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Frey K, Bauer J, Unholtz D, Kurz C, Krämer M, Bortfeld T, Parodi K. TPSPET—A TPS-based approach forin vivodose verification with PET in proton therapy. Phys Med Biol 2013; 59:1-21. [DOI: 10.1088/0031-9155/59/1/1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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102
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Bauer J, Unholtz D, Kurz C, Parodi K. An experimental approach to improve the Monte Carlo modelling of offline PET/CT-imaging of positron emitters induced by scanned proton beams. Phys Med Biol 2013; 58:5193-213. [PMID: 23835872 DOI: 10.1088/0031-9155/58/15/5193] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report on the experimental campaign carried out at the Heidelberg Ion-Beam Therapy Center (HIT) to optimize the Monte Carlo (MC) modelling of proton-induced positron-emitter production. The presented experimental strategy constitutes a pragmatic inverse approach to overcome the known uncertainties in the modelling of positron-emitter production due to the lack of reliable cross-section data for the relevant therapeutic energy range. This work is motivated by the clinical implementation of offline PET/CT-based treatment verification at our facility. Here, the irradiation induced tissue activation in the patient is monitored shortly after the treatment delivery by means of a commercial PET/CT scanner and compared to a MC simulated activity expectation, derived under the assumption of a correct treatment delivery. At HIT, the MC particle transport and interaction code FLUKA is used for the simulation of the expected positron-emitter yield. For this particular application, the code is coupled to externally provided cross-section data of several proton-induced reactions. Studying experimentally the positron-emitting radionuclide yield in homogeneous phantoms provides access to the fundamental production channels. Therefore, five different materials have been irradiated by monoenergetic proton pencil beams at various energies and the induced β(+) activity subsequently acquired with a commercial full-ring PET/CT scanner. With the analysis of dynamically reconstructed PET images, we are able to determine separately the spatial distribution of different radionuclide concentrations at the starting time of the PET scan. The laterally integrated radionuclide yields in depth are used to tune the input cross-section data such that the impact of both the physical production and the imaging process on the various positron-emitter yields is reproduced. The resulting cross-section data sets allow to model the absolute level of measured β(+) activity induced in the investigated targets within a few per cent. Moreover, the simulated distal activity fall-off positions, representing the central quantity for treatment monitoring in terms of beam range verification, are found to agree within 0.6 mm with the measurements at different initial beam energies in both homogeneous and heterogeneous targets.
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Affiliation(s)
- J Bauer
- Heidelberg Ion-Beam Therapy Center, Im Neuenheimer Feld 450, D-69120 Heidelberg, Germany.
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103
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Aust S, Oshafu Z, Mayerhofer K, Kurz C, Ott J. Hormonelle Charakteristika von infertilen Patientinnen mit Endometriose. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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104
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Frey K, Bauer J, Unholtz D, Kurz C, Kraemer M, Bortfeld T, Parodi K. TH-C-144-06: TPS PET
- A TPS-Based Approach for In-Vivo Dose Verification with PET in Proton Therapy. Med Phys 2013. [DOI: 10.1118/1.4815800] [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: 11/07/2022] Open
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105
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Bauer J, Hildebrandt M, Unholtz D, Kurz C, Parodi K. TH-C-144-12: On the Modelling of Facility-Specific PET Imaging for Proton Treatment Verification: Experimental Validation and Inter-Facility Comparison. Med Phys 2013. [DOI: 10.1118/1.4815806] [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: 11/07/2022] Open
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106
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Parodi K, Bauer J, Kurz C, Unholtz D, Sommerer F, Frey K, Haberer T, Herfarth K, Welzel T, Combs S, Debus J. WE-G-500-06: Offline PET/CT Imaging of Scanned Proton and Carbon Ion Beams: Initial Clinical Experience for Different Tumour Sites. Med Phys 2013. [DOI: 10.1118/1.4815639] [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: 11/07/2022] Open
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107
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Schug M, Huwer J, Kurz C, Müller P, Eschner J. Heralded photonic interaction between distant single ions. Phys Rev Lett 2013; 110:213603. [PMID: 23745873 DOI: 10.1103/physrevlett.110.213603] [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] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Indexed: 06/02/2023]
Abstract
We establish a heralded interaction between two remotely trapped single (40)Ca(+) ions through the exchange of single photons. In the sender ion, we release single photons with a controlled temporal shape on the P(3/2) to D(5/2) transition and transmit them to the distant receiver ion. Individual absorption events in the receiver ion are detected by quantum jumps. For continuously generated photons, the absorption reduces significantly the lifetime of the long-lived D(5/2) state. For triggered single-photon transmission, we observe a coincidence between the emission at the sender and quantum jump events at the receiver.
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Affiliation(s)
- M Schug
- Universität des Saarlandes, Experimentalphysik, Campus E2 6, 66123 Saarbrücken, Germany.
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108
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Bauer J, Unholtz D, Sommerer F, Kurz C, Haberer T, Herfarth K, Welzel T, Combs SE, Debus J, Parodi K. Implementation and initial clinical experience of offline PET/CT-based verification of scanned carbon ion treatment. Radiother Oncol 2013; 107:218-26. [DOI: 10.1016/j.radonc.2013.02.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 10/26/2022]
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109
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Robert C, Dedes G, Battistoni G, Böhlen TT, Buvat I, Cerutti F, Chin MPW, Ferrari A, Gueth P, Kurz C, Lestand L, Mairani A, Montarou G, Nicolini R, Ortega PG, Parodi K, Prezado Y, Sala PR, Sarrut D, Testa E. Distributions of secondary particles in proton and carbon-ion therapy: a comparison between GATE/Geant4 and FLUKA Monte Carlo codes. Phys Med Biol 2013; 58:2879-99. [DOI: 10.1088/0031-9155/58/9/2879] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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110
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Barinoff J, Hils R, Bender A, Groß J, Kurz C, Tauchert S, Mann E, Schwidde I, Ipsen B, Sawitzki K, Heitz F, Harter P, Traut A, du Bois A. Clinicopathological differences between breast cancer in patients with primary metastatic disease and those without: a multicentre study. Eur J Cancer 2012; 49:305-11. [PMID: 22940292 DOI: 10.1016/j.ejca.2012.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/17/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Approximately 6% of breast cancer (BC) patients present with primary metastatic disease (pmBC) at first diagnosis. The clinicopathological differences between tumours from patients who have metastatic disease and those who do not are unclear. METHODS This study was an exploratory analysis of patients with pmBC treated in 8 German breast cancer centres between 1998 and 2010. Phenotypes were defined using the following immunohistochemical markers: oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2). The control arm included the group of patients who had neither local recurrence nor distant metastases at a follow-up of at least 30 months after initial diagnosis. RESULTS A total of 2214 patients were included. Of these, 1642 had non metastatic BC, and 572 had pmBC. Eighty-five patients (15%) with pmBC were diagnosed at stage T1. On multivariate analysis, factors associated with pmBC were as follows: positive lymph node status, grade 3, lobular histology and Luminal B phenotype (Her 2 positive). Of the sample, 197 patients (34%) with pmBC were diagnosed as stage T2, 90 patients (16%) were diagnosed as stage T3, and 200 patients (35%) were diagnosed as stage T4. Only positive lymph node status and grade 3 were reported as risk factors for distant metastases in patients with stage T3 and T4 cancer. CONCLUSION There are differences in the clinicopathological features among breast cancer patients with primary metastases and those without. Receptor expression and histological type play a minor role in the risk for metastasis in patients with stage T3 and T4 disease when compared to patients with T1 pmBC tumours. On initial diagnosis, lobular histology and Luminal B positivity (Her 2 positive) in T1 pmBC were determined to be risk factors for primary metastatic disease.
