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Tsagkas C, Horvath-Huck A, Haas T, Amann M, Todea A, Altermatt A, Müller J, Cagol A, Leimbacher M, Barakovic M, Weigel M, Pezold S, Sprenger T, Kappos L, Bieri O, Granziera C, Cattin P, Parmar K. Fully Automatic Method for Reliable Spinal Cord Compartment Segmentation in Multiple Sclerosis. AJNR Am J Neuroradiol 2023; 44:218-227. [PMID: 36702504 PMCID: PMC9891337 DOI: 10.3174/ajnr.a7756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Fully automatic quantification methods of spinal cord compartments are needed to study pathologic changes of the spinal cord GM and WM in MS in vivo. We propose a novel method for automatic spinal cord compartment segmentation (SCORE) in patients with MS. MATERIALS AND METHODS The cervical spinal cords of 24 patients with MS and 24 sex- and age-matched healthy controls were scanned on a 3T MR imaging system, including an averaged magnetization inversion recovery acquisition sequence. Three experienced raters manually segmented the spinal cord GM and WM, anterior and posterior horns, gray commissure, and MS lesions. Subsequently, manual segmentations were used to train neural segmentation networks of spinal cord compartments with multidimensional gated recurrent units in a 3-fold cross-validation fashion. Total intracranial volumes were quantified using FreeSurfer. RESULTS The intra- and intersession reproducibility of SCORE was high in all spinal cord compartments (eg, mean relative SD of GM and WM: ≤ 3.50% and ≤1.47%, respectively) and was better than manual segmentations (all P < .001). The accuracy of SCORE compared with manual segmentations was excellent, both in healthy controls and in patients with MS (Dice similarity coefficients of GM and WM: ≥ 0.84 and ≥0.92, respectively). Patients with MS had lower total WM areas (P < .05), and total anterior horn areas (P < .01 respectively), as measured with SCORE. CONCLUSIONS We demonstrate a novel, reliable quantification method for spinal cord tissue segmentation in healthy controls and patients with MS and other neurologic disorders affecting the spinal cord. Patients with MS have reduced areas in specific spinal cord tissue compartments, which may be used as MS biomarkers.
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Affiliation(s)
- C Tsagkas
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
| | - A Horvath-Huck
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - T Haas
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
| | - M Amann
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
- Medical Image Analysis Center AG (M.A., A.A.), Basel, Switzerland
| | - A Todea
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Radiology; Department of Neuroradiology (A.T.), Clinic for Radiology & Nuclear Medicine; and Research Center for Clinical Neuroimmunology
| | - A Altermatt
- Medical Image Analysis Center AG (M.A., A.A.), Basel, Switzerland
| | - J Müller
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
| | - A Cagol
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - M Leimbacher
- Medical Faculty (M.L., P.C.), University of Basel, Basel, Switzerland
| | - M Barakovic
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - M Weigel
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - S Pezold
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - T Sprenger
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - L Kappos
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Neuroscience Basel (RC2NB) (L.K.), Departments of Medicine, Clinical Research, and Biomedical Imaging, University Hospital Basel and University of Basel, Basel, Switzerland
| | - O Bieri
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - C Granziera
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - P Cattin
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
- Medical Faculty (M.L., P.C.), University of Basel, Basel, Switzerland
| | - K Parmar
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Reha Rheinfelden (K.P.), Rheinfelden, Switzerland
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2
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Ryu K, Baek H, Skare S, Cho E, Nam I, Kim T, Sprenger T. Clinical Feasibility of Ultrafast Contrast-Enhanced T1-Weighted 3D-EPI for Evaluating Intracranial Enhancing Lesions in Oncology Patients: Comparison with Standard 3D MPRAGE Sequence. AJNR Am J Neuroradiol 2022; 43:195-201. [PMID: 35027347 PMCID: PMC8985684 DOI: 10.3174/ajnr.a7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced 3D T1WI is a preferred sequence for brain tumor imaging despite the long scan time. This study investigated the clinical feasibility of ultrafast contrast-enhanced T1WI by 3D echo-planar imaging compared with a standard contrast-enhanced 3D MPRAGE sequence for evaluating intracranial enhancing lesions in oncology patients. MATERIALS AND METHODS Sixty-one patients in oncology underwent brain MR imaging including both contrast-enhanced T1WI, 3D-EPI and 3D MPRAGE, in a single examination session for evaluating intracranial tumors. Two neuroradiologists evaluated image quality, lesion conspicuity, diagnostic confidence, number and size of the lesions, and contrast-to-noise ratio measurements from the 2 different sequences. RESULTS Ultrafast 3D-EPI T1WI did not reveal significant differences in diagnostic confidence, contrast-to-noise ratiolesion/parenchyma, and the number of enhancing lesions compared with MPRAGE (P > .05). However, ultrafast 3D-EPI T1WI revealed inferior image quality, inferior anatomic delineation and greater susceptibility artifacts with fewer motion artifacts than images obtained with MPRAGE. The mean contrast-to-noise ratioWM/GM and visual conspicuity of the lesion on ultrafast 3D-EPI T1WI were lower than those of MPRAGE (P < .001). CONCLUSIONS Ultrafast 3D-EPI T1WI showed comparable diagnostic performance with sufficient image quality and a 7-fold reduction in scan time for evaluating intracranial enhancing lesions compared with standard MPRAGE, even though it was limited by an inferior image quality and frequent susceptibility artifacts. Therefore, we believe that ultrafast 3D-EPI T1WI may be a viable option in oncology patients prone to movement during imaging studies.
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Affiliation(s)
- K.H. Ryu
- From the Departments of Radiology (K.H.R., H.J.B., E.C., I.C.N.)
| | - H.J. Baek
- From the Departments of Radiology (K.H.R., H.J.B., E.C., I.C.N.),Department of Radiology (H.J.B.), Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S. Skare
- Department of Neuroradiology (S.S.),Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden
| | - E. Cho
- From the Departments of Radiology (K.H.R., H.J.B., E.C., I.C.N.)
| | - I.C. Nam
- From the Departments of Radiology (K.H.R., H.J.B., E.C., I.C.N.)
| | - T.H. Kim
- Internal Medicine (T.H.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - T. Sprenger
- Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden,MR Applied Science Laboratory Europe (T.S.), GE Healthcare, Stockholm, Sweden
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Alghamdi AH, Munday JC, Campagnaro GD, Gurvic D, Svensson F, Okpara CE, Kumar A, Quintana J, Martin Abril ME, Milić P, Watson L, Paape D, Settimo L, Dimitriou A, Wielinska J, Smart G, Anderson LF, Woodley CM, Kelly SPY, Ibrahim HM, Hulpia F, Al-Salabi MI, Eze AA, Sprenger T, Teka IA, Gudin S, Weyand S, Field M, Dardonville C, Tidwell RR, Carrington M, O'Neill P, Boykin DW, Zachariae U, De Koning HP. Positively selected modifications in the pore of TbAQP2 allow pentamidine to enter Trypanosoma brucei. eLife 2020; 9:56416. [PMID: 32762841 PMCID: PMC7473772 DOI: 10.7554/elife.56416] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022] Open
Abstract
Mutations in the Trypanosoma brucei aquaporin AQP2 are associated with resistance to pentamidine and melarsoprol. We show that TbAQP2 but not TbAQP3 was positively selected for increased pore size from a common ancestor aquaporin. We demonstrate that TbAQP2’s unique architecture permits pentamidine permeation through its central pore and show how specific mutations in highly conserved motifs affect drug permeation. Introduction of key TbAQP2 amino acids into TbAQP3 renders the latter permeable to pentamidine. Molecular dynamics demonstrates that permeation by dicationic pentamidine is energetically favourable in TbAQP2, driven by the membrane potential, although aquaporins are normally strictly impermeable for ionic species. We also identify the structural determinants that make pentamidine a permeant although most other diamidine drugs are excluded. Our results have wide-ranging implications for optimising antitrypanosomal drugs and averting cross-resistance. Moreover, these new insights in aquaporin permeation may allow the pharmacological exploitation of other members of this ubiquitous gene family. African sleeping sickness is a potentially deadly illness caused by the parasite Trypanosoma brucei. The disease is treatable, but many of the current treatments are old and are becoming increasingly ineffective. For instance, resistance is growing against pentamidine, a drug used in the early stages in the disease, as well as against melarsoprol, which is deployed when the infection has progressed to the brain. Usually, cases resistant to pentamidine are also resistant to melarsoprol, but it is still unclear why, as the drugs are chemically unrelated. Studies have shown that changes in a water channel called aquaglyceroporin 2 (TbAQP2) contribute to drug resistance in African sleeping sickness; this suggests that it plays a role in allowing drugs to kill the parasite. This molecular ‘drain pipe’ extends through the surface of T. brucei, and should allow only water and a molecule called glycerol in and out of the cell. In particular, the channel should be too narrow to allow pentamidine or melarsoprol to pass through. One possibility is that, in T. brucei, the TbAQP2 channel is abnormally wide compared to other members of its family. Alternatively, pentamidine and melarsoprol may only bind to TbAQP2, and then ‘hitch a ride’ when the protein is taken into the parasite as part of the natural cycle of surface protein replacement. Alghamdi et al. aimed to tease out these hypotheses. Computer models of the structure of the protein were paired with engineered changes in the key areas of the channel to show that, in T. brucei, TbAQP2 provides a much broader gateway into the cell than observed for similar proteins. In addition, genetic analysis showed that this version of TbAQP2 has been actively selected for during the evolution process of T. brucei. This suggests that the parasite somehow benefits from this wider aquaglyceroporin variant. This is a new resistance mechanism, and it is possible that aquaglyceroporins are also larger than expected in other infectious microbes. The work by Alghamdi et al. therefore provides insight into how other germs may become resistant to drugs.
