 9th semester. Ten schools were able to implement a partly longitudinal curriculum, while the other sites only offer stand-alone courses. Of the 34 dental schools, six assess communication skills in a summative way. Three of those schools also use formative assessments for their students. Another seven sites only use formative assessment. From the various formats of assessment, OSCE is mentioned most frequently. CONCLUSION The necessity to train and assess communication skills has reached German-speaking dental schools. The present survey allows an overview of the training and assessment of communication skills in undergraduate dental education in German-speaking Europe.
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Affiliation(s)
- S Rüttermann
- Department of Operative Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - A Sobotta
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - P Hahn
- Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Medical School and Hospital, Freiburg, Germany
| | - C Kiessling
- Department of Assessment, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - A Härtl
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
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16
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Unglaub F, Langer MF, Unglaub JM, Sauerbier M, Müller LP, Krimmer H, Hahn P, Spies CK. (Teil‑)Arthrodesen am Handgelenk. Unfallchirurg 2017; 120:513-526. [DOI: 10.1007/s00113-017-0356-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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17
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Abstract
Joint infections of the hand may lead to irreversible lesions and impairment of hand function due to early cartilage damage. Furthermore, persistent infections which are not treated immediately can cause osteitis and/or spread systemically. Finger joints are prone to infection due to bite wounds or crush and sharp injuries. Whereas the wrist is often affected in patients with immunosuppression or chronic diseases, such as diabetes mellitus. If diagnosis and therapy are delayed, joint damage may be inevitable. Therefore, urgent treatment of the infected joint is imperative to preserve the function of the hand. This article reviews the current diagnostics and treatment of joint infections of the hand.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - J M Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - B Hohendorff
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Kliniken Stade-Buxtehude GmbH, Stade, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Köln, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - S Löw
- Orthopädie und Unfallchirurgie, Caritas-Krankenhaus, Bad Mergentheim, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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18
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpiusklinik, Bad Rappenau Medizinische Fakultät Mannheim der Universität Heidelberg
| | - P Hahn
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau
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19
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Spies CK, Schäfer M, Ahrens C, Hahn P, Unglaub F. [Compression of the median nerve by chronic palmar dislocation of the lunate due to carpal collapse]. Unfallchirurg 2017; 120:712-714. [PMID: 28361358 DOI: 10.1007/s00113-017-0345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Carpal tunnel syndrome is among the most frequently diagnosed forms of peripheral nerve compression. Carpal tunnel syndrome due to carpal collapse that had progressed over decades, with a palmarly dislocated lunate, is rare. Hints of past trauma to the wrist going back decades should prompt further radiological examination in case of recurrent median nerve compression. With sufficient preoperative evaluation, the causes can be accurately detected and treated. Therefore, precise and complete history-taking is mandatory. Conclusions on further diagnostics that can be drawn from the latter must be consistently implemented to enable adequate therapy.
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Affiliation(s)
- C K Spies
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland.
| | - M Schäfer
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - C Ahrens
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
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20
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Abstract
Dupuytren's disease is a chronic disease of the elderly. Assuming that life expectancy will increase considerably in the coming decades, Dupuytren's disease will gain more medical and socioeconomic relevance. In addition to well-known familial and genetic causes, other environmental factors (nicotine, diabetes, alcohol, trauma, work) are discussed. Knowledge of all factors and their influence on the onset and severity of the disease is important for diagnosis, therapy, and prevention of the disease.
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Affiliation(s)
- P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74206, Bad Rappenau, Deutschland.
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21
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Abstract
Dupuytren disease is a benign fibroproliferative disease of the palmar aponeurosis, which can cause considerable functional deficiencies for the person concerned. Partial aponeurectomy is the gold standard in primary surgery. Because it is minimally invasive and has short recovery and low complication rates, the importance of needle aponeurotomy under specific indications has been increasing in the last years. Needle aponeurotomy is a cost-effective treatment with low complication rates. The revision rate compared to partial aponeurectomy is higher. Under consideration of specified indications, needle aponeurotomy is an alternative treatment option.
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Affiliation(s)
- J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
- Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland
| | - S Löw
- Sektion Handchirurgie Klinik für Orthopädie und Unfallchirurgie, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland
| | - C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik Bad Rappenau, Vulpiusstraße 29, 70906, Bad Rappenau, Deutschland.