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111
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Kurz C, Mairani A, Parodi K. First experimental-based characterization of oxygen ion beam depth dose distributions at the Heidelberg Ion-Beam Therapy Center. Phys Med Biol 2012; 57:5017-34. [DOI: 10.1088/0031-9155/57/15/5017] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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112
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Leuner K, Schütt T, Kurz C, Eckert SH, Schiller C, Occhipinti A, Mai S, Jendrach M, Eckert GP, Kruse SE, Palmiter RD, Brandt U, Dröse S, Wittig I, Willem M, Haass C, Reichert AS, Müller WE. Mitochondrion-derived reactive oxygen species lead to enhanced amyloid beta formation. Antioxid Redox Signal 2012; 16:1421-33. [PMID: 22229260 PMCID: PMC3329950 DOI: 10.1089/ars.2011.4173] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [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: 12/21/2022]
Abstract
AIMS Intracellular amyloid beta (Aβ) oligomers and extracellular Aβ plaques are key players in the progression of sporadic Alzheimer's disease (AD). Still, the molecular signals triggering Aβ production are largely unclear. We asked whether mitochondrion-derived reactive oxygen species (ROS) are sufficient to increase Aβ generation and thereby initiate a vicious cycle further impairing mitochondrial function. RESULTS Complex I and III dysfunction was induced in a cell model using the respiratory inhibitors rotenone and antimycin, resulting in mitochondrial dysfunction and enhanced ROS levels. Both treatments lead to elevated levels of Aβ. Presence of an antioxidant rescued mitochondrial function and reduced formation of Aβ, demonstrating that the observed effects depended on ROS. Conversely, cells overproducing Aβ showed impairment of mitochondrial function such as comprised mitochondrial respiration, strongly altered morphology, and reduced intracellular mobility of mitochondria. Again, the capability of these cells to generate Aβ was partly reduced by an antioxidant, indicating that Aβ formation was also ROS dependent. Moreover, mice with a genetic defect in complex I, or AD mice treated with a complex I inhibitor, showed enhanced Aβ levels in vivo. INNOVATION We show for the first time that mitochondrion-derived ROS are sufficient to trigger Aβ production in vitro and in vivo. CONCLUSION Several lines of evidence show that mitochondrion-derived ROS result in enhanced amyloidogenic amyloid precursor protein processing, and that Aβ itself leads to mitochondrial dysfunction and increased ROS levels. We propose that starting from mitochondrial dysfunction a vicious cycle is triggered that contributes to the pathogenesis of sporadic AD.
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Affiliation(s)
- Kristina Leuner
- Department of Pharmacology, ZAFES, Biocenter, University of Frankfurt, Frankfurt/Main, Germany.
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Cernescu M, Stark T, Kalden E, Kurz C, Leuner K, Deller T, Göbel M, Eckert GP, Brutschy B. Laser-Induced Liquid Bead Ion Desorption Mass Spectrometry: An Approach to Precisely Monitor the Oligomerization of the β-Amyloid Peptide. Anal Chem 2012; 84:5276-84. [DOI: 10.1021/ac300258m] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mihaela Cernescu
- Institute for Physical and Theoretical
Chemistry, Goethe-University, Frankfurt/M,
Germany, 60438
| | - Tina Stark
- Institute
for Organic Chemistry
and Chemical Biology, Goethe-University, Frankfurt/M, Germany, 60438
| | - Elisabeth Kalden
- Institute
for Organic Chemistry
and Chemical Biology, Goethe-University, Frankfurt/M, Germany, 60438
| | - Christopher Kurz
- Department of Pharmacology, Biocentre, Goethe-University, Frankfurt/M, Germany, 60438
| | - Kristina Leuner
- Department of Pharmacology, Biocentre, Goethe-University, Frankfurt/M, Germany, 60438
| | - Thomas Deller
- Institute of Clinical Neuroanatomy,
Dr. Senckenberg Anatomy, Goethe-University, Neuroscience Center, Frankfurt/M, Germany, 60590
| | - Michael Göbel
- Institute
for Organic Chemistry
and Chemical Biology, Goethe-University, Frankfurt/M, Germany, 60438
| | - Gunter P. Eckert
- Department of Pharmacology, Biocentre, Goethe-University, Frankfurt/M, Germany, 60438
| | - Bernhard Brutschy
- Institute for Physical and Theoretical
Chemistry, Goethe-University, Frankfurt/M,
Germany, 60438
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Eckert GP, Renner K, Eckert SH, Eckmann J, Hagl S, Abdel-Kader RM, Kurz C, Leuner K, Muller WE. Mitochondrial Dysfunction—A Pharmacological Target in Alzheimer's Disease. Mol Neurobiol 2012; 46:136-50. [DOI: 10.1007/s12035-012-8271-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/16/2012] [Indexed: 12/12/2022]
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115
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Ott J, Wattar L, Kurz C, Seemann R, Huber JC, Mayerhofer K, Vytiska-Binstorfer E. Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study. Eur J Endocrinol 2012; 166:897-902. [PMID: 22330149 DOI: 10.1530/eje-11-1070] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 11/08/2022]
Abstract
OBJECTIVE To evaluate whether parameters for calcium metabolism were associated with characteristics of polycystic ovary syndrome (PCOS). DESIGN A prospective cohort study. METHODS Ninety-one anovulatory, infertile women with PCOS patients underwent clomiphene citrate (CC) stimulation. Main outcome measures were parathyroid hormone (PTH); 25-hydroxyvitamin D3 (25OHD3); serum levels of calcium, phosphorus, magnesium, albumin, and total protein; the serum calcium-phosphorus product; LH; FSH; sexual hormone binding globulin; testosterone; and androstenedione. RESULTS PTH correlated inversely with serum calcium (r=-0.235; P=0.004) and 25OHD3 (r=-0.664; P<0.001), whereas positive correlations were found between PTH and body mass index (BMI; r=0.270; P=0.010) and between PTH and testosterone (r=0.347; P=0.001). After stimulation with 50 mg CC, 57.1% (52/91) developed a follicle, whereas 26.4% (24/91) became pregnant. In a multivariate model to predict both follicle development and pregnancy, BMI and 25OHD3 deficiency were significant predictive parameters. CONCLUSIONS 25OHD3 deficiency was an independent predictive parameter of CC stimulation outcome, in terms of follicle development and pregnancy. Our results suggest a substantial role of vitamin D in PCOS and infertility treatment in these patients.
