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Gualandro DM, Puelacher C, Chew MS, Andersson H, Lurati Buse G, Glarner N, Mueller D, Cardozo FAM, Burri K, Mork C, Wussler D, Bolliger D, Osswald S, Caramelli B, Mueller C. Acute heart failure after non-cardiac surgery: incidence, phenotypes, determinants and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Primary acute heart failure (AHF) is an established and common cause of hospitalization. AHF may also develop secondarily, e.g. postoperatively (pAHF). Little is known about pAHF.
Purpose
To assess the incidence, phenotypes, determinants and outcomes of pAHF following non-cardiac surgery.
Methods
We prospectively included 9,164 consecutive patients at high cardiovascular risk undergoing 11,262 non-cardiac surgeries. The incidence, phenotypes, determinants and outcome of pAHF, centrally adjudicated by independent cardiologists, was determined. Logistic regression models identified the risk factors for pAHF. Cox regression analysis compared mortality and AHF readmission within 1 year in patients with and without pAHF. External validation was performed using a prospective cohort multicenter study of 1250 patients.
Results
The incidence of pAHF was 2.5% (95% confidence interval [CI] 2.2–2.8%). pAHF most often occurred on postoperative day 2 (median day 4). About half of pAHF (51%) occurred in patients without known HF (de novo pAHF), and 49% in patients with chronic HF. Preserved left ventricular ejection fraction (LVEF) was the dominant phenotype among de novo pAHF (72%), while reduced LVEF was dominant among pAHF in chronic HF (43%). Age, coronary artery disease, peripheral artery disease, diabetes, urgent/emergent surgery, chronic HF, atrial fibrillation, chronic obstructive pulmonary disease, anemia, and chronic myocardial injury were independent predictors of pAHF. Patients with pAHF had significantly higher all-cause mortality (44% vs. 11%, p<0.001) and AHF readmission (15% vs. 2%, p<0.001) within 1 year than patients without pAHF. pAHF was an independent predictor of all-cause mortality (adjusted hazard ratio [aHR] 1.7 [95% CI 1.3–2.2]; P<0.001) and AHF readmission (aHR 2.7 [95% CI 1.7–4.2]; P<0.001) within 1 year. Findings were confirmed in an external validation cohort of 1250 patients, e.g. incidence of pAHF 2.4% (95% CI, 1.6–3.3%).
Conclusions
pAHF frequent developed following non-cardiac surgery, being de novo in about half of cases, and associated with an unacceptable high mortality. Strategies focusing on early detection and treatment of pAHF seem warranted.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
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Ziswiler T, Luciani M, Vanetta C, Springer A, Diteepeng T, Von Eckardstein A, Mueller D, Barbagallo M, Conen D, Rodondi N, Moschovitis G, Osswald S, Kuehne M, Bonati LH, Beer JH. Trimethylamine N-oxide is associated with impaired cognitive function in patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Since patients with atrial fibrillation (AF) are predisposed to suffer from major adverse cerebrovascular events (MACE), they are more likely to suffer MACE linked sequelae, such as cognitive impairment. We hypothesised that the gut microbiome derivate trimethylamine N-oxide (TMAO) may amplify this pathomechanism given its hypercoagulative, proinflammatory and proatherogenic effects.
Methods
Patients of the Swiss-AF cohort with determined TMAO plasma levels, cognitive scores (n=2'379) and cerebral magnetic resonance imaging (cMRI) (n=1'722) collected at baseline were included. TMAO levels were measured by liquid chromatography-mass spectrometry (HPLC). Overall cognitive performance was evaluated using the Cognitive Construct (CoCo) score reflecting different cognitive functions measured by four validated neuropsychological assessments, namely the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT parts A and B), Semantic Fluency Test (SFT) and Digital Symbol Substitution Test (DSST). The scores were compared with the quartiles of patients' TMAO plasma levels (Q1: 0.6–4, Q2: 4–5.8, Q3: 5.8–9.1, Q4: 9.1–164μmol/l) in linear effect models. All models were adjusted for multiple covariates correlating with this association: For TMAO (overall meat consumption >3 times per week, physical activity, glomerular filtration rate, presence of diabetes mellitus), cognitive function (EQ-5D-5L score, geriatric depression scale, education level) and cerebral affects (white matter lesions volume and total brain volume in cMRI). The relevance of high TMAO plasma levels in different stroke groups in cMRI (i.e., clinically overt, silent, or no stroke) were analysed in a subgroup analysis. The subgroups were additionally adjusted for total brain volume to eliminate the effect of simultaneous decrease of cerebral white matter.
