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Lahmer T, Stock K, Rasch S, Porubsky S, Jeske S, Schustetter C, Protzer U, Heemann U, Schmid R, Weichert W, Weirich G, Slotta-Huspenina J. [Interdisciplinary ultrasound-guided, minimally invasive autopsy in COVID-19-deceased patients in the intensive care unit of a university hospital : A proof-of-concept study]. Pathologie (Heidelb) 2023; 44:193-197. [PMID: 38051339 PMCID: PMC10739551 DOI: 10.1007/s00292-023-01248-8] [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] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/07/2023]
Abstract
In this feasibility study, we carried out in an interdisciplinary team standardised, ultrasound-guided, minimally invasive autopsy (US-MIA) directly at the bedside of patients who died of COVID-19 in the intensive care unit of the Rechts der Isar Hospital of the Technical University Munich (TUM). The aim of the study was to verify the feasibility, time efficiency and infection hygiene aspects of the process, as well as the quality of the tissue samples. Our results show that bedside US-MIA is suitable for obtaining tissue samples before the onset of postmortem autolysis, and that it can also be carried out quickly and safely. The potential of US-MIA, which has gained little recognition so far, deserves special attention in the context of postmortem diagnosis, research and quality assurance. In the future, these strengths of US-MIA could help to lead postmortem diagnosis into the modern age of pathological deep analytics ("omics").
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Affiliation(s)
- T Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - K Stock
- Abteilung für Nephrologie - Nierenheilkunde, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Porubsky
- Institut für allgemeine Pathologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - S Jeske
- Institut für Virologie, Technische Universität München, München, Deutschland
| | - C Schustetter
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - U Protzer
- Institut für Virologie, Technische Universität München, München, Deutschland
| | - U Heemann
- Abteilung für Nephrologie - Nierenheilkunde, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - R Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - W Weichert
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - G Weirich
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675
| | - J Slotta-Huspenina
- Institut für Allgemeine Pathologie und Pathologische Anatomie, TUM School of Medicine and Health, Technische Universität München, München, Deutschland, Trogerstr. 18, 81675.
- Pathologie Starnberg MVZ GmbH, Starnberg, Deutschland.
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Engelhardt M, Schmid R, Kölbel B, Hyhlik-Dürr A, Zerwes S, Zischek C. Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course. Eur Surg 2023; 55:89-93. [PMID: 37206194 PMCID: PMC10123566 DOI: 10.1007/s10353-023-00800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Background The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce a vascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. Methods The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. Results In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. A fundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with a surgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. Conclusion The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.
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Affiliation(s)
- M. Engelhardt
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - R. Schmid
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - B. Kölbel
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - A. Hyhlik-Dürr
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - S. Zerwes
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - C. Zischek
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
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Barroux M, Househam J, Lakatos E, Ronel T, Baker AM, Salié H, Mossner M, Smith K, Kimberley C, Nowinski S, Berner A, Gunasri V, Jansen M, Caravagna G, Steiger K, Slotta-Huspenina J, Weichert W, Alberstmeier M, Chain B, Friess H, Bengsch B, Schmid R, Siveke J, Quante M, Graham T. Evolutionary and immune microenvironment dynamics during neoadjuvant treatment of oesophagael adenocarcinoma. Res Sq 2023:rs.3.rs-2738048. [PMID: 37090678 PMCID: PMC10120745 DOI: 10.21203/rs.3.rs-2738048/v1] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Locally advanced oesophageal adenocarcinoma (EAC) remains difficult to treat because of common resistance to neoadjuvant therapy and high recurrence rates. The ecological and evolutionary dynamics responsible for treatment failure are incompletely understood. Here, we performed a comprehensive multi-omic analysis of samples collected from EAC patients in the MEMORI clinical trial, revealing major changes in gene expression profiles and immune microenvironment composition that did not appear to be driven by changes in clonal composition. Multi-region multi-timepoint whole exome (300x depth) and paired transcriptome sequencing was performed on 27 patients pre-, during and after neoadjuvant treatment. EAC showed major transcriptomic changes during treatment with upregulation of immune and stromal pathways and oncogenic pathways such as KRAS, Hedgehog and WNT. However, genetic data revealed that clonal sweeps were rare, suggesting that gene expression changes were not clonally driven. Additional longitudinal image mass cytometry was performed in a subset of 15 patients and T-cell receptor sequencing in 10 patients, revealing remodelling of the T-cell compartment during treatment and other shifts in microenvironment composition. The presence of immune escape mechanisms and a lack of clonal T-cell expansions were linked to poor clinical treatment response. This study identifies profound transcriptional changes during treatment with limited evidence that clonal replacement is the cause, suggesting phenotypic plasticity and immune dynamics as mechanisms for therapy resistance with pharmacological relevance.
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Affiliation(s)
- Melissa Barroux
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar, Technical University of Munich
| | | | | | - Tahel Ronel
- Barts Cancer Institute, Queen Mary University of London
| | | | | | | | | | | | | | - Alison Berner
- Barts Cancer Institute, Queen Mary University of London
| | | | - Mamix Jansen
- UCL Cancer Institute: University College London Cancer Institute
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich
| | | | | | | | | | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich
| | | | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München
| | - Jens Siveke
- German Cancer Consortium (DKTK) partner site Essen and Institute for Developmental Cancer Therapeutics (BIT), University Hospital Essen at the University Duisburg-Essen, Germany
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Halfter K, Schubert-Fritschle G, Klauschen F, Werner J, Mayerle J, Weichert W, Friess H, Schmid R, Kremer M, Ruppert R, Hoelzl J, Krenz D, Nerlich A, Agha A, Fuchs M, Becker I, Nowak K, Engel J, Schlesinger-Raab A. The other colon cancer: a population-based cohort study of appendix tumour trends and prognosis. Colorectal Dis 2023; 25:943-953. [PMID: 36748436 DOI: 10.1111/codi.16510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
AIM Appendiceal neoplasms are rare subtypes of colorectal tumours that mainly affect younger patients some 20 years earlier than other colon tumours. The aim of this study was to gain more insight into the histological subtypes of this rare disease and include cases previously excluded, such as mucinous neoplasia. METHOD The cohort study included 1097 patients from the Munich Cancer Registry (MCR) diagnosed between 1998 and 2020. Joinpoint analysis was used to determine trend in incidence. Baseline demographic comparisons and survival analyses using competing risk and univariate/multivariate methods were conducted according to tumour histology: adenocarcinoma (ADENO), neuroendocrine neoplasia (NEN), mixed adeno-neuroendocrine carcinoma (MANEC), and low- (LAMN) and high-grade mucinous neoplasia (HAMN). RESULTS Up to 2016 the number of cases increased significantly [annual per cent change (APC) = 6.86, p < 0.001] followed by a decline in the following years (APC = -14.82, p = 0.014; average APC = 2.5, p = 0.046). Comparison of all patients showed that NEN (48.4%) and mucinous neoplasms (11.6%) had a considerably better prognosis than ADENO (36.0%) and MANEC (3.0%, p < 0.0001). A multivariate analysis within the NEN and ADENO subgroups revealed that further histological classification was not prognostically relevant, while older age and regional tumour spread at diagnosis were associated with a poor prognosis. ADENO histology with high tumour grade and appendectomy only was also associated with poorer survival. CONCLUSION Appendiceal neoplasms are histologically heterogeneous; however, this diversity becomes less relevant compared with the marked difference from cancers of the remaining colon. The previously observed increase in cases appears to be abating; fewer cases of appendicitis and/or appendectomies or changes in histopathological assessment may be behind this trend.
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Affiliation(s)
- Kathrin Halfter
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich (TUM), Munich, Germany
| | - Helmut Friess
- Department of General Surgery, Klinikum rechts der Isar, Technical University Munich (TUM) School of Medicine, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, University Hospital, Technical University Munich (TUM), Munich, Germany
| | - Marcus Kremer
- Institute of Pathology, Clinic Munich-Neuperlach, Munich, Germany
| | - Reinhard Ruppert
- Department of Surgery, Clinic Munich-Neuperlach Hospital, Munich, Germany
| | | | - Detlef Krenz
- Department of General, Vascular, Thyroid and Thorax Surgery, Hospital Dritter Orden, Munich, Germany
| | - Andreas Nerlich
- Institute of Pathology, Clinic Munich-Bogenhausen, Munich, Germany
| | - Ayman Agha
- Department of General, Visceral, Endocrine and Minimal-Invasive Surgery, Clinic Munich-Bogenhausen, Munich, Germany
| | - Martin Fuchs
- Department of Gastroenterology, Hepatology and Gastrointestinal-Oncology, Clinic Munich-Bogenhausen, Munich, Germany
| | | | - Kai Nowak
- Department of General, Vascular and Thorax Surgery, Clinic Rosenheim, Rosenheim, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Anne Schlesinger-Raab
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Munich, Germany
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Fasoula NA, Karlas A, Prokopchuk O, Katsouli N, Bariotakis M, Liapis E, Goetz A, Kallmayer M, Reber J, Novotny A, Friess H, Ringelhan M, Schmid R, Eckstein HH, Hofmann S, Ntziachristos V. Non-invasive multispectral optoacoustic tomography resolves intrahepatic lipids in patients with hepatic steatosis. Photoacoustics 2023; 29:100454. [PMID: 36794122 PMCID: PMC9922962 DOI: 10.1016/j.pacs.2023.100454] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Hepatic steatosis is characterized by intrahepatic lipid accumulation and may lead to irreversible liver damage if untreated. Here, we investigate whether multispectral optoacoustic tomography (MSOT) can offer label-free detection of liver lipid content to enable non-invasive characterization of hepatic steatosis by analyzing the spectral region around 930 nm, where lipids characteristically absorb. In a pilot study, we apply MSOT to measure liver and surrounding tissues in five patients with liver steatosis and five healthy volunteers, revealing significantly higher absorptions at 930 nm in the patients, while no significant difference was observed in the subcutaneous adipose tissue of the two groups. We further corroborated the human observations with corresponding MSOT measurements in high fat diet (HFD) - and regular chow diet (CD)-fed mice. This study introduces MSOT as a potential non-invasive and portable technique for detecting/monitoring hepatic steatosis in clinical settings, providing justification for larger studies.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Angelos Karlas
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
| | - Olga Prokopchuk
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Nikoletta Katsouli
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michail Bariotakis
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Evangelos Liapis
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anna Goetz
- Institute for Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josefine Reber
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Alexander Novotny
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Helmut Friess
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Marc Ringelhan
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
| | - Susanna Hofmann
- Institute for Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Internal Medicine IV, Klinikum der Ludwig Maximilian University of Munich, Munich, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
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Borkenstein AF, Borkenstein EM, Schmid R. Analysis of a novel hydrophobic acrylic enhanced monofocal intraocular lens compared to its standard monofocal type on the optical bench. BMC Ophthalmol 2022; 22:356. [PMID: 36057556 PMCID: PMC9440489 DOI: 10.1186/s12886-022-02584-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction The aim of this laboratory study is to objectively analyze the new hydrophobic, acrylic, enhanced monofocal intraocular lens Acunex Quantum (AN6Q) and compare it with the monofocal platform Acunex AN6. Methods Two IOL models were analyzed (Acunex Quantum AN6Q and Acunex AN6, Teleon Surgical, Spankeren, Netherlands), each having the same refractive power of + 22.0 D, on the optical bench with the OptiSpheric IOL PRO 2. The measurements followed the guidelines of the International Standard Organization with following parameters: ISO 2 cornea (+ 0,28 µ), ISO 11979/2, lens placement in situ in NaCl with 35° temperature, 546 nm and selection of different aperture sizes (3.0 mm vs 4.5 mm). The aberrations of each IOL were evaluated by the WaveMaster IOL 2, a high-resolution Shack-Hartmann sensor in reverse projection setup. An in-situ model eye was used according to ISO 11979 in NaCl (n = 1.337) with 546 nm, mask width 4.51. Zernike polynomials up to 10th order were determined by means of the measured wavefront that describe the optical properties of the IOL. Results Through frequency modulation transfer function (mean) at 50 lp/mm (AN6Q/AN6 centered) was 0.687/0.731 (3.0 mm aperture) and 0.400/0.509 (4.5 mm aperture). The SR (mean) was 0.592/0.809 (3.0 mm) and 0.332/0.372 (4.5 mm). The MTF (mean) at 50 lp/mm (AN6Q/AN6 decentered by 1 mm) was 0.413/0.478 (3.0 mm) and 0.257/0.229 (4.5 mm). The SR (mean) was 0.393/0.404 (3.0 mm) and 0.183/0.212 (4.5 mm). The MTF (mean) at 50 lp/mm (AN6Q/AN6 tilted by 5°) was 0.508/0.710 (3.0 mm) and 0.337/0.513 (4.5 mm). The SR (mean) was 0.508/0.760 (3.0 mm) and 0.235/0.2372 (4.5 mm). AN6Q showed MTF peak of 0.55 with an enlarged depth of power of about 2.5 D and two cusps in the MTF curve. The spherical aberration Z 4–0 was about -0.21 µm and the secondary spherical aberration Z 6–0 was about 0.16 µm. No other relevant aberration showed up. Conclusion The new, enhanced monofocal AN6Q provides an extended range of focus with only slight decrease in contrast quality. Both types of the hydrophobic, acrylic Acunex IOL platform have its particular advantages in clinical settings and therefore its importance, respectively.