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Affiliation(s)
- J Ott
- Departments of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria.
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Bauer J, Unholtz D, Sommerer F, Kurz C, Haberer T, Combs S, Welzel T, Herfarth K, Debus J, Parodi K. PO-0828 FIRST CLINICAL EXPERIENCE WITH OFFLINE PET/CT-BASED IN-VIVO VERIFICATION OF SCANNED CARBON ION IRRADIATION. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71161-1] [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: 11/16/2022]
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117
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Seravalli E, Bauer J, Robert C, Stichelbaut F, Kurz C, Smeets J, Schaart D, Buvat I, Parodi K, Verhaegen F. PO-0813 COMPARISON OF MONTE CARLO POSITRON-EMITTER-YIELD CALCULATIONS IN PROTON RADIOTHERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71146-5] [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: 10/28/2022]
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118
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Combs SE, Bauer J, Unholtz D, Kurz C, Welzel T, Habermehl D, Haberer T, Debus J, Parodi K. Monitoring of patients treated with particle therapy using positron-emission-tomography (PET): the MIRANDA study. BMC Cancer 2012; 12:133. [PMID: 22471947 PMCID: PMC3350391 DOI: 10.1186/1471-2407-12-133] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/03/2012] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The purpose of this clinical study is to investigate the clinical feasibility and effectiveness of offline Positron-Emission-Tomography (PET) quality assurance for promoting the accuracy of proton and carbon ion beam therapy. METHODS/DESIGN A total of 240 patients will be recruited, evenly sampled among different analysis groups including tumors of the brain, skull base, head and neck region, upper gastrointestinal tract including the liver, lower gastrointestinal tract, prostate and pelvic region. From the comparison of the measured activity with the planned dose and its corresponding simulated activity distribution, conclusions on the delivered treatment will be inferred and, in case of significant deviations, correction strategies will be elaborated. DISCUSSION The investigated patients are expected to benefit from this study, since in case of detected deviations between planned and actual treatment delivery a proper intervention (e.g., correction) could be performed in a subsequent irradiation fraction. In this way, an overall better treatment could be achieved than without any in-vivo verification. Moreover, site-specific patient-population information on the precision of the ion range at HIT might enable improvement of the CT-range calibration curve as well as safe reduction of the treatment margins to promote enhanced treatment plan conformality and dose escalation for full clinical exploitation of the promises of ion beam therapy. TRIAL REGISTRATION NCT01528670.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, University Hospital of Heidelberg, Germany.
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Seravalli E, Robert C, Bauer J, Stichelbaut F, Kurz C, Smeets J, Van Ngoc Ty C, Schaart DR, Buvat I, Parodi K, Verhaegen F. Monte Carlo calculations of positron emitter yields in proton radiotherapy. Phys Med Biol 2012; 57:1659-73. [PMID: 22398196 DOI: 10.1088/0031-9155/57/6/1659] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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120
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Parodi K, Bauer J, Frey K, Kurz C, Mairani A, Rinaldi I, Schwaab J, Sommerer F, Unholtz D. 91 EXPERIMENTAL CHARACTERIZATION, MODELING AND IN-VIVO IMAGING TO FOSTER HIGH PRECISION ION BEAM THERAPY AT THE HEIDELBERG ION BEAM THERAPY CENTER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70067-1] [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: 11/27/2022]
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121
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Kurz C, Bauer J, Bert C, Bongers A, Jenne J, Richter D, Saito N, Schoenahl F, Unholtz D, Parodi K. 129 FIRST STEPS TOWARDS 4D OFFLINE PET-BASED TREATMENT VERIFICATION AT THE HEIDELBERG ION BEAM THERAPY CENTER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70101-9] [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: 10/28/2022]
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122
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Barinoff J, Hils R, Bender A, Gross J, Kurz C, Tauchert S, Mann E, Schwidde I, Ipsen B, Sawitzki K, Heitz F, Harter P, Traut A, du BA. P4-10-07: Clinico-Pathologic Features of Breast Cancer Patients with Primary Metastatic Disease Versus Localized Disease: A Multicenter Study. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Approximately 6% of breast cancer patients present with primary metastatic disease (pmBC) at first diagnosis. Clinicopathological differences to non-metastatic patients are undetermined.
Methods: Exploratory analysis of patients with pmBC treated in 8 breast cancer units between 1998 and 2010. Tumor characteristics of these patients were compared with non-metastatic breast cancer patients (BC) of one breast cancer center who had neither local-recurrence nor distant metastases during 30 months of follow-up after first diagnosis. Standard staging in patients with first diagnosis of BC included chest X-ray, abdominal ultrasonography and bone scan. Molecular subtypes were analyzed and defined by immunohistochemical markers (ER, PR, Her2-receptor).
Results: 2.214 patients were included, 1.642 with BC and 572 with pmBC, respectively. Patients with pmBC were 7 years older (BC 58 years of age vs. pmBC 65 years; p=0.000) and were more likely to be postmenopausal (74% vs. 83%; p=0.000). Most common localizations of distant first metastases were bone (61,5%), liver (24%), lung (21%) and non-axillary lymph nodes (12%).