Results
After multivariable adjustment, AF patients in the highest quartile of TMAO levels performed significantly poorer in the global cognitive score (CoCo: estimate −0.11, 95% CI [−0.17, −0.05], p=0.002) compared to patients in the lowest quartile. This was observed also in the MoCA, SFT, DSST, TMT-A and TMT-B.
In the subgroup analysis, an association between the highest TMAO quartile (compared with the lowest quartile) and lower CoCo score was found in the group of patients with overt strokes (−0.18, 95% CI [−0.33, −0.04], p=0.012). Weak evidence of the same association was found in the group of patients with silent strokes (−0.13, 95% CI [−0.25, 0.002], p=0.053) and patients with no strokes (−0.08, 95% CI [−0.16, 0.01], p=0.07).
After adjustment for decreased brain volume, the association remained for silent strokes (−0.14, 95% CI [−0.28, −0.01], p=0.036) indicating the impact of TMAO in this subgroup.
Conclusion
TMAO plasma levels were associated with cognitive impairment in patients with AF. Longitudinal data will clarify dynamics and likely causality between TMAO and cognitive impairment.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation
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VALKOVA K, Huellner M, Mueller D, Luyckx V, Schachtner T, Mueller T. POS-217 DEVELOPMENT OF A PROTOCOL FOR THE DYNAMIC MEASUREMENT OF RENAL FUNCTIONAL RESERVE. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Luciani M, Mueller D, Vanetta C, Diteepeng T, Von Eckardstein A, Aeschbacher S, Rodondi N, Moschovitis G, Reichlin T, Bonati L, Luescher T, Kuehne M, Osswald S, Conen D, Beer J. Trimethylamine-N-oxide (TMAO) is associated with cardiovascular mortality and vascular brain lesions in patients with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Trimethylamine-N-oxide (TMAO) is a well characterized pro-atherogenic metabolite derived from the microbial processing of phosphatidylcholine and carnitine (usually present in red meat) and subsequent hepatic oxydation, which promotes endothelial dysfunction, platelet activation and thrombosis initiation. Its role concerning cerebral and cardiovascular adverse events has been assessed in various patient subpopulations but not for long term in patients with atrial fibrillation.
Methods
Baseline TMAO plasma levels were measured by high-performance liquid chromatography/mass spectrometry in plasmas of 2,379 subjects from our multicentric study. Among them, 1,722 participants at time of recruitment underwent brain MRI. Participants were stratified into TMAO tertiles and Cox PH models, linear mixed effect models or logistic mixed effect models were employed adjusting for several risk factors (age, sex, BMI, active and past smoke habit, cystatin c levels, heart failure, diabetes mellitus, hypertension, coronary artery disease and history of TIA/stroke). Subjects were prospectively followed with a median observation time of 4 years.
Results
Subjects in the highest tertile of TMAO were older (75.4 vs. 70.6 years in low tertile p<0.001) and had significantly more often comorbidities, (26.9% of subjects were diabetic vs. 9.1% in low tertile p<0.001), with higher BMI (28.1 vs 27.0, p<0.001) and worse renal function as assessed by serum cystatin C (1.46 vs 1.07, mg/dl; p<0.001). Heart failure was present in 37.9% participants in the upper compared to 15.8% in the lower tertile. (p<0.001). As shown in Figure 1, Kaplan Meier estimates showed increased cardiovascular mortality with increasing TMAO tertiles (p<0.0001). After adjustment for the abovementioned factors the upper tertile (T3) had an increased hazard ratio (HR) compared to the lowest one (HR 2.36 95% CI 1.56–3.58 p<0.01). Similar trends for global and ischemic stroke occurrences were not found although TMAO levels positively weakly correlated with NIHSS severity (Spearman's coefficient 0.31 p=0.02). Concerning brain MRI findings, TMAO tertiles identified individuals with different prevalence of small non-cortical infarcts (30.5%, 18.1% and 17.4% in high, middle and low tertiles respectively; p<0.001) and when present, larger white matter lesions volumes (5061 mm3, 4158 mm3 and 2970 mm3; p<0.001). After adjustment, the association with small non-cortical infarcts with TMAO levels remained significant in the highest tertile (T3) (OR 1.48 95% CI 1.07–2.05; p=0.02) and a trend towards larger white matter lesions volumes was observed (estimate 1307 95% CI −90–2705; p=0.07).
