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Whelan C, Coelho T, Conceicao I, Brannagan Iii TH, Wang AK, Polydefkis MJ, Dyck PJ, Berk JL, Obici L, Kristen A, Narayana A, Olugemo K, Aquino P, Benson MD, Gertz M. Long-term efficacy and safety of inotersen in patients with hereditary transthyretin amyloid polyneuropathy with or without cardiomyopathy: post hoc analysis of NEURO-TTR open-label extension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2745] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Cardiomyopathy (CM) with associated heart failure and polyneuropathy (PN) are common manifestations of hereditary transthyretin amyloidosis (ATTRv), a progressive, debilitating, and fatal disease that results from the deposition of misfolded transthyretin (TTR) protein throughout the body. NEURO-TTR (NCT01737398) showed that inotersen, an antisense oligonucleotide inhibitor of TTR protein production, slowed the progression of PN and maintained quality of life in patients with ATTRv.
Purpose
To report efficacy and safety from the open-label extension (OLE) of the NEURO-TTR study in patients with ATTRv PN overall and in CM subgroups.
Methods
Patients who completed NEURO-TTR, enrolled in the OLE (NCT02175004), and either switched from placebo in NEURO-TTR to inotersen in the OLE (placebo-inotersen) or received inotersen in NEURO-TTR and remained on inotersen in the OLE (inotersen-inotersen) were included. Assessments included the modified Neuropathy Impairment Score +7 composite score (mNIS+7 [range –22.3 to 346.3], a measure of neuropathy with higher scores indicative of poorer function), TTR levels, and safety monitoring. Utilizing patients from Europe and North America (EU+NA) as of 28 July 2020, this post hoc analysis examined two subgroups: CM ECHO and severe CM ECHO. CM was defined as a diagnosis of ATTRv CM at study entry or all of the following criteria: a left ventricular wall thickness of ≥1.3 cm on transthoracic echocardiography at baseline, no known history of persistent hypertension (systolic blood pressure ≥150 mm Hg) within 12 months before study screening, and evaluable baseline ECHO obtained by central assessment. Severe CM was defined as an interventricular septum thickness ≥1.5 cm at baseline. Descriptive statistics are reported.
Results
In the overall population and both CM subgroups, the placebo-inotersen group demonstrated slowing of neurological disease progression compared with natural history based on NEURO-TTR placebo projection (estimated natural history will be presented). Furthermore, in the overall population and both CM subgroups, the inotersen-inotersen group demonstrated sustained benefit compared with the placebo-inotersen group (Table). Change in serum TTR levels will be presented. There have been no reports of grade 4 thrombocytopenia or acute glomerulonephritis under enhanced monitoring in patients in the EU+NA despite the increased duration of exposure. No new safety concerns were identified.
Conclusions
Inotersen treatment for >3 years slowed the progression of PN associated with ATTRv in patients with CM, including severe CM. In both subgroups, greater neurological preservation was observed in those who initiated inotersen earlier (inotersen-inotersen group), underscoring the benefits of early treatment. No new safety signals were detected in this OLE analysis; enhanced monitoring is successful in managing the risk for thrombocytopenia and acute glomerulonephritis.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Akcea Therapeutics, an affiliate of Ionis Pharmaceuticals, Inc.