85 (15%) patients with pmBC were diagnosed in stage T1. Factors associated with pmBC in multivariate analysis for this group were positive lymph node status (OR 3.4; 95%CI 2.3−6.0; p=0.000), grading 3 (OR 2.3; 95%CI 1.3−4.0; p=0.003), lobular histology (OR 2.3; 95%CI 1.2−4.5; p=0,010) and phenotype Luminal B (OR 2.4; 95%CI 1.25−5.0; p=0.014). 197 (34%) patients with pmBC were diagnosed in stage T2; positive lymph node status (OR 4.8; 95%CI 1.1−3.0; p=0.017) and grading 3 (OR 1.6; 95% CI 1.6−2.3; p=0.019) were reported as risk factors for this group. 90 (16%) and 200 (35%) patients were diagnosed with stages T3 and T4, respectively. In T3/4 tumors a positive lymph node status (OR 5.2; 95% CI 2.9−9.3; p=0.000) and grading 3 (OR 2.2; 95%CI 1.2−3.9; p=0.009) could be defined as significant risk factors for distant metastases. Postmenopausal status was associated with primary metastases in stage T2 (OR 1.8; 95%CI 1.2−2.9; p=0.008) and T3/4 (OR 2.4; 95%CI 1.2−4.7; p=0.011) but not in T1 tumors (OR 1.3; 95%CI 0.7−2.1; p=0.420). There was no association with hormone or Her2 receptor status nor with a specific phenotype for T2-4 tumors.
Conclusion: The clinico-pathological features of breast cancer patients with or without primary metastases differ. In all stages positive lymph node status and higher grading were associated with pmBC significantly. Lobular histology was reported as a risk factor for T1-2 compared to patients without metastases. This feature was not found for T3/4 pmBC. T1 pmBC were likely to be associated with luminal B phenotype. T3-4 pmBC have not been associated with any phenotype or hormone receptor constellation as risk factor for metastases. Tumor biology seems to play a minor role for risk of metastases in T3-4 stages compared to patients with T1-tumors. Findings from this analysis should be considered in the choice of staging methods, especially in stage T1.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-07.
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Affiliation(s)
- J Barinoff
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - R Hils
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - A Bender
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - J Gross
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - C Kurz
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - S Tauchert
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - E Mann
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - I Schwidde
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - B Ipsen
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - K Sawitzki
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - F Heitz
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - P Harter
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - A Traut
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
| | - Bois A du
- 1Kliniken Essen Mitte, Essen, Germany; Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany; Asklepios Klinik, Lich, Germany; Sankt Gertrauden-Krankenhaus, Berlin-Wilmersdorf, Germany; Klinikum Esslingen, Esslingen am Neckar, Germany; Caritsklinik St. Theresia, Saarbrücken, Germany; Universitätsklinikum Gieβen und Marburg, Standort Marburg, Marburg, Germany; Klinikum Frankfurt Höchst, Frankfurt am Main, Germany; Evangelisches Krankenhaus Wesel, Wesel, Germany
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Quan P, Pateisky P, Leditznig N, Gaba A, Szabo L, Kurz C, Tschugguel W, Yotova I. Kooperation der Östrogenrezeptoren ERα und ERβ mit GPR30 in der Regulation der östrogeninduzierten ERK-Aktivierung in primären humanen endometrialen Stromazellen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286404] [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: 10/17/2022] Open
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Yotova I, Quan P, Gaba A, Leditznig N, Pateisky P, Kurz C, Tschugguel W. Raf-1-Level bestimmen die Migrationsrate von primären endometrialen Stromazellen von Patientinnen mit Endometriose. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286517] [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: 10/17/2022] Open
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125
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Ott J, Mayerhofer K, Vytiska-Binstorfer E, Walch K, Huber JC, Kurz C. Intraoperative Androstendion-Kinetik bei Laparoskopischer Ovarialstichelung. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278560] [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] Open
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Leuner K, Kurz C, Guidetti G, Orgogozo JM, Müller WE. Improved mitochondrial function in brain aging and Alzheimer disease - the new mechanism of action of the old metabolic enhancer piracetam. Front Neurosci 2010; 4. [PMID: 20877425 PMCID: PMC2944646 DOI: 10.3389/fnins.2010.00044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 06/08/2010] [Indexed: 12/18/2022] Open
Abstract
Piracetam, the prototype of the so-called nootropic drugs' is used since many years in different countries to treat cognitive impairment in aging and dementia. Findings that piracetam enhances fluidity of brain mitochondrial membranes led to the hypothesis that piracetam might improve mitochondrial function, e.g., might enhance ATP synthesis. This assumption has recently been supported by a number of observations showing enhanced mitochondrial membrane potential, enhanced ATP production, and reduced sensitivity for apoptosis in a variety of cell and animal models for aging and Alzheimer disease. As a specific consequence, substantial evidence for elevated neuronal plasticity as a specific effect of piracetam has emerged. Taken together, this new findings can explain many of the therapeutic effects of piracetam on cognition in aging and dementia as well as different situations of brain dysfunctions.
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Affiliation(s)
- Kristina Leuner
- Department of Pharmacology, Biocenter, University of Frankfurt Frankfurt, Germany
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Müller WE, Eckert A, Kurz C, Eckert GP, Leuner K. Mitochondrial dysfunction: common final pathway in brain aging and Alzheimer's disease--therapeutic aspects. Mol Neurobiol 2010; 41:159-71. [PMID: 20461558 DOI: 10.1007/s12035-010-8141-5] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 04/15/2010] [Indexed: 12/21/2022]
Abstract
As a fully differentiated organ, our brain is very sensitive to cumulative oxidative damage of proteins, lipids, and DNA occurring during normal aging because of its high energy metabolism and the relative low activity of antioxidative defense mechanisms. As a major consequence, perturbations of energy metabolism including mitochondrial dysfunction, alterations of signaling mechanisms and of gene expression culminate in functional deficits. With the increasing average life span of humans, age-related cognitive disorders such as Alzheimer's disease (AD) are a major health concern in our society. Age-related mitochondrial dysfunction underlies most neurodegenerative diseases, where it is potentiated by disease-specific factors. AD is characterized by two major histopathological hallmarks, initially intracellular and with the progression of the disease extracellular accumulation of oligomeric and fibrillar beta-amyloid peptides and intracellular neurofibrillary tangles composed of hyperphosphorylated tau protein. In this review, we focus on findings in AD animal and cell models indicating that these histopathological alterations induce functional deficits of the respiratory chain complexes and therefore consecutively result in mitochondrial dysfunction and oxidative stress. These parameters lead synergistically with the alterations of the brain aging process to typical signs of neurodegeneration in the later state of the disease, including synaptic dysfunction, loss of synapses and neurites, and finally neuronal loss. We suggest that mitochondrial protection and subsequent reduction of oxidative stress are important targets for prevention and long-term treatment of early stages of AD.