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Affiliation(s)
- Ali H Alghamdi
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Jane C Munday
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | | | - Dominik Gurvic
- Computational Biology Centre for Translational and Interdisciplinary Research, University of Dundee, Dundee, United Kingdom
| | - Fredrik Svensson
- IOTA Pharmaceuticals Ltd, St Johns Innovation Centre, Cambridge, United Kingdom
| | - Chinyere E Okpara
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - Arvind Kumar
- Chemistry Department, Georgia State University, Atlanta, United States
| | - Juan Quintana
- School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | | | - Patrik Milić
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Laura Watson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Daniel Paape
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Luca Settimo
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Anna Dimitriou
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Joanna Wielinska
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Graeme Smart
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Laura F Anderson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | | | - Siu Pui Ying Kelly
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hasan Ms Ibrahim
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Fabian Hulpia
- Laboratory for Medicinal Chemistry, University of Ghent, Ghent, Belgium
| | - Mohammed I Al-Salabi
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Anthonius A Eze
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Teresa Sprenger
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Ibrahim A Teka
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Simon Gudin
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Simone Weyand
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Mark Field
- School of Life Sciences, University of Dundee, Dundee, United Kingdom.,Institute of Parasitology, Biology Centre, Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | | | - Richard R Tidwell
- Department of Pathology and Lab Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Mark Carrington
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Paul O'Neill
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - David W Boykin
- Chemistry Department, Georgia State University, Atlanta, United States
| | - Ulrich Zachariae
- Computational Biology Centre for Translational and Interdisciplinary Research, University of Dundee, Dundee, United Kingdom
| | - Harry P De Koning
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
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Ryu KH, Baek HJ, Skare S, Moon JI, Choi BH, Park SE, Ha JY, Kim TB, Hwang MJ, Sprenger T. Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment. AJNR Am J Neuroradiol 2020; 41:424-429. [PMID: 32029473 DOI: 10.3174/ajnr.a6427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.
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Affiliation(s)
- K H Ryu
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - H J Baek
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea .,Department of Radiology (H.J.B.), Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S Skare
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology (S.S.), Karolinska University Hospital, Stockholm, Sweden
| | - J I Moon
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - B H Choi
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - S E Park
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J Y Ha
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - T B Kim
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - M J Hwang
- MR Applications and Workflow, GE Healthcare (M.J.H.), Seoul, Republic of Korea
| | - T Sprenger
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,MR Applied Science Laboratory Europe (T.S.), GE Healthcare Stockholm, Sweden
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5
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Tsagkas C, Horvath A, Altermatt A, Pezold S, Weigel M, Haas T, Amann M, Kappos L, Sprenger T, Bieri O, Cattin P, Parmar K. Automatic Spinal Cord Gray Matter Quantification: A Novel Approach. AJNR Am J Neuroradiol 2019; 40:1592-1600. [PMID: 31439628 DOI: 10.3174/ajnr.a6157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Currently, accurate and reproducible spinal cord GM segmentation remains challenging and a noninvasive broadly accepted reference standard for spinal cord GM measurements is still a matter of ongoing discussion. Our aim was to assess the reproducibility and accuracy of cervical spinal cord GM and WM cross-sectional area measurements using averaged magnetization inversion recovery acquisitions images and a fully-automatic postprocessing segmentation algorithm. MATERIALS AND METHODS The cervical spinal cord of 24 healthy subjects (14 women; mean age, 40 ± 11 years) was scanned in a test-retest fashion on a 3T MR imaging system. Twelve axial averaged magnetization inversion recovery acquisitions slices were acquired over a 48-mm cord segment. GM and WM were both manually segmented by 2 experienced readers and compared with an automatic variational segmentation algorithm with a shape prior modified for 3D data with a slice similarity prior. Precision and accuracy of the automatic method were evaluated using coefficients of variation and Dice similarity coefficients. RESULTS The mean GM area was 17.20 ± 2.28 mm2 and the mean WM area was 72.71 ± 7.55 mm2 using the automatic method. Reproducibility was high for both methods, while being better for the automatic approach (all mean automatic coefficients of variation, ≤4.77%; all differences, P < .001). The accuracy of the automatic method compared with the manual reference standard was excellent (mean Dice similarity coefficients: 0.86 ± 0.04 for GM and 0.90 ± 0.03 for WM). The automatic approach demonstrated similar coefficients of variation between intra- and intersession reproducibility as well as among all acquired spinal cord slices. CONCLUSIONS Our novel approach including the averaged magnetization inversion recovery acquisitions sequence and a fully-automated postprocessing segmentation algorithm demonstrated an accurate and reproducible spinal cord GM and WM segmentation. This pipeline is promising for both the exploration of longitudinal structural GM changes and application in clinical settings in disorders affecting the spinal cord.
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Affiliation(s)
- C Tsagkas
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
| | - A Horvath
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - A Altermatt
- Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - S Pezold
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - M Weigel
- Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - T Haas
- Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology
| | - M Amann
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Division of Diagnostic and Interventional Neuroradiology (M.A.), Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
| | - L Kappos
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
| | - T Sprenger
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Department of Neurology (T.S.), DKD HELIOS Klinik, Wiesbaden, Germany
| | - O Bieri
- Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - P Cattin
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - K Parmar
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering .,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
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6
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Sprenger T, Yamout B, Comi G, Lebrun-frenay C, Park M, Chinchilla D, Lincoln J, Kappos L, Radue E, Lublin A, Cavalier S, Thangavelu K, Wuerfel J. Investigating the Effect of Teriflunomide on Diffuse Brain Tissue Damage in the Phase 3 TEMSO Study. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.088] [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: 10/27/2022]
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7
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Sprenger T, Beißbarth T, Sauer R, Tschmelitsch J, Fietkau R, Liersch T, Hohenberger W, Staib L, Gaedcke J, Raab HR, Rödel C, Ghadimi M. Long-term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO-94. Br J Surg 2018; 105:1510-1518. [DOI: 10.1002/bjs.10877] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/11/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
Abstract
Background
The influence of postoperative complications on survival in patients with locally advanced rectal cancer undergoing combined modality treatment is debatable. This study evaluated the impact of surgical complications on oncological outcomes in patients with locally advanced rectal cancer treated within the randomized CAO/ARO/AIO-94 (Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society) trial.
Methods
Patients were assigned randomly to either preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) or postoperative CRT between 1995 and 2002. Anastomotic leakage and wound healing disorders were evaluated prospectively, and their associations with overall survival, and distant metastasis and local recurrence rates after a long-term follow-up of more than 10 years were determined. Medical complications (such as cardiopulmonary events) were not analysed in this study.
Results
A total of 799 patients were included in the analysis. Patients who had anterior or intersphincteric resection had better 10-year overall survival than those treated with abdominoperineal resection (63·1 versus 51·3 per cent; P < 0·001). Anastomotic leakage was associated with worse 10-year overall survival (51 versus 65·2 per cent; P = 0·020). Overall survival was reduced in patients with impaired wound healing (45·7 versus 62·2 per cent; P = 0·009). At 10 years after treatment, patients developing any surgical complication (anastomotic leakage and/or wound healing disorder) had impaired overall survival (46·6 versus 63·8 per cent; P < 0·001), a lower distant metastasis-free survival rate (63·2 versus 72·0 per cent; P = 0·030) and more local recurrences (15·5 versus 6·4 per cent; P < 0·001). In a multivariable Cox regression model, lymph node metastases (P < 0·001) and surgical complications (P = 0·008) were the only independent predictors of reduced overall survival.
Conclusion
Surgical complications were associated with adverse oncological outcomes in this trial.
