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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. HNO 2024; 72:393-404. [PMID: 38578463 DOI: 10.1007/s00106-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. DER NERVENARZT 2024; 95:342-352. [PMID: 38277047 PMCID: PMC11014872 DOI: 10.1007/s00115-023-01598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Au M, Heddle G, Young E, Ryan E, Graf S, Tee D, Philpott H. Anti-tumour necrosis factor-induced skin rashes in inflammatory bowel disease: a systematic review and evidence-based management algorithm. Intern Med J 2023; 53:1854-1865. [PMID: 35760771 DOI: 10.1111/imj.15859] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor alpha (anti-TNF) agents are a highly effective treatment for inflammatory bowel disease (IBD). Skin lesions, including psoriasiform, eczematous and lupoid eruptions, may paradoxically result from anti-TNF use and cause significant morbidity leading to discontinuation of therapy. There are no consensus guidelines on the management of these lesions. AIMS This systematic review considers the existing evidence regarding cutaneous complications of anti-TNF therapy in IBD and the development of an algorithm for management. METHODS A systematic review was performed by searching Medline (Pubmed) and Embase for articles published from inception to January 2021. The following search terms were used 'anti-tumour necrosis factor alpha', 'infliximab', 'adalimumab', 'certolizumab', 'golimumab', 'inflammatory bowel disease', 'Crohn disease', 'Ulcerative colitis', 'psoriasis', 'psoriasiform', 'dermatitis', 'lupus', 'skin lesion' and 'skin rash'. Reference lists of relevant studies were reviewed to identify additional suitable studies. RESULTS Thirty-four studies were included in the review. Eczema can generally be managed with topical agents and the anti-TNF can be continued, while the development of lupus requires immediate cessation of the anti-TNF and consideration of alternative immunomodulators. Management of psoriasis and psoriasiform lesions may follow a step-wise algorithm where topical treatments will be trialled in less severe cases, with recourse to an alternative anti-TNF or a switch to an alternative class of biological agent. CONCLUSION Assessment of anti-TNF skin lesions should be performed in conjunction with a dermatologist and rheumatologist in complex cases. High-quality prospective studies are needed to clarify the validity of these algorithms in the future.
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Egle M, Graf S, Segiser A, Sanz M, Clavier A, Arnold M, Kadner A, Carrel T, Siepe M, Longnus S. Functional Assessment During Unloaded, Ex-Vivo Perfusion Could Help Predict Recovery in Cardiac Dcd Grafts: Studies in a Porcine Model. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Graf S, Egle M, Sanz M, Segiser A, Arnold M, Kadner A, Siepe M, Longnus S. Circulating Factors, Measured Both in the Donor and During Ex-Vivo Heart Perfusion, Correlate with Subsequent Heart Recovery in a Pig Model of Dcd. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Jauffret C, Ottaviani S, Latourte A, Ea HK, Graf S, Lioté F, Bardin T, Richette P, Pascart T. POS1161 CAN DOCTORS TREAT GOUT WELL? INSIGHT ON GOUT MANAGEMENT IN REFERRAL CENTRES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRecent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout (RECO) in 2020 [1,2], which were deliberately simple and concise.ObjectivesTo determine the profile of patients referred to French gout expert centres, and to examine the results of their management.MethodsThree hundred patients attending a first visit for gout management in three French referral centres were retrospectively included. Visits were performed at baseline (M0) and scheduled for month 6 (M6), month 12 (M12), and month 24 (M24). Data collected included: patient profile; disease activity and treatments; serum urate (SU) level; estimated glomerular filtration rate (eGFR).ResultsPatients were 81% male, mean age 62.2 ± 15.2 years, 42.7% prevalence of eGFR <60ml/min/1.73m2, 28.1% diabetes mellitus, and 25.4% had a history of major cardiovascular event. Management followed French recommendations after the baseline visit in 94.9% of cases. Overall, 50 patients (16.7%) received off-label anakinra for flare treatment or flare prophylaxis. SU levels were below 6.0mg/dL in 59.4% of patients at M6, 67.9% at M12, and 78.6% at M24. At M24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36mg/d). At inclusion, 94% of patients had experienced at least one flare in the previous six months, versus 23.6% at M12, and 13.1% at M24 (of which 8/12 (66.7%) had SU>6.0mg/dL).ConclusionSimple application of gout management guidelines is feasible in clinical practice, and is efficient with a majority of patients achieving SU targets and clinical improvement. A minority of patients in referral centres have ‘difficult-to-treat’ gout requiring specific management.References[1]Latourte A, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares. Joint Bone Spine 2020;87:387-93.