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Affiliation(s)
- Walter E Müller
- Department of Pharmacology, Biocenter, University of Frankfurt, Max-von Laue-Strasse 9, 60438, Frankfurt, Germany.
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128
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Wirth S, Kurz C, Nouri K, Mayerhofer K, Huber JC, Ott J. Schwangerschaftsoutcome nach Ovarialstichelung bei Patientinnen mit Polyzystischem Ovarsyndrom. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1254986] [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: 10/19/2022] Open
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129
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Kurz C, Ungerer I, Lipka U, Kirr S, Schütt T, Eckert A, Leuner K, Müller WE. The metabolic enhancer piracetam ameliorates the impairment of mitochondrial function and neurite outgrowth induced by beta-amyloid peptide. Br J Pharmacol 2010; 160:246-57. [PMID: 20218980 DOI: 10.1111/j.1476-5381.2010.00656.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE beta-Amyloid peptide (Abeta) is implicated in the pathogenesis of Alzheimer's disease by initiating a cascade of events from mitochondrial dysfunction to neuronal death. The metabolic enhancer piracetam has been shown to improve mitochondrial dysfunction following brain aging and experimentally induced oxidative stress. EXPERIMENTAL APPROACH We used cell lines (PC12 and HEK cells) and murine dissociated brain cells. The protective effects of piracetam in vitro and ex vivo on Abeta-induced impairment of mitochondrial function (as mitochondrial membrane potential and ATP production), on secretion of soluble Abeta and on neurite outgrowth in PC12 cells were investigated. KEY RESULTS Piracetam improves mitochondrial function of PC12 cells and acutely dissociated brain cells from young NMRI mice following exposure to extracellular Abeta(1-42). Similar protective effects against Abeta(1-42) were observed in dissociated brain cells from aged NMRI mice, or mice transgenic for mutant human amyloid precursor protein (APP) treated with piracetam for 14 days. Soluble Abeta load was markedly diminished in the brain of those animals after treatment with piracetam. Abeta production by HEK cells stably transfected with mutant human APP was elevated by oxidative stress and this was reduced by piracetam. Impairment of neuritogenesis is an important consequence of Abeta-induced mitochondrial dysfunction and Abeta-induced reduction of neurite growth in PC12 cells was substantially improved by piracetam. CONCLUSION AND IMPLICATIONS Our findings strongly support the concept of improving mitochondrial function as an approach to ameliorate the detrimental effects of Abeta on brain function.
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Affiliation(s)
- C Kurz
- Department of Pharmacology, Biocenter, University Frankfurt/M, Germany
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Obermair A, Czerwenka K, Kurz C, Schemper M, Sevelda P. Vessel Invasion Predicts Early Recurrence in Breast Cancer: Preliminary Results. Oncol Res Treat 2009. [DOI: 10.1159/000218302] [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: 11/19/2022]
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Obermair A, Czerwenka K, Kurz C, Buxbaum P, Schemper M, Sevelda P. Influence of Tumoral Microvessel Density on the Recurrence-Free Survival in Human Breast Cancer: Preliminary Results. Oncol Res Treat 2009. [DOI: 10.1159/000218380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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134
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Burstein A, Kurz C, Tesar L. Trade, production sharing, and the international transmission of business cycles. J Monet Econ 2008; 55:775-795. [PMID: 32287879 PMCID: PMC7115791 DOI: 10.1016/j.jmoneco.2008.03.004] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 05/12/2023]
Abstract
Countries that are more engaged in production sharing exhibit higher bilateral manufacturing output correlations. We use data on trade flows between US multinationals and their affiliates as well as trade between the United States and Mexican maquiladoras to measure production-sharing trade and its link with the business cycle. We then develop a quantitative model of international business cycles that generates a positive link between the extent of vertically integrated production-sharing trade and internationally synchronized business cycles. A key assumption in the model is a relatively low elasticity of substitution between home and foreign inputs in the production of the vertically integrated good.
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Affiliation(s)
| | | | - Linda Tesar
- Department of Economics, University of Michigan, 611 Tappan Street, Ann Arbor, MI 48109, USA and NBER
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Walch K, Unfried G, Huber J, Kurz C, Trotsenburg MV, Wenzl R. Behandlungsmöglichkeit der symptomatischen Endometriose mit Implanon®. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983617] [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] Open
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Lipovac M, Kurz C, Reithmayr F, Verhoeven HC, Huber JC, Imhof M. Prevention of recurrent bacterial urinary tract infections by intravesical instillation of hyaluronic acid. Int J Gynaecol Obstet 2007; 96:192-5. [PMID: 17280667 DOI: 10.1016/j.ijgo.2006.11.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 11/19/2006] [Accepted: 11/29/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy of vesical instillation of hyaluronic acid against recurrent urinary tract infections. METHODS Twenty women with a history of recurrent urinary tract infections each received 9 intravesical instillations of hyaluronic acid over 6 months. Their status was assessed prospectively over 47.6 weeks and compared with a retrospective review of patient charts covering 36.2+/-6.2 weeks. RESULTS The total numbers of urinary tract infections were 67 before and 10 after treatment (p<0.001). Thirteen patients (65%) were free of recurrences until the end of the study. One had a recurrence during treatment, and 6 (30%) during follow-up. The number of infections per year per patient was reduced from 4.99+/-0.92 to 0.56+/-0.82 (p<0.001). In women with recurrences, time to recurrence was 178.3+/-25.5 days, compared with 76.7+/-24.6 days before treatment (p<0.001). CONCLUSION Intravesical instillation of hyaluronic acid is effective in preventing recurrent urinary tract infections.
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Affiliation(s)
- M Lipovac
- Medical University of Vienna, Department of Obstetrics and Gynecology, AKH, Vienna, Austria.