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Affiliation(s)
- T Sprenger
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - T Beißbarth
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - R Sauer
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - J Tschmelitsch
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, St Veit an der Glan, Austria
| | - R Fietkau
- Department of Radiotherapy, University Medical Centre Erlangen, Erlangen, Germany
| | - T Liersch
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - W Hohenberger
- Department of Surgery, University Medical Centre Erlangen, Erlangen, Germany
| | - L Staib
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - J Gaedcke
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
| | - H-R Raab
- University Department of General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Medical Centre Frankfurt, Frankfurt/Main, Germany
| | - M Ghadimi
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, Göttingen, Germany
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Spilker ME, Sprenger T, Hauser AI, Platzer S, Boecker H, Toelle TR, Wester HJ, Henriksen G. Gender dependent rate of metabolism of the opioid receptor-PET ligand [18F]fluoroethyldiprenorphine. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: The morphinane-derivate 6-O-(2-[18F]fluoroethyl)- 6-O-desmethyldiprenorphine ([18F]FDPN) is a nonselective opioid receptor ligand currently used in positron emission tomography (PET). Correction for plasma metabolites of the arterial input function is necessary for quantitative measurements of [18F]FDPN binding. A study was undertaken to investigate if there are gender dependent differences in the rate of metabolism of [18F]FDPN. Methods: The rate of metabolism of [18F]FDPN was mathematically quantified by fitting a bi-exponential function to each individual’s dynamic metabolite data. Results: No statistically significant gender differences were found for age, weight, body mass index or dose. However, significant differences (p <0.01) in two of the four kinetic parameters describing the rate of metabolism were found between the two groups, with women metabolizing [18F]FDPN faster than men. These differences were found in the contribution of the fast and slow kinetic components of the model describing the distribution of radioactive species in plasma, indicating a higher rate of enzyme-dependent degradation of [18F]FDPN in women than in men. Conclusion: The findings reinforce the need for individualized metabolite correction during [18F]FDPN-PET scans and also indicate that in certain cases, grouping according to gender could be performed in order to minimize methodological errors of the input function prior to kinetic analyses.
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9
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Hanssen H, Minghetti A, Magon S, Rossmeissl A, Rasenack M, Papadopoulou A, Klenk C, Faude O, Zahner L, Sprenger T, Donath L. Effects of different endurance exercise modalities on migraine days and cerebrovascular health in episodic migraineurs: A randomized controlled trial. Scand J Med Sci Sports 2018; 28:1103-1112. [PMID: 29161767 DOI: 10.1111/sms.13023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/12/2022]
Abstract
Aerobic exercise training is a promising complementary treatment option in migraine and can reduce migraine days and improve retinal microvascular function. Our aim was to elucidate whether different aerobic exercise programs at high vs moderate intensities distinctly affect migraine days as primary outcome and retinal vessel parameters as a secondary. In this randomized controlled trial, migraine days were recorded by a validated migraine diary in 45 migraineurs of which 36 (female: 28; age: 36 (SD:10)/BMI: 23.1 (5.3) completed the training period (dropout: 20%). Participants were assigned (Strata: age, gender, fitness and migraine symptomatology) to either high intensity interval training (HIT), moderate continuous training (MCT), or a control group (CON). Intervention groups trained twice a week over a 12-week intervention period. Static retinal vessel analysis, central retinal arteriolar (CRAE) and venular (CRVE) diameters, as well as the arteriolar-to-venular diameter ratio (AVR) were obtained for cerebrovascular health assessment. Incremental treadmill testing yielded maximal and submaximal fitness parameters. Overall, moderate migraine day reductions were observed (ηP2 = .12): HIT revealed 89% likely beneficial effects (SMD = 1.05) compared to MCT (SMD = 0.50) and CON (SMD = 0.59). Very large intervention effects on AVR improvement (ηP2 = 0.27), slightly favoring HIT (SMD=-0.43) over CON (SMD=0), were observed. HIT seems more effective for migraine day reduction and improvement of cerebrovascular health compared to MCT. Intermittent exercise programs of higher intensities may need to be considered as an additional treatment option in migraine patients.
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Affiliation(s)
- H Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - A Minghetti
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - S Magon
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - A Rossmeissl
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - M Rasenack
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - A Papadopoulou
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - C Klenk
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - O Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - L Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland.,Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - L Donath
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,German Sport University, Institute of Exercise Training and Computer Science in Sport, Cologne, Germany
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10
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Sprenger T, Ruether KV, Boecker H, Valet M, Berthele A, Pfaffenrath V, Wöller A, Tölle TR. Altered Metabolism in Frontal Brain Circuits in Cluster Headache. Cephalalgia 2016; 27:1033-42. [PMID: 17666083 DOI: 10.1111/j.1468-2982.2007.01386.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neuroimaging studies have explored cerebral activation patterns in patients with cluster headache (CH) during attacks and have revealed activation of multiple brain areas known to belong to the general pain-processing network. However, it is still unclear which changes in brain metabolism are inherent to the shift from the ‘in bout’ to the ‘out of bout’ period. We measured cerebral glucose metabolism in 11 episodic CH patients during the cluster and again during the remission period with 18F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) and compared these data with 11 healthy controls. ‘In bout’ compared with ‘out of bout’ scans were associated with increases of metabolism in the perigenual anterior cingulate cortex (ACC), posterior cingulate cortex, prefrontal cortex, insula, thalamus and temporal cortex. Decreases in metabolism were observed in the cerebellopontine area. Compared with healthy volunteers, hypometabolism in the patient group (‘in bout’ and ‘out of bout’) was found in the perigenual ACC, prefrontal and orbitofrontal cortex. Thus, FDG-PET in CH patients revealed ‘in bout’ activation of brain structures which are involved in descending pain control. Compared with controls, the regional brain metabolism was constitutively decreased in most of these structures, irrespective of the bout. This finding indicates a deficient top-down modulation of antinociceptive circuits in CH patients. We suggest that trigger mechanisms of CH are insufficiently controlled and thus promote the initiation of the bout period and acute attack.
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Affiliation(s)
- T Sprenger
- Department of Neurology, Klinikum rechts der Isaar, Technische Universität München, Munich, Germany.
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11
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Radue EW, Sprenger T, Vollmer T, Giovannoni G, Gold R, Havrdova E, Selmaj K, Stefoski D, You X, Elkins J. Daclizumab high-yield process reduced the evolution of new gadolinium-enhancing lesions to T1 black holes in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2016; 23:412-5. [PMID: 26806217 DOI: 10.1111/ene.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE In the SELECT study, treatment with daclizumab high-yield process (DAC HYP) versus placebo reduced the frequency of gadolinium-enhancing (Gd(+) ) lesions in patients with relapsing-remitting multiple sclerosis (RRMS). The objective of this post hoc analysis of SELECT was to evaluate the effect of DAC HYP on the evolution of new Gd(+) lesions to T1 hypointense lesions (T1 black holes). METHODS SELECT was a randomized double-blind study of subcutaneous DAC HYP 150 or 300 mg or placebo every 4 weeks. Magnetic resonance imaging (MRI) scans were performed at baseline and weeks 24, 36 and 52 in all patients and monthly between weeks 4 and 20 in a subset of patients. MRI scans were evaluated for new Gd(+) lesions that evolved to T1 black holes at week 52. Data for the DAC HYP groups were pooled for analysis. RESULTS Daclizumab high-yield process reduced the number of new Gd(+) lesions present at week 24 (P = 0.005) or between weeks 4 and 20 (P = 0.014) that evolved into T1 black holes at week 52 versus placebo. DAC HYP treatment also reduced the percentage of patients with Gd(+) lesions evolving to T1 black holes versus placebo. CONCLUSIONS Treatment with DAC HYP reduced the evolution of Gd(+) lesions to T1 black holes versus placebo, suggesting that inflammatory lesions that evolved during DAC HYP treatment are less destructive than those evolving during placebo treatment.
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Affiliation(s)
- E-W Radue
- Department of Neurology and Medical Image Analysis Center, MIAC, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of Neurology and Medical Image Analysis Center, MIAC, University Hospital Basel, Basel, Switzerland.,DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - T Vollmer
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - G Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - R Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - E Havrdova
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - K Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - D Stefoski
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - X You
- Biogen, Cambridge, MA, USA
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12
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Sprenger T, Valet M, Hammes M, Erhard P, Berthele A, Conrad B, Tolle TR. Hypothalamic Activation in Trigeminal Autonomic Cephalgia: Functional Imaging of an Atypical Case. Cephalalgia 2016; 24:753-7. [PMID: 15315531 DOI: 10.1111/j.1468-2982.2004.00753.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report headache induced BOLD changes in an atypical case of trigeminal autonomic cephalgia (TAC). A 68-year-old patient was imaged using fMRi during three attacks of a periorbital head-pain with a average duration of 3 min. During the attacks, left sided conjunctival injection, rhinorrhea, lacrimation, facial sweating and hypersalivation were apparent. These attacks were usually partly responsive to oxygen administration but otherwise refractory to any drug. The patient described either attacks with a duration of one minute or less or longer attacks persisting for maximum of 20 min with headaches occurring up to 100 times a day. When considering the symptoms, frequency, duration and therapeutic response of the patient's headache, no clear-cut classification to one of the subtypes of trigeminal autonomic cephalgias (cluster headache, paroxysmal hemicrania, SUNCT) or trigeminal neuralgia was possible. The cerebral activation pattern was similar but not identical to those previously observed in cluster headache and SUNCT with a prominent activation in the hypothalamic grey matter. This case study underlines the conceptual value of the term TAC for the group of headaches focusing around the trigeminal-autonomic reflex. Our results emphasize the importance of the hypothalamus as key region in the pathophysiology of this entity.