[2]Pascart T, et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine 2020;87:395- 404.Disclosure of InterestsCharlotte Jauffret: None declared, Sebastien Ottaviani: None declared, Augustin Latourte Consultant of: Novartis, Hang Korng Ea: None declared, Sahara Graf: None declared, Frederic Lioté Grant/research support from: for the European Crystal Network workshops from Astra-Zeneca, Grunenthal, Horizon Pharmaceuticals, Ipsen Pharma, Menarini France and global, Novartis France, Olatec, Selecta, SOBI, Thomas Bardin Consultant of: Astra-Zeneca, Biomex, Grunenthal, Horizon Pharmaceuticals, Ipsen Pharma, Menarini France and global, Novartis France, Savient and Sobi, Pascal Richette: None declared, Tristan Pascart Consultant of: from Novartis, Grant/research support from: from Horizon Pharmaceuticals, Novartis, Variant Bio
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Bartolome G, Starrost U, Schröter-Morasch H, Schilling B, Fischbacher L, Kues L, Graf S, Ziegler W. Validation of the munich swallowing score (mucss) in patients with neurogenic dysphagia: A preliminary study. NeuroRehabilitation 2021; 49:445-457. [PMID: 34180423 DOI: 10.3233/nre-210011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.
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Graf S, Kranz J, Schmidt S, Bellut L, Uhlig A. [Types of evidence syntheses]. Urologe A 2021; 60:434-443. [PMID: 33656592 PMCID: PMC7927776 DOI: 10.1007/s00120-021-01476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
This manuscript outlines various types of review articles as forms of evidence synthesis with special regard to their strengths and limitations. Review articles not only present summarised data, but also offer an evaluation of the quality of the individual studies included in it. The validity and the reliability of outcomes of reviews is strongly dependent on the quality of the data included. For this reason, a comprehensive literature selection process is paramount. Fundamental knowledge of bias and literature assessment is also necessary when reading reviews. This article presents selected tools for evidence appraisal and evaluation of bias risk.
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Graf S, Arnold M, Segiser A, Méndez-Carmona N, Kalbermatter N, Carrel T, Longnus S. Pre-Ischemic Lactate Levels Affect Post-Ischemic Functional Recovery in an Isolated Rat Heart Model of Donation after Circulatory Death (DCD). J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Graf S, Kirschstein L, Knopf A, Mansour N, Jeleff-Wölfler O, Buchberger AMS, Hofauer B. Systematic evaluation of laryngeal impairment in Sjögren's syndrome. Eur Arch Otorhinolaryngol 2021; 278:2421-2428. [PMID: 33765165 PMCID: PMC8165056 DOI: 10.1007/s00405-021-06746-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/10/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Sjögren's syndrome (SjS) causes malfunction of the salivary and lacrimal glands. Consequently, patients suffer from xerostomia and keratoconjunctivitis sicca. This can further affect the voice and swallowing function resulting in an impaired quality of life. Aim of this study is the systematic evaluation of the impact on voice and swallowing-related quality of life in patients with SjS. MATERIAL AND METHODS SjS patients were classified according to the American-European Consensus Group (AECG) criteria; antibodies to Ro (SS-A) or La (SS-B) antigens were detected, ESSPRI was completed. We used the following quality of life questionnaires: EORTC QLQ H&N 35, Anderson Dysphagia Inventory (ADI) and Voice Handicap Index (VHI). Patients additionally received a detailed phoniatric examination (auditory perception, videostroboscopy, acoustic analysis, Dysphonia Severity Index (DSI), aerodynamics measurements). RESULTS Almost all the 54 patients (96.3%) had a limited quality of life due to their swallowing problems and 48% due to their voice problems. Both values correlated significantly with the degree of xerostomia. In the phoniatric examination, 77.8% had an increased DSI and two-thirds had abnormalities in videostroboscopy. CONCLUSIONS A reasonable impairment of quality of life in patients with SjS due to the limitations in voice and swallowing function was observed. As SjS does not limitate life expectancy, preservation of quality of life is important. Detection of voice and swallowing problems as potential reasons for quality of life impairment should be detected and, if diagnosed, treated accordingly.