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a disease with progressive and devastating deterioration of lung function and a fatal prognosis, despite aggressive therapeutic attempts, which, in the majority of cases are futile. Recently, a preliminary study of long-term treatment with interferon (IFN)-gamma1b and low-dose prednisolone in patients with IPF suggested that IFN-gamma1b treatment may improve lung function parameters of patients with IPF. Ever since, specialists in respiratory medicine who treat patients with IPF, are called by patients demanding treatment with IFN-gamma1b. Therefore, the authors here present another prospective investigation of IFN-gamma1b in five patients with IPF. According to the previously published design, patients received 200 microg IFN-gamma1b subcutaneously three-times per week and 10 mg prednisolone orally for 12 months. Two patients stopped IFN-gamma1b treatment after 4 months due to side-effects and further lung function deterioration and one patient died 3 months after commencement of therapy. In total, pulmonary function improved in only one patient during IFN-gamma1b treatment, while four patients deteriorated. To conclude, this small series of idiopathic pulmonary fibrosis cases treated with interferon-gamma1b and corticosteroids does not support previous data that this treatment improves pulmonary function or alters the natural course of idiopathic pulmonary fibrosis. Furthermore, in the authors' experience, side-effects of interferon-gamma1b treatment can significantly reduce patients' quality of life.
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Affiliation(s)
- A Prasse
- Dept of Pneumology, University Clinic, Freiburg, Germany.
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Wieser F, Schneeberger C, Hudelist G, Singer C, Kurz C, Nagele F, Gruber C, Huber JC, Tschugguel W. Endometrial nuclear receptor co-factors SRC-1 and N-CoR are increased in human endometrium during menstruation. Mol Hum Reprod 2002; 8:644-50. [PMID: 12087079 DOI: 10.1093/molehr/8.7.644] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
Steroid hormone receptor co-factors are abundantly expressed in the uterus in order to modify steroid hormone receptor action, either leading to activation or repression of transcription in the endometrium. However, the role of co-factors in remodelling of the human endometrium has not been established. We therefore endeavoured to evaluate the presence of the co-activator SRC (steroid receptor co-activator)-1 and the co-repressors N-CoR (nuclear receptor co-repressor) and steroid co-repressor SMRT (silencing mediator of retinod and thyroid) receptors in the human endometrium during the different phases of the menstrual cycle. By using a real-time RT-PCR assay, we showed that SRC-1, N-CoR and SMRT mRNA are expressed in human endometrium during all phases of the menstrual cycle, as well as in inactive endometrium. Moreover, endometrial expression of SRC-1 and N-CoR mRNA increased during menstruation when compared with the other phases of the menstrual cycle (P < 0.001). Immunohistochemistry demonstrated that SRC-1 and N-CoR stain positive in the glandular epithelium and stroma in menstrual phase endometrium. The staining was weak in proliferative and secretory endometrium and absent in inactive endometrium. Our results suggest that differential expression of endometrial steroid receptor co-factors probably play a role in the regulation of human endometrium remodelling.
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Affiliation(s)
- F Wieser
- Division of Gynaecological Endocrinology and Reproductive Medicine, University of Vienna Medical School, Vienna, Austria
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Kurz C, Tempfer CB, Boecskoer S, Unfried G, Nagele F, Hefler LA. The PROGINS progesterone receptor gene polymorphism and idiopathic recurrent miscarriage. J Soc Gynecol Investig 2001; 8:295-8. [PMID: 11677150 DOI: 10.1016/s1071-5576(01)00123-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Progesterone inhibits lymphocyte cytotoxicity, natural killer cell degranulation, and release of proinflammatory cytokines and has been shown to protect against spontaneous miscarriage. We investigated the association between idiopathic recurrent miscarriage (IRM) and the PROGINS 306 base pair insertion polymorphism in intron G of the progesterone receptor gene, which is known to segregate with progesterone-dependent neoplasms. METHODS In a case-control study we investigated 125 women with a history of three or more consecutive pregnancy losses before 20 weeks' gestation and 79 healthy controls with at least two live births and no history of pregnancy loss. Peripheral venous puncture, DNA extraction, and polymerase chain reaction were used to genotype women for the presence of the PROGINS polymorphism. RESULTS Allele frequencies among women with IRM and controls were 85.2% and 89.2%, respectively, for allele T1 (wild type) and 14.8% and 10.8%, respectively, for allele T2 (mutant). No association between allele T2 and the occurrence of IRM was found (P =.3; odds ratio [OR] 0.69; confidence interval [CI] 0.34, 1.40). Genotype frequencies were not significantly different between the study group (T1/T1 73.6%, T1/T2 23.2%, T2/T2 3.2%) and the control group (T1/T1 79.7%, T1/T2 19%, T2/T2 1.3%) (P =.4). Between women with primary and secondary IRM, there were no statistically significant differences with respect to allele frequencies (82% versus 87%, P =.4 for allele T1 and 12% versus 13%, P =.6 for allele T2). CONCLUSIONS We found that the PROGINS polymorphism in the progesterone receptor gene was not associated with IRM in white women.
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Affiliation(s)
- C Kurz
- Department of Endocrinology and Reproductive Medicine, University of Vienna School of Medicine, Vienna, Austria
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Affiliation(s)
- F Wieser
- Division of Gynecological Endocrinology & Reproductive Medicine, University Department of Obstetrics and Gynecology, Waeringer Guertel 18-20, A-1090 Vienna, Austria
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Kurz C, Hefler L, Zeisler H, Schatten C, Husslein P, Tempfer C. Maternal basic fibroblast growth factor serum levels are associated with pregnancy-induced hypertension. J Soc Gynecol Investig 2001; 8:24-6. [PMID: 11223353] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To test the hypothesis that serum levels of basic fibroblast growth factor (bFGF) are altered among women with pregnancy-induced hypertension (PIH) and are associated with disease severity. METHODS We evaluated serum levels of bFGF in 46 women with PIH, 46 age- and parity-matched healthy pregnant women, and 46 healthy nonpregnant controls. Enzyme-linked immunosorbent assays were used to determine serum levels of bFGF. Results were correlated to clinical data. RESULTS The overall mean serum levels of bFGF were 3.2 (standard deviation [SD] 9.3) micromol/L. Mean serum levels of bFGF in normal controls, healthy pregnant women, and women with PIH were 0 (SD 0) micromol/L, 2.6 (SD 6.3) micromol/L, and 6.8 (SD 13.8) micromol/L, respectively (P =.003) for normal controls compared with healthy pregnant women and P <.001 for healthy pregnant women compared with women with PIH). In a univariate logistic regression model bFGF showed a significant influence on the odds of presenting with PIH compared with healthy pregnant women (P =.002). The mean serum levels of bFGF in women with severe PIH and in women with mild PIH were 4.4 (SD 10.6) micromol/L and 9.5 (SD 17.3) micromol/L, respectively (P =.1). In a univariate logistic regression model bFGF did not reveal a significant influence on the odds of developing severe PIH (P =.3). CONCLUSIONS Elevated serum levels of bFGF are associated with PIH, but bFGF does not seem to be a useful prognostic parameter for severe PIH.