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Affiliation(s)
- T Sprenger
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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13
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Sprenger T, Rothe H, Beissbarth T, Conradi LC, Kauffels A, Homayounfar K, Behnes CL, Rödel C, Liersch T, Ghadimi M. [Lymph node metastases in ypT1/2 rectal cancer after neoadjuvant chemoradiotherapy : The Achilles heel of organ-preserving operative procedures?]. Chirurg 2016; 87:593-601. [PMID: 27106241 DOI: 10.1007/s00104-016-0170-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND For patients with rectal cancer and complete remission (ypT0) or with good response and residual tumor restricted only to the bowel wall (ypT1-2) after neoadjuvant chemoradiotherapy (CRT), local excision has been suggested as an alternative to avoid the significant morbidity and functional deficits associated with total mesorectal excision (TME). The aim of this investigation was to investigate the incidence, distribution and tumor-related localization of mesorectal lymph node (LN) metastases in TME specimens with complete remission (ypT0), intramural (ypT1-2) and extramural (ypT3-4) residual tumor tissue. PATIENTS AND METHODS Specimens of TME from 81 patients with locally advanced rectal cancer (UICC II-III) undergoing neoadjuvant CRT within the phase III German rectal cancer trial CAO/ARO/AIO-04 were prospectively evaluated. The entire mesorectal compartment was microscopically screened after complete paraffin embedding. The number and localization of all detectable LN metastases were documented in relation to the primary tumor. RESULTS Whereas 50 patients (62 %) had ypT3-4 rectal cancer after neoadjuvant CRT, 20 patients (25 %) presented with residual tumor within the bowel wall (ypT1-2), 11 patients (14 %) had pathological complete remission (ypT0), an average of 28 ± 13.7 LN were detected per specimen and 25 patients (31 %) had residual LN metastases after CRT. Although the incidence of LN metastases was higher in the ypT3-4 group (40 %), 25 % of patients in the ypT1-2 group with intramural residual tumor had a mean number of 2.2 residual LN metastases of which 55 % were located far from the primary lesion in the proximal mesorectum. None of the patients with ypT0 status (complete response) had residual LN metastases. CONCLUSION Even in patients with good response and post-CRT tumor tissue restricted only to the bowel wall (ypT1-2), there is still a considerable risk for residual LN metastases. Local excision of residual rectal cancer was accompanied by a higher rate of local failure and radical surgery with TME should remain the standard treatment in these patients. To date, valid selection criteria for patients eligible for organ-sparing surgery are still lacking.
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Affiliation(s)
- T Sprenger
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland.
| | - H Rothe
- Medizinisches Versorgungszentrum Göttingen (MVZ), 37081, Göttingen, Deutschland
| | - T Beissbarth
- Institut für Medizinische Statistik, Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland
| | - L-C Conradi
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - A Kauffels
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - K Homayounfar
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - C L Behnes
- Institut für Pathologie, Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland
| | - C Rödel
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, 60590, Frankfurt/Main, Deutschland
| | - T Liersch
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
| | - M Ghadimi
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
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14
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Yaldizli Ö, Penner IK, Yonekawa T, Naegelin Y, Kuhle J, Pardini M, Chard DT, Stippich C, Kira JI, Bendfeldt K, Amann M, Radue EW, Kappos L, Sprenger T. The association between olfactory bulb volume, cognitive dysfunction, physical disability and depression in multiple sclerosis. Eur J Neurol 2015; 23:510-9. [PMID: 26699999 DOI: 10.1111/ene.12891] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/04/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Olfactory bulb atrophy is associated with cognitive dysfunction in Parkinson's and Alzheimer's disease, and with major depression. It has been suggested that olfactory bulb atrophy or dysfunction is therefore a marker of neurodegeneration. Multiple sclerosis (MS) is now also recognized as having a significant neurodegenerative component. Thus, the aim of this study was to investigate associations between physical and cognitive disability, depression and olfactory bulb volume in MS. METHODS In total, 146 patients with MS (mean age 49.0 ± 10.9 years, disease duration 21.2 ± 9.3 years, median Expanded Disability Status Scale (EDSS) score 3.0 (range 0-7.5), 103 relapsing-remitting, 35 secondary progressive and eight primary progressive MS) underwent a standardized neurological examination, comprehensive neuropsychological testing and magnetic resonance imaging (MRI); data of 27 healthy people served as age- and gender-matched control subjects. The olfactory bulb was semi-automatically segmented on high-resolution three-dimensional T1-weighted MRI. RESULTS Mean olfactory bulb volume was lower in MS patients than healthy controls (183.9 ± 40.1 vs. 209.2 ± 59.3 μl; P = 0.018 adjusted to intracranial volume). Olfactory bulb volume was similar across clinical disease subtypes and did not correlate with cognitive performance, EDSS scores or total proton density/T2 white matter lesion volume. However, in progressive MS, the mean olfactory bulb volume correlated with depression scores (Spearman's rho = -0.38, P < 0.05) confirmed using a multivariate linear regression analysis including cognitive fatigue scores. This association was not observed in relapsing-remitting MS. CONCLUSION Olfactory bulb volume was lower in MS than in healthy controls. Olfactory bulb volume does not seem to mirror cognitive impairment in MS; however, it is associated with higher depression scores in progressive MS.
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Affiliation(s)
- Ö Yaldizli
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Institute of Neurology, London, UK
| | - I-K Penner
- Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland
| | - T Yonekawa
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Naegelin
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - J Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - M Pardini
- Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Institute of Neurology, London, UK.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - D T Chard
- Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Institute of Neurology, London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - C Stippich
- Department of Radiology, Division of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - J-I Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Bendfeldt
- Medical Image Analysis Center, Basel, Switzerland
| | - M Amann
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Department of Radiology, Division of Neuroradiology, University Hospital Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland
| | - E-W Radue
- Medical Image Analysis Center, Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
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15
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Constantinescu C, Stefano ND, Kappos L, Radue EW, Sprenger T, Meier DP, Häring D, Tomic D. PARTIAL INDEPENDENCE OF FINGOLIMOD EFFECT ON DIFFUSE VS. FOCAL DAMAGE. J Neurol Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo investigate if the effects of fingolimod 0.5mg on brain volume loss are mediated through effects on focal disease activity (FD) or independent-reduction of diffuse damage (DD).MethodsFREEDOMS and FREEDOMS-II data was pooled and analyzed post-hoc. Assessment of the percent brain volume change (PBVC) at M12 and 24, in patients with no evidence of FD, (absence of new Gd+ T1-lesions and/or new/enlarging T2-lesions) and clinical relapses. Regression analysis of the intent-to-treat (ITT) population to quantified whether the extent of the treatment effect was maintained for patients with new/active lesions and relapsesResultsOf the 1383 patients included, 808 patients (placebo=142; fingolimod=666) showed no FD at M12 and 573 patients (placebo=79; fingolimod=494) at M24 showed no FD. Fingolimod significantly reduced PBVC by 52% and 42% vs. placebo, over 12M and 24M respectively. In the pooled ITT population, fingolimod reduced 49% of PBVC (p<0.001)vs placebo over 24M. This effect was still evident when adjusting for new-active lesions and relapse activity (28% reduction vs placebo, p<0.001). The regression model suggests 57% of fingolimod effect on PBVC is FD-independent. Fingolimod effect on DD is partly independent of its treatment effect on FD, suggesting fingolimod impacts both inflammatory and neurodegenerative components.
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Kappos L, Arnold D, Bar-Or A, Camm J, Derfuss T, Kieseier B, Sprenger T, Greenough K, Ni P, Harada T. MT-1303, a novel selective s1p1 receptor modulator in RRMS - results of a placebo controlled, double blind phase II trial (momentum). J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matsushita T, Madireddy L, Sprenger T, Khankhanian P, Magon S, Naegelin Y, Caverzasi E, Lindberg RLP, Kappos L, Hauser SL, Oksenberg JR, Henry R, Pelletier D, Baranzini SE. Genetic associations with brain cortical thickness in multiple sclerosis. Genes Brain Behav 2015; 14:217-27. [PMID: 25684059 DOI: 10.1111/gbb.12190] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 02/04/2023]
Abstract
Multiple sclerosis (MS) is characterized by temporal and spatial dissemination of demyelinating lesions in the central nervous system. Associated neurodegenerative changes contributing to disability have been recognized even at early disease stages. Recent studies show the importance of gray matter damage for the accrual of clinical disability rather than white matter where demyelination is easily visualized by magnetic resonance imaging (MRI). The susceptibility to MS is influenced by genetic risk, but genetic factors associated with the disability are not known. We used MRI data to determine cortical thickness in 557 MS cases and 75 controls and in another cohort of 219 cases. We identified nine areas showing different thickness between cases and controls (regions of interest, ROI) (eight of them were negatively correlated with Kurtzke's expanded disability status scale, EDSS) and conducted genome-wide association studies (GWAS) in 464 and 211 cases available from the two data sets. No marker exceeded genome-wide significance in the discovery cohort. We next combined nominal statistical evidence of association with physical evidence of interaction from a curated human protein interaction network, and searched for subnetworks enriched with nominally associated genes and for commonalities between the two data sets. This network-based pathway analysis of GWAS detected gene sets involved in glutamate signaling, neural development and an adjustment of intracellular calcium concentration. We report here for the first time gene sets associated with cortical thinning of MS. These genes are potentially correlated with disability of MS.