Conclusions
TMAO represents a robust prognostic independent biomarker identifying multimorbid, high risk patients for cardiovascular mortality and brain damage.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation (SNSF) and Theodor und Ida Herzog-Egli Foundation Figure 1. CV mortality according to TMAOFigure 2. Brain lesions assessment
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Berweck S, Bonikowski M, Kim H, Althaus M, Flatau-Baqué B, Mueller D, Banach MD. Placebo-Controlled Clinical Trial of IncobotulinumtoxinA for Sialorrhea in Children: SIPEXI. Neurology 2021; 97:e1425-e1436. [PMID: 34341153 PMCID: PMC8520391 DOI: 10.1212/wnl.0000000000012573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the efficacy and safety of repeated injections of incobotulinumtoxinA (incoBoNT/A) for treatment of chronic sialorrhea (drooling) associated with neurologic disorders (e.g., cerebral palsy, traumatic brain injury) or intellectual disability in children and adolescents in a prospective phase III study (SIPEXI [Sialorrhea Pediatric Xeomin Investigation]). METHODS The study enrolled 2- to 17-year-old patients with sialorrhea due to neurologic disorders or intellectual disability. Patients received body weight-dependent doses of incoBoNT/A (20-75 U). A main period with 1 injection cycle (placebo-controlled, double-blind, 6- to 17-year-olds) was followed by an open-label extension with up to 3 further cycles. An additional cohort of 2- to 5-year-olds received active treatment throughout the study. Coprimary endpoints were the change in unstimulated salivary flow rate (uSFR) from baseline to week 4 and the carers' Global Impression of Change Scale (GICS) rating at week 4. Adverse events were recorded. RESULTS In the main period, 220 patients aged 6-17 years were randomized and treated (148 patients in incoBoNT/A group, 72 patients in placebo group). A total of 35 patients aged 2-5 years received incoBoNT/A (no placebo). A total of 214 patients aged 6-17 years and 33 patients aged 2-5 years continued treatment in the open-label extension period. For the 6- to 17-year-olds, a significant difference between incoBoNT/A and placebo was seen in mean uSFR decrease (difference -0.06 g/min; p = 0.0012) and the carers' GICS rating (difference 0.28 points; p = 0.032) at week 4, in favor of active treatment. The secondary endpoints consistently supported these results. A sustained benefit was observed during the extension. Incidences of adverse events were comparable between incoBoNT/A and placebo and did not increase notably with repeated injections. The most common adverse events were respiratory infections. Efficacy and safety were also favorable in the uncontrolled cohort of 2- to 5-year-olds. DISCUSSION Both co-primary efficacy endpoints were reached and superiority of incoBoNT/A over placebo was confirmed. IncoBoNT/A (up to 75 U, up to 4 cycles) is an effective and well-tolerated treatment for sialorrhea associated with neurologic disorders in children. TRIAL REGISTRATION INFORMATION Clinicaltrials.gov: NCT02270736 (clinicaltrials.gov/ct2/show/results/NCT02270736); EU Clinical Trials Register: 2013-004532-30 (clinicaltrialsregister.eu/ctr-search/search?query=2013-004532-30). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that injection of incobotulinumtoxinA decreases drooling in children aged 6 to 17 years with neurologic disorders.
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Abdulkarim M, Grema HM, Adamu IH, Mueller D, Schulz M, Ulbrich M, Miocic JM, Preusser F. Effect of Using Different Chemical Dispersing Agents in Grain Size Analyses of Fluvial Sediments via Laser Diffraction Spectrometry. Methods Protoc 2021; 4:mps4030044. [PMID: 34209527 PMCID: PMC8293417 DOI: 10.3390/mps4030044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Laser diffraction spectrometry allows for efficiently obtaining high-resolution grain size data. However, pretreatment and dispersion of aggregates in sediment samples are essential pre-requisites for acquiring accurate results using this method. This study evaluates the effectiveness of five dispersing agents in deflocculating the investigated fluvial sediments and the resulting grain size distribution obtained by laser diffraction spectrometry. We also examine the ability of the different dispersing agents to deflocculate sediment samples treated by thermal combustion. Distilled water presented a low efficiency in deflocculating the samples and yielded a near-zero clay content for samples with an expected clay content. The other chemical dispersants were effective in dispersing aggregates and yielding clay, albeit with different efficiencies. Calgon had the highest dispersing ability, followed closely by sodium tripolyphosphate. The performance of chemical treatment with sodium oxalate approaches that of sodium tripolyphosphate. However, it leads to the formation of precipitates in the samples, obscuring the actual grain size data. Sodium pyrophosphate derived the least amount of deflocculation among the four chemical dispersants. Furthermore, all the chemical dispersants were found to be ineffective in dispersing aggregates in samples treated by thermal combustion.