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Affiliation(s)
- C Whelan
- National Amyloidosis Centre, Royal Free Hospital, London, United Kingdom
| | - T Coelho
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - I Conceicao
- CHULN, Hospital Santa Maria and Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - T H Brannagan Iii
- Columbia University Medical Center, New York, United States of America
| | - A K Wang
- University of California, Irvine, Orange, United States of America
| | - M J Polydefkis
- Johns Hopkins University, Baltimore, United States of America
| | - P J Dyck
- Mayo Clinic, Rochester, United States of America
| | - J L Berk
- Boston University, Boston, United States of America
| | - L Obici
- Amyloidosis Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - A Kristen
- Amyloidosis Center, Heidelberg University Hospital, Heidelberg, Germany
| | - A Narayana
- Akcea Therapeutics, Boston, United States of America
| | - K Olugemo
- Akcea Therapeutics, Boston, United States of America
| | - P Aquino
- Akcea Therapeutics, Boston, United States of America
| | - M D Benson
- Indiana University School of Medicine, Indianapolis, United States of America
| | - M Gertz
- Mayo Clinic, Rochester, United States of America
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Maurer M, Kristen A, Benson M, Falk R, Buchele G, Brambatti M, Tsimikas S, Viney N, Tai L, Monteiro C, Yang Q, O'Dea L, Schneider E, Geary R, Monia B. EVALUATION OF THE EFFICACY AND SAFETY OF IONIS-TTR-LRX IN PATIENTS WITH TRANSTHYRETIN-MEDIATED AMYLOID CARDIOMYOPATHY: THE CARDIO-TTRANSFORM STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Krietsch A, Reyes Rodriguez M, Kristen A, Kadoke D, Abbas Z, Krause U. Ignition temperatures and flame velocities of metallic nanomaterials. J Loss Prev Process Ind 2021. [DOI: 10.1016/j.jlp.2021.104482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Abstract
Background
In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), tafamidis was shown to be an effective treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Further assessment of the efficacy of tafamidis in patients with more advanced ATTR-CM would aid treatment decisions.
Purpose
To characterize the benefits of tafamidis in patients with advanced ATTR-CM.
Methods
In ATTR-ACT, ATTR-CM patients were randomized to tafamidis (n=264) or placebo (n=177) for 30 months. Efficacy outcomes included all-cause mortality and frequency of cardiovascular (CV)-related hospitalisations. Key secondary endpoints were change from baseline to Month 30 in 6MWT distance and KCCQ-OS score. Efficacy assessments in NYHA Class III patients at baseline (n=141) were a pre-specified analysis. In a post-hoc analysis, mortality and CV-related hospitalizations were assessed in all patients grouped into quartiles of increasing disease severity based on 6MWT distance at baseline. Longer-term all-cause mortality (as of 1 Aug 2019) was assessed in NYHA Class III patients utilizing data from ATTR-ACT patients who enrolled in a long-term, extension study (LTE) and continued treatment with higher dose tafamidis (n=55; median treatment duration 51.6 months); or, if previously treated with placebo, started tafamidis treatment (placebo/tafamidis; n=63 [50.1 months]).
Results
In advanced ATTR-CM patients (NYHA Class III), tafamidis reduced the risk of death (HR [95% CI] 0.837, [0.541, 1.295], P=0.4253), and the decline in 6MWT distance (LS mean [SE], 31.6 (22.1) m; P=0.1526) and KCCQ-OS score (LS mean [SE], 13.1 (5.0); P=0.0090), vs placebo. Paradoxically, there was a higher frequency of CV-related hospitalizations with tafamidis (RR [95% CI] vs placebo, 1.411 [1.048, 1.900]). In all patients by 6MWT quartile, CV-related hospitalizations/year with tafamidis and placebo increased with disease severity, with the exception that placebo-treated patients in the highest severity quartile had fewer CV-related hospitalisations (0.73) than those in the third quartile (0.92). Mortality with tafamidis and placebo increased, and was greater with placebo, in every quartile (Figure). Survival (NYHA Class III patients in ATTR-ACT and LTE) was improved with high dose tafamidis with longer term follow-up (HR vs placebo/tafamidis [95% CI], 0.6569 [0.4175, 1.0336]; P=0.0692).