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Gatterer C, Mundigler G, Graf S, Beitzke D, Sunder-Plassmann G. T1 mapping in patients with Fabry disease predicts functional and morphological abnormalities in cardiac MRI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0268] [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
About 50% of Fabry disease (FD) patients develop cardiac manifestation, also known as Fabry cardiomyopathy. Beside echocardiography, cardiac magnetic resonance imaging (CMR) is included in the regular assessment of these patients, allowing non-invasive tissue characterization via T1 Mapping but also evaluation of morphological and functional characteristics.
Purpose
Myocardial strain measured by feature-tracking CMR has been previously shown to be a sensitive indicator of mechanical dysfunction in different diseases. We therefore evaluated changes of these parameters over the time, potentially reflecting disease progression in patients with FD. Furthermore, we also assessed the association of T1 mapping with follow-up changes of myocardial strain. Thus, our data may provide novel insights about cardiac changes in the natural course of the disease and cardiac effects of specific therapies.
Methods
We used post processing software for CMR to analyze baseline and follow-up cardiac involvement in a cohort of FD patients who were enrolled in the KarMA study, which examines cardiac changes over time. We measured left ventricular mass (LVM), left ventricular end-systolic and end-diastolic volume (LVEDV, LVESV), left ventricular ejection fraction (LVEF), mean left ventricular T1 relaxation times (T1), global longitudinal strain (GLS), global regional strain (GRS) and global circumferential strain (GCS). Statistical analyses included T-test and Spearman's correlation.
Results
CMR Images of 33 Patients were analyzed (22 females; mean age 40.8±16.3 years; at baseline 17 were therapy naïve and 16 on ERT), of whom 31 underwent a second CMR. In 18 patients (10 females; 44.9±16.0 years) myocardial strain measurement by feature-tracking was possible in both examinations. T1, LVM, LVEDV and LVESV, LVEF as well as GLS, GRS and GCS showed no significant change during the mean follow-up period of 43 (±17) months in all patients. However, we found a significant correlation of baseline T1 (967±84.5ms) with follow up values of LVM (84.9±32.7 g/m2; p=0.02, ρ=−0.462), LVEDV (63.0±17.6 g/m2 p=0.049 ρ=−0.398) and GRS (70.2±14.2% p=0.011 ρ=−0.5). Baseline T1 also correlated with changes in LVM (p=0.036 ρ=−0.44) and changes of GCS (p=0.001 ρ=−0.858) from baseline to follow up. Differences in T1 from baseline to follow up correlated with follow-up values of GLS (−19.5±3.57 p=0.044, ρ=−0.414) and GRS (69.1±18.7 p=0.003, ρ=−0.588).
Conclusion
T1, reflecting glycosphingolipid accumulation might predict changes in LVM, LVEDV and strain. Moreover, changes in T1, reflecting myocardial remodeling, go in parallel with worse left ventricular function shown by more positive values of GLS, GCS and GRS. T1 mapping together with strain parameters are important markers for monitoring patients with FD.