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Affiliation(s)
- T Matsushita
- Department of Neurology, University of California, San Francisco, CA, USA
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Sormani MP, De Stefano N, Francis G, Sprenger T, Chin P, Radue EW, Kappos L. Fingolimod effect on brain volume loss independently contributes to its effect on disability. Mult Scler 2015; 21:916-24. [DOI: 10.1177/1352458515569099] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/24/2014] [Indexed: 11/17/2022]
Abstract
Background: Brain volume loss occurs in patients with relapsing–remitting MS. Fingolimod reduced brain volume loss in three phase 3 studies. Objective: To evaluate whether the effect of fingolimod on disability progression was mediated by its effects on MRI lesions, relapses or brain volume loss, and the extent of this effect. Methods: Patients (992/1272; 78%) from the FTY720 Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study were analyzed. Month-24 percentage brain volume change, month-12 MRI-active lesions and relapse were assessed. The Prentice criteria were used to test surrogate marker validity. The proportion of treatment effect on disability progression explained by each marker was calculated. Results: Two-year disability progression was associated with active T2 lesions (OR = 1.24; p = 0.001) and more relapses during year 1 (OR = 2.90; p < 0.001) and lower percentage brain volume change over two years (OR = 0.78; p < 0.001). Treatment effect on active T2 lesions, relapses and percentage brain volume change explained 46%, 60% and 23% of the fingolimod effect on disability. Multivariate analysis showed the number of relapses during year 1 (OR = 2.62; p < 0.001) and yearly percentage brain volume change over two years (OR = 0.85; p = 0.009) were independent predictors of disability progression, together explaining 73% of fingolimod effect on disability. Conclusions: The treatment effect on relapses and, to a lesser extent, brain volume loss were both predictors of treatment effect on disability; combining these predictors better explained the effect on disability than either factor alone.
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Affiliation(s)
- MP Sormani
- Biostatistics Unit, University of Genoa, Italy
| | - N De Stefano
- Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - G Francis
- Novartis Pharmaceuticals Corporation, New Jersey, USA
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Switzerland/Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - P Chin
- Novartis Pharmaceuticals Corporation, New Jersey, USA
| | - EW Radue
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital Basel, Switzerland
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Hougaard A, Amin FM, Magon S, Sprenger T, Rostrup E, Ashina M. No abnormalities of intrinsic brain connectivity in the interictal phase of migraine with aura. Eur J Neurol 2015; 22:702-e46. [DOI: 10.1111/ene.12636] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/27/2014] [Indexed: 01/01/2023]
Affiliation(s)
- A. Hougaard
- Danish Headache Center and Department of Neurology; Glostrup Hospital; Faculty of Health and Medical Sciences; University of Copenhagen; Glostrup Denmark
| | - F. M. Amin
- Danish Headache Center and Department of Neurology; Glostrup Hospital; Faculty of Health and Medical Sciences; University of Copenhagen; Glostrup Denmark
| | - S. Magon
- Department of Neurology; University Hospital Basel; Basel Switzerland
| | - T. Sprenger
- Department of Neurology; University Hospital Basel; Basel Switzerland
| | - E. Rostrup
- Functional Imaging Unit and Department of Diagnostics; Glostrup Hospital; Faculty of Health and Medical Sciences; University of Copenhagen; Glostrup Denmark
| | - M. Ashina
- Danish Headache Center and Department of Neurology; Glostrup Hospital; Faculty of Health and Medical Sciences; University of Copenhagen; Glostrup Denmark
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Magon S, May A, Stankewitz A, Goadsby PJ, Tso AR, Ashina M, Amin FM, Seifert CL, Chakravarty M, Müller J, Sprenger T. EHMTI-0079. Reduced volume of anterior thalamic nuclei in migraineurs. J Headache Pain 2014. [PMCID: PMC4181951 DOI: 10.1186/1129-2377-15-s1-f17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Amin FM, Hougaard A, Magon S, Asghar MS, Ahmad NN, Rostrup E, Sprenger T, Ashina M. EHMTI-0393. Abnormal ictal large-scale network connectivity in migraine without aura: a resting-state functional connectivity study. J Headache Pain 2014. [PMCID: PMC4181897 DOI: 10.1186/1129-2377-15-s1-k1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Schankin C, Maniyar F, Seo Y, Kori S, Eller M, Blecha J, Murphy S, Sprenger T, VanBrocklin H, Goadsby P. EHMTI-0125. Studying the permeability of the blood-brain barrier during migraine attacks using [11C]-dihydroergotamine. J Headache Pain 2014. [PMCID: PMC4182228 DOI: 10.1186/1129-2377-15-s1-f22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Hougaard A, Amin FM, Magon S, Sprenger T, Rostrup E, Ashina M. EHMTI-0372. No abnormalities of intrinsic brain connectivity during the interictal phase of migraine with aura. J Headache Pain 2014. [PMCID: PMC4182269 DOI: 10.1186/1129-2377-15-s1-k5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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24
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Magon S, May A, Stankewitz A, Goadsby PJ, Schankin C, Ashina M, Amin FM, Müller J, Seifert CL, Chakravarty M, Sprenger T. EHMTI-0186. Multi-center 3T MRI study of cortical thickness abnormalities in migraine. J Headache Pain 2014. [PMCID: PMC4180363 DOI: 10.1186/1129-2377-15-s1-a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Dimopoulou C, Athanasoulia AP, Hanisch E, Held S, Sprenger T, Toelle TR, Roemmler-Zehrer J, Schopohl J, Stalla GK, Sievers C. Clinical characteristics of pain in patients with pituitary adenomas. Eur J Endocrinol 2014; 171:581-91. [PMID: 25117460 DOI: 10.1530/eje-14-0375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. DESIGN In a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma). METHODS Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). RESULTS We recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n=34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL. CONCLUSIONS Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.
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Affiliation(s)
- C Dimopoulou
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - A P Athanasoulia
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - E Hanisch
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - S Held
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T R Toelle
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Roemmler-Zehrer
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Schopohl
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - G K Stalla
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - C Sievers
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
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Maniyar FH, Sprenger T, Schankin C, Goadsby PJ. Photic hypersensitivity in the premonitory phase of migraine--a positron emission tomography study. Eur J Neurol 2014; 21:1178-83. [PMID: 24780052 DOI: 10.1111/ene.12451] [Citation(s) in RCA: 60] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/18/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Sensitivity to light (photophobia) is a common ill-understood symptom of migraine, whose neurobiology is important in understanding the disorder. METHODS Patients reporting premonitory symptoms before migraine headache were infused with nitroglycerin (GTN) at a first visit. Patients who responded with premonitory symptoms followed by a delayed headache resembling their migraine had positron emission tomography (PET) scans at least 1 week later, during which GTN infusion was repeated. H2 (15) O PET scans were performed during baseline (pain free), premonitory phase (pain free) and migraine headache. Patients were divided into two groups, with and without photophobia in the premonitory phase. The differences between the premonitory and baseline scans were analysed within groups and between groups using statistical parametric mapping. RESULTS Thirteen patients participated in the PET study, 10 of whom had at least one PET scan during the premonitory phase in the absence of pain. Data from these 10 patients were included in the final analysis. Five patients had photophobia and five patients did not have photophobia in the premonitory phase. Comparing the premonitory scans to baseline scans, there was activation of extrastriate visual cortex (BA18) in patients with photophobia. This activation was significantly greater than in the patients without photophobia. CONCLUSION Our findings indicate that photic hypersensitivity is linked to activation of the visual cortex during the premonitory phase of migraine in the absence of headache.