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22
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Bitter K, Rüttermann S, Lippmann M, Hahn P, Giesler M. Self-assessment of competencies in dental education in Germany - a multicentred survey. Eur J Dent Educ 2016; 20:229-236. [PMID: 26272302 DOI: 10.1111/eje.12165] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The aim was to assess the competencies of undergraduate dental students in Germany in the domains team competence, communicative competence, learning competence and scholarship. MATERIALS AND METHODS The survey was conducted at 11 dental schools that are equally distributed all over Germany. Competencies were assessed with the Freiburg Questionnaire to Assess Competencies in Medicine (FCM). A short version of the FCM was used in this study. This short form included the four domains: team competence (three items), communicative competence (eight items), learning competence (five items) and scholarship (four items). Students had to rate each item twice: first with regard to the respondent's current level of competence and second with regard to the level of competence that respondents think is required by their job. All items were rated on a five-point Likert scale (1 'very much' and 5 'not at all'). Responsible lecturers from all selected dental schools received another questionnaire to answer the questions whether the FCM domain corresponding learning objectives were taught at the respective dental school. RESULTS A total of 317 undergraduate students from 11 dental schools in their last clinical year participated. The response rate varied between 48% and 92%. Cronbach's α for the FCM scales addressing the current level of competencies ranged from 0.70 to 0.89 and for the scales measuring the presumed level of competencies demanded by their job ranged from 0.72 to 0.82. The mean values of the scales for the assessment of the presumed level of competencies demanded by the job were significantly lower compared to the mean values of the scales for the current level of competencies (P < 0.001 in all analyses). We found large differences between the two levels - in terms of 'standardised response means' (SRM) - in the domains team competence (SRM 1.34), learning competence (SRM 1.27) and communicative competence (SRM 1.18). Overall, the learning objectives that correspond to the assessed domains of competencies were taught to 19.6% completely, to 55.4% partially and to 25% not at all at the participating dental schools. CONCLUSION The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. These results indicate that the assessed domains are still barely integrated into dental medicine curricula in Germany and that further research in this field is needed.
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Affiliation(s)
- K Bitter
- Department of Operative Dentistry and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - S Rüttermann
- Department of Operative Dentistry, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt, Frankfurt, Germany
| | - M Lippmann
- Department of Medical Psychology and Medical Sociology, Medical Faculty, TU Dresden, Dresden, Germany
| | - P Hahn
- Department of Operative Dentistry and Periodontology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - M Giesler
- Students Deanery, Medical Faculty, University of Freiburg, Freiburg, Germany
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23
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Hahn P, Kirchberger MC, Unglaub F, Spies CK. [How Congruent is the Rating of the Results of Flexor Tendon Injury Repairs Using the Scores by Buck-Gramcko, Strickland, and the American Society for Surgery of the Hand?]. HANDCHIR MIKROCHIR P 2016; 48:290-5. [PMID: 27580442 DOI: 10.1055/s-0042-111892] [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: 10/21/2022] Open
Abstract
PURPOSE Scores are essential for comparing function after flexor tendon reconstructions. The Buck-Gramcko Score, the Strickland Score and the ASSH (American Society for Surgery of the Hand) Score are the most commonly applied rating systems. The purpose of this study is to evaluate these systems and their interchangeability. METHOD Based on an unrestricted metacarpophalangeal (MCP) joint of 0-0-90° or limited range of motion of the MCP joint of 0-30-90°, the scores of the 3 rating systems were assessed and graphically displayed for each possible finger position regarding proximal (PIP) and distal (DIP) interphalangeal joints. RESULTS Based on an unrestricted MCP joint, the scores of the 3 rating systems differed in 24-33% of the obtained values, depending on the sum of joint flexion and extension deficits of the aforementioned PIP and DIP joints. If the range of motion was restricted to 0-30-90° in the MCP joint, differing values were only observed in 16-19% of the obtained values. In extreme cases, scores for the same clinical presentation may thus be "excellent", "fair" or "poor", depending on which system has been used. CONCLUSION The different rating systems for the evaluation of flexor tendon reconstruction are neither identical nor adjustable. Therefore, consensus or at least a recommendation is needed regarding the system to be used. It may even be necessary to develop a generally accepted rating system to compare studies. In the meantime, the readings of the active and passive range of motion of all joints of the affected finger/thumb ought to be published in studies to compare and validate the results.