Funding Acknowledgement
Type of funding source: None
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Shanahan EM, Glaezter K, Gill T, Hill C, Graf S, Allcroft P. A case series of suprascapular nerve block (with an historical comparator) for shoulder pain in motor neurone disease. Palliat Med 2020; 34:1127-1133. [PMID: 32469625 DOI: 10.1177/0269216320929553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shoulder pain is a distressing but under-reported and poorly managed symptom in people with motor neurone disease. OBJECTIVES This study aimed to assess the efficacy of suprascapular nerve block for the management of shoulder pain in patients with motor neurone disease. METHODS A total of 27 patients with motor neurone disease and shoulder pain were offered a suprascapular nerve block. Ten of these patients had bilateral shoulder pain and both were injected, making a total of 37 shoulders. The patients were followed up for a total of 3 months, or until death. Shoulder pain was measured using the pain scale (out of 100) of the shoulder pain and disability index and compared with baseline scores and a placebo control group from an earlier study using the same methodology (ACTRN12619000353190). RESULTS Following the nerve block there was a significant improvement of pain scores from baseline (58.4) at week 1 (20.8, p < 0.000), week 6 (17.6, p < 0.000) and week 12 (30.4, p = 0.001) and a significant improvement compared with the control group across each time interval. CONCLUSION Suprascapular nerve block is a safe, effective therapy for patients with chronic shoulder pain.
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Geneid A, Nawka T, Schindler A, Oguz H, Chrobok V, Calcinoni O, am Zehnhoff-Dinnesen A, Neumann K, Farahat M, Abou-Elsaad T, Moerman M, Chavez E, Fishman J, Yazaki R, Arnold B, Frajkova Z, Graf S, Pflug C, Drsata J, Desuter G, Samuelsson C, Tedla M, Costello D, Sjögren E, Hess M, Kinnari T, Rubin J. Union of the European Phoniatricians' position statement on the exit strategy of phoniatric and laryngological services: staying safe and getting back to normal after the peak of coronavirus disease 2019 (issued on 25th May 2020). J Laryngol Otol 2020; 134:661-664. [PMID: 32613918 PMCID: PMC7399138 DOI: 10.1017/s002221512000122x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. OBJECTIVES This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. CONCLUSION As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.
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Davis C, Ruediger C, Dyer K, Lester S, Graf S, Kroon FPB, Whittle S, Hill C. FRI0399 COLCHICINE IS NOT EFFECTIVE FOR REDUCING OSTEOARTHRITIC HAND PAIN COMPARED TO PLACEBO: A RANDOMISED, PLACEBO-CONTROLLED TRIAL (COLAH). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Current pharmacotherapies to treat or prevent hand osteoarthritis are limited. Colchicine, an anti-inflammatory agent effective at reducing joint pain and swelling in gouty arthritis, may offer relief in hand osteoarthritis, though this has not been investigated before.1Objectives:To investigate the efficacy of colchicine compared to placebo on VAS pain scores over 12 weeks in adults with hand osteoarthritis in a randomised, double-blind controlled trial.Methods:64 community-dwelling adults with hand osteoarthritis (American College of Rheumatology criteria)2(54 females, 48-79 years) were randomised 1:1 to colchicine (0.5mg twice daily) or placebo for 12 weeks. VAS pain scores (worst affected hand) were obtained at baseline and weeks 6, 12, and after treatment withdrawal at week 16. Secondary outcome measures included grip strength, C-reactive protein (CRP) and tender and swollen joint count (TSJC). Grip strength, TSJC and CRP were obtained at baseline and week 12. Intention-to-treat analyses, adjusted for age and gender, were performed using constrained longitudinal data analysis models in Stata v16.3This study is registered with the Australia New Zealand Clinical Trials Registry, ACTRN12617001524381.Results:58 participants completed the study (N=27 colchicine, N=31 placebo, withdrawal rate 9%). Mean (S.D) VAS score of the affected hand at baseline was 71.4 (14.5) mm in the placebo and 65.4 (15.0) mm in the colchicine group (p = 0.11). VAS scores improved during treatment, but were comparable between groups at week 6, 