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Affiliation(s)
- F H Maniyar
- Headache Group - Clinical Neurosciences, King's College London, London, UK; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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27
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Homayounfar K, Bleckmann A, Helms HJ, Lordick F, Rüschoff J, Conradi LC, Sprenger T, Ghadimi M, Liersch T. Discrepancies between medical oncologists and surgeons in assessment of resectability and indication for chemotherapy in patients with colorectal liver metastases. Br J Surg 2014; 101:550-7. [PMID: 24756914 DOI: 10.1002/bjs.9436] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multidisciplinary discussion of the treatment of patients with colorectal liver metastases (CRLM) is advocated currently. The aim of this study was to investigate medical oncologists' and surgeons' assessment of resectability and indication for chemotherapy, and the effect of an educational intervention on such assessment. METHODS Medical histories of 30 patients with CRLM were presented to ten experienced medical oncologists and 11 surgeons at an initial virtual tumour board meeting (TB1). Treatment recommendations were obtained from each participant by voting for standardized answers. Following lectures on the potential of chemotherapy and surgery, assessment was repeated at a second virtual tumour board meeting (TB2), using the same patients and participants. RESULTS Overall, 630 answers (21 × 30) were obtained per tumour board meeting. At TB1, resectability was expected more frequently by surgeons. Participants changed 56·8 per cent of their individual answers at TB2. Assessment shifted from potentially resectable to resectable CRLM in 81 of 161 and from unresectable to (potentially) resectable CRLM in 29 of 36 answers. Preoperative chemotherapy was indicated more often by medical oncologists, and overall was included in 260 answers (41·3 per cent) at TB1, compared with only 171 answers (27·1 per cent) at TB2. Medical oncologists more often changed their decision to primary resection in resectable patients (P = 0·006). Postoperative chemotherapy was included in 51·9 and 52·4 per cent of all answers at TB1 and TB2 respectively, with no difference in changes between medical oncologists and surgeons (P = 0·980). CONCLUSION Resectability and indication for preoperative chemotherapy were assessed differently by medical oncologists and surgeons. The educational intervention resulted in more patients deemed resectable by both oncologists and surgeons, and less frequent indication for chemotherapy.
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Affiliation(s)
- K Homayounfar
- Departments of General and Visceral Surgery, Georg-August University, Göttingen, Germany
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Wagner KJ, Schulz CM, Sprenger T, Pieper T, Heuser F, Hohmann CP, Wermke M, Martin J, Drzezga A. Comparing propofol versus sevoflurane anesthesia for epileptogenic focus detection during positron emission tomography in pediatric patients. Minerva Anestesiol 2013; 79:1264-1268. [PMID: 23811627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fluoro-D-deoxyglucose positron emission tomography (FDG-PET) is a standard procedure for interictal assessment and accurate pre-surgical evaluation of presumed epileptogenic zone localization. Profound sedation or general anesthesia is frequently required to reduce movement artefacts in young or cognitively impaired patients during image acquisition. This study compares the impact of propofol and sevoflurane anesthesia on overall quality of PET images, detectability of a hypometabolic lesion and demarcation of the detected lesion in pediatric patients suffering from focal epilepsia. METHODS Pediatric patients with focal epilepsia were anesthesized using propofol (N.=37) or sevoflurane (N.=43). Two independent blinded investigators rated the PET-scans on a 3-point Likert scale with respect to overall quality of PET images, detectability of a hypometabolic lesion and demarcation of the detected lesion. Mann-Whitney-U-Test was conducted to compare the rating results between the two anesthesia regimes. Inter-rater reliability was calculated using Cohen's Kappa. RESULTS Anesthesia was throughout uneventful and there was no clinical evidence for peridiagnostic seizures. Differences in neither single dimension ratings nor in sum scores (mean 5.8 ± SD 1.5 for propofol, and 5.7 ± SD 1.5 for sevoflurane; P=0.567) were statistically significant. Cohen's Kappa was between 0.428 and 0.499. CONCLUSION For surgical planning in patients with epilepsy, FDG-PET imaging is an indispensable functional imaging technique to detect hypometabolism. We conclude that both, sevoflurane and propofol based anesthetic regimes are suitable to detect hypometabolic cerebral lesions during FDG-PET.
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Affiliation(s)
- K J Wagner
- Klinik für Anaesthesiologie, Technische Universität München, Klinikum rechts der Isar, München, Germany -
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Kearney H, Rocca MA, Valsasina P, Balk L, Sastre-Garriga J, Reinhardt J, Ruggieri S, Rovira A, Stippich C, Kappos L, Sprenger T, Tortorella P, Rovaris M, Gasperini C, Montalban X, Geurts JJG, Polman CH, Barkhof F, Filippi M, Altmann DR, Ciccarelli O, Miller DH, Chard DT. Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration. Mult Scler 2013; 20:72-80. [PMID: 23812283 PMCID: PMC4107776 DOI: 10.1177/1352458513492245] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Understanding long-term disability in multiple sclerosis (MS) is a key goal of
research; it is relevant to how we monitor and treat the disease. Objectives: The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the
relationship of brain lesion load, and brain and spinal cord atrophy, with physical
disability in patients with long-established MS. Methods: Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord,
from which we determined brain grey (GMF) and white matter (WMF) fractional volumes,
upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume
(T2LV). We assessed patient disability using the Expanded Disability Status Scale
(EDSS). We analysed associations between EDSS and MRI measures, using two regression
models (dividing cohort by EDSS into two and four sub-groups). Results: In the binary model, UCCA (p < 0.01) and T2LV (p =
0.02) were independently associated with the requirement of a walking aid. In the
four-category model UCCA (p < 0.01), T2LV (p =
0.02) and GMF (p = 0.04) were independently associated with
disability. Conclusions: Long-term physical disability was independently linked with atrophy of the spinal cord
and brain T2 lesion load, and less consistently, with brain grey matter atrophy.
Combinations of spinal cord and brain MRI measures may be required to capture
clinically-relevant information in people with MS of long disease duration.
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Affiliation(s)
- H Kearney
- Institute of Neurology, University College London, UK
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Ricklin ME, Lorscheider J, Waschbisch A, Paroz C, Mehta SK, Pierson DL, Kuhle J, Fischer-Barnicol B, Sprenger T, Lindberg RLP, Kappos L, Derfuss T. T-cell response against varicella-zoster virus in fingolimod-treated MS patients. Neurology 2013; 81:174-81. [DOI: 10.1212/wnl.0b013e31829a3311] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Seifert CL, Mallar Chakravarty M, Sprenger T. The complexities of pain after stroke--a review with a focus on central post-stroke pain. Panminerva Med 2013; 55:1-10. [PMID: 23474660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pain is frequently reported following stroke, but seems to be an underemphasized phenomenon since it can importantly impact rehabilitation and long-term outcomes. Two major forms of pain have to be distinguished in patients with post-stroke pain: central, neuropathic pain, arising from the vascular lesion defined as central post-stroke pain (CPSP) and pain primarily triggered by peripheral mechanisms such as hemiplegic shoulder pain and spasticity-related pain. Headache after stroke is difficult to classify since the pathophysiology is unclear. The suggested underlying mechanisms as well as treatment strategies of post-stroke pain differ according to the origin (peripheral versus central). This article aims at reviewing the pertinent evidence regarding clinical characteristics and mechanisms of post-stroke pain generation with a focus on CPSP. We discuss possible treatment options and highlight current pathophysiological concepts.
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Affiliation(s)
- C L Seifert
- Department of Neurology, Technische Universität München, Munich, Germany
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Weier K, Naegelin Y, Amann M, Magon S, Mueller-Lenke N, Radue EW, Kappos L, Stippich C, Gass A, Sprenger T. Six-year follow-up of a case series with non-communicating syringomyelia in multiple sclerosis. Eur J Neurol 2012; 20:578-583. [PMID: 23252517 DOI: 10.1111/ene.12052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/31/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-communicating syringomyelia (NCS) has occasionally been described in case reports and small case series as an incidental finding of spinal cord (SC) pathology in patients with multiple sclerosis (MS), but only little is known on the clinical course and progression of NCS, and in more general terms on the prognosis of patients with MS and NCS. METHODS Nine patients with MS with known NCS at baseline and a control group of 18 age-, sex- and disease course-matched patients with MS without NCS were recruited for a follow-up visit after 6 years. All 27 patients underwent clinical examination and brain magnetic resonance imaging (MRI), and 8/9 patients with NCS were additionally studied with MRI of the SC. MRI data were analysed for changes in length and maximal cross-sectional area of the NCS, lesion volumes of the brain and cord as well as for volumetric metrics of the whole brain (using SIENAX), the cerebellum and medulla oblongata (using ECCET). RESULTS NCS did not significantly change in size when corrected for multiple comparisons. The clinical data (annual relapse rate, EDSS and disease duration) and MRI metrics (T2 and T1 lesion load; whole brain, cerebellar and medulla oblongata volumes as well as their percentage volume change per year) did not significantly differ between patients with MS with or without NCS. CONCLUSION The stable findings regarding size and shape of the syrinx and lack of distinguishing MRI and clinical features support the assumption that NCS is not defining a prognostically or pathogenetically distinct subgroup of patients with MS.