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Affiliation(s)
- C Kurz
- Department of Obstetrics and Gynecology, University of Vienna Medical School, Währinger Gürtel 19-20, A-1090 Vienna, Austria
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Tschugguel W, Schneeberger C, Unfried G, Bräutigam G, Wieser F, Czerwenka K, Vytiska-Binstorfer E, Kurz C, Weninger W, Mildner M, Waselmayr B, Bursch W, Kaider A, Waldhör T, Breitschopf H, Ellinger A, Huber JC. [The role of nitric oxide in reproduction]. Gynakol Geburtshilfliche Rundsch 2000; 38:44-6. [PMID: 9658716 DOI: 10.1159/000022226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nitrix oxide (NO) is a highly reactive and short-lived radical (half-life time: 10-12 s), which is derived from L-arginine by the NO synthases (NOS) in several organ systems. The release of NO by endothelial cells leads to rapid relaxation of vascular smooth muscle cells, whereas release by several neuronal cells causes neurotransmission. When NOS is actively induced in immune cells or certain epithelia it causes cytotoxicity and/or apoptosis of these cells. In the reproductive organs NO is now considered to be an important trigger molecule for several physiological mechanisms. Follicular synthesized NO is involved in rupture of the follicle during ovulation. Moreover, NO participates in the acrosome reaction of spermatozoa during capacitation. Apoptosis and collagenolysis of the functional endometrium may be involved in endometrial shedding during menstruation. Since NO induces both apoptosis and collagenolysis, the newly discovered production of NO in late secretory endometrium could act as a key mechanism in the process of menstrual disintegration of the endometrium. Additionally, NO is necessary to support and maintain the decidualization process and plays a pivotal role in implantation.
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Affiliation(s)
- W Tschugguel
- Abteilung für gynäkologische Endokrinologie und Sterilitätsbehandlung, Klinik für Geburtshilfe und Frauenheilkunde, Universität Wien, Osterreich.
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143
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Jirecek S, Wieser F, Kurz C, Albrecht A, Nagele F, Wenzl R. [Technique and results of laparoscopic conservative organ-preserving myoma enucleation]. Wien Klin Wochenschr 2000; 112:276-80. [PMID: 10815303] [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: 02/16/2023]
Abstract
Myoma is one of the most common benign diseases of the female genital tract. The surgical management of this entity has been altered over the last years from complete hysterectomy to conservative enucleation of the myomas. We retrospectively compared our data concerning laparoscopic or open myomectomies. Over a period of 2 years, we operated 207 myomas in 102 patients. Of this collective, 69 (67.6%) were operated on laparoscopically and 33 (32.4%) via an open approach. In both groups, the median number of myomas was 2 (1-7). The mean diameter of the largest myoma was 5.1 +/- 2.4 cm (laparoscopy) and 6.2 +/- 2.6 cm (laparotomy), respectively. The additive diameter of myomas was 7.7 +/- 5.1 cm (laparoscopy) and 9.8 +/- 4.1 cm (laparotomy), respectively. There was no relevant difference between the groups in terms of operating time and blood loss. Four (3.9%) laparoscopies had to be converted to an open approach. In three cases (2.9%) a laparoscopically assisted enucleation had to be performed, requiring a mini-laparotomy 4 to 5 cm in length. We encountered no severe complications. Given appropriate indication, laparoscopic myomectomy is an easy-to-perform and minimally invasive technique with a low complication rate.
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Affiliation(s)
- S Jirecek
- Abteilung für Geburtshilfe und Gynäkologie, Universitätsklinik für Frauenheilkunde, Wien, Osterreich.
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Lahousen M, Haas J, Pickel H, Hackl A, Kurz C, Ogris H, Stummvoll W, Winter R. Chemotherapy versus radiotherapy versus observation for high-risk cervical carcinoma after radical hysterectomy: A randomized, prospective, multicenter trial. Gynecol Oncol 1999; 73:196-201. [PMID: 10329034 DOI: 10.1006/gyno.1999.5343] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [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: 11/22/2022]
Abstract
BACKGROUND Adjuvant treatment modalities after radical hysterectomy have long been used in an attempt to eradicate microscopic tumor residuals in patients at high risk for recurrence. However, it has not been clearly demonstrated that adjuvant radiation, adjuvant chemotherapy, or both improve the outcome. To evaluate the effect of adjuvant treatment in patients with high-risk cervical cancer after radical hysterectomy, the Austrian Gynecologic Oncology Group conducted a prospective, randomized, multicenter clinical trial between 1989 and 1995. MATERIAL AND METHODS Seventy-six patients with stage IB-IIB cervical cancer treated with radical hysterectomy with pelvic lymph node metastases and/or vascular invasion randomly received adjuvant chemotherapy (400 mg/m2 carboplatin, and 30 mg bleomycin), standardized external pelvic radiation therapy, or no further treatment. RESULTS After a median follow-up of 4.1 years (range, 2-7) there were no statistically significant differences (P = 0.9530) in disease-free survival among the three treatment arms. CONCLUSION The data suggest that adjuvant chemotherapy or radiation do not improve survival or recurrence rates in high-risk cervical cancer patients after radical hysterectomy. The most important treatment for these patients seems to be radical abdominal hysterectomy with systematic pelvic lymphadenectomy.
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Affiliation(s)
- M Lahousen
- Department of Gynecology and Obstetrics, University of Graz, Graz, A-8036, Austria
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Wieser F, Albrecht A, Kurz C, Wenzl R, Nagele F. [Ambulatory hysteroscopy in evaluation of postmenopausal bleeding]. Wien Klin Wochenschr 1999; 111:289-93. [PMID: 10355040] [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: 02/12/2023]
Abstract
INTRODUCTION Diagnostic hysteroscopy is the most precise procedure to evaluate diseases involving the uterine cavity. There is, however, only limited data concerning the use of hysteroscopy carried out as an outpatient procedure in patients with postmenopausal bleeding. MATERIALS AND METHODS In this study we report on 360 postmenopausal patients with erratic bleeding, who were referred to our outpatient hysteroscopy clinic. 185 women had frank postmenopausal bleeding (PMB) and another 175 had abnormal uterine bleeding while taking hormone replacement therapy (AUB). The mean age was 57.9 years (range: 42-86). All hysteroscopies were performed using a standard 5-mm hysteroscope with a 30 degrees fore-oblique lens; the uterine cavity was generally distended with normal saline. RESULTS Outpatient hysteroscopy was performed successfully in 339 patients (94.2%). In 166 cases (46.1%) cervical dilatation was necessary, and 138 required (38.3%) intracervical anaesthesia. Intrauterine pathology was diagnosed in 49.6% of cases, with endometrial polyps (20.9%) and fibroids (15.9%) being the most common abnormalities. While there was no difference in the incidence of intrauterine lesions between patients with AUB and those with PMB, endometrial carcinoma was more common in the latter group (PMB: n = 11 vs. AUB: n = 1; p < 0.002). CONCLUSION Due to its high accuracy and patient acceptance, outpatient diagnostic hysteroscopy should become a first line investigation in postmenopausal patients with bleeding disorders.