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Affiliation(s)
- P Hahn
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
| | | | - F Unglaub
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
| | - C K Spies
- Vulpius Klinik, Abteilung für Handchirurgie, Bad Rappenau
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24
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Affiliation(s)
- F. Unglaub
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - P. Hahn
- Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - C. Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau
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25
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Abstract
Many congenital malformations of the hand and forearm, e. g. polydactyly, thumb duplication, syndactyly and radial aplasia, are already evident at birth and newborns are promptly referred to specialized departments. In contrast, orthopedic surgeons are often confronted with malformations of the hand and forearm, which gradually become clinically conspicuous during growth. This review article focuses on these specific malformations, which regularly upset the patients in practice and in most cases the parents even more so. In addition to the diagnostics and differential diagnostics, the conservative and surgical treatment options are presented.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - F Cakmak
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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26
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McDermott S, McCarthy C, Kilcoyne A, Hahn P, Gervais D, Blake M. Predictive value of image-guided percutaneous adrenal biopsy in patients with a new or suspected diagnosis of lung cancer. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Spies CK, Hohendorff B, Müller LP, Neiss WF, Hahn P, Unglaub F. [Proximal carpal row carpectomy]. Oper Orthop Traumatol 2016; 28:204-17. [PMID: 26914674 DOI: 10.1007/s00064-016-0440-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/15/2015] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Resection of the proximal carpal row, termed proximal row carpectomy (PRC), is performed in order to treat pathologies of the proximal carpal row or radiocarpal joint between the scaphoid and scaphoid facet. It entails the articulation of the capitate and the lunate facet. INDICATIONS Lunate necrosis, carpal collapse, joint infection with concomitant intercarpal ligament lesions. CONTRAINDICATIONS Severe cartilage lesions of the lunate facet and the capitate, wrist capsule laxity, rheumatoid arthritis, neuromuscular dysbalance of the wrist-covering soft tissue structures. SURGICAL TECHNIQUE Dorsal approach to the wrist, incision of the third and fourth extensor compartments, resection and coagulation of the dorsal interosseous nerve, usage of a ligament-sparing capsule incision, identification of the proximal carpal row and inspection of cartilage of the lunate facet and capitate, mobilization and excision of the lunate, scaphoid and triquetrum, articulation of lunate facet and capitate is controlled clinically and fluoroscopically, wound closure, application of plaster slabs. POSTOPERATIVE MANAGEMENT Immobilization of the wrist on plaster slabs for 2 weeks, removal of sutures after 14 days. RESULTS PRC is a surgical procedure with few complications. Satisfactory range of motion and grip strength could be preserved without limiting function of the upper extremity. Postoperative osteoarthritis of capitate and lunate facet did not correlate with the good clinical outcome.
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Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - B Hohendorff
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Stade, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - W F Neiss
- Institut I für Anatomie, Medizinische Fakultät, Köln, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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28
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Unglaub F, Langer MF, Hahn P, Müller LP, Ahrens C, Spies CK. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options]. Unfallchirurg 2016; 119:133-43; quiz 144-5. [PMID: 26826026 DOI: 10.1007/s00113-016-0142-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Hahn
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - L P Müller
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - C Ahrens
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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29
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Spies CK, Müller LP, Oppermann J, Neiss WF, Hahn P, Unglaub F. Die operative Dekompression des Ramus superficialis des Nervus radialis. Oper Orthop Traumatol 2015; 28:145-52. [DOI: 10.1007/s00064-015-0431-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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30
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Spies CK, Müller LP, Skouras E, Bassemir D, Hahn P, Unglaub F. [Percutaneous needle aponeurotomy for Dupuytren's disease]. Oper Orthop Traumatol 2015; 28:12-9. [PMID: 26303259 DOI: 10.1007/s00064-015-0417-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/19/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Percutaneous transverse aponeurotomy of the cord by using a hypodermic needle as a scalpel blade in order to improve function of the hand. INDICATIONS Symptomatic flexion contracture with positive table top test caused by a single, palpable cord within the palm (primarily Tubiana stages I and II). CONTRAINDICATIONS Multiple, infiltrating or broad-based cords within the palm; irritated skin conditions; exclusive digital cord localization; recurrence after aponeurectomy; previous surgical intervention at the site of interest, digital nerve lesions; lack of patient compliance. SURGICAL TECHNIQUE Pinpoint surface anesthesia is obtained by injecting each portal area subdermally with 0.1 ml of local anesthetic. These applications start from distally to proximally within the palm while the most distal injection site is located proximal to the distal palm crease. Then the needle tip is introduced perpendicular to the cord. Sawing movements through the cord are performed transversely. While passively extending the contracted finger, the cord is held under tension which guarantees safe cutting. Patients are encouraged to report immediate pain sensation or numbness in order to prevent injuries to neurovascular structures and active finger flexion excludes tendon lesions during the procedure. Introducing the needle tip may be performed at several sites along the cord, if necessary, from distal to proximal at least 5 mm apart with prior pinpoint surface anesthesia. Finally, cautious passive stretching may be done after each release. POSTOPERATIVE MANAGEMENT Bandaging allowing immediate motion; application of a hand-based extension splint-glove during the night for 3-6 months. RESULTS Recurrence rate was 53% in 15 retrospectively examined patients after a mean interval of 40 months postoperatively.