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Affiliation(s)
- K Weier
- Department of Neurology, University Hospital Basel, Switzerland
| | - Y Naegelin
- Department of Neurology, University Hospital Basel, Switzerland
| | - M Amann
- Department of Neurology, University Hospital Basel, Switzerland.,Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - S Magon
- Department of Neurology, University Hospital Basel, Switzerland
| | - N Mueller-Lenke
- Medical Image Analysis Center (MIAC), University Hospital Basel, Switzerland
| | - E-W Radue
- Medical Image Analysis Center (MIAC), University Hospital Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - C Stippich
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - A Gass
- Department of Neurology, University Hospital Basel, Switzerland.,MR Research Neurology, University Hospital Mannheim, Germany
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Switzerland.,Division of Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
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Rödel F, Sprenger T, Kaina B, Liersch T, Rödel C, Fulda S, Hehlgans S. Survivin as a prognostic/predictive marker and molecular target in cancer therapy. Curr Med Chem 2012; 19:3679-88. [PMID: 22680927 DOI: 10.2174/092986712801661040] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/20/2011] [Accepted: 01/25/2012] [Indexed: 11/22/2022]
Abstract
Evasion from apoptotic cell death is reported to be a pivotal mechanism by which tumor cells acquire resistance to therapeutic treatment. Targeting the apoptotic pathways may constitute a promising strategy to counteract therapy resistance and to re-sensitize cancer cells. Expression of survivin, the smallest and structurally unique member of the inhibitor of apoptosis protein (IAP) family, has been shown to be associated with poor clinical outcome, more aggressive clinicopathologic features and resistance to both, conventional chemo and radiation therapy. Moreover, survivin detection in cancer tissue, in circulating tumor cells and in patient's serum has prognostic and predictive relevance and may display a prerequisite for marker based molecular therapies. Indeed, due to its universal over expression in malignant tissue, and its prominent role at disparate networks of cellular division, intracellular signaling, apoptosis and adaption to unfavorable surroundings, survivin has been shown to be a suitable target for a targeted therapy. The applicability of survivindriven strategies in clinical practice is currently under investigation as the first survivin antagonists (small molecule inhibitors, antisense oligonucleotides and immunotherapy) successfully entered phase I/II trials. Taken together, these data provide a rationale for the implementation of both, survivin as a molecular diagnostic tool and survivin targeted therapies, within future clinical practice.
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Affiliation(s)
- F Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Seifert C, Sprenger T, Mucke T, Forschler A, Poppert H, Hemmer B, Sellner J. Is Systemic Thrombolysis Justified in Patients with Ischemic Stroke and Recent Dental Extraction? (P03.009). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Homayounfar K, Bleckmann A, Conradi LC, Sprenger T, Beissbarth T, Lorf T, Niessner M, Sahlmann CO, Meller J, Becker H, Liersch T, Ghadimi BM. Bilobar spreading of colorectal liver metastases does not significantly affect survival after R0 resection in the era of interdisciplinary multimodal treatment. Int J Colorectal Dis 2012; 27:1359-67. [PMID: 22430890 PMCID: PMC3449057 DOI: 10.1007/s00384-012-1455-1] [Citation(s) in RCA: 15] [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] [Accepted: 03/02/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Bilobar colorectal liver metastases (CRLM) are often considered incurable or associated with poor prognosis even after R0 resection. In this single-center study, we evaluate the impact of CRLM spreading on recurrence-free survival (RFS) and cancer-specific overall survival (CSS) after R0 resection of CRLM with respect to multimodal treatment strategies including perioperative chemotherapy and multistep resections. METHODS Between January 2001 and December 2010, R0 resection could be achieved in 70 patients with bilobar and 100 with unilobar CRLM. Extent of disease, perioperative chemotherapy, surgical procedures, adjuvant treatment, histopathological workup, RFS, and CSS were compared between both cohorts. RESULTS Forty-six (66 %) patients with bilobar and 26 (26 %) patients with unilobar CRLM received preoperative chemotherapy (p < 0.001). For bilobar CRLM, more extended and multistep resection including portal vein occlusion were performed (29 % versus 3 %; p < 0.001). Morbidity (39 % versus 28 %, p = 0.183) and mortality (1 % versus 3 %, p = 0.644) rates were comparable in both patients' cohorts. Postoperative therapy was applied in adjuvant intent to 42 (60 %) versus 51 (51 %) patients (p = 0.275). The 5-year RFS and CSS rates were 24 % versus 31 % (p = 0.169) and 42 % versus 55 % (p = 0.131), respectively. CONCLUSIONS To our single-center experience, there is no significant effect of CRLM spreading (bilobar versus unilobar) on RFS and CSS rates. Bilobar CRLM are more likely to require extended multimodal efforts to achieve R0 resection.
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Affiliation(s)
- K. Homayounfar
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - A. Bleckmann
- Department of Hematology and Oncology, University Medical Center, Georg August University Göttingen, Göttingen, Germany ,Department of Medical Statistics, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - L. C. Conradi
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Sprenger
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Beissbarth
- Department of Medical Statistics, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - T. Lorf
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - M. Niessner
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - C. O. Sahlmann
- Department of Nuclear Medicine, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - J. Meller
- Department of Nuclear Medicine, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - H. Becker
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Liersch
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - B. M. Ghadimi
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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Conradi L, Bleckmann A, Sprenger T, Schirmer M, Homayounfar K, Wolff H, Becker H, Ghadimi B, Beissbarth T, Liersch T. 6126 POSTER Thymidylate Synthase as Biomarker in Rectal Cancer Patients After 5-FU-based Radiochemotherapy – Evaluation of the Prognostic Capacity in Pre-treatment Biopsies and Resected Adenocarcinoma. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71771-3] [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: 11/17/2022]
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Sprenger T, Herrmann KH, Jochimsen T, Reichenbach JR. Vergleich einer TSE-Sequenz mit konventioneller Fettsättigung und einer Multiecho-GRASE-Sequenz mit VARPRO-Fett-Wasser-Trennung. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sprenger T, Rödel F, Beissbarth T, Conradi L, Homayounfar K, Ghadimi BM, Yildrim M, Becker H, Rödel C, Liersch T. Association of survivin expression following neoadjuvant radiochemotherapy in rectal cancer with distant metastases and survival. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
483 Background: Valid molecular markers need to be implemented in clinical trials to fulfill the demand of a risk-adapted and more individualized multimodal therapy of locally advanced primary rectal cancer. In the present study the expression of the inhibitor-of-apoptosis (IAP) protein Survivin was evaluated in pre-treatment biopsies and corresponding post-treatment resection specimens, and was correlated to histo-pathological tumor characteristics and clinical follow-up. Methods: 116 patients with stage II/III rectal cancer treated with 5-FU-based neoadjuvant radiochemotherapy (RCT) within the German Rectal Cancer Trials were investigated. Survivin expression in pre-treatment biopsies and surgical resection specimens were determined by immunohistochemistry by two independent institutions and correlated with histopathologic parameters, tumor recurrences, disease-free and overall cancer-specific survival. Results: In pre-treatment biopsies, a higher Survivin expression correlated with advanced ypT (p=0.026) and ypUICC (p=0.05) stage as well as decreased disease-free survival (p=0.038) after preoperative RCT. High post-treatment Survivin levels were associated with advanced ypT stage (p=0.03) and residual lymph node metastases (p=0.04). Moreover, neoadjuvant RCT resulted in a significant down-regulation of Survivin expression (p < 0.0001). A failure of RCT-induced down-regulation was associated with development of distant metastases (p=0.0056) and cancer-related death (p=0.026), and was significantly correlated with disease-free (p=0.011*/0.02**) and cancer-specific survival (p=0.0017*/0.01**) in uni*- and multivariate** analyses. Conclusions: Survivin expression displays a marker with prognostic validity in rectal cancers. These results underline the usefulness of Survivin to monitor individual response to RCT in rectal cancer, and encourage anti-Survivin strategies in multimodal rectal cancer therapy within future randomised clinical trials. No significant financial relationships to disclose.
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Affiliation(s)
- T. Sprenger
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - F. Rödel
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - T. Beissbarth
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - L. Conradi
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - K. Homayounfar
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - B. M. Ghadimi
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - M. Yildrim
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - H. Becker
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - C. Rödel
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
| | - T. Liersch
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany; Department of Radiotherapy and Oncology, Frankfurt, Germany
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Conradi L, Bleckmann A, Schirmer M, Sprenger T, Homayounfar K, Wolff HA, Becker H, Ghadimi BM, Beissbarth T, Liersch T. Biomarker study in rectal cancer patients after 5FU-based radiochemotherapy: Evaluation of the prognostic capacity of thymidylate synthase in pretreatment biopsies and resected adenocarcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
435 Background: Fluorouracil (5FU) remains the backbone of neoadjuvant radiochemotherapy (RCT) as well as adjuvant therapeutic strategies in multimodal treatment of rectal cancer patients. Due to its central role as the major target of 5FU thymidylate synthase (TS) is a promising biomarker in rectal cancer. We assessed TS in 208 patients with regard to its predictive/prognostic capacity for disease free DFS and overall cancer specific survival (CSS). Methods: 167 patients cUICC stages II (28%) and III (72%) received preoperative 5FU based RCT followed by total mesorectal excision (TME) A comparison group n = 41 received postoperative RCT after primary TME. All patients were treated after standardized protocols within phase-II/-III trials of the German Rectal Cancer Study Group. TS levels from pretreatment biopsies and corresponding resection specimens were assessed by immunohistochemical staining for their impact on DFS and CSS. Additionally, a TS gene polymorphism (28 bp repeat) was analysed in respect to intracellular protein expression levels and prognostic significance. Results: Patients with low TS expression in pre-treatment biopsies showed a correlation with impaired CSS (p = 0.015). After neoadjuvant RCT there was evidence of lymph node metastases ypUICC stage III in 32.6%. Complete histopathologically confirmed tumor regression TRG 4 was achieved in 16 patients (9.5%). During follow-up (median 57 months) patients with low intratumoral TS expression and positive nodal status were at high risk for local and/or distant metastatic recurrence (p = 0.040). Analysis of the 28bp repeat revealed a correlation of *3/*3 genotype with high TS expression in pretherapeutical biopsies (p = 0.05). Conclusions: TS represents a prognostic biomarker in locally advanced rectal cancer indicating an unfavourable outcome for patients with low TS expression and might help to adapt adjuvant therapy regimens by stratifying patients according to their risk for cancer recurrence. No significant financial relationships to disclose.