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Hahn SH, Han H, Woo M, Bak J, Chung J, Jeon Y, Jeong J, Joung M, Juhn J, Kim H, Kim H, Lee M, Shin G, Tak T, Yoon S, Barr J, Eidietis N, Humphreys D, Hyatt A, Penaflor B, Piglowski D, Walker M, Welander A, Boyer M, Erickson K, Mueller D. Advances and challenges in KSTAR plasma control toward long-pulse, high-performance experiments. FUSION ENGINEERING AND DESIGN 2020. [DOI: 10.1016/j.fusengdes.2020.111622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Deibl S, Mueller D, Kirchdorfer K, Stemer G, Hoppel M, Weidmann AE. Self-reported clinical pharmacy service provision in Austria: an analysis of both the community and hospital pharmacy sector-a national study. Int J Clin Pharm 2020; 42:1050-1060. [PMID: 32494989 DOI: 10.1007/s11096-020-01066-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
Background With expansion of more advanced clinical roles for pharmacists we need to be mindful that the extent to which clinical pharmacy services are implemented varies from one country to another. To date no comprehensive assessment of number and types of services provided by either community or hospital pharmacies in Austria exists. Objective To analyse and describe the number and types of clinical pharmacy services provided in both community and hospital pharmacies, as well as the level of clinical pharmacy education of pharmacists across Austria. Setting Austrian community and hospital pharmacies. Method An electronic questionnaire to determine number and types of clinical pharmacy services provided was send to all chief pharmacists at all community (n = 1365) and hospital pharmacies (n = 40) across Austria. Besides current and future services provision, education and training provision were also assessed. Main outcome measure Extent of and attitude towards CPS in Austria. Results Response rates to the surveys were 19.1% (n = 261/1365) in community and 92.5% (n = 37/40) in hospital pharmacies. 59.0% and 89.2% of community and hospital pharmacies, respectively, indicated that the provision of clinical pharmacy services in Austria has increased substantially over the past 10 years. Fifty-one percent of community pharmacies reported to provide a medication review service, while 97.3% of hospitals provide a range of services. Only 18.0% of community pharmacies offer services other than medication review services at dispensing. Binary regressions show that provision of already established medication management is a predictor for the willingness of community pharmacists to extend the range of CPS (p < 0.01), while completed training in the area of clinical pharmacy is not (p > 0.05). More hospital than community pharmacists have postgraduate education in clinical pharmacy (17.4% vs 6.5%). A desire to complete postgraduate education was shown by 28.3% of community and 14.7% of hospital pharmacists. Lack of time, inadequate remuneration, lack of resources and poor relationship between pharmacists and physicians were highlighted as barriers. Conclusion Both community and hospital pharmacists show strong willingness to expand their service provision and will need continued support, such as improved legislative structures, more supportive resources and practice focused training opportunities, to further these services.
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Meyre P, Gugganig R, Aeschbacher S, Leong DP, Blum S, Coslovsky M, Beer JH, Moschovitis G, Mueller D, Rodondi N, Stempfel S, Mueller C, Kuehne M, Conen D, Osswald S. P3782Frailty to predict unplanned hospitalizations, stroke, bleeding and death in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aim
We investigated the prevalence of frailty, and the relationships between frailty and the risk of adverse clinical outcomes in patients with atrial fibrillation (AF).