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Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - E Skouras
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - D Bassemir
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
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Spies CK, Hahn P, Müller LP, Unglaub F. [In Process Citation]. Unfallchirurg 2015; 118:719-23. [PMID: 26242547 DOI: 10.1007/s00113-015-0055-2] [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]
Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland,
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Affiliation(s)
- P Hahn
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.
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Abstract
Simultaneous flexion of thumb and fingers is described as the Linburg-Comstock phenomenon. Congenital and acquired coupling of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons is the reason for this clinical entity. Additionally, coupling of the FPL and the flexor digitorum superficialis II or III has been described. The coupling can be between the muscles, the tendon sheaths or the tendons themselves. Asymptomatic and symptomatic coupling should be differentiated. In general symptomatic congenital or acquired coupling demands surgical intervention. We report about a 35-year-old patient with a congenital asymptomatic coupling of FPL and FDP-II who suffered a distorsion of the thumb. Afterwards she complained of pain and strength loss. An accessory tendon of 3 mm in diameter and 3.5 cm length between FPL and FDP-II was identified during surgery. The patient recovered completely after resection of this coupling.
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Affiliation(s)
| | - P Hahn
- Abteilung für Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - F M Leclère
- Abteilung für Plastische Chirurgie und Handchirurgie, Universitätsklinikum Bordeaux, Frankreich
| | - C K Spies
- Abteilung für Handchirurgie, Vulpius Klinik, Bad Rappenau
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Ahrens C, Unglaub F, Hahn P, Leclère FM, Spies CK. [Symptomatic carpal coalition of scaphoid, trapezium and trapezoid with coexisting ipsilateral hypoplasia of the thumb]. HANDCHIR MIKROCHIR P 2015; 47:70-2. [PMID: 25706179 DOI: 10.1055/s-0034-1398609] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We present the case of a 54-year-old woman with symptomatic coalition of scaphoid, trapezium and trapezoid as well as a coexisting ipsilateral hypoplasia of the thumb.
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Affiliation(s)
- C Ahrens
- Abteilung für Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - F Unglaub
- Abteilung für Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - P Hahn
- Abteilung für Handchirurgie, Vulpiusklinik, Bad Rappenau
| | - F M Leclère
- Abteilung für Plastische Chirurgie und Handchirurgie, Universitätsklinikum Bordeaux, Frankreich
| | - C K Spies
- Abteilung für Handchirurgie, Vulpiusklinik, Bad Rappenau
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Unglaub F, Hahn P, Spies CK. [Is indirect MR arthrography really equivalent to direct MR arthrography with respect to assessment of TFCC?]. Unfallchirurg 2015; 118:256-7. [PMID: 25630965 DOI: 10.1007/s00113-014-2706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Unglaub
- Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland,
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Kirchberger MC, Unglaub F, Hahn P, Spies CK. [Isolated capitate fractures in the frontal plane]. Unfallchirurg 2014; 117:1141-4. [PMID: 25274463 DOI: 10.1007/s00113-014-2661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Isolated fractures of the capitate in the frontal plane are both very rare and most of the time very discreet. There is a great risk to miss such fractures with potential longterm consequences. The following report of two independent patients highlights the importance of computed tomography in order to verify fractures and initiate adequate treatment.