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Affiliation(s)
- A F Borkenstein
- Borkenstein and Borkenstein Private Practice, Privatklinik Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria.
| | - E M Borkenstein
- Borkenstein and Borkenstein Private Practice, Privatklinik Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria
| | - R Schmid
- Accuratis, Practice for Refractive Eye Surgery, Hirschstrasse 1, 89073, Ulm, Germany
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Peschke K, Jakubowski H, Schäfer A, Maurer C, Lange S, Orben F, Bernad R, Harder F, Eiber M, Öllinger R, Schlitter M, Weichert W, Phillip V, Schlag C, Schmid R, Braren R, Kong B, Demir E, Friess H, Rad R, Saur D, Schneider G, Reichert M. Abstract PO-070: Longitudinal precision oncology platform to identify chemotherapy-induced vulnerabilities in pancreatic cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.panca21-po-070] [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
Pancreatic ductal adenocarcinoma (PDAC) remains a devastating disease with poor survival rates as almost all patients develop resistance towards chemotherapy and molecular-informed targeted therapies are reserved to a few. Here, we aim to establish a longitudinal precision oncology platform with a multi-dimensional characterization of PDAC biopsies including genomic, transcriptomic as well as functional analyses to identify and exploit treatment-induced vulnerabilities. In order to investigate adaptive processes of tumors under treatment we aimed to generate PDAC patient-derived organoids (PDOs) and 2D cell lines before and after chemotherapy. Therefore, we enrolled a patient with borderline resectable PDAC who received neoadjuvant FOLFIRINOX. Endoscopic fine needle (pre-FFX) and surgical biopsies (post-FFX) were used to generate PDOs and 2D cells. Whole exome sequencing (WES) and RNA sequencing data of the pre-FFX and post-FFX organoids were compared in order to evaluate the genetic landscape and PDAC subtypes. 2D cells were subjected to an unbiased automated drug screening of 415 compounds to investigate FFX-induced vulnerabilities. Top targets were validated manually in the 2D cells and organoids. Although transcriptional subtyping classified both PDOs as classical PDAC, gene set enrichment analysis (GSEA) revealed a reduced pathway activation linked to the basal-like phenotype such as KRAS signaling in the post-FFX organoids. WES did not show major differences in the genetic landscape of the tumor pre- and post-FFX induction suggesting a plasticity process rather than a clonal selection during chemotherapy. Importantly, post-FFX cells exhibited an increased sensitivity in the unbiased drug screening towards MEK and EGFR inhibition compared to pre-FFX cells. 2D cells and organoids were treated with different MEK inhibitors (MEKi) for validation and post-FFX cells showed a highly increased response compared to the treatment-naïve cells, as well. Interestingly, when placed into the context of a panel of 15 primary PDAC cell lines the pre-FFX cells cluster with highly MEKi resistant PDAC cells whereas post-FFX cells belong to the most sensitive cell lines. In sum, integrating functional layers into personalized medicine allowed us to identify chemotherapy-induced vulnerabilities as potent targeted therapy options in PDAC. Thus, this longitudinal precision oncology platform harbors a unique opportunity to understand adaptive processes in tumor evolution and/or treatment-imposed pressure in PDAC patients.
Citation Format: Katja Peschke, Hannah Jakubowski, Arlett Schäfer, Carlo Maurer, Sebastian Lange, Felix Orben, Raquel Bernad, Felix Harder, Matthias Eiber, Rupert Öllinger, Melissa Schlitter, Wilko Weichert, Veit Phillip, Christoph Schlag, Roland Schmid, Rickmer Braren, Bo Kong, Ekin Demir, Helmut Friess, Roland Rad, Dieter Saur, Günter Schneider, Maximilian Reichert. Longitudinal precision oncology platform to identify chemotherapy-induced vulnerabilities in pancreatic cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-070.
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Affiliation(s)
- Katja Peschke
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Hannah Jakubowski
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Arlett Schäfer
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Carlo Maurer
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Sebastian Lange
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Felix Orben
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Raquel Bernad
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Felix Harder
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Matthias Eiber
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Rupert Öllinger
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Melissa Schlitter
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Wilko Weichert
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Veit Phillip
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Christoph Schlag
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Roland Schmid
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Rickmer Braren
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Bo Kong
- 2University of Ulm, Ulm, Germany
| | - Ekin Demir
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Helmut Friess
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Roland Rad
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Dieter Saur
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
| | - Günter Schneider
- 1Technical University of Munich, Klinikum rechts der Isar, Munich, Germany,
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Gerum S, Iglseder W, Schmid R, Peterka K, Knocke-Abulesz T, Harl P, Schwaiger S, Reiter I, Salinger J, Venhoda C, Kurzweil G, Jaeger R, Celedin B, Clemens P, Sedlmayer F, Roeder F. Practice of Radiation Therapy for Anal Cancer in Austria: A Survey on Behalf of the Austrian Radiation Oncology Society Gastrointestinal Tumor Group (ÖGRO-GIT). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.362] [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: 11/28/2022]
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Furrer K, Weder W, Eboulet E, Betticher D, Pless M, Stupp R, Krueger T, Perentes J, Schmid R, Lardinois D, Furrer M, Fruh M, Peters S, Curioni-Fontecedro A, Stahel R, Rothschild S, Hayoz S, Thierstein S, Biaggi C, Opitz I. P30.01 Extended Resections for Advanced Stages T3/T4 NSCLC After Neoadjuvant Treatment: Conclusions of SAKK Pooled Analysis (16/96, 16/00, 16/01). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gerum S, Iglseder W, Schmid R, Peterka K, Knocke-Abulesz TH, Harl P, Schwaiger S, Reiter I, Salinger J, Venhoda C, Kurzweil G, Poetscher M, Jaeger R, Celedin B, Clemens P, Roeder F. Practice of radiation therapy for anal cancer in Austria-a survey on behalf of the Austrian radiation oncology society gastrointestinal tumor group (ÖGRO-GIT). Strahlenther Onkol 2021; 197:953-961. [PMID: 34591119 PMCID: PMC8547205 DOI: 10.1007/s00066-021-01842-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose We conducted a patterns-of-care survey on chemoradiation for locoregionally confined anal cancer in Austria to evaluate areas of disagreement and to identify possible targets for further standardization. Methods An anonymous questionnaire comprising 38 questions was sent to all Austrian radiation oncology departments. Results were analyzed descriptively and compared to two international guidelines. Results The response rate was 93%. Work-up generally includes DRE, endoscopy, and cross-sectional imaging of chest/abdomen and pelvis. PET-CT is used by 38%. Screening for HIV and biopsies of suspicious lymph nodes are infrequently used. All centers perform IMRT, mainly with daily IGRT. Median doses to the primary are 54.7 Gy (T1–2) and 59.4 Gy (T3–4). Suspicious nodes receive a boost (median dose 54 Gy), while elective nodal areas are mainly treated with 45–50.4 Gy. Target delineation of elective nodal areas seems generally uniform, although disagreement exists regarding inclusion of the common iliac nodes. No agreement was found for OAR-delineation and dose constraints. Concurrent chemotherapy is mitomycin and 5‑FU/capecitabine. Supportive care beyond skin care is infrequently offered. Intensive follow-up is performed for at least 5 years. Treatment of T1N0 shows considerable disagreement. Conclusion We found a high rate of agreement between the centers and concordance with major guidelines. PET-CT, routine HIV testing, and biopsies of suspicious LN seem underrepresented. The largest controversy regarding target volumes concerns inclusion of the common iliac nodes. Prescribed doses are generally in line with the recommendations or higher. OAR delineation, dose constraints, supportive care, and treatment of early anal cancer represent areas for further standardization. Supplementary Information The online version of this article (10.1007/s00066-021-01842-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Gerum
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - W Iglseder
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Schmid
- Universitätsklinik für Radioonkologie, Medizinische Universität Wien, Universitätsklinikum AKH Wien, Comprehensive Cancer Center Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - K Peterka
- Institut für Radioonkologie, Kaiser-Franz-Josef-Spital/SMZ Süd-Klinik Favoriten, Kundratstraße 3, 1100, Wien, Austria
| | - T H Knocke-Abulesz
- Sonderabteilung Strahlentherapie, Wiener Gesundheitsverbund Klinik Hietzing, Wolkersbergenstraße 1, 1130, Wien, Austria
| | - P Harl
- Institut für Radioonkologie, SMZ - Ost Donauspital der Stadt Wien, Langobardenstraße 122, 1220, Wien, Austria
| | - S Schwaiger
- Institut für Radioonkologie, Klinik Ottakring, Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Wien, Austria
| | - I Reiter
- Institut für Radioonkologie und Strahlentherapie, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Germany
| | - J Salinger
- Klinische Abteilung für Strahlentherapie - Radioonkologie, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Mitterweg 10, 3500, Krems an der Donau, Austria
| | - C Venhoda
- Klinik für Radioonkologie, Klinikum der Barmherzigen Schwestern, Ordensklinikum Linz, Seilerstätte 4, 4010, Linz, Austria
| | - G Kurzweil
- Klinik für Radioonkologie/Strahlentherapie, Salzkammergutklinikum Vöcklabruck, Dr.-Wilhelm-Boch-Straße 1, 4840, Vöcklabruck, Austria
| | - M Poetscher
- Universitätsklinik für Strahlentherapie - Radioonkologie, Comprehensive Cancer Center Graz, Medizinische Universität Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - R Jaeger
- Universitätsklinik für Strahlentherapie - Radioonkologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - B Celedin
- Institut für Strahlentherapie/Radioonkologie, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Austria
| | - P Clemens
- Institut für Radioonkologie und Strahlentherapie, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - F Roeder
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Yang Z, Liang S, Zheng B, Chen C, Peng R, Schmid R. P71.03 A New Combination Therapy for FGFR1-Amplified Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tenison E, Hernandez M, Mazza N, Pommier N, Rush E, Capone G, Testa N, Carr A, Holshue H, Schmid R, Carey K, Grega L. The Effect of COVID-19 Related Stress on the Health and Wellness Behaviors of Faculty and Staff at a Mid-Size University. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tenison E, Hernandez M, Mazza N, Testa N, Pommier N, Grega L, Schmid R, Carey K, Capone G, Carr A, Holshue H, Rush E. Implementation of a University Based Wellness Program in Response to Pandemic Related Loss of Community Nutrition Supervised Practice Rotations. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tenison E, Hernandez M, Mazza N, Pommier N, Holshue H, Carr A, Testa N, Grega L, Schmid R, Carey K, Capone G, Rush E. The Barriers and Enablers to Participation in Wellness Behaviors Post COVID-19 among Faculty and Staff at a Mid-Size University. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Neumann K, Arnold B, Baumann A, Bohr C, Euler HA, Fischbach T, Hausschild J, Heinrich D, Keilmann A, Köhler C, Krägeloh-Mann I, Kummer P, Mathmann P, Noterdaeme M, Plontke S, Schliewenz R, Schmid R, Schmitz-Salue C, Schröder M, Seidel A, Wichmann J, Kiese-Himmel C. Neue Terminologie für Sprachentwicklungsstörungen? Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01148-2] [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: 11/24/2022]
Abstract
Zusammenfassung
Hintergrund
Sprachtherapeutisch-linguistische Fachkreise empfehlen die Anpassung einer von einem internationalen Konsortium empfohlenen Änderung der Nomenklatur für Sprachstörungen im Kindesalter, insbesondere für Sprachentwicklungsstörungen (SES), auch für den deutschsprachigen Raum.