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Affiliation(s)
- F Wieser
- Abteilung für gynäkologische Endokrinologie und Sterilitätsbehandlung, Universitätsklinik für Frauenheilkunde, Wien, Osterreich
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146
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Abstract
OBJECTIVE It has been suggested that exposure to relatively high levels of unopposed estrogen is a risk factor for endometrial cancer. Combined therapy of estrogen with cyclic progestagen was therefore highly recommended for menopausal women with an intact uterus. METHODS The cases of two postmenopausal women who developed endometrial cancer after taking continuous sequential HRT for 15 months are reported. Both were without bleeding for more than 2 years and presented with a normal vaginal ultrasound. They had severe menopausal symptoms and asked for HRT. RESULTS After 15 months irregular bleeding occurred and a hysterectomy was performed. The pathohistological finding in both cases was endometrial cancer. As we measured the serum estradiol levels 4 h after tablet ingestion supraphysiologic values ranging between 418 and 442 pg/ml were found. CONCLUSION Our report strengthens the evidence that supraphysiologic estradiol levels despite combination with cyclic progestagen therapy, increase the risk of endometrial cancer.
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Affiliation(s)
- D M Gruber
- Department of Gynecological Endocrinology and Reproductive Medicine, University of Vienna, Austria.
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147
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Knappitsch G, Gruböck K, Salzer H, Kaider A, Kurz C, Vavra N, Speiser P, Sevelda P. [Survival prognosis in ovarian carcinoma Figo stages III and IV: 1980-1985 versus 1986-1993. A comparison of 2 treatment periods]. Gynakol Geburtshilfliche Rundsch 1998; 37:221-6. [PMID: 9609931 DOI: 10.1159/000272858] [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: 11/19/2022]
Abstract
We examined the survival prognosis of 638 patients who had ovarian carcinoma Figo stages III and IV. We considered two separate time periods, 1980-1985 versus 1986-1993, including the size of the postoperative residual tumor, polychemotherapy with and without platinum, histological grading 1 versus 2 and 3, Figo stage III versus IV, and ascites present versus no ascites. Since 1986, 96% of the patients received platinum-containing polychemotherapy at a dosage of > or = 75 mg/m2, whereas between 1980 and 1985, only 76% of these patients received platinum-containing polychemotherapy at a dosage of 50 mg/m2, and 24% of the patients received polychemotherapy without platinum. The size of residual tumor masses and also the time period of treatment had an independent influence on survival prognosis. Patients treated from 1980 to 1985 had a relative risk to die which was 1.44 times higher than for the patients who were studied from 1986 to 1993.
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Affiliation(s)
- G Knappitsch
- Abteilung für Geburtshilfe und Gynäkologie, Universitäts-Frauenklinik Wien, Osterreich
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Abstract
OBJECTIVE To evaluate the efficacy of topical anesthesia routinely administered to reduce discomfort and the need for additional local anesthesia during outpatient hysteroscopy. DESIGN Comparative observational study. SETTING Outpatient hysteroscopy clinic in a University hospital. PATIENT(S) Three hundred patients undergoing outpatient hysteroscopy. INTERVENTION(S) Application of lidocaine spray both to the surface of the cervix and into the cervical canal before performing hysteroscopy. MAIN OUTCOME MEASURE(S) The discomfort during passage of the hysteroscope through the cervical canal, the need for additional local anesthesia, and the failure rate of outpatient hysteroscopy. RESULT(S) One hundred fifty consecutive patients receiving lidocaine spray before the hysteroscopy were compared to a control group of another 150 consecutive patients who underwent the examination without pretreatment. Women treated with spray experienced significantly less pain at insertion of the hysteroscope. Furthermore, the spray significantly reduced both the need for additional anesthesia and the rate of failed hysteroscopies due to intolerable pain. CONCLUSION(S) Topical anesthesia with lidocaine spray is a simple method to alleviate patients' discomfort during cervical passage. It is effective in reducing the need for local anesthesia and should reduce the rate of failed outpatient hysteroscopies.
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Affiliation(s)
- F Wieser
- University Hospital of Vienna, Minimally Access Surgery Unit, Austria
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Abstract
It is generally accepted that mitochondria are able to proliferate even in postmitotic cells due to their natural turnover and also to satisfy increased cell energy requirements. However, no detailed studies are available, particularly with respect to specific cell types. Since [3H]-thymidine is incorporated not only into nuclear (n) DNA but also into the DNA of cytoplasmic mitochondria, an autoradiographic approach was developed at the light microscopy level in order to study basic questions of mitochondrial (mt) proliferation in organs of rodents in situ via the cytoplasmic incorporation of [3H]-thymidine injected into the animals 1 h before sacrifice. Experiments carried out on mice after X-irradiation showed that cytoplasmic labeling was not due to a process such as unscheduled nuclear DNA synthesis (nUDS). Furthermore, half-lives of mitochondria between 8-23 days were deduced specifically in relation to cell types. The phase of mtDNA synthesis was about 75 min. Finally, mt proliferation was measured in brain cells of mice as a function of age. While all neurons showed a decreasing extent of mtDNA synthesis during old age, nUDS decreased only in distinct cell types of the cortex and hippocampus. We conclude that the leading theories explaining the phenomenon of aging are closely related, i.e., aging is due to a decreasing capacity of nDNA repair, which leads to unrepaired nDNA damage, or to an accumulation of mitochondria with damaged mtDNA, which leads to a deficit of cellular energy production.
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Affiliation(s)
- H Korr
- Department of Anatomy and Cell Biology, RWTH University of Aachen, Germany.
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Abstract
This is the case report of a 30-year-old actress who presented with a Class I bimaxillary protrusion. Because of esthetic concerns related to her public career, she was treated with a lingual appliance. An extraction of four premolars resulted in a greatly improved facial profile.
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