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Affiliation(s)
- M C Kirchberger
- Vulpius Klinik GmbH, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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Spies CK, Hahn P, Unglaub F. [MRI is not suitable for primary screening of wrist injuries and cannot replace meticulous examination by a hand surgeon]. Unfallchirurg 2014; 117:562-3. [PMID: 24903507 DOI: 10.1007/s00113-014-2598-z] [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: 10/25/2022]
Affiliation(s)
- C K Spies
- Abteilung für Handchirurgie, Bad Rappenau
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Hahn P, Dullweber F, Unglaub F, Spies CK. [Text mining, a method for computer-assisted analysis of scientific texts, demonstrated by an analysis of author networks]. HANDCHIR MIKROCHIR P 2014; 46:186-91. [PMID: 24810335 DOI: 10.1055/s-0034-1371820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Searching for relevant publications is becoming more difficult with the increasing number of scientific articles. Text mining as a specific form of computer-based data analysis may be helpful in this context. Highlighting relations between authors and finding relevant publications concerning a specific subject using text analysis programs are illustrated graphically by 2 performed examples.
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Affiliation(s)
- P Hahn
- Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - F Dullweber
- Target Discovery Research, Boehringer Ingelheim, Biberach
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau
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Manogue M, Rohlin M, Mattheos N, Gorter R, Winning T, Walmsley D, Christersson C, Kavadella A, Hahn P, Manzanares Cespedes C. A need to clarify the outcome of dental education in terms of competence. Eur J Dent Educ 2014; 18:69. [PMID: 24750220 DOI: 10.1111/eje.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Spies CK, Hahn P, Leclère FM, Unglaub F. [A 15-year-old adolescent presenting both Madelung deformity with Vickers' ligament and additional palmaris profundus muscle]. HANDCHIR MIKROCHIR P 2014; 46:199-201. [PMID: 24573910 DOI: 10.1055/s-0033-1363979] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The palmaris profundus muscle is a rare entity which has been mentioned in association with nerve compressions. Madelung deformity is based both on an osteochondral lesion of the distal radial physis and often on the Vickers' ligament which originates around the lunate and inserts proximally in the radial physis. A 15-year-old right-handed female adolescent suffered from symptomatic left-sided Madelung deformity with Vickers' ligament and additional palmaris profundus muscle.
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Affiliation(s)
- C K Spies
- Vulpiusklinik, Handchirurgie, Bad Rappenau
| | - P Hahn
- Medizinische Fakultät Mannheim, Universität Heidelberg
| | | | - F Unglaub
- Vulpiusklinik, Handchirurgie, Bad Rappenau
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Spies CK, Schwarz-Furlan S, Hahn P, Oppermann J, Unglaub F. [Idiopathic palmar vein thrombosis of the fingers - rare but relevant]. HANDCHIR MIKROCHIR P 2013; 45:297-9. [PMID: 24089306 DOI: 10.1055/s-0033-1354411] [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: 10/26/2022] Open
Abstract
Idiopathic thrombosis of palmar finger veins is rare and women suffer from it almost exclusively. Synovial cysts, epidermoid inclusion cysts, giant cell tumours and haemangiomatous lesions should be considered in the process of diagnosis. We present a 56-year-old woman with idiopathic and symptomatic thrombosis of palmar finger veins. Using the palmar approach the painful veins were identified and excised completely. An uncomplicated wound healing has followed with completely unrestricted and painless range of motion. Surgical excision of the finger vein thrombosis should be considered if there is continuing pain.
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Affiliation(s)
- C K Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau
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Spies CK, Hahn P, Oppermann J, Unglaub F. [Spontaneous fixation of MP-joint of the index finger in flexion]. HANDCHIR MIKROCHIR P 2013; 45:183-5. [PMID: 23860706 DOI: 10.1055/s-0033-1349104] [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: 10/26/2022] Open
Abstract
Spontaneous fixations of MP-joints of fingers and thumbs are rare and are often a challenging task for hand surgeons. We present a 25-year-old female office employee with a fixed painless MP-joint of the left index finger in 90° flexion with normal PIP- und DIP-joint range of motion. Using the palmar approach to the MP-joint the entrapped accessory collateral ligament which was constrained by a prominent radial condylus could be identified. Operative removal of the prominence has released the joint. An uncomplicated wound healing has followed with completely unrestricted range of motion. If a closed reduction should be considered, it ought to be done cautiously without anaesthetics. A failed -reduction entails an operative revision using the palmar approach.