Fragestellung
Ist eine solche Änderung in der Terminologie aus ärztlicher und psychologischer Sicht sinnvoll?
Material und Methode
Kritische Abwägung der Argumente für und gegen eine Nomenklaturänderung aus medizinischer und psychologischer Sicht eines Fachgesellschaften- und Leitliniengremiums.
Ergebnisse
Die ICD-10-GM (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification) und eine S2k-Leitlinie unterteilen SES in umschriebene SES (USES) und SES assoziiert mit anderen Erkrankungen (Komorbiditäten). Die USES- wie auch die künftige SES-Definition der ICD-11 (International Classification of Diseases 11th Revision) fordern den Ausschluss von Sinnesbehinderungen, neurologischen Erkrankungen und einer bedeutsamen intellektuellen Einschränkung. Diese Definition erscheint weit genug, um leichtere nonverbale Einschränkungen einzuschließen, birgt nicht die Gefahr, Kindern Sprach- und weitere Therapien vorzuenthalten und erkennt das ICD(International Classification of Disease)-Kriterium, nach dem der Sprachentwicklungsstand eines Kindes bedeutsam unter der Altersnorm und unterhalb des seinem Intelligenzalter angemessenen Niveaus liegen soll, an. Die intendierte Ersetzung des Komorbiditäten-Begriffs durch verursachende Faktoren, Risikofaktoren und Begleiterscheinungen könnte die Unterlassung einer dezidierten medizinischen Differenzialdiagnostik bedeuten.
Schlussfolgerungen
Die vorgeschlagene Terminologie birgt die Gefahr, ätiologisch bedeutsame Klassifikationen und differenzialdiagnostische Grenzen zu verwischen und auf wertvolles ärztliches und psychologisches Fachwissen in Diagnostik und Therapie sprachlicher Störungen im Kindesalter zu verzichten.
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Staubitz JI, Clerici T, Riss P, Watzka F, Bergenfelz A, Bareck E, Fendrich V, Goldmann A, Grafen F, Heintz A, Kaderli RM, Karakas E, Kern B, Matter M, Mogl M, Nebiker CA, Niederle B, Obermeier J, Ringger A, Schmid R, Triponez F, Trupka A, Wicke C, Musholt TJ. [EUROCRINE®: adrenal surgery 2015-2019- surprising initial results]. Chirurg 2021; 92:448-463. [PMID: 32945919 PMCID: PMC8081706 DOI: 10.1007/s00104-020-01277-6] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hintergrund Seit 2015 erfolgt in Europa mithilfe des EUROCRINE®-Registers eine systematische Dokumentation endokrin-chirurgischer Operationen. Ziel dieser ersten Auswertung war eine Darstellung der Versorgungsrealität für Nebenniereneingriffe in einem homogenen Versorgungsumfeld, entsprechend des deutschsprachigen Raums – bzw. des Präsenzgebiets der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) – einschließlich einer Analyse der Adhärenz zu geltenden Therapieempfehlungen. Methodik Es erfolgte eine deskriptive Analyse der präoperativen Diagnostik, der angewandten Operationstechniken sowie der zugrunde liegenden histologischen Entitäten der zwischen den Jahren 2015 und 2019 über EUROCRINE® in Deutschland, Österreich und der Schweiz dokumentierten Nebennierenoperationen. Ergebnisse In den insgesamt 21 teilnehmenden Kliniken des deutschsprachigen EUROCRINE®-Gebiets wurden 658 Operationen an Nebennieren durchgeführt. In 90 % erfolgten unilaterale, in 3 % bilaterale Adrenalektomien und in 7 % andere Resektionsverfahren. Die in 41 % der Operationen dokumentierte histologische Hauptdiagnose war das adrenokortikale Adenom. In 15 % lagen maligne Befunde zugrunde (einschließlich 6 % Nebennierenrindenkarzinome (ACC) und 8 % Nebennierenmetastasen). 23 % der Operationen erfolgten bei Phäochromozytomen. Diese wurden zu 82 % minimal-invasiv operiert, Nebennierenrindenkarzinome lediglich zu 28 % und Nebennierenmetastasen zu 66 %. Schlussfolgerung Überraschenderweise wurden nach Nebennierenadenomen und Phäochromozytomen an dritthäufigster Stelle Nebennierenmetastasen unterschiedlicher Primärtumoren reseziert. 28 % der ACC waren für minimal-invasive Techniken vorgesehen, wobei 20 % dieser Fälle eine Konversion zur offenen Operation erforderten. Die aktuelle Analyse deckte Diskrepanzen zwischen Versorgungsrealität und Leitlinienempfehlungen auf, aus denen sich zahlreiche Fragestellungen ergeben, welche nun in ein überarbeitetes EUROCRINE®-Modul zur Dokumentation von Nebennierenoperationen einfließen werden.
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Affiliation(s)
- J I Staubitz
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | - T Clerici
- Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - P Riss
- Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - F Watzka
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland
| | | | - E Bareck
- Abteilung für Chirurgie, KRAGES Burgenländische Krankenanstalten-Ges.m.b.H., Oberpullendorf, Österreich
| | - V Fendrich
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland
| | - A Goldmann
- Viszeral- und Thoraxchirurgie, Kantonsspital Winterthur, Winterthur, Schweiz
| | - F Grafen
- Chirurgische Klinik, Spital Limmattal, Schlieren, Schweiz
| | - A Heintz
- Allgemein- und Viszeralchirurgie, Katholisches Klinikum Mainz, Mainz, Deutschland
| | - R M Kaderli
- Viszerale Chirurgie, Universitätsspital Bern, Bern, Schweiz
| | - E Karakas
- Klinik für Allgemein‑, Visceral- und Endokrine Chirurgie, Krankenhaus Maria Hilf Krefeld, Krefeld, Deutschland
| | - B Kern
- Viszeralchirurgie, St. Claraspital Basel, Basel, Schweiz
| | - M Matter
- Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Schweiz
| | - M Mogl
- Chirurgische Klinik, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C A Nebiker
- Viszeralchirurgie, Kantonsspital Aarau, Aarau, Schweiz
| | - B Niederle
- Abteilung für Chirurgie, Franziskus Spital Wien, Wien, Österreich
| | - J Obermeier
- Klinik für Chirurgie, Klinikum Dortmund gGmbH, Dortmund, Deutschland
| | - A Ringger
- Chirurgie, Solothurner Spitäler AG, Solothurn, Schweiz
| | - R Schmid
- Viszeralchirurgie, Spitalzentrum Biel, Biel, Schweiz
| | - F Triponez
- Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires Genève, Genève, Schweiz
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg, Starnberg, Deutschland
| | - C Wicke
- Kantonsspital Luzern, Luzern, Schweiz
| | - T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, 55131, Deutschland.
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Liotta L, Lange S, Maurer HC, Olive KP, Braren R, Pfarr N, Burger S, Muckenhuber A, Jesinghaus M, Steiger K, Weichert W, Friess H, Schmid R, Algül H, Jost PJ, Ramser J, Fischer C, Quante AS, Reichert M, Quante M. PALLD mutation in a European family conveys a stromal predisposition for familial pancreatic cancer. JCI Insight 2021; 6:141532. [PMID: 33764904 PMCID: PMC8119201 DOI: 10.1172/jci.insight.141532] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUNDPancreatic cancer is one of the deadliest cancers, with low long-term survival rates. Despite recent advances in treatment, it is important to identify and screen high-risk individuals for cancer prevention. Familial pancreatic cancer (FPC) accounts for 4%-10% of pancreatic cancers. Several germline mutations are related to an increased risk and might offer screening and therapy options. In this study, we aimed to identity of a susceptibility gene in a family with FPC.METHODSWhole exome sequencing and PCR confirmation was performed on the surgical specimen and peripheral blood of an index patient and her sister in a family with high incidence of pancreatic cancer, to identify somatic and germline mutations associated with familial pancreatic cancer. Compartment-specific gene expression data and immunohistochemistry were also queried.RESULTSThe identical germline mutation of the PALLD gene (NM_001166108.1:c.G154A:p.D52N) was detected in the index patient with pancreatic cancer and the tumor tissue of her sister. Whole genome sequencing showed similar somatic mutation patterns between the 2 sisters. Apart from the PALLD mutation, commonly mutated genes that characterize pancreatic ductal adenocarcinoma were found in both tumor samples. However, the 2 patients harbored different somatic KRAS mutations (G12D and G12V). Healthy siblings did not have the PALLD mutation, indicating a disease-specific impact. Compartment-specific gene expression data and IHC showed expression in cancer-associated fibroblasts (CAFs).CONCLUSIONWe identified a germline mutation of the palladin (PALLD) gene in 2 siblings in Europe, affected by familial pancreatic cancer, with a significant overexpression in CAFs, suggesting that stromal palladin could play a role in the development, maintenance, and/or progression of pancreatic cancer.FUNDINGDFG SFB 1321.
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Affiliation(s)
- Lucia Liotta
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Lange
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H. Carlo Maurer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kenneth P. Olive
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Rickmer Braren
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicole Pfarr
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Sebastian Burger
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Muckenhuber
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Moritz Jesinghaus
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Katja Steiger
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
| | - Wilko Weichert
- Institut für Pathologie und pathologische Anatomie, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
| | - Helmut Friess
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roland Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hana Algül
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Philipp J. Jost
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
- Innere Medizin III, Hämatologie und Onkologie, Technische Universität München, Munich, Germany
| | - Juliane Ramser
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Fischer
- Institut für Humangenetik, Ruprecht-Karls Universität, Heidelberg, Germany
| | - Anne S. Quante
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian Reichert
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
| | - Michael Quante
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Deutschen Konsortium für Translationale Krebsforschung (DKTK), Partner site Munich, Technische Universität München, Munich, Germany
- Klinik für Innere Medizin II, Universität Freiburg, Germany
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Kadeerhan G, Gerhard M, Gao JJ, Mejías-Luque R, Zhang L, Vieth M, Ma JL, Bajbouj M, Suchanek S, Liu WD, Ulm K, Quante M, Li ZX, Zhou T, Schmid R, Classen M, Li WQ, Zhang Y, You WC, Pan KF. Microbiota alteration at different stages in gastric lesion progression: a population-based study in Linqu, China. Am J Cancer Res 2021; 11:561-575. [PMID: 33575087 PMCID: PMC7868750] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023] Open
Abstract
In addition to Helicobacter pylori (H.pylori), gastric microbiota may be involved in carcinogenesis process. However, the longitudinal study to assess changes in the gastric microbiota associated with the development of gastric carcinogenesis is still limited. The aim of this study is to explore dynamic microbial alterations in gastric cancer (GC) development based on a 4-year endoscopic follow-up cohort in Linqu County, China. Microbial alterations were investigated by deep sequencing of the microbial 16S ribosomal RNA gene in 179 subjects with various gastric lesions, and validated in paired gastric biopsies prospectively collected before and after lesion progression and in non-progression controls. Significant differences were found in microbial diversity and community structure across various gastric lesions, with 62 candidate differential taxa between at least two lesion groups. Further validations identified Helicobacter, Bacillus, Capnocytophaga and Prevotella to be associated with lesion progression-to-dysplasia (DYS)/GC (all P < 0.05), especially for subjects progressing from intestinal metaplasia (IM) to DYS/GC. The combination of the four genera in a microbial dysbiosis index showed a significant difference after lesion progression-to-DYS/GC compared to controls (P = 0.027). The panel including the four genera identified subjects after progression-to-DYS/GC with an area under the receiver-operating curve (AUC) of 0.941. Predictive significance was found before lesion progression-to-DYS/GC with an AUC = 0.776 and an even better AUC (0.927) for subjects progressing from IM to DYS/GC. Microbiota may play different roles at different stages in gastric carcinogenesis. A panel of bacterial genera associated with gastric lesions may help to assess gastric microbial dysbiosis and show potential predictive values for lesion progression. Our findings provide new clues for the microbial mechanism of H.pylori-associated carcinogenesis.