12 and 16 (Table 1). There were no differences between groups at week 12 for CRP, TSJC or grip strength (Table 1). Adverse events related to study medications included nausea (n=4), diarrhoea (n=9), vomiting (n=3), bloating (n=1) and reflux (n=1).Table 1.COLAH study primary and secondary outcomes, from constrained longitudinal data analysis modelOutcomeTimepointColchicine (SE)Placebo (SE)Colchicine-Placebo(95% CI)p-valueVAS Pain (mm)6 weeks53.5 (4.5)53.9 (4.6)-0.4 (-12.3, 13.1)0.9512 weeks57.1 (4.4)48.4 (4.6)8.7 (-21.2, 3.9)0.1816 weeks62.0 (4.3)61.6 (3.7)-0.4 (-11.4, 10.5)0.94TSJC (0-20)12 weeks5.6 (0.7)3.8 (0.7)1.8 (-4.1, 0.5)0.13Grip strength (kg)12 weeks14.4 (0.8)15.3 (0.8)-0.9 (-0.2, 2.0)0.10CRP (mg/L)12 weeks4.5 (1.4)4.0 (1.3)0.5 (-3.8, 2.9)0.77Conclusion:Colchicine 1mg daily for 12 weeks was not effective in improving pain, tender and swollen joint count or grip strength in symptomatic hand osteoarthritis patients. This study does not support colchicine for treatment of symptoms of hand osteoarthritis.References:[1]Leung, YY, Hui, LLY, Kraus, VB 2015. Colchicine-Update on mechanisms of action and therapeutic uses.Seminars in Arthritis and Rheumatism; 45: 341-350.[2]Altman, R, Alarcon, G, Appelrouth, D et al, 1990. American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.Arthritis Rheumatology;33(11): 1601-10.[3]Liu GF, Lu K, Mogg R, et al. 2009. Should baseline be a covariate or dependent variable in analyses of change from baseline in clinical trials?Stat Med; 28: 2509–30.Characters from table content including title and footnotes: 465Disclosure of Interests:None declared
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Lamby P, Krüger-Genge A, Franke RP, Mrowietz C, Falter J, Graf S, Schellenberg EL, Jung F, Prantl L. Effect of iodinated contrast media on the oxygen tension in the renal cortico-medullary region of pigs. Clin Hemorheol Microcirc 2020; 73:261-270. [PMID: 31322554 DOI: 10.3233/ch-199009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Repeated injections of iodinated contrast media (CM) can lead to a deterioration of the renal blood flow, can redistribute blood from the renal cortex to other parts of the kidney and can cause small decreases of the blood flow in cortical capillaries, a significant reduction in blood flow in peritubular capillaries and a significant reduction in blood flow in the vasa recta. Therefore, a study in pigs was designed, to show whether the repeated injection of CM boli, alone, can cause a reduction of oxygenation in the cortico-medullar renal tissue - the region with the highest oxygen demand in the kidney - of pigs.While the mean pO2-value had only decreased by 0.3 mmHg from 29.9±4.3 mmHg to 29.6±4.3 mmHg (p = 0.8799) after the tenth Iodixanol bolus, it decreased by 5.9 mmHg from 34.0±4.3 mmHg to 28.1±4.3 mmHg after the tenth Iopromide bolus (p = 0.044). This revealed a remarkable difference in the influence of these CM on the oxygen partial pressure in the kidney.Repeated applications of CM had a significant influence on the renal oxygen partial pressure. In line with earlier studies showing a redistribution of blood from the cortex to other renal areas, this study revealed that Iodixanol - in contrast to Iopromide - induced no changes in the pO2 in the cortico-medullar region which confirms that Iodixanol did not hinder the flow of blood through the renal micro-vessels. These results are in favor of a hypothesis from Brezis that a microcirculatory disorder might be the basis for the development of CI-AKI.
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Gatterer C, Beitzke D, Bartko PE, Schneider M, Binder T, Hengstenberg C, Bergler-Klein J, Sunder-Plassmann G, Mundigler G, Graf S. P1832 T1 mapping and echo-global longitudinal strain are early markers of cardiac involvement in patients with fabry disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1175] [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
OnBehalf
Constantin Gatterer
Introduction
Fabry disease (FD) is one of the most common lysosomal storage diseases caused by deficiency of Alpha-Galactosidase A and accumulation of glycosphingolipids in all cells containing lysosomes. Cardiac involvement is characterized by left ventricular hypertrophy, conduction abnormalities and myocardial fibrosis with consecutive cardiomyopathy in late stages.