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Affiliation(s)
- C K Spies
- Vulpiusklinik, Handchirurgie, Bad Rappenau
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Mayer S, Hahn P, Bruckner T, Unglaub F. [Diagnostic value of preopratively performed MRI regarding lesions of the scapholunate ligament in clinical routine]. HANDCHIR MIKROCHIR P 2013; 45:26-32. [PMID: 23519713 DOI: 10.1055/s-0033-1333689] [Citation(s) in RCA: 3] [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] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The purpose of this retrospective study was to examine the sensitivity and specificity of preoperatively performed MRI of the wrist in identifying tears of the scapholunate ligament. Additionally, these findings were then compared with findings from a subsequently performed -arthroscopy of the wrist. PATIENTS AND METHODS The study was based on the MRI records of 401 patients who received MRI examinations between January 2004 and April 2012 in the context of ulnar-sided wrist pain. Subsequently, all patients received an arthroscopy of the wrist. The study included 218 male and 183 female patients with an average age of 42.4±14.3 years (range 12-84 years). The MRI examinations were conducted in various techniques and with various sequences. The MRI findings were evaluated by 88 experienced radiologists. The arthroscopies were performed by 16 experienced hand-surgeons who had seen the MRI results prior to the surgical intervention. -Arthroscopic findings were compared with MRI records and used as the benchmark. RESULTS Only 31 of 98 arthroscopically verified cases of a torn scapholunate ligament could be identified in an MRI examination. In contrast, MRI could correctly diagnose an intact ligament in 269 out of 276 arthroscopically verified cases. When compared with arthroscopy MRI sensitivity and specificity were 32% and 98%, respectively. In 91 out of 401 MRI examinations the use of a dedicated surface coil was recorded. In 66 out of 401 MRI examinations the use of contrast medium was documented. MRI specificity slightly improved upon use of contrast medium. CONCLUSION The comparison of MRI vs. arthroscopic sensitivity and specificity in the detection of scapholunate tears on a sufficiently large group of patients showed MRI to be a reliable method in excluding scapholunate ligament tears. Outside of clinical study conditions, however, it was found to be an unsuitable method in identifying and classifying scapholunate ligament tears. The high MRI sensitivity found by other studies could not be confirmed in our study.
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Affiliation(s)
- S Mayer
- Handchirurgie, Vulpius Klinik, Bad Rappenau
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Polydorou O, Wirsching M, Wokewitz M, Hahn P. Three-Month Evaluation of Vital Tooth Bleaching Using Light Units—A Randomized Clinical Study. Oper Dent 2013; 38:21-32. [DOI: 10.2341/12-041-c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
The aim of this study was to evaluate the color stability of vital bleaching using a halogen unit, laser, or only chemical activation up to three months after treatment. A total of 60 patients were divided into three groups, and their teeth were bleached with 38% hydrogen peroxide using three methods: acceleration of the bleaching process with halogen (eight minutes), laser (30 seconds), or chemical activation only. All teeth were bleached a maximum of four times (4 × 15 minutes) until a change of six shade tabs took place. The color was evaluated both visually and with a spectrophotometer before bleaching, immediately after bleaching, and one and three months after bleaching. Directly after bleaching, the use of halogen showed better results than laser (p≤0.05). One and three months after bleaching, no significant difference was found between the tested methods relative to the shade change, independent of the method of shade evaluation (p>0.05). As far as the color stability is concerned, bleaching with halogen resulted in stable color throughout the three months (p>0.05), whereas the other two methods resulted in whiter teeth after one and three months compared with the color directly after bleaching (p≤0.05). Bleaching with laser needed more time than halogen for the desired shade change (p≤0.05). Although directly after treatment bleaching with halogen resulted in better results, one and three months after bleaching the kind of acceleration used in the bleaching process did not have any effect on the esthetic results.