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Affiliation(s)
- Gaohaer Kadeerhan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
| | - Markus Gerhard
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität MünchenMunich, Germany
- German Center for Infection Research, Partner Site MunichMunich, Germany
| | - Juan-Juan Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
| | - Raquel Mejías-Luque
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität MünchenMunich, Germany
- German Center for Infection Research, Partner Site MunichMunich, Germany
| | - Lian Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
| | - Michael Vieth
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- Institute of Pathology, Klinikum BayreuthBayreuth, Germany
| | - Jun-Ling Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
| | - Monther Bajbouj
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität MünchenMunich, Germany
| | - Stepan Suchanek
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- Department of Medicine, 1st Faculty of Medicine, Military University Hospital, Charles UniversityPrague, Czech Republic
| | - Wei-Dong Liu
- Linqu Public Health BureauLinqu, Shandong, China
| | - Kurt Ulm
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität MünchenMunich, Germany
| | - Michael Quante
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität MünchenMunich, Germany
| | - Zhe-Xuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
| | - Roland Schmid
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität MünchenMunich, Germany
| | - Meinhard Classen
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
- International Digestive Cancer AllianceGermany
| | - Wen-Qing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
| | - Wei-Cheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
| | - Kai-Feng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & InstituteBeijing, China
- PYLOTUM Key Joint Laboratory for Upper GI Cancer, Technische Universität München, Munich, Germany, Peking University Cancer Hospital & InstituteBeijing, China
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Schmid R, Studer E, Hirsbrunner G. [Oestrus suppression in a dairy herd by means of anti-GnRH vaccination Improvac®: A prospective field study]. SCHWEIZ ARCH TIERH 2020; 162:93-100. [PMID: 32004139 DOI: 10.17236/sat00245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the duration of estrus suppression after a double administration of the anti-GnRH vaccine Improvac® (Zoetis Schweiz GmbH, 2800 Delémont) in cows. Furthermore, it should be investigated, if a third administration could prolong the effect of the cycle suppression. A total of 21 cows (more than four weeks post partum) were vaccinated twice, at least 35 days apart, with 2 ml Improvac® (0.4 mg of a GnRH-analogon) subcutaneously on one side of the neck. Over a period of 368 days and in the course of 18 farm visits these cows were examined gynecologically and re-vaccinated if they showed signs of estrus behaviour or ovarian activity. After the second vaccination the cycle of the cows was suppressed for an average period of 114 days (59-175 days) and the effect could be prolonged by a booster of the vaccine for another 127 days in three cows. Estrus behaviour was absent for a longer period than ovarian activity was. The vaccine was tolerated well: apart from slight swelling at the injection site, no side effects were observed. Our results demonstrate that two immunizations with Improvac® are an easily applicable method for the suppression of cyclic activity in cows for a mean period of 114 days. The duration of cycle suppression was prolonged by a booster of the vaccination.
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Affiliation(s)
- R Schmid
- Wiederkäuerklinik, Vetsuisse-Fakultät, Universität Bern
| | - E Studer
- Wiederkäuerklinik, Vetsuisse-Fakultät, Universität Bern
| | - G Hirsbrunner
- Wiederkäuerklinik, Vetsuisse-Fakultät, Universität Bern
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Guo Y, Zhang Y, Gerhard M, Gao JJ, Mejias-Luque R, Zhang L, Vieth M, Ma JL, Bajbouj M, Suchanek S, Liu WD, Ulm K, Quante M, Li ZX, Zhou T, Schmid R, Classen M, Li WQ, You WC, Pan KF. Effect of Helicobacter pylori on gastrointestinal microbiota: a population-based study in Linqu, a high-risk area of gastric cancer. Gut 2020; 69:1598-1607. [PMID: 31857433 PMCID: PMC7456744 DOI: 10.1136/gutjnl-2019-319696] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [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: 08/22/2019] [Revised: 11/06/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Gastrointestinal microbiota may be involved in Helicobacter pylori-associated gastric cancer development. The aim of this study was to explore the possible microbial mechanisms in gastric carcinogenesis and potential dysbiosis arising from H. pylori infection. DESIGN Deep sequencing of the microbial 16S ribosomal RNA gene was used to investigate alterations in paired gastric biopsies and stool samples in 58 subjects with successful and 57 subjects with failed anti-H. pylori treatment, relative to 49 H. pylori negative subjects. RESULTS In H. pylori positive subjects, richness and Shannon indexes increased significantly (both p<0.001) after successful eradication and showed no difference to those of negative subjects (p=0.493 for richness and p=0.420 for Shannon index). Differential taxa analysis identified 18 significantly altered gastric genera after eradication. The combination of these genera into a Microbial Dysbiosis Index revealed that the dysbiotic microbiota in H. pylori positive mucosa was associated with advanced gastric lesions (chronic atrophic gastritis and intestinal metaplasia/dysplasia) and could be reversed by eradication. Strong coexcluding interactions between Helicobacter and Fusobacterium, Neisseria, Prevotella, Veillonella, Rothia were found only in advanced gastric lesion patients, and were absent in normal/superficial gastritis group. Changes in faecal microbiota included increased Bifidobacterium after successful H. pylori eradication and more upregulated drug-resistant functional orthologs after failed treatment. CONCLUSION H. pylori infection contributes significantly to gastric microbial dysbiosis that may be involved in carcinogenesis. Successful H. pylori eradication potentially restores gastric microbiota to a similar status as found in uninfected individuals, and shows beneficial effects on gut microbiota.
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Affiliation(s)
- Yang Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
| | - Markus Gerhard
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Juan-Juan Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Raquel Mejias-Luque
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Lian Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Michael Vieth
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Jun-Ling Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Monther Bajbouj
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Stepan Suchanek
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- Department of Medicine, 1st Faculty of Medicine, Military University Hospital, Charles University, Prague, Czech Republic
| | - Wei-Dong Liu
- Linqu Public Health Bureau, Linqu, Shandong, China
| | - Kurt Ulm
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Michael Quante
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhe-Xuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Roland Schmid
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Meinhard Classen
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Wen-Qing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
| | - Wei-Cheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
| | - Kai-Feng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China
- PYLOTUM Key joint laboratory for upper GI cancer, Technische Universität München/Peking University Cancer Hospital & Institute, Munich/Beijing, Germany/China
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Huber W, Findeisen M, Lahmer T, Herner A, Rasch S, Mayr U, Hoppmann P, Jaitner J, Okrojek R, Brettner F, Schmid R, Schmidle P. Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time. PLoS One 2020; 15:e0232720. [PMID: 32374755 PMCID: PMC7202606 DOI: 10.1371/journal.pone.0232720] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Early recognition of high-risk-patients with acute respiratory distress syndrome (ARDS) might improve their outcome by less protracted allocation to intensified therapy including extracorporeal membrane oxygenation (ECMO). Among numerous predictors and classifications, the American European Consensus Conferenece (AECC)- and Berlin-definitions as well as the oxygenation index (OI) and the Murray-/Lung Injury Score are the most common. Most studies compared the prediction of mortality by these parameters on the day of intubation and/or diagnosis of ARDS. However, only few studies investigated prediction over time, in particular for more than three days. Objective Therefore, our study aimed at characterization of the best predictor and the best day(s) to predict 28-days-mortality within four days after intubation of patients with ARDS. Methods In 100 consecutive patients with ARDS severity according to OI (mean airway pressure*FiO2/paO2), modified Murray-score without radiological points (Murray_mod), AECC- and Berlin-definition, were daily documented for four days after intubation. In the subgroup of 49 patients with transpulmonary thermodilution (TPTD) monitoring (PiCCO), extravascular lung water index (EVLWI) was measured daily. Primary endpoint Prediction of 28-days-mortality (Area under the receiver-operating-characteristic curve (ROC-AUC)); IBM SPSS 26. Results In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). OI was the best predictor among the ARDS-scores (AUC=0.689 on day-1; 4-day-mean AUC = 0.625). AECC and Murray_mod had 4-day-means AUCs below 0.6. Among the 49 patients with TPTD, EVLWI (4-day-mean AUC=0.696) and OI (4-day-mean AUC=0.695) were the best predictors. AUCs were 0.789 for OI on day-1, and 0.786 for EVLWI on day-2. In binary regression analysis of patients with TPTD, EVLWI (B=-0.105; Wald=7.294; p=0.007) and OI (B=0.124; Wald=7.435; p=0.006) were independently associated with 28-days-mortality. Combining of EVLWI and OI provided ROC-AUCs of 0.801 (day-1) and 0.824 (day-2). Among the totality of patients, the use of TPTD-monitoring „per se“ and a lower SOFA-score were independently associated with a lower 28-days-mortality. Conclusions Prognosis of ARDS-patients can be estblished within two days after intubation. The best predictors were EVLWI and OI and their combination. TPTD-monitoring „per se“ was independently associated with reduced mortality.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
- * E-mail:
| | - Michael Findeisen
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Alexander Herner
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Sebastian Rasch
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Ulrich Mayr
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Petra Hoppmann
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Juliane Jaitner
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Rainer Okrojek
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Franz Brettner
- Abteilung Intensivmedizin, Krankenhaus Barmherzige Brüder, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Paul Schmidle
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Kaissis GA, Jungmann F, Ziegelmayer S, Lohöfer FK, Harder FN, Schlitter AM, Muckenhuber A, Steiger K, Schirren R, Friess H, Schmid R, Weichert W, Makowski MR, Braren RF. Multiparametric Modelling of Survival in Pancreatic Ductal Adenocarcinoma Using Clinical, Histomorphological, Genetic and Image-Derived Parameters. J Clin Med 2020; 9:jcm9051250. [PMID: 32344944 PMCID: PMC7287805 DOI: 10.3390/jcm9051250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Rationale: Pancreatic ductal adenocarcinoma (PDAC) remains a tumor entity of exceptionally poor prognosis, and several biomarkers are under current investigation for the prediction of patient prognosis. Many studies focus on promoting newly developed imaging biomarkers without a rigorous comparison to other established parameters. To assess the true value and leverage the potential of all efforts in this field, a multi-parametric evaluation of the available biomarkers for PDAC survival prediction is warranted. Here we present a multiparametric analysis to assess the predictive value of established parameters and the added contribution of newly developed imaging features such as biomarkers for overall PDAC patient survival. Methods: 103 patients with resectable PDAC were retrospectively enrolled. Clinical and histopathological data (age, sex, chemotherapy regimens, tumor size, lymph node status, grading and resection status), morpho-molecular and genetic data (tumor morphology, molecular subtype, tp53, kras, smad4 and p16 genetics), image-derived features and the combination of all parameters were tested for their prognostic strength based on the concordance index (CI) of multivariate Cox proportional hazards survival modelling after unsupervised machine learning preprocessing. Results: The average CIs of the out-of-sample data were: 0.63 for the clinical and histopathological features, 0.53 for the morpho-molecular and genetic features, 0.65 for the imaging features and 0.65 for the combined model including all parameters. Conclusions: Imaging-derived features represent an independent survival predictor in PDAC and enable the multiparametric, machine learning-assisted modelling of postoperative overall survival with a high performance compared to clinical and morpho-molecular/genetic parameters. We propose that future studies systematically include imaging-derived features to benchmark their additive value when evaluating biomarker-based model performance.