Purpose
As the detection of early signs of cardiac involvement is crucial for the initiation of enzyme replacement therapy (ERT) or Chaperon therapy, we intended to find early imaging markers.
Methods
Cardiac MRI (CMR) including Late Gadolinium Enhancement (LGE), representing fibrosis, and T1-mapping as well as echocardiography with measurement of global longitudinal strain (GLS) were done as part of the regular check-ups for patients with FD.
Results
The study cohort of 30 FD patients (20-69 years, 53% women) in different stages of disease showed low GLS values already at the time of baseline echocardiography (mean: -17,22%), correlating with the amount of LGE (r = 0,73; p = 0,003) and ejection fraction measured by CMR (CMR-EF; r=-0,74; p = 0,002).
After an average follow-up of 39 months (STD 18), GLS values were significantly declined (-15,51 %; p = 0,009) and correlated with T1 times (r = 0,7; p = 0,04), while LGE and CMR-EF did not significantly change compared to baseline.
Baseline T1 times correlated negatively with the reduction of GLS (r=-0,7; p = 0,003), while LGE and CMR-EF showed no correlation with the course of GLS. ERT appeared to have no influence on the extend of GLS reduction.
Conclusion
Low native CMR T1 times, indicating sphingolipid accumulation in the myocardium, seem to represent the beginning of cardiac involvement in FD and might predict the course of GLS. GLS is a sensitive parameter for early detection of cardiac manifestation and disease progression, while LGE and CMR-EF could not recognize slight deterioration of left ventricular function.
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Blessberger H, Bergler-Klein J, Graf S, Syeda B, Wagner H, Kammler J, Steinwender C, Binder T. P1540 Imaging parameters vs. operator dependence of global longitudinal strain values. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.961] [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: 11/12/2022] Open
Abstract
Abstract
Background
Speckle tracking based global longitudinal strain (GLS) values have proven useful in the assessment of subtle changes in left ventricular function. From a clinical point of view, robustness and reliability of measured values are critical to ensure a valid patient assessment and follow-up. However, it is still a matter of debate if imaging parameters systematically alter measured strain values and if these changes are relevant as compared with GLS fluctuations that are caused by different operators or different studies by the same operator.
Methods
In a consecutive everyday patient population (n = 35), we recorded the apical four chamber view several times in each patient with different ultrasound machine settings (modification of gain, frame rate, sector depth, and transducer frequencies) using a commercially available ultrasound imaging system. Furthermore, apical four chamber views with ‘optimized’ imaging settings at the operators’ discretion were recorded by two different observers (obA/obB) in each subject to compute inter- and intra-observer variability. GLS values were calculated offline with a dedicated software. We fitted a linear mixed effects model with random intercept and slope to assess the effect of imaging parameters on GLS and compared the two investigators with Bland-Altman plots.
Results
Ejection fraction ranged between 10% and 76% and was correlated well with GLS (r = -0.78). Neither gain settings (range: -24 to 24 arbitrary units, p = 0.68) nor frame rate (range: 51-113 sec-1, p = 0.77) systematically changed measured GLS values. Conversely, higher sector depth increased (range: 12 to 24 cm, mean effect: -0.16%/cm; 95% CI -0.24% to -0.07%, p < 0.01), and higher transducer imaging frequencies decreased absolute GLS values (range for harmonic imaging: 1.5/3.1 MHz to 2.0/4.3 MHz, mean effect 1.10%/MHz; 95% CI 0.61% to 1.59%, p < 0.01). According to our data, a 12 cm increase of sector depth would translate into an average change of -1.87% GLS (95% CI: -2.87% to -0.86%), whereas a switch of the second harmonic imaging frequency from 3.1 MHz to 4.3 MHz would cause a 1.32% GLS change (95% CI: 0.73% to 1.91%). Intra- and inter-observer variability showed good correlation and limits of agreement (obA: mean difference [MD]: -0.20%; 95% limits of agreement [LOA]: -2.42% to 2.02%, p = 0.86, obB: MD: -0.10%; 95% LOA: -4.28% to 4.07%, p = 0.12, obA vs. obB: MD: -0.53%; 95% LOA: -3.68% to 2.62%, p = 0.92).