Methods
Patients with known AF were enrolled in a nation-wide observational cohort study in Switzerland. Information on medical history, medication, lifestyle factors and clinical measurements were obtained. The primary outcome was unplanned hospitalizations, secondary outcomes were all-cause mortality, bleeding and stroke. The frailty index (FI) was measured using a cumulative deficit approach according to previously published criteria. Participants were divided into three groups (non-frail, pre-frail and frail) according to their FI at study entry. The association between frailty and clinical outcomes was assessed using multivariable adjusted Cox proportional hazard models.
Results
We included 2369 patients with a mean age of 73±8 years (27.3% female). The prevalence of frailty and pre-frailty was 10.6% and 60.7%, respectively. Frailty was associated with unplanned hospitalization (adjusted hazard ratio [HR] 3.59; 95% confidence interval [95% CI], 2.78–4.63; p<0.001), all-cause mortality (adjusted HR 16.72; 95% CI 7.75–36.05; p<0.001), bleeding (adjusted HR 2.46; 95% CI 1.61–3.77; p<0.001), and stroke (adjusted HR 3.29; 95% CI 1.29–8.39; p=0.01) (Figure). Similarly, pre-frailty was significantly associated with unplanned hospitalization (adjusted HR 1.82; 95% CI 1.49–2.22; p<0.001), all-cause mortality (adjusted HR 5.07; 95% CI 2.43–10.59; p<0.001) and bleeding (adjusted HR 1.53; 95% CI 1.11–2.13; p=0.01), but not with stroke.
Cumulative incidence of adverse events
Conclusion
In our cohort, more than two thirds of AF patients were either pre-frail or frail. These patients have a high risk of unplanned hospitalizations and other adverse outcomes, indicating that frailty is a powerful tool to predict adverse clinical outcomes in AF patients.
Acknowledgement/Funding
Swiss National Science Foundation; Foundation for Cardiovascular Research Basel; University of Basel
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Mueller D, Hahn S, Eidietis N, Bak J, Boyer M, Humphreys D, Hyatt A, Jeon Y, Kim H, Walker M. Improved fast vertical control in KSTAR. FUSION ENGINEERING AND DESIGN 2019. [DOI: 10.1016/j.fusengdes.2019.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hawryluk R, Barnes CW, Batha S, Beer M, Bell M, Bell R, Berk H, Bitter M, Bretz N, Budny R, Bush C, Cauffman S, Chang CS, Chang Z, Cheng C, Darrow D, Dendy R, Dorland W, Dudek L, Duong H, Durst R, Efthimion P, Evenson H, Fisch N, Fisher R, Fonck R, Forrest C, Fredrickson E, Fu G, Furth H, Gorelenkov N, Grek B, Grisham L, Hammett G, Heidbrink W, Herrmann H, Herrmann M, Hill K, Hooper B, Hosea J, Houlberg W, Hughes M, Jassby D, Jobes F, Johnson D, Kaita R, Kamperschroer J, Kesner J, Krazilniknov A, Kugel H, Kumar A, LaMarche P, LeBlanc B, Levine J, Levinton F, Lin Z, Machuzak J, Majeski R, Mansfield D, Mazzucato E, Mauel M, McChesney J, McGuire K, McKee G, Meade D, Medley S, Mikkelsen D, Mimov S, Mueller D, Navratil G, Nazikian R, Nevins B, Okabayashi M, Osakabe M, Owens D, Park H, Park W, Paul S, Petrov M, Phillips C, Phillips M, Phillips P, Ramsey A, Redi M, Rewoldt G, Rice B, Rogers J, Roquemore A, Ruskov E, Sabbagh S, Sasao M, Schilling G, Schmidt G, Scott S, Semenov I, Skinner C, Spong D, Strachan J, Strait E, Stratton B, Synakowski E, Takahashi H, Tang W, Taylor G, Goeler SV, Halle AV, White R, Williams M, Wilson J, Wong K, Wurden G, Young K, Zarnstorff M, Zweben S. Review of D-T Results from TFTR. ACTA ACUST UNITED AC 2018. [DOI: 10.13182/fst96-a11963011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Schaik IN, Bril V, van Geloven N, Hartung HP, Lewis RA, Sobue G, Lawo JP, Praus M, Mielke O, Durn BL, Cornblath