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Affiliation(s)
- Georgios A. Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department of Computing, Faculty of Engineering, Imperial College of Science, Technology and Medicine, London SW7 2BU, UK
| | - Friederike Jungmann
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Fabian K. Lohöfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Felix N. Harder
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Anna Melissa Schlitter
- Institute for Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- German Cancer Consortium, Partner Site Technical University of Munich, D-69120 Heidelberg, Germany
| | - Alexander Muckenhuber
- Institute for Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Katja Steiger
- Institute for Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Rebekka Schirren
- School of Medicine, Surgical Clinic and Policlinic, Technical University of Munich, 81675 Munich, Germany
| | - Helmut Friess
- School of Medicine, Surgical Clinic and Policlinic, Technical University of Munich, 81675 Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Wilko Weichert
- Institute for Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Rickmer F. Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-4140-5627
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23
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Li H, Shi K, Reichert M, Lin K, Tselousov N, Braren R, Fu D, Schmid R, Li J, Menze B. Differential Diagnosis for Pancreatic Cysts in CT Scans Using Densely-Connected Convolutional Networks. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2095-2098. [PMID: 31946314 DOI: 10.1109/embc.2019.8856745] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The lethal nature of pancreatic ductal adenocarcinoma (PDAC) calls for early differential diagnosis of pancreatic cysts, which are identified in up to 16% of normal subjects, and some of them may develop into PDAC. Pancreatic cysts have a large variation in size and shape, and the precise segmentation of them remains rather challenging, which restricts the computer-aided interpretation of CT images acquired for differential diagnosis. We propose a computer-aided framework for early differential diagnosis of pancreatic cysts without pre-segmenting the lesions using densely-connected convolutional networks (Dense-Net). The Dense-Net learns high-level features from whole abnormal pancreas and builds mappings between medical imaging appearance to different pathological types of pancreatic cysts. To enhance the clinical applicability, we integrate saliency maps in the framework to assist the physicians to understand the decision of the deep learning method. The test on a cohort of 206 patients with 4 pathologically confirmed subtypes of pancreatic cysts has achieved an overall accuracy of 72.8%, which is significantly higher than the baseline accuracy of 48.1%. The superior performance on this challenging dataset strongly supports the clinical potential of our developed method.
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Kaissis GA, Ziegelmayer S, Lohöfer FK, Harder FN, Jungmann F, Sasse D, Muckenhuber A, Yen HY, Steiger K, Siveke J, Friess H, Schmid R, Weichert W, Makowski MR, Braren RF. Image-Based Molecular Phenotyping of Pancreatic Ductal Adenocarcinoma. J Clin Med 2020; 9:jcm9030724. [PMID: 32155990 PMCID: PMC7141256 DOI: 10.3390/jcm9030724] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 02/17/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
To bridge the translational gap between recent discoveries of distinct molecular phenotypes of pancreatic cancer and tangible improvements in patient outcome, there is an urgent need to develop strategies and tools informing and improving the clinical decision process. Radiomics and machine learning approaches can offer non-invasive whole tumor analytics for clinical imaging data-based classification. The retrospective study assessed baseline computed tomography (CT) from 207 patients with proven pancreatic ductal adenocarcinoma (PDAC). Following expert level manual annotation, Pyradiomics was used for the extraction of 1474 radiomic features. The molecular tumor subtype was defined by immunohistochemical staining for KRT81 and HNF1a as quasi-mesenchymal (QM) vs. non-quasi-mesenchymal (non-QM). A Random Forest machine learning algorithm was developed to predict the molecular subtype from the radiomic features. The algorithm was then applied to an independent cohort of histopathologically unclassifiable tumors with distinct clinical outcomes. The classification algorithm achieved a sensitivity, specificity and ROC-AUC (area under the receiver operating characteristic curve) of 0.84 ± 0.05, 0.92 ± 0.01 and 0.93 ± 0.01, respectively. The median overall survival for predicted QM and non-QM tumors was 16.1 and 20.9 months, respectively, log-rank-test p = 0.02, harzard ratio (HR) 1.59. The application of the algorithm to histopathologically unclassifiable tumors revealed two groups with significantly different survival (8.9 and 39.8 months, log-rank-test p < 0.001, HR 4.33). The machine learning-based analysis of preoperative (CT) imaging allows the prediction of molecular PDAC subtypes highly relevant for patient survival, allowing advanced pre-operative patient stratification for precision medicine applications.
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Affiliation(s)
- Georgios A. Kaissis
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
- Imperial College of Science, Technology and Medicine, Faculty of Engineering, Department of Computing, SW7 2AZ London, UK
| | - Sebastian Ziegelmayer
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Fabian K. Lohöfer
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Felix N. Harder
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Friederike Jungmann
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Daniel Sasse
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Alexander Muckenhuber
- Technical University of Munich, School of Medicine, Institute for Pathology, 81675 Munich, Germany; (A.M.); (H.-Y.Y.); (K.S.); (W.W.)
| | - Hsi-Yu Yen
- Technical University of Munich, School of Medicine, Institute for Pathology, 81675 Munich, Germany; (A.M.); (H.-Y.Y.); (K.S.); (W.W.)
| | - Katja Steiger
- Technical University of Munich, School of Medicine, Institute for Pathology, 81675 Munich, Germany; (A.M.); (H.-Y.Y.); (K.S.); (W.W.)
| | - Jens Siveke
- Institute of Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, parter site Essen, Germany) and German Cancer Research Center, DKFZ, 69120 Heidelberg, Germany
| | - Helmut Friess
- Technical University of Munich, School of Medicine, Surgical Clinic and Policlinic, 81675 Munich, Germany;
| | - Roland Schmid
- Technical University of Munich, School of Medicine, Department of Internal Medicine II, 81675 Munich, Germany;
| | - Wilko Weichert
- Technical University of Munich, School of Medicine, Institute for Pathology, 81675 Munich, Germany; (A.M.); (H.-Y.Y.); (K.S.); (W.W.)
| | - Marcus R. Makowski
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
| | - Rickmer F. Braren
- Technical University of Munich, School of Medicine, Department of Diagnostic and Interventional Radiology, 81675 Munich, Germany; (G.A.K.); (S.Z.); (F.K.L.); (F.N.H.); (F.J.); (D.S.); (M.R.M.)
- Correspondence: ; Tel.: +49-89-4140-5627
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Plaster B, Adamek E, Allgeier B, Anaya J, Back H, Bagdasarova Y, Berguno D, Blatnik M, Boissevain J, Bowles T, Broussard L, Brown MP, Carr R, Clark D, Clayton S, Cude-Woods C, Currie S, Dees E, Ding X, Du S, Filippone B, García A, Geltenbort P, Hasan S, Hawari A, Hickerson K, Hill R, Hino M, Hoagland J, Hoedl S, Hogan G, Hona B, Hong R, Holley A, Ito T, Kawai T, Kirch K, Kitagaki S, Knecht A, Lamoreaux S, Liu CY, Liu J, Makela M, Mammei R, Martin J, Meier N, Melconian D, Mendenhall M, Moore S, Morris C, Mortensen R, Nepal S, Nouri N, Pattie R, Pérez Galván A, Phillips II D, Pichlmaier A, Picker R, Pitt M, Ramsey J, Rios R, Russell R, Sabourov K, Sallaska A, Salvat D, Saunders A, Schmid R, Seestrom S, Servicky C, Sharapov E, Sjue S, Slutsky S, Smith D, Sondheim W, Sun X, Swank C, Swift G, Tatar E, Teasdale W, Terai C, Tipton B, Utsuro M, Vogelaar R, VornDick B, Wang Z, Wehring B, Wexler J, Womack T, Wrede C, Xu Y, Yan H, Young A, Yuan J, Zeck B. Final results for the neutron β-asymmetry parameter A0 from the UCNA experiment. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921904004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The UCNA experiment was designed to measure the neutron β-asymmetry parameter A0 using polarized ultracold neutrons (UCN). UCN produced via downscattering in solid deuterium were polarized via transport through a 7 T magnetic field, and then directed to a 1 T solenoidal electron spectrometer, where the decay electrons were detected in electron detector packages located on the two ends of the spectrometer. A value for A0 was then extracted from the asymmetry in the numbers of counts in the two detector packages. We summarize all of the results from the UCNA experiment, obtained during run periods in 2007, 2008–2009, 2010, and 2011–2013, which ultimately culminated in a 0.67% precision result for A0.
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Huber W, Wiedemann C, Lahmer T, Hoellthaler J, Einwächter H, Treiber M, Schlag C, Schmid R, Heilmaier M. Body surface and body core temperatures and their associations to haemodynamics: The BOSTON-I-study: Validation of a thermodilution catheter (PiCCO) to measure body core temperature and comparison of body surface temperatures to thermodilutionderived Cardiac Index. Math Biosci Eng 2019; 17:1132-1146. [PMID: 32233573 DOI: 10.3934/mbe.2020059] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Assessment of peripheral perfusion and comparison of surface and body core temperature (BST; BCT) are diagnostic cornerstones of critical care. Infrared non-contact thermometers facilitate the accurate measurement of BST. Additionally, a corrected measurement of BST on the forehead provides an estimate of BCT (BCT_Forehead). In clinical routine BCT is measured by ear thermometers (BCT_Ear). The PiCCO-device (PiCCO: Pulse contour analysis) provides thermodilution-derived Cardiac Index (CI_TD) using an arterial catheter with a thermistor tip in the distal aorta. Therefore, the PiCCO-catheter might be used for continuous BCT-measurement (BCT_PiCCO) in addition to intermittent CI-measurement. To the best of our knowledge, BCT_PiCCO has not been validated compared to standard techniques of BCT-measurement including measurement of urinary bladder temperature (BCT_Bladder). Therefore, we compared BCT_PiCCO to BCT_Ear and BCT_Bladder in 52 patients equipped with the PiCCO-device (Pulsion; Germany). Furthermore, this setting allowed to compare different BSTs and their differences to BCT with CI_TD. BCT_PiCCO, BCT_Ear (ThermoScan; Braun), BCT_Bladder (UROSID; ASID BONZ), BCT_Forehead and BSTs (Thermofocus; Tecnimed) were measured four times within 24h. BSTs were determined on the great toe, finger pad and forearm. Immediately afterwards TPTD was performed to obtain CI_TD. 32 (62%) male, 20 (38%) female patients; APACHE-II 23.8 ±8.3. Bland-Altman-analysis demonstrated low bias and percentage error (PE) values for the comparisons of BCT_PiCCO vs. BCT_Bladder (bias 0.05 ±0.27° Celsius; PE = 1.4%), BCT_PiCCO vs. BCT_Ear (bias 0.08 ±0.38° Celsius; PE = 2.0%) and BCT_Ear vs. BCT_Bladder (bias 0.04 ±0.42° Celsius; PE = 2.2). While BCT_PiCCO, BCT_Ear and BCT_Bladder can be considered interchangeable, Bland-Altman-analyses of BCT_Forehead vs. BCT_PiCCO (bias =-0.63 ±0.75° Celsius; PE = 3.9%) Celsisus, BCT_Ear (bias = -0.58 ±0.68° Celsius; PE = 3.6%) and BCT_Bladder (bias = -0.55 ±0.74° Celsius; PE = 3.9%) demonstrate a substantial underestimation of BCT by BCT_Forehead. BSTs and differences between BCT and BST (DCST) significantly correlated with CI_TD with r-values between 0.230 and 0.307 and p-values between 0.002 and p < 0.001. The strongest association with CI_TD was found for BST_forearm (r = 0.307; p < 0.001). In a multivariate analysis regarding CI_TD and including biometric data, BSTs and and their differences to core-temperatures (DCST), only higher temperatures on the forearm and the great toe, young age, low height and male gender were independently associated with CI_TD. The estimate of CI based on this model (CI_estimated) correlated with CI_TD (r = 0.594; p < 0.001). CI_estimated provided large ROC-areas under the curve (AUC) regarding the critical thresholds of CI_TD ≤ 2.5 L/min/m2 (AUC = 0.862) and CI_TD ≥ 5.0 L/min/m2 (AUC = 0.782). 1.) BCT_PiCCO, BCT_Ear and BCT_Bladder are interchangeable. 2.) BCT_Forehead significantly underestimates BCT by about 0.5° Celsius. 3.) All measured BSTs and DCSTs were significantly associated with CI_TD. 4.) CI_estimated is promising, in particular for the prediction of critical thresholds of CI.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Claudia Wiedemann
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Joseph Hoellthaler
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Henrik Einwächter
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Matthias Treiber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Christoph Schlag
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
| | - Markus Heilmaier
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany
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Kaissis G, Ziegelmayer S, Lohöfer F, Algül H, Eiber M, Weichert W, Schmid R, Friess H, Rummeny E, Ankerst D, Siveke J, Braren R. A machine learning model for the prediction of survival and tumor subtype in pancreatic ductal adenocarcinoma from preoperative diffusion-weighted imaging. Eur Radiol Exp 2019; 3:41. [PMID: 31624935 PMCID: PMC6797674 DOI: 10.1186/s41747-019-0119-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 05/16/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background To develop a supervised machine learning (ML) algorithm predicting above- versus below-median overall survival (OS) from diffusion-weighted imaging-derived radiomic features in patients with pancreatic ductal adenocarcinoma (PDAC). Methods One hundred two patients with histopathologically proven PDAC were retrospectively assessed as training cohort, and 30 prospectively accrued and retrospectively enrolled patients served as independent validation cohort (IVC). Tumors were segmented on preoperative apparent diffusion coefficient (ADC) maps, and radiomic features were extracted. A random forest ML algorithm was fit to the training cohort and tested in the IVC. Histopathological subtype of tumor samples was assessed by immunohistochemistry in 21 IVC patients. Individual radiomic feature importance was evaluated by assessment of tree node Gini impurity decrease and recursive feature elimination. Fisher’s exact test, 95% confidence intervals (CI), and receiver operating characteristic area under the curve (ROC-AUC) were used. Results The ML algorithm achieved 87% sensitivity (95% IC 67.3–92.7), 80% specificity (95% CI 74.0–86.7), and ROC-AUC 90% for the prediction of above- versus below-median OS in the IVC. Heterogeneity-related features were highly ranked by the model. Of the 21 patients with determined histopathological subtype, 8/9 patients predicted to experience below-median OS exhibited the quasi-mesenchymal subtype, whilst 11/12 patients predicted to experience above-median OS exhibited a non-quasi-mesenchymal subtype (p < 0.001). Conclusion ML application to ADC radiomics allowed OS prediction with a high diagnostic accuracy in an IVC. The high overlap of clinically relevant histopathological subtypes with model predictions underlines the potential of quantitative imaging in PDAC pre-operative subtyping and prognosis. Electronic supplementary material The online version of this article (10.1186/s41747-019-0119-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Hana Algül
- Department of Internal Medicine II, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Department of Pathology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany
| | - Donna Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Jens Siveke
- West German Cancer Center, University of Essen, Essen, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, DE-81675, Munich, Germany.