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Affiliation(s)
- L. Conradi
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - A. Bleckmann
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - M. Schirmer
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - T. Sprenger
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - K. Homayounfar
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - H. A. Wolff
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - H. Becker
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - B. M. Ghadimi
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - T. Beissbarth
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
| | - T. Liersch
- Department of General and Visceral Surgery, University Medical Center, Georg-August University, Göttingen, Germany; Department of Hematology and Oncology, University Medical Center, Göttingen, Germany; Department of Clinical Pharmacology, University Medical Center, Göttingen, Germany; Department of Radiooncology, University Medical Center, Göttingen, Germany; Department of Medical Statistics, University Medical Center, Georg-August-University, Göttingen, GA, Germany
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Rodel F, Reichert S, Sprenger T, S. Gaipl U, Mirsch J, Liersch T, Fulda S, Rodel C. The Role of Survivin for Radiation Oncology: Moving Beyond Apoptosis Inhibition. Curr Med Chem 2011; 18:191-9. [DOI: 10.2174/092986711794088362] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/18/2010] [Indexed: 11/22/2022]
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Sprenger T, Rodel F, Rothe H, Beissbarth T, Conradi L, Ghadimi BM, Becker H, Rödel C, Liersch T. Survivin: A potential predictive and prognostic marker in multimodal rectal cancer therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14115] [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: 11/20/2022] Open
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Wagner KJ, Valet M, Kochs EF, Kriner M, Tölle TR, Sprenger T. The mu-opioid receptor agonist remifentanil induces acute dysphoria irrespective of its analgesic properties. J Psychopharmacol 2010; 24:355-61. [PMID: 18801832 DOI: 10.1177/0269881108095811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mu-opioidergic agonists are believed to induce euphoria, whereas kappa-agonists are thought to lead to dysphoria. Our study investigated mood effects of remifentanil, a mu-receptor opioid agonist, in healthy male volunteers. Moreover, we examined interactions between mood and pain. Three conditions were investigated in 21 volunteers: saline, 0.05 and 0.15 microg kg(-1) min(- 1) remifentanil. Each condition was investigated during non-painful heat and during painful heat stimulation. Mood was measured with the von Zerssen's mood scale (Bf-S score) and pain intensity using a Visual Analogue Scale (VAS). High Bf-S scores are reflecting discontent and dysphoria. Changes were tested for significance using a linear mixed model approach. Remifentanil significantly increased Bf-S scores during painful heat (+91.4%), indicating a negative mood effect, although it reduced VAS scores of painful heat intensity (-49.0%). The type of sensory stimulation (non-painful versus painful) had no effect on mood. There was no interaction between remifentanil dose and type of stimulation. Our results provide evidence for negative mood effects of remifentanil. These effects occur with and without pain. Taken into account that remifentanil reduces pain, one could have expected analgesia-related amelioration of mood instead. In clinical practice, these remifentanil effects should be considered and a comedication might be advisable.
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Affiliation(s)
- K J Wagner
- Klinik für Anaesthesiologie, Technische Universität München, Klinikum rechts der Isar, München, Germany.
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Pfab F, Valet M, Sprenger T, Huss-Marp J, Athanasiadis GI, Baurecht HJ, Konstantinow A, Zimmer C, Behrendt H, Ring J, Tölle TR, Darsow U. Temperature modulated histamine-itch in lesional and nonlesional skin in atopic eczema - a combined psychophysical and neuroimaging study. Allergy 2010; 65:84-94. [PMID: 19804445 DOI: 10.1111/j.1398-9995.2009.02163.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Itch is the major symptom of many allergic diseases; yet it is still difficult to measure objectively. The aim of this study was to use an evaluated itch stimulus model in lesional (LS) and nonlesional (NLS) atopic eczema (AE) skin and to characterize cerebral responses using functional magnetic resonance imaging (fMRI). METHODS Thermal modulation was performed on a histamine stimulus in randomized order on LS or NLS in rapid alternating order from 32 degrees C (warm) to 25 degrees C (cold). Subjective itch ratings were recorded. Additionally, fMRI measurements were used to analyze the cerebral processing (n = 13). Healthy skin (HS) of age-matched volunteers served as control (n = 9). RESULTS Mean VAS itch intensity was significantly (P < 0.0001) higher during the relative cold [55.2 +/- 8.3% (LS); 48.6 +/- 8.2% (NLS)] compared to the relative warm blocks [36.0 +/- 7.3% (LS); 33.7 +/- 7.6% (NLS)]. Compared to HS, the itch response was delayed in LS and NLS. Itch intensity was perceived highest in LS, followed by NLS and HS. For NLS, fMRI revealed at the beginning of the itch provocation a cerebral deactivation pattern in itch processing structures (thalamus, prefrontal, cingulate, insular, somatosensory and motor cortex). During the course of stimulation, the cerebral deactivation was reduced with time and instead an activation of the basal ganglia occurred. In contrast LS showed an activation instead of deactivation pattern already at the beginning of the stimulation in the above mentioned structures. CONCLUSIONS Moderate short-term temperature modulation led to a reproducible, significant enhancement of histamine-induced itch with the strongest effect in LS. The differences in itch perception and itch kinetics between healthy volunteers and NLS in patients point towards an ongoing central inhibitory activity patients with AE, especially at the beginning of the itch provocation.
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Affiliation(s)
- F Pfab
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
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Rosenberg-Nordmann M, Berthele A, Tölle TR, Sprenger T. [Trigeminal autonomic cephalgias. After initial diagnosis, consider secondary causes]. Nervenarzt 2009; 80:1417-1423. [PMID: 19367384 DOI: 10.1007/s00115-009-2711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Trigeminal autonomic cephalgias (TAC) are classified as primary headache syndromes. The use of instrumental procedures including neuroimaging in the diagnostic workup of the TACs is controversially discussed in the literature. Several case reports have been previously published, reporting trigeminal autonomic cephalgias related to structural lesions. We contribute two of our own cases of symptomatic TACs and demonstrate that a "classic" clinical presentation does not preclude a symptomatic etiology. Thus, we advocate a systematic diagnostic evaluation including neuroimaging in every patient presenting with symptoms indicative of TAC for the first time.
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Affiliation(s)
- M Rosenberg-Nordmann
- Neurologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse, Munich, Germany.
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Sprenger T, Liersch T, Rothe H, Schulze F, Homayounfar K, Ghadimi B, Becker H, Langer C. Extramuraler GIST des Magens mit Manifestation durch Spontanruptur und akuter intraabdomineller Blutung mit Hämatoperitoneum. Zentralbl Chir 2009; 135:75-8. [DOI: 10.1055/s-0029-1224606] [Citation(s) in RCA: 5] [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: 10/20/2022]
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Sprenger T, Chakravarty M, Seifert C, Valet M, Foerschler A, Zimmer C, Collins DL, Tölle TR. Läsionsmapping bei Patienten mit Thalamusschmerzen. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238369] [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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Boecker H, Weindl A, Liedtke C, Miederer M, Sprenger T, Wagner K, Miederer I. PET Evidence of GABAergic Dysfunction in Essential Tremor. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dimopoulou C, Sievers C, Sprenger T, Roemmler J, Schopohl J, Stalla GK. Pain characteristics in acromegalic patients compared to patients with non-functioning pituitary adenomas. Exp Clin Endocrinol Diabetes 2008. [DOI: 10.1055/s-0028-1096357] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Valet M, Pfab F, Sprenger T, Zimmer C, Behrendt H, Ring J, Darsow U, Tölle T. Die Untersuchung der Juckreizverarbeitung in Patienten mit atopischer Dermatitis – eine kombinierte psychophysische und funktionelle Bildgebungsstudie. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086736] [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: 10/21/2022]
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Seifert C, Valet M, von Kalckreuth A, Pfaffenrath V, Boecker H, Rüther K, Tölle T, Sprenger T. Neurometabolische Korrelate von Schmerz, Depression und Lebensqualität bei Patienten mit episodischem Cluster-Kopfschmerz. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086592] [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: 10/21/2022]
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