Conclusion
Overall, GLS values were robust and reproducible in our cohort of patients. In comparison, potential systematic changes of GLS values caused by modification of imaging parameters (sector depth/transducer frequency) were much less in number than GLS variations caused by different operators or different studies by the same operator.
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Ramel S, Le Bihan J, Gueganton L, Floch M, Graf S. P242 Evaluation of a pulmonary rehabilitation program offered to adult cystic fibrosis patients by the French cystic fibrosis centre of Roscoff. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lamby P, Wolff D, Mielke S, Grigoleit GU, Ljungman P, Hilgendorf I, Holler E, Holler B, Weber D, Herr W, Schiltz D, Klein S, Graf S, Bjornhagen-Safwenberg V, Dolderer J, Prantl L. Allogeneic donor split skin grafts for treatment of refractory ulcers in cutaneous chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation-a retrospective analysis on seven patients. Ann Hematol 2019; 98:1867-1875. [PMID: 30993415 DOI: 10.1007/s00277-019-03687-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/06/2019] [Indexed: 12/19/2022]
Abstract
Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.
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Khorsand A, Stix G, Nekolla S, Becherer A, Kletter K, Dudczak R, Sochor H, Maurer G, Porenta G, Graf S. Attenuation correction for myocardial perfusion imaging. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAim: We investigated the impact of photon attenuation in myocardial perfusion imaging with SPECT and PET in patients with coronary artery disease. In fact, the regional tracer distribution can be quantitatively assessed by polar map analysis if the effects of photon attenuation are accounted for. PET imaging permits accurate measurement of and correction for photon attenuation, whereas results of attenuation correction in SPECT imaging have been inconsistent. Patients, methods: We compared photon attenuation in resting perfusion imaging studies with SPECT (99mTc-sestamibi) and PET (13N-ammonia) from 21 patients. Transaxial images were reconstructed with and without attenuation correction and reoriented into short axis images. Polar map analysis was utilized to generate regional tracer uptake in six anatomical segments. Results: Average segmental photon attenuation calculated as the ratio of counts in corrected and uncorrected images was 7.2 ± 1.4 in SPECT and 14.0 ± 3.1 in PET imaging (p <0.01). This attenuation factor was significantly related to body mass index for both methods (p <0.001). While attenuation correction for SPECT imaging did compensate for attenuation effects in the inferior wall (from –15% to +6% vs. PET), relative tracer uptake in the anterior wall in SPECT images was significantly reduced after attenuation correction (from –2% to –18% vs. PET, p <0.01). Conclusion: Differential effects of attenuation correction for myocardial SPECT perfusion imaging need to be considered when algorithms designed to compensate effects of photon attenuation in SPECT imaging are employed in clinical practice.
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Oshima T, Heidegger CP, Makhlouf AM, Graf S, Dupertuis YM, Pichard C. MON-LB310: Can Mechanical Ventilators Affect Indirect Calorimetry Measurements? Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oshima T, Dupertuis YM, Graf S, Makhlouf AM, Ragusa M, Heidegger CP, Pichard C. MON-LB311: In-Vitro Validation of the New Indirect Calorimeter Against Mass Spectrometry Measurements in Simulated Gas Exchange. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mareschal J, Altwegg J, Berthet D, Chikhi M, Chopard P, Graf S, Sierro C, Pichard C, Genton L. SUN-P205: Indication and Prescription of Oral Nutritional Supplements in a Swiss University Hospital. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sponder M, Kopecky C, Campean I, Emich M, Bergler-Klein J, Graf S, Saeemann M, Strametz-Juranek J. P5311Influence of physical activity on hdl-quality reflected by serum amyloid a and surfactant protein b. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5311] [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: 11/13/2022] Open
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Sponder M, Campean I, Dalos D, Emich M, Fritzer-Szekeres M, Litschauer B, Bergler-Klein J, Graf S, Strametz-Juranek J. P1516Influence of long-term physical activity on serum PCSK9, HDL/LDL-cholesterol and lipoprotein a-levels. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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