DR, Merkies ISJ, Sabet A, George K, Roberts L, Carne R, Blum S, Henderson R, Van Damme P, Demeestere J, Larue S, D'Amour C, Bril V, Breiner A, Kunc P, Valis M, Sussova J, Kalous T, Talab R, Bednar M, Toomsoo T, Rubanovits I, Gross-Paju K, Sorro U, Saarela M, Auranen M, Pouget J, Attarian S, Le Masson G, Wielanek-Bachelet A, Desnuelle C, Delmont E, Clavelou P, Aufauvre D, Schmidt J, Zschuentssch J, Sommer C, Kramer D, Hoffmann O, Goerlitz C, Haas J, Chatzopoulos M, Yoon R, Gold R, Berlit P, Jaspert-Grehl A, Liebetanz D, Kutschenko A, Stangel M, Trebst C, Baum P, Bergh F, Klehmet J, Meisel A, Klostermann F, Oechtering J, Lehmann H, Schroeter M, Hagenacker T, Mueller D, Sperfeld A, Bethke F, Drory V, Algom A, Yarnitsky D, Murinson B, Di Muzio A, Ciccocioppo F, Sorbi S, Mata S, Schenone A, Grandis M, Lauria G, Cazzato D, Antonini G, Morino S, Cocito D, Zibetti M, Yokota T, Ohkubo T, Kanda T, Kawai M, Kaida K, Onoue H, Kuwabara S, Mori M, Iijima M, Ohyama K, Baba M, Tomiyama M, Nishiyama K, Akutsu T, Yokoyama K, Kanai K, van Schaik I, Eftimov F, Notermans N, Visser N, Faber C, Hoeijmakers J, Rejdak K, Chyrchel-Paszkiewicz U, Casanovas Pons C, Alberti Aguiló M, Gamez J, Figueras M, Marquez Infante C, Benitez Rivero S, Lunn M, Morrow J, Gosal D, Lavin T, Melamed I, Testori A, Ajroud-Driss S, Menichella D, Simpson E, Chi-Ho Lai E, Dimachkie M, Barohn R, Beydoun S, Johl H, Lange D, Shtilbans A, Muley S, Ladha S, Freimer M, Kissel J, Latov N, Chin R, Ubogu E, Mumfrey S, Rao T, MacDonald P, Sharma K, Gonzalez G, Allen J, Walk D, Hobson-Webb L, Gable K. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2018; 17:35-46. [DOI: 10.1016/s1474-4422(17)30378-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Koenig A, Krug S, Mueller D, Barth PJ, Koenig U, Scharf M, Ellenrieder V, Michl P, Moll R, Homayunfar K, Kann PH, Stroebel P, Gress TM, Rinke A. Clinicopathological hallmarks and biomarkers of colorectal neuroendocrine neoplasms. PLoS One 2017; 12:e0188876. [PMID: 29232390 PMCID: PMC5726657 DOI: 10.1371/journal.pone.0188876] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/14/2017] [Indexed: 12/29/2022] Open
Abstract
Chromogranin A (CgA) is a well-established marker for diagnosis and follow up of patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Recently, it has been shown that plasma levels of CgA correlate with tumor load and predict survival of patients with NEN of the small bowel. It is assumed that this is as well valid for NEN of the colon and rectum, however, this is not supported by data. To evaluate this assumption, we analyzed 62 patients with NEN of the colon and rectum listed in the Marburg GEP-NEN registry for clinicopathological characteristics, expression and plasma levels of CgA. The present study demonstrates that immunohistochemical CgA and synaptophysin are good markers for histological diagnosis in patients with NEN of the colon and rectum. However, plasma CgA is a poor marker to follow-up these patients because only a minority exhibited increased levels which did not increase significantly during tumor progression. In contrast to NEN of the small bowel, there is no correlation of CgA plasma levels with tumor burden or survival. Patients with NEN of the colon and rectum displayed a relatively good prognosis resulting in a median survival of 8.5 years. However, a subset of patients affected by G3 neoplasms, exhibited a poorer prognosis with a median survival of 2.5 years. Taken together, CgA is a valuable marker for immunohistochemical diagnosis, but CgA plasma concentration is not suitable to mirror tumor burden or prognosis in patients with NEN of the colon and rectum.