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Affiliation(s)
- O Polydorou
- Olga Polydorou, associate professor, DDS, Dr.med.dent, PD, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Dental School and Hospital, Freiburg, Germany
| | - M Wirsching
- Mira Wirsching, assistant, Dr.med,dent, Department of Orthodontics, University of Heidelberg, Heidelberg, Germany
| | - M Wokewitz
- Martin Wokewitz, scientific assistant, Dr.sc.hum, Institute of Medical Biometry and Medical Informatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - P Hahn
- Petra Hahn, professor, Dr.med.dent, PD, Department of Operative Dentistry and Periodontology, University Medical Center Freiburg, Dental School and Hospital, Freiburg, Germany
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Affiliation(s)
- P. Hahn
- Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - A. Häusler
- Handchirurgie, Vulpius Klinik, Bad Rappenau
| | - T. Bruckner
- Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg
| | - F. Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau
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Leclère FMP, Unglaub F, Gohritz A, Hahn P. Carpal tunnel syndrome caused by supernumerous lumbrical muscle in hemihyperplasia of the upper extremity. Neurochirurgie 2012; 58:309-13. [PMID: 22749082 DOI: 10.1016/j.neuchi.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hemihyperplasia of the upper extremity is a rare pathology that occurs in 1/86,000 births. Carpal tunnel syndrome may be associated with this disease. CLINICAL PRESENTATION We describe the case of a 74-year-old male who has hemihyperplasia of both upper extremities since birth. At the age of 73, he started experiencing continuous, progressive and high intensity pain that occurred more frequently at night and was localized in the right hand. It was associated with paresthesia and hypoesthesia predominantly of the thumb, index finger and middle finger. Clinical examination and electrodiagnosis led to diagnosis of carpal tunnel syndrome. RESULTS The patient underwent surgical carpal tunnel release to treat the disease. The enlarged nerve was compressed by a supernumerous lumbrical muscle, which was resected intraoperatively. After six months of follow-up the patient has normal sensitivity and grip strength in the right hand. CONCLUSION Hemihyperplasia should be clearly distinguished from other complex pathologies that may also entail CTS. Since significant variation in the anatomy of the hemihyperplasic extremities is the rule rather than the exception, a conventional open approach should be taken to localize and treat the compression.
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Affiliation(s)
- F M P Leclère
- Vulpiusklinik, Akademisches Lehrkrankenhaus der Universität Heidelberg, Vulpiusstraße 29, 74906 Bad Rappenau, Germany.
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Hahn P, Braun AC, Unglaub F. [Oscar Vulpius and tendon transfer in the hand]. HANDCHIR MIKROCHIR P 2012; 44:187-8. [PMID: 22664895 DOI: 10.1055/s-0032-1312654] [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: 10/28/2022] Open
Abstract
Oscar Vulpius dealt extensively with the problem of tendon transfer for motoric deficits. An analysis of his works shows that the knowledge of tendon healing, aftercare and operative techniques was already very widely advanced at the beginning of the last century.
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Affiliation(s)
- P Hahn
- Vulpius Klinik, Handchirurgie, Bad Rappenau.
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Leclère FMP, Manz S, Unglaub F, Cardenas E, Hahn P. [Endoscopic decompression of the ulnar nerve in the cubital tunnel syndrome: about 55 patients]. Neurochirurgie 2011; 57:73-7. [PMID: 21530986 DOI: 10.1016/j.neuchi.2011.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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: 07/31/2010] [Accepted: 03/21/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sulcus ulnaris syndrome is the second most common neurocompression syndrome in the upper limb after carpal tunnel syndrome. Its severity can be appreciated by the Dellon Classification. We present our experience and results after endoscopic decompression. PATIENTS AND METHODS A retrospective chart review of 55 patients operated over a 3-year period was performed. The patients, 37 men and 18 women, had an average age of 54 years (range: 27-82 years) at the time of surgery. The clinical diagnostic was always confirmed by a neurophysiological examination of the nerve conduction. According to the Dellon Classification, 11 patients had mild sulcus ulnaris syndrome, 31 had moderate and 13 had severe. The mean follow-up time was 21 months (range: 6-42 months). RESULTS The sensibility was normalised in 85% of the patients. Compared to the contralateral non-operated side, the mean grip strength improved from 68 to 94% and the mean pinch grip from 72 to 95%. The rate of nerve luxation did not change (5.5%). According to the modified Bishop rating system, 38 patients (69%) had excellent, 13 patients (23.5%) good and four patients (7.5%) fair results. One haematoma necessitating a revision, a minimal lesion of the ulnar nerve with restitution ad integrum and a hypoesthesia of the elbow, occurred after surgery resulting in a complication rate of 5.5%. Ninety-eight percent of the patients responded that they would undergo the endoscopic procedure again if needed. CONCLUSION Endoscopic decompression of the ulnar nerve in sulcus ulnaris syndrome is very well appreciated by patients and also provides promising clinical results.
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Affiliation(s)
- F M P Leclère
- Service de chirurgie plastique et chirurgie de la main, Vulpiusklinik, Universität Heidelberg, Vulpiusstrasse 29, Bad Rappenau, Germany.
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