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Kaissis G, Ziegelmayer S, Lohöfer F, Steiger K, Algül H, Muckenhuber A, Yen HY, Rummeny E, Friess H, Schmid R, Weichert W, Siveke JT, Braren R. A machine learning algorithm predicts molecular subtypes in pancreatic ductal adenocarcinoma with differential response to gemcitabine-based versus FOLFIRINOX chemotherapy. PLoS One 2019; 14:e0218642. [PMID: 31577805 PMCID: PMC6774515 DOI: 10.1371/journal.pone.0218642] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Development of a supervised machine-learning model capable of predicting clinically relevant molecular subtypes of pancreatic ductal adenocarcinoma (PDAC) from diffusion-weighted-imaging-derived radiomic features. METHODS The retrospective observational study assessed 55 surgical PDAC patients. Molecular subtypes were defined by immunohistochemical staining of KRT81. Tumors were manually segmented and 1606 radiomic features were extracted with PyRadiomics. A gradient-boosted-tree algorithm was trained on 70% of the patients (N = 28) and tested on 30% (N = 17) to predict KRT81+ vs. KRT81- tumor subtypes. A gradient-boosted survival regression model was fit to the disease-free and overall survival data. Chemotherapy response and survival were assessed stratified by subtype and radiomic signature. Radiomic feature importance was ranked. RESULTS The mean±STDEV sensitivity, specificity and ROC-AUC were 0.90±0.07, 0.92±0.11, and 0.93±0.07, respectively. The mean±STDEV concordance indices between the disease-free and overall survival predicted by the model based on the radiomic parameters and actual patient survival were 0.76±0.05 and 0.71±0.06, respectively. Patients with a KRT81+ subtype experienced significantly diminished median overall survival compared to KRT81- patients (7.0 vs. 22.6 months, HR 4.03, log-rank-test P = <0.001) and a significantly improved response to gemcitabine-based chemotherapy over FOLFIRINOX (10.14 vs. 3.8 months median overall survival, HR 2.33, P = 0.037) compared to KRT81- patients, who responded significantly better to FOLFIRINOX over gemcitabine-based treatment (30.8 vs. 13.4 months median overall survival, HR 2.41, P = 0.027). Entropy was ranked as the most important radiomic feature. CONCLUSIONS The machine-learning based analysis of radiomic features enables the prediction of subtypes of PDAC, which are highly relevant for disease-free and overall patient survival and response to chemotherapy.
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Affiliation(s)
- Georgios Kaissis
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hana Algül
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Muckenhuber
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hsi-Yu Yen
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wilko Weichert
- Department of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens T. Siveke
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rickmer Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
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Zens P, Bello C, Scherz A, Ochsenbein A, Von Gunten M, Schmid R, Neppl C, Berezowska S. P2.09-19 Effect of Neoadjuvant (Radio)chemotherapy on PD-L1 Expression in Resected Non-Small Cell Lung Cancers. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1668] [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: 10/25/2022]
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Kündig A, Fung C, Scherz A, Ochsenbein A, Herrmann E, Ermis E, Schmid R, Hewer E, Berezowska S. P1.04-05 PD-L1 Expression (SP263) in Lung Cancer and Paired Brain Metastases – A Single Center Study in 211 Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baum P, Visvanathan S, Bossert S, Lang B, Schmid R, Garcet S, Padula S, Bachelez H, Thoma C, Krueger J. LB1140 Treatment with BI 655130, an anti-interleukin-36 receptor antibody, in patients with generalized pustular psoriasis, is associated with the downregulation of biomarkers linked to innate, Th1/Th17, and neutrophilic pathways. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.113] [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: 10/26/2022]
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Baum P, Visvanathan S, Bossert S, Lang B, Schmid R, Garcet S, Padula S, Bachelez H, Thoma C, Krueger J. 388 Treatment with spesolimab, an anti-interleukin-36 receptor antibody, in patients with generalized pustular psoriasis, is associated with the downregulation of biomarkers linked to innate, Th1/17 and neutrophilic pathways. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques. Front Med (Lausanne) 2019; 6:50. [PMID: 30968023 PMCID: PMC6438879 DOI: 10.3389/fmed.2019.00050] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 02/25/2019] [Indexed: 12/13/2022] Open
Abstract
Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Therefore, this review reports on interactions of macro- and micro-circulation as well as on specific regional and micro-circulation. Regarding global micro-circulation the last two decades brought advances in a more systematic approach of clinical examination including capillary refill time, a graded assessment of mottling of the skin and accurate measurement of body surface temperatures. As a kind of link between macro- and microcirculation, a number of biochemical markers can easily be obtained. Among those are central-venous oxygen saturation (ScvO2), plasma lactate and the difference between central-venous and arterial CO2 (cv-a-pCO2-gap). These inexpensive markers have become part of clinical routine and guideline recommendations. While their potential to replace parameters of macro-circulation such as cardiac output (CO) is limited, they facilitate the interpretation of the adequacy of CO and other macro-circulatory markers. Furthermore, they give additional hints on micro-circulatory impairment. In addition, a number of more sophisticated technical approaches to quantify and visualize micro-circulation including video-microscopy, laser flowmetry, near-infrared spectroscopy (NIRS), and partial oxygen pressure measurement have been introduced within the last 20 years. These technologies have been extensively used for scientific purposes. Moreover, they have been successfully used for educational purposes and to visualize micro-circulatory disturbances during sepsis and other causes of shock. Despite several studies demonstrating the association of these techniques and parameters with outcome, their practical application still is limited. However, future improvements in automated and “online” diagnosis will help to make these technologies more applicable in clinical routine. This approach is promising with regard to several studies which demonstrated the potential to guide therapy in different types of shock. Finally several organs have specific patterns of circulation related to their special anatomy (liver) or their auto-regulatory capacities (brain, kidney). Therefore, this review also discusses specific issues of monitoring liver, brain, and kidney circulation and function.
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Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Robert Zanner
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Gerhard Schneider
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Kessel KA, Vogel MME, Kessel C, Bier H, Biedermann T, Friess H, Herschbach P, von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Bassermann F, Schmid R, Schwaiger M, Combs SE. Cancer clinical trials - Survey evaluating patient participation and acceptance in a university-based Comprehensive Cancer Center (CCC). Clin Transl Radiat Oncol 2018; 13:44-49. [PMID: 30345398 PMCID: PMC6192009 DOI: 10.1016/j.ctro.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
>50% of patients are willing to participate in clinical trials, only 18% are currently enrolled. The top reason to participate in trials was to serve medical progress and cancer research. Reasons for refusing were extensive travel time, no therapeutic advantage and too time-consuming. Good information strategies need to be implemented, and doctors need to be aware of running trials. Trial concepts must include patients’ needs, e.g. number of appointments, risk-benefit profile.
Introduction Prospective clinical trials are essential to translate new therapy concepts or rather any scientific development into the medical routine. Besides a sophisticated trial protocol, the success of clinical trials depends on patient recruitment and participation. Patient recruitment remains a challenge and depends on several factors. To get a current picture of the patients’ attitude, we conducted the present survey. Methods We designed a survey with seven questions, which was given to all oncological patients treated within a timeframe of three months between Mai and July 2017. Participation was voluntary and anonymous. The questionnaire mainly inquires patients’ participation in clinical trials in a university-based setting, their attitude towards clinical trials regarding risks and benefits, and their source of information in this context. Results 771 patients (1:1 male/female) participated with a median age of 61 years (range 18–91 years) with a response rate of 71.5%. Of all, 17.8% (137/771) were participating in a clinical trial. The most mentioned reason was to serve medical progress and cancer research. Out of the patients not currently participating in a trial, 79 (12.7%, 79/623) refusers named the following main reasons: extensive travel time to the clinic, no therapeutic advantage, and too time-consuming. Out of the patients not offered to take part in a trial, 265 (51.0%, 265/520) would participate if offered. Of all patients, 8.3% (64/771) used the clinics' homepage as a source of information, of those 79.7% (51/64) were satisfied with its content. To enhance patient recruitment strategies, we asked how patients wish to be informed about possible trials: More than half (52.0%) of the questioned patients preferred an individual medical consultation with their physician. We further analyzed the trial participation depending on age, gender, unit, and tumor entity. We could show a significant influence of age (p < 0.001) but not for gender (p = 0.724). The trial participation was also significantly associated with the treating unit (p < 0.001) and tumor entity (p = 0.001). Conclusion Patients are willing to participate in clinical trials. Better information strategies need to be implemented. Physicians need to be aware of running trials within their department and must counseling counsel patients effectively to improve recruitment. Trial concepts should keep in mind patients’ needs including an adequate number of appointments, positive risk-benefit profiles, and information material.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Carmen Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Henning Bier
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Otorhinolaryngology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Tilo Biedermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Biedersteiner Straße 29, Munich, Germany
| | - Helmut Friess
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Peter Herschbach
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich (TUM), Trogerstraße 26, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Orthopedic Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Bernhard Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marion Kiechle
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gynecology and Obstetrics, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Ulrich Keller
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christian Peschel
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Florian Bassermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Roland Schmid
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gastroentereology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Markus Schwaiger
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Nuclear Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
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Beck S, Darsow U, Chocano P, Schmid R, Lehmann S, Klaghofer R, Spies L, Bischoff-Ferrari HA. 75PREDICTION ACCURACY OF CLINICAL ASSESSMENT FOR CONVERSION TO ALZHEIMER’S DISEASE DEMENTIA IN SUBJECTS WITH SUBJECTIVE AND MILD COGNITIVE IMPAIRMENT: A LONGITUDINAL STUDY. Age Ageing 2018. [DOI: 10.1093/ageing/afy118.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Beck
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich Switzerland
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
| | - U Darsow
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich Switzerland
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
| | - P Chocano
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich
| | - R Schmid
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
| | - S Lehmann
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
| | - R Klaghofer
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - L Spies
- Jung Diagnostics GmbH, Hamburg, Germany
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich Switzerland
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
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Gao JJ, Zhang Y, Gerhard M, Mejias-Luque R, Zhang L, Vieth M, Ma JL, Bajbouj M, Suchanek S, Liu WD, Ulm K, Quante M, Li ZX, Zhou T, Schmid R, Classen M, Li WQ, You WC, Pan KF. Association Between Gut Microbiota and Helicobacter pylori-Related Gastric Lesions in a High-Risk Population of Gastric Cancer. Front Cell Infect Microbiol 2018; 8:202. [PMID: 29971220 PMCID: PMC6018392 DOI: 10.3389/fcimb.2018.00202] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
Eradication of Helicobacter pylori has been found to be effective for gastric cancer prevention, but uncertainties remain about the possible adverse consequences such as the potential microbial dysbiosis. In our study, we investigated the association between gut microbiota and H. pylori-related gastric lesions in 47 subjects by deep sequencing of microbial 16S ribosomal RNA (rRNA) gene in fecal samples. The dominant phyla in fecal samples were Bacteroidetes, Firmicutes, and Proteobacteria with average relative abundances of 54.77, 31.37 and 12.91%, respectively. Microbial diversity analysis showed that observed species and Shannon index were increased in subjects with past or current H. pylori infection compared with negative subjects. As for the differential bacteria, the average relative abundance of Bacteroidetes was found to significantly decrease from H. pylori negative (66.16%) to past infection group (33.01%, p = 0.007), as well as from normal (76.49%) to gastritis (56.04%) and metaplasia subjects (46.83%, p = 0.027). For Firmicutes and Proteobacteria, the average relative abundances showed elevated trends in the past H. pylori infection group (47.11, 20.53%) compared to negative group (23.44, 9.05%, p = 0.068 and 0.246, respectively), and similar increased trends were also found from normal (18.23, 5.05%) to gastritis (35.31, 7.23%, p = 0.016 and 0.294, respectively) or metaplasia subjects (32.33, 20.07%, both p < 0.05). These findings suggest that the alterations of fecal microbiota, especially the dominant phyla of Bacteroidetes, Firmicutes and Proteobacteria, may be involved in the process of H. pylori-related gastric lesion progression and provide hints for future evaluation of microbial changes after H. pylori eradication.