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Granic M, Suton P, Mueller D, Cvrljevic I, Luksic I. Prognostic factors in head and neck mucoepidermoid carcinoma: experience at a single institution based on 64 consecutive patients over a 28-year period. Int J Oral Maxillofac Surg 2017; 47:283-288. [PMID: 28969884 DOI: 10.1016/j.ijom.2017.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
Abstract
Mucoepidermoid carcinoma (MEC) is the most common malignancy of the salivary glands. The clinical behaviour of MEC is largely unpredictable, ranging from indolent tumour growth to highly aggressive metastatic spread. The objective of this study was to determine the clinicopathological predictors of recurrence and survival in patients with head and neck MEC. The medical records of 64 patients who underwent surgical treatment for head and neck MEC between 1982 and 2010 were reviewed. The main outcome measures were disease-free survival (DFS) and overall survival (OS). Clinicopathological parameters evaluated were age, sex, anatomical subsite, histological grade, tumour stage, tumour size, adjuvant therapy, and nodal and margin status. For the entire cohort, the 5-year DFS was 82.8% and the 5-year OS was 67.2%. Histological grade and tumour subsite were statistically significant predictors of OS. Furthermore, tumour stage and nodal status were statistically significant predictors with respect to OS. Advanced tumour stage, high histological grade, submandibular/sublingual localization, and positive nodal status were independent predictors of the prognosis in patients with head and neck MEC. Further studies into the molecular biology of MEC are needed in order to provide new therapeutic strategies for patients with locally aggressive and highly metastatic carcinomas.
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Murakami M, Arunasalam V, Bell J, Bell M, Bitter M, Blanchard W, Boody F, Boyd D, Bretz N, Bush C, Callen J, Cecchi J, Colchin R, Coonrod J, Davis S, Dimock D, Dylla H, Efthimion P, Emerson L, England A, Eubank H, Fonck R, Fredrickson E, Furth H, Grisham L, von Goeler S, Goldston R, Grek B, Grove D, Hawryluk R, Hendel H, Hill K, Hulse R, Johnson D, Johnson L, Kaita R, Kamperschroer J, Kaye S, Kikuchi M, Kilpatrick S, Kugel H, LaMarche P, Little R, Ma C, Manos D, Mansfield D, McCarthy M, McCann R, McCune D, McGuire K, Meade D, Medley S, Mikkelsen D, Mueller D, Nieschmidt E, Owens D, Pare V, Park H, Prichard B, Ramsey A, Rasmussen D, Roquemore A, Rutherford P, Sauthoff N, Schivell J, Schwob JL, Scott S, Sesnic S, Shimada M, Simpkins J, Sinnis J, Stauffer F, Stratton B, Suckewer S, Tait G, Taylor G, Tenney F, Thomas C, Towner H, Ulrickson M, Wieland R, Williams M, Wong KL, Wouters A, Yamada H, Yoshikawa S, Young K, Zarnstorff M. Confinement Studies In TFTR. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst85-a40115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hawryluk RJ, Mueller D, Hosea J, Barnes CW, Beer M, Bell MG, Bell R, Biglari H, Bitter M, Boivin R, Bretz NL, Budny R, Bush CE, Chen L, Cheng CZ, Cowley S, Dairow DS, Efthimion PC, Fonck RJ, Fredrickson E, Furth HP, Greene G, Grek B, Grisham LR, Hammett G, Heidbrink W, Hill KW, Hoffman D, Hulse RA, Hsuan H, Janos A, Jassby DL, Jobes FC, Johnson DW, Johnson LC, Kamperschroer J, Kesner J, Phillips CK, Kilpatrick SJ, Kugel H, LaMarche PH, LeBlanc B, Manos DM, Mansfield DK, Marmar ES, Mazzucato E, McCarthy MP, Machuzak J, Mauel M, McCune D, McGuire KM, Medley SS, Monticello DR, Mikkelsen D, Nagayama Y, Navratil GA, Nazikian R, Owens DK, Park H, Park W, Paul S, Perkins F, Pitcher S, Rasmussen D, Redi MH, Rewoldt G, Roberts D, Roquemore AL, Sabbagh S, Schilling G, Schivell J, Schmidt GL, Scott SD, Snipes J, Stevens J, Stratton BC, Strachan JD, Stodiek W, Synakowski E, Tang W, Taylor G, Terry J, Timberlake JR, Ulrickson HH, Towner M, von Goeler S, Wieland R, Wilson JR, Wong KL, Woskov P, Yamada M, Young KM, Zamstorff MC, Zweben SJ. Status and Plans for TFTR. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst92-a29907] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Schaerli N, Honegger U, Abaecherli R, Rinderknecht T, Mueller D, Twerenbold R, Pretre G, Wagener M, Puelacher C, Strebel I, Leber R, Osswald S, Zellweger M, Mueller C, Reichlin T. P6373Incremental diagnostic value of high-frequency QRS analysis for the detection of exercise induced myocardial ischemia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reiner M, Mueller D, Gobbato S, Stalder O, Limacher A, Bonetti N, Stivala S, Mean M, Rodondi N, Aujesky D, Luescher T, Camici G, Von Eckardstein A, Beer J. P5320Trimethylamine-N-oxide (TMAO) Predicts Total Mortality, but not Recurrent Venous Thromboembolism in Elderly Patients with Acute Venous Thromboembolism. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hamzic S, Kummer D, Milesi S, Mueller D, Joerger M, Aebi S, Amstutz U, Largiader CR. Novel Genetic Variants in Carboxylesterase 1 Predict Severe Early-Onset Capecitabine-Related Toxicity. Clin Pharmacol Ther 2017; 102:796-804. [DOI: 10.1002/cpt.641] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
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Leuer JA, Xiao BJ, Humphreys DA, Walker ML, Hyatt AW, Jackson GL, Mueller D, Penaflor BG, Piglowski DA, Johnson RD, Welander AS, Yuan QP, Wang HZ, Luo JR. Tokamak Start-Up Modeling and Design for EAST First Plasma Campaign. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst10-a9268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Yang HL, Kwak JG, Oh YK, Park KR, Kim WC, Lee SG, Kim JY, Bae YS, Park YM, Kim HK, Chu Y, Park MK, Kim JS, In SR, Joung SH, Choe WH, Park HK, Hwang YS, Na YS, Park JG, Ahn JW, Park YS, Kwon M, Leuer JA, Eidietis NW, Hyatt AW, Walker M, Gorelov Y, Lohr J, Mueller D, Grisham LR, Sabbagh SA, Watanabe K, Inoue T, Sakamoto K, Oda Y, Kajiwara K, Ellis R, Hosea J, Delpech L, Hoang TT, Litaudon X, Namkung W, Cho MH. Overview of KSTAR Results in Phase-I Operation. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst13-a19130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gerhardt SP, Mastrovito D, Bell MG, Cropper M, Gates DA, Kolemen E, Lawson J, Marsala B, Menard JE, Mueller D, Stevenson T. Implementation of βN Control in the National Spherical Torus Experiment. FUSION SCIENCE AND TECHNOLOGY 2017. [DOI: 10.13182/fst12-a13336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mueller D, Kulkarni H, Baum RP, Odparlik A. Rapid Synthesis of 68Ga-labeled macroaggregated human serum albumin (MAA) for routine application in perfusion imaging using PET/CT. Appl Radiat Isot 2017; 122:72-77. [PMID: 28113072 DOI: 10.1016/j.apradiso.2017.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/21/2016] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
99mTc-labeled MAA is commonly used for single photon emission computed tomography SPECT. In contrast, positron emission tomography/CT (PET/CT) delivers images with significantly higher resolution. The generator produced radionuclide 68Ga is widely used for PET/CT imaging agents and 68Ga-labeled MAA represents an attractive alternative to 99mTc-labeled MAA. We report a simple and rapid NaCl based labeling procedure for the labeling of MAA with 68Ga using a commercially available MAA labeling kit for 99mTc. The procedure delivers 68Ga-labeled MAA with a high specific activity and a high labeling efficiency (>99%). The synthesis does not require a final step of separation or the use of organic solvents.
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Alarhayem A, Myers J, Dent D, Liao L, Muir M, Mueller D, Nicholson S, Cestero R, Johnson M, Stewart R, O'Keefe G, Eastridge B. Time is the enemy: Mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg 2016; 212:1101-1105. [DOI: 10.1016/j.amjsurg.2016.08.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
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Hahn SH, Kim Y, Penaflor B, Bak J, Han H, Hong J, Jeon Y, Jeong J, Joung M, Juhn J, Kim J, Kim H, Lee W, Woo M, Eidietis N, Ferron J, Humphreys D, Hyatt A, Johnson R, Piglowski D, Walker M, Welander A, Mueller D, Milne P. Progress and plan of KSTAR plasma control system upgrade. FUSION ENGINEERING AND DESIGN 2016. [DOI: 10.1016/j.fusengdes.2016.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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