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Affiliation(s)
- Juan-Juan Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Markus Gerhard
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.,German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Raquel Mejias-Luque
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.,German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Lian Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Jun-Ling Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Monther Bajbouj
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Stepan Suchanek
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague, Czechia
| | - Wei-Dong Liu
- Linqu Public Health Bureau, Linqu, Shandong, China
| | - Kurt Ulm
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Michael Quante
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhe-Xuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Roland Schmid
- II. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Wen-Qing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Wei-Cheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kai-Feng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
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Ruess D, Heynen G, Ciecielski K, Birchmeier W, Schmid R, Algül H. PO-201 Mutant KRAS-driven cancers depend on PTPN11/SHP2 phosphatase. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.719] [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: 11/04/2022] Open
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Bender N, Duncan N, Schmid R, Kasprzak J, Olasz-Harken E. 129 Genetic transformation of keratoacanthoma-type cutaneous squamous cell carcinoma following intralesional chemotherapy. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Herner A, Haller B, Mayr U, Rasch S, Offman L, Schmid R, Huber W. Accuracy and precision of ScvO2 measured with the CeVOX-device: A prospective study in patients with a wide variation of ScvO2-values. PLoS One 2018; 13:e0192073. [PMID: 29664900 PMCID: PMC5903646 DOI: 10.1371/journal.pone.0192073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Central-venous oxygen saturation (ScvO2) is a key parameter of hemodynamic monitoring and has been suggested as therapeutic goal for resuscitation. Several devices offer continuous monitoring features. The CeVOX-device (Pulsion Medical Systems) uses a fibre-optic probe inserted through a conventional central-venous catheter (CVC) to obtain continuous ScvO2. OBJECTIVES Since there is a lack of studies validating the CeVOX, we prospectively analyzed data from 24 patients with CeVOX-monitoring. To increase the yield of lower ScvO2-values, 12 patients were equipped with a femoral CVC. METHODS During the 8h study period ScvO2_CeVOX was documented immediately before withdrawal of blood to measure ScvO2 by blood gas analysis (ScvO2_BGA) 6min, 1h, 4h, 5h and 8h after the initial calibration. No further calibrations were performed. RESULTS In patients with jugular CVC (primary endpoint; 60 measurements), bias, lower and upper limits of agreement (LLOA; ULOA) and percentage error (PE) of the estimate of ScvO2 (ScvO2_CeVOX_jug) were acceptable with 0.45%, -13.0%, 13.9% and 16.6%, respectively. As supposed, ScvO2 was lower in the femoral compared to the jugular measurements (69.5±10.7 vs. 79.4±5.8%; p<0.001). While the bias (0.64%) was still acceptable, LLOA (-23.8%), ULOA (25.0%) and PE (34.5%) were substantially higher for femoral assessment of ScvO2 by the CeVOX (ScvO2_CeVOX_fem). Analysis of the entire data-pool with jugular as well as femoral CVCs allowed for a multivariate analysis which demonstrated that the position of the CVC per se was not independently associated with the bias ScvO2_CeVOX-ScvO2_BGA. The amount of the bias |ScvO2_CeVOX-ScvO2_BGA| was independently associated with the amount of the change of ScvO2_CeVOX compared to the initial calibration to ScvO2_BGA_baseline (|ScvO2_CeVOX-ScvO2_BGA_baseline|) as well as with low values of ScvO2_BGA_baseline. Furthermore, increasing time to the initial calibration was associated to the amount of the bias with borderline significance. A statistical model based on |ScvO2_CeVOX-ScvO2_BGA_baseline| and "time to last calibration" derived from an evaluation dataset (80 of 120 datasets, 16 of 24) provided a ROC-AUC of 0.903 to predict an amount of the bias |ScvO2_CeVOX-ScvO2_BGA| ≥5% in an independent validation group (40 datasets of 8 patients). CONCLUSION These findings suggest that the CeVOX device is capable to detect stability or instability of ScvO2_BGA. ScvO2_CeVOX accurately estimates ScvO2_BGA in case of stable values. However, intermittent measurement of ScvO2_BGA and re-calibration should be performed in case of substantial changes in ScvO2_CeVOX compared to baseline. Therefore, continuous measurement of ScvO2 with the CeVOX cannot replace ScvO2_BGA in instable patients. On the other hand, CeVOX might be useful for the monitoring of stable patients as a pre-test tool for more differentiated monitoring in case of changes in ScvO2_CeVOX.
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Affiliation(s)
- Alexander Herner
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Ulrich Mayr
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Sebastian Rasch
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Lea Offman
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roland Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technische Universität München, München, Germany
- * E-mail:
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Kessel K, Kessel C, Vogel M, Bier H, Biedermann T, Friess H, Herschbach P, Von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Schmid R, Schwaiger M, Combs S. OC-0094: Cancer Clinical Trials - survey evaluating patient participation and attitude in an Oncology Center. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30404-3] [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: 10/14/2022]
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Heilmann M, Schmid R, Kirisits C, Berger D, Nesvacil N, Pötter R, Widder J, Schmid M. PV-0252: Image-guided boost brachytherapy for anal canal cancer: tumour and functional outcome. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30562-0] [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: 10/14/2022]
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Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S, Kuhn KA. Informatics and Medicine. Methods Inf Med 2018. [DOI: 10.3414/me9117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: To clarify challenges and research topics for informatics in health and to describe new approaches for interdisciplinary collaboration and education. Methods: Research challenges and possible solutions were elaborated by scientists of two universities using an interdisciplinary approach, in a series of meetings over several months. Results and Conclusion: In order to translate scientific results from bench to bedside and further into an evidence-based and efficient health system, intensive collaboration is needed between experts from medicine, biology, informatics, engineering, public health, as well as social and economic sciences. Research challenges can be attributed to four areas: bioinformatics and systems biology, biomedical engineering and informatics, health informatics and individual healthcare, and public health informatics. In order to bridge existing gaps between different disciplines and cultures, we suggest focusing on interdisciplinary education, taking an integrative approach and starting interdisciplinary practice at early stages of education.* See more detailed authors´ affiliations at the end of the article.
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Schwenzer K, Brinkbäumer K, Schmid R, Szeimies U, Pöpperl G, Hahn K, Dresel S. [F-18]FDG imaging of head and neck tumors: Comparison of hybrid PET, dedicated PET and CT. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1623883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: Aim of the study was to evaluate [F-18] FDG imaging of head and neck tumors using a Hybrid-PET device of the 2nd or 3rd generation. Examinations were compared to dedicated PET and Spiral-CT. Methods: 54 patients suffering from head and neck tumors were examined using dedicated PET and Hybrid-PET after injection of 185-350 MBq [F-18] FDG. Examinations were carried out on the dedicated PET first followed by a scan on the Hybrid-PET. Dedicated PET was acquired in 3D mode, Hybrid-PET was performed in list mode using an axial filter. Reconstruction of data was performed itera-tively on both, dedicated PET and Hybrid-PET. All patients received a CT scan in multislice technique. All finding have been verified by the goldstandard histology or in case of negative histology by follow up. Results: Using dedicated PET the primary or recurrent lesion was correctly diagnosed in 47/48 patients, using Hybrid-PET in 46/ 48 patients and using CT in 25/48 patients. Metastatic disease in cervical lymph nodes was diagnosed in 17/ 18 patients with dedicated PET, in 16/18 patients with Hybrid-PET and in 15/18 with CT. False positive results with regard to lymph node metastasis were seen with one patient for dedicated PET and Hybrid-PET, respectively, and with 18 patients for CT. In a total of 11 patients unknown metastastic lesions were seen with dedicated PET and with Hybrid-PET elsewhere in the body. Additional malignant disease other than the head and neck tumor was found in 4 patients. Conclusion: Using Hybrid-PET for [F-18] FDG imaging reveals a loss of sensitivity and specificity of about 1-5% as compared to dedicated PET in head and neck tumors. [F-18] FDG PET with both, dedicated PET and Hybrid-PET is superior to CT in the diagnosis of primary or recurrent lesions as well as in the assessment of lymph node involvement.
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Pedersen ED, Stenager E, Vadgaard JL, Jensen MB, Schmid R, Meland N, Magnussen G, Frederiksen JL. Adherence to subcutaneous interferon beta-1a treatment using an electronic injection device: a prospective open-label Scandinavian noninterventional study (the ScanSmart study). Patient Prefer Adherence 2018; 12:569-575. [PMID: 29720872 PMCID: PMC5916453 DOI: 10.2147/ppa.s154417] [Citation(s) in RCA: 8] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Disease modifying drugs help control the course of relapsing remitting multiple sclerosis (RRMS); however, good adherence is needed for long-term outcomes. OBJECTIVE To evaluate patient adherence to treatment with subcutaneous interferon beta-1a using RebiSmart® and assess injection-site reactions and treatment satisfaction. METHODS This prospective, single-arm, open-label, noninterventional multicenter Phase IV trial included disease modifying drug-experienced mobile patients with RRMS. Adherence was measured over 12 weeks. Items 13-23, 35, 37, and 38 of the Multiple Sclerosis Treatment Concerns Questionnaire (injection-site reactions and treatment satisfaction) were recorded at 12 weeks. RESULTS Sixty patients were recruited (mean age 43.7 [±SD 7.9] years; 83% female; mean years since multiple sclerosis diagnosis 6.7 [SD 4.5]). Adherence data were obtained in 54 patients only due to technical problems with six devices. Over 12 weeks, 89% (n=48) of patients had ≥90% adherence to treatment. Most patients experienced mild influenza-like symptoms and injection-site reactions, and global side effects were minimal. Most patients (78%) rated the convenience as the most important aspect of the device, and most experienced no or mild pain. CONCLUSION RRMS patients treated with subcutaneous interferon beta-1a, administered with RebiSmart, demonstrated generally good adherence, and the treatment was generally well tolerated.
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Affiliation(s)
- Elena Didenko Pedersen
- Akershus University Hospital, Department of Neurology, Loerenskog, Norway
- Sandvika Nevrosenter, Sandvika, Norway
- Correspondence: Elena Didenko Pedersen, Sandvika Nevrosenter, Sandviksveien 178, N-1337 Sandvika, Norway, Tel +47 924 11 141, Email
| | - Egon Stenager
- MS Clinic of Southern Jutland, Department of Neurology, Hospital of Southern Denmark, Odense, Denmark
- Institute of Regional Research, University of Southern Denmark, Odense, Denmark
| | - JL Vadgaard
- Department of Neurology, Sjællands University Hospital, Roskilde NeuroCenter, Roskilde, Denmark
| | - MB Jensen
- Department of Neurology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - R Schmid
- MS Clinic, Department of Neurology, Vejle Hospital, Vejle, Denmark
| | - N Meland
- Smerud Medical Research, Oslo, Norway
| | - G Magnussen
- Merck Norway, An Affiliate of Merck AB (Merck AB NUF), Oslo, Norway
| | - Jette L Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Science, Glostrup, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Ayvaz M, Wagenpfeil S, Eckel F, Schmid R, Lersch C, Delius SV. Effect of low-molecular-weight heparin on survival in patients with advanced pancreatic adenocarcinoma. Thromb Haemost 2017. [DOI: 10.1160/th07-01-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThis retrospective analysis aimed to identify whether low-molecular- weight heparins (LMWH) might improve survival in patients receiving chemotherapeutic treatment for advanced pancreatic adenocarcinoma.Two hundred forty-three patients who had received chemotherapy for advanced pancreatic adenocarcinoma were identified from a prospectively maintained database. Of these, 30 patients had to be excluded from analysis due to insufficient documentation. Of the remaining 213 patients 94 patients had been treated with LMWH, whereas 119 patients served as controls. Outcome was assessed in relation to overall survival, which was calculated from the date of initiation of chemotherapy to the date of death.There was no significant difference (hazard ratio, 0.8; 95% confidence interval (CI), 0.6 to 1.1; P=0,2) between the two groups in terms of overall survival. The median survival was 7.1 months (95% CI,5.8–8.4 months) in the LMWH group and 5.9 months (95% CI, 5.1–6.7 months) in the non-LMWH group. A positive effect of LMWH was seen in patients with metastatic disease (hazard ratio for LMWH vs. non-LMWH, 0,6; 95% CI, 0,4 to 0,8; P=0,006) in contrast to those without metastatic disease (hazard ratio for LMWH vs. non-LMWH, 1; 95% CI, 0.6 to 1.7; P=0,96).The median survival of patients with metastatic disease was 6,6 months (95% CI, 5–8,2 months) and 3.8 months (95% CI, 2.5–5.1 months) for the LMWH group and the non-LMWH group, respectively. In conclusion, we found for metastatic pancreatic adenocarcinoma a survival advantage for patients receiving LMWH. Nevertheless, our observations need confirmation by prospective randomized studies.
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Ritsema JAS, Herschberg EMA, Borgos SE, Løvmo C, Schmid R, Te Welscher YM, Storm G, van Nostrum CF. Relationship between polarities of antibiotic and polymer matrix on nanoparticle formulations based on aliphatic polyesters. Int J Pharm 2017; 548:730-739. [PMID: 29133206 DOI: 10.1016/j.ijpharm.2017.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 06/12/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022]
Abstract
In the field of nanomedicine, nanoparticles are developed to target antibiotics to sites of bacterial infection thus enabling adequate drug exposure and decrease development of resistant bacteria. In the present study, we investigated the encapsulation of two antibiotics with different polarity into different PEGylated polymeric nanoparticles based on aliphatic polyesters, to obtain a better understanding of critical factors determining encapsulation and release. The nanoparticles were prepared from diblock copolymers comprising of a poly(ethylene glycol) block attached to an aliphatic polyester block of varying polarity: poly(lactic-co-glycolic acid) (mPEG-PLGA), poly(lactic-co-hydroxymethyl glycolic acid) (mPEG-PLHMGA) and poly(lactic-co-benzyloxymethyl glycolic acid) (mPEG-PLBMGA). Hydrophobic bedaquiline and hydrophilic vancomycin were encapsulated via single and double-emulsion solvent evaporation techniques, respectively. Encapsulation, degradation and release studies at physiological simulating conditions were performed. Drug polarity and preparation techniques influenced encapsulation efficiency into polymer nanoparticles, giving almost complete encapsulation of bedaquiline and approx. 30% for vancomycin independent of the polymer type. The nonpolar bedaquiline showed a predominantly diffusion-controlled release independent of polymer composition. However, polar vancomycin was released by a combination of diffusion and polymer degradation, which was significantly affected by polymer composition, the most hydrophilic polymer displaying the fastest release.
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Affiliation(s)
- J A S Ritsema
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - E M A Herschberg
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - S E Borgos
- Department of Biotechnology and Nanomedicine, SINTEF Materials and Chemistry, Trondheim, Norway
| | - C Løvmo
- Department of Biotechnology and Nanomedicine, SINTEF Materials and Chemistry, Trondheim, Norway
| | - R Schmid
- Department of Biotechnology and Nanomedicine, SINTEF Materials and Chemistry, Trondheim, Norway
| | - Y M Te Welscher
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - G Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - C F van Nostrum
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
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Ringelhan M, Geisler F, Schmid R. Die infektiöse Hepatitis: extrahepatische Manifestationen und der Einfluss auf die antirheumatische Therapie. AKTUEL RHEUMATOL 2017. [DOI: 10.1055/s-0043-101522] [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: 10/18/2022]
Abstract
ZusammenfassungRheumatologische Beschwerden bei gleichzeitig vorliegender Infektion mit dem hepatotropen Hepatitis B (HBV) und Hepatitis C Virus (HCV) stellen häufig ein diagnostisches Dilemma dar, da beide Virusinfektionen neben einer Hepatitis, extrahepatische rheumatoide Manifestationen verursachen können. Beispielsweise ist das Auftreten von Arthralgien, einer Arthritis, einer Vaskulitis, als auch einer Sicca-Symptomatik möglich. Diese sprechen zumeist gut auf eine antivirale Therapie an. Als auslösende Pathomechanismen sind sowohl virusspezifische Faktoren, wie Immunkomplexe oder eine Stimulation von B-Zellen, als auch patientenspezifische Faktoren bekannt. Zugleich schließt eine HBV oder HCV Infektion eine zeitgleiche, nicht virusassoziierte rheumatische Erkrankung nicht aus, deren Diagnostik bei unspezifischer Erhöhung von Autoantikörpern im Rahmen einer HBV oder HCV Infektion häufig erschwert ist. Darüber hinaus stellen vor allem auch moderne antirheumatische Therapien im Falle einer chronischen Virushepatitis ein signifikantes Risiko für eine Reaktivierung bis hin zum fulminanten Leberversagen dar. Im Folgenden gehen wir daher auf häufige extrahepatische Manifestationen der Hepatitis B und C ein, welche eine relevante Differenzialdiagnose für die rheumatologische Praxis darstellen. Zudem werden aktuelle Empfehlungen und Risiken der Anwendung antirheumatischer Therapien bei Patienten mit rheumatologischen Erkrankungen und chronischer HBV oder HCV Infektion diskutiert.
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Affiliation(s)
- Marc Ringelhan
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
| | - Fabian Geisler
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
| | - Roland Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München
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Schmid R, Tai A, Ramahi K, Klawikowski S, Li A, Robbins J. A Dosimetric Investigation of Interfractional Organ-at-Risk Movements during Stereotactic Body Radiation Therapy for Liver Malignancies. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2334] [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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Walter B, Schmid R, von Delius S. A Smartphone App for Improvement of Colonoscopy Preparation (ColoprAPP): Development and Feasibility Study. JMIR Mhealth Uhealth 2017; 5:e138. [PMID: 28931498 PMCID: PMC5628282 DOI: 10.2196/mhealth.7703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Optimal bowel preparation is one of the major cornerstones for quality of colonoscopy. But poor bowel preparation still occurs in 10% to 25% of all patients. To optimize patient guidance, we developed a new smartphone app (ColoprAPP) for Android smartphones which guides and accompanies the patient starting 4 days before colonoscopy throughout the whole colonoscopy preparation procedure. Objective The objective of this study was to assess the function of a newly developed smartphone app for supporting colonoscopy preparation. Methods We carried out a prospective feasibility study including 25 patients undergoing outpatient colonoscopy at our hospital. As a control, we retrieved the data of 25 patients undergoing outpatient colonoscopy matching in age, sex, and indication for colonoscopy from our colonoscopy database. Patients were asked to download the smartphone app, ColoprAPP, in addition to being given the regular colonoscopy preparation leaflet. All colonoscopies were performed in the morning after using a split-dose preparation containing a polyethlene glycol–based purgative. The study was designed to test feasibility of the prototype, evaluate grade of bowel cleanliness (Boston bowel preparation scale [BBPS]), and assess patient satisfaction with the app. Results The smartphone app use was feasible in all patients. BBPS count as a marker for grade of bowel preparation was significantly higher in the smartphone app–supported group (mean 8.1 [SD 0.3] vs 7.1 [SD 0.4], P=.02). Left (mean 2.8 [SD 0.1] vs 2.4 [SD 0.11], P=.02) and transverse colon (mean 2.8 [SD 0.07] vs 2.4 [SD 0.11], P<.001) revealed significantly higher BBPS counts in the smartphone app–supported group than in controls. Patient satisfaction with a smartphone app–supported colonoscopy preparation was high with an average numeric rating scale score for usefulness of 8.2 (visual analog scale 1-10). Conclusions A novel developed smartphone app for reinforced education of bowel cleansing was feasible and led to high BBPS scores and patient satisfaction. Trial registration ClinicalTrials.gov NCT02512328; https://clinicaltrials.gov/ct2/show/NCT02512328 (Archived by WebCite at http://www.webcitation.org/6sz3Kk26z)
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Affiliation(s)
- Benjamin Walter
- Universitätsklinik Ulm, Medizinische Klinik I, Universität Ulm, Ulm, Germany
| | - Roland Schmid
- Klinikum rechts der Isar der Technischen Universität München, II. Medizinische Klinik und Poliklinik, Technische Universität München, München, Germany
| | - Stefan von Delius
- Klinikum rechts der Isar der Technischen Universität München, II. Medizinische Klinik und Poliklinik, Technische Universität München, München, Germany
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Walter B, Schmid R, von Delius S. Improving patient information – are the new media already requested? – A questionnaire study at a gastroenterology outpatient clinic. Z Gastroenterol 2017; 55:551-556. [DOI: 10.1055/s-0043-106860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Information provided for patients is an essential factor for communication between patients and health-care professionals. To analyze the most used sources of medical information and requested media for patient information, a questionnaire study was initiated.
Methods A single-center questionnaire study at an outpatient clinic at a tertiary care hospital. Two hundred participating patients, average age 54.4 years (1:1.5 m:f). Results were displayed in total and as count per participant (i. e., how often is a medium mentioned per participant).
Results As a source for general information, printed media are mentioned 112 times (0.56 counts per participant), the Internet 125 (0.62), and television 124 (0.62). As a source for medical information, printed media were mentioned 84 times (0.42) and the Internet 133 (0.67). As the most requested source for additional patient information, printed media were mentioned 105 times (0.53) and medical apps 63 (0.32).
Conclusion A majority of our patients regularly use the Internet for medical information. Paper-print media are still highly requested by patients. New media are more often requested in younger patients but still reach the ages for screening programs and therefore offer big opportunities towards patient-doctor communication. By a good mixture of media provided a higher patient satisfaction and adherence could be ensured by the health-care professionals.
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Affiliation(s)
- Benjamin Walter
- Klinik für Innere Medizin I, Universitätsklinik Ulm, Germany
| | - Roland Schmid
- II. Medizinische Klinik und Poliklinik, MRI der TU München, Germany
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