Conclusions
These analyses, including longer-term follow-up, demonstrate that patients with advanced ATTR-CM benefit from tafamidis. The decrease in CV-related hospitalisations in more severe patients treated with placebo suggests that the comparatively greater hospitalisation frequency in NYHA Class III patients treated with tafamidis is a consequence of their lower mortality rate.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was sponsored by Pfizer
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Affiliation(s)
- C Rapezzi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - A.V Kristen
- University of Heidelberg, Amyloidosis Center, Department of Cardiology, Heidelberg, Germany
| | | | - M.B Sultan
- Pfizer Inc, New York, United States of America
| | - M Hanna
- Cleveland Clinic, Cleveland, United States of America
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Polydefkis M, Gillmore J, Dispenzieri A, Chen J, Sweetser M, Vest J, Melanson M, Conceicao I, Kristen A. Risk Factors for Mortality in Patients with Hereditary Transthyretin-Mediated Amyloidosis: An Analysis of APOLLO and Global Open Label Extension Studies. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kreusser M, Kristen A, Blum P, Schönland S, Ruhparwar A, Hegenbart U, Katus H, Raake P. Herztransplantation bei kardialer Amyloidose - Erfahrung aus 48 Patienten am Universitätsklinikum Heidelberg. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Kreusser
- University of Heidelberg, Heidelberg, Germany
| | - A. Kristen
- University of Heidelberg, Heidelberg, Germany
| | - P. Blum
- University of Heidelberg, Heidelberg, Germany
| | | | | | | | - H. Katus
- University of Heidelberg, Heidelberg, Germany
| | - P. Raake
- University of Heidelberg, Heidelberg, Germany
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Alavi N, Reshetukha T, Prost E, Kristen A, Groll D. What is commonly missed in the suicidal risk assessments in the emergency room? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionSuicidal behaviour remains the most common reason for presentation to the emergency rooms. In spite of identifiable risk factors, suicide remains essentially unpredictable by current tools and assessments. Moreover, some factors may not be included consistently in the suicidal risk assessments in the emergency room by either emergency medicine physicians or psychiatrists.MethodStep 1 involved the administration of a survey on the importance of suicide predictors for assessment between psychiatry and emergency medicine specialties. In step 2 a chart review of psychiatric emergency room patients in Kingston, Canada was conducted to determine suicide predictor documentation rates. In step 3, based on the result of the first 2 steps a suicide risk assessment tool (Suicide RAP [Risk Assessment Prompt]) was developed and presented to both teams. A second patient chart review was conducted to determine the effectiveness of the educational intervention and suicide RAP in suicide risk assessment.ResultsSignificant differences were found in the rating of importance and the documentation rates of suicide predictors between the two specialties. Several predictors deemed important, have low documentation rates. Thirty of the suicide predictors showed increased rates of documentation after the educational intervention and the presentation of the suicide RAP.ConclusionThough a surfeit of information regarding patient risk factors for suicide is available, clinicians and mental health professionals face difficulties in integrating and applying this information to individuals. Based on the result of this study suicide RAP and educational intervention could be helpful in improving the suicidal risk assessment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kristen A, Sack FU, Dösch A, Schnabel P, Katus H, Dengler T. Das verflixte 7. Jahr? Erfreulicher Langzeitverlauf nach Herztransplantation bei kardialer Transthyretin-Amyloidose. Aktuel Kardiol 2012. [DOI: 10.1055/s-0032-1324822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Kristen
- Medizinische Universitätsklinik Heidelberg, Abteilung für Innere Medizin III (Kardiologie, Angiologie, Pneumologie)
| | - F.-U. Sack
- Chirurgische Universitätsklinik Heidelberg, Abteilung Herzchirurgie
| | - A. Dösch
- Medizinische Universitätsklinik Heidelberg, Abteilung für Innere Medizin III (Kardiologie, Angiologie, Pneumologie)
| | - P. Schnabel
- Institut für Pathologie der Universität Heidelberg
| | - H. Katus
- Medizinische Universitätsklinik Heidelberg, Abteilung für Innere Medizin III (Kardiologie, Angiologie, Pneumologie)
| | - T. Dengler
- Medizinische Universitätsklinik Heidelberg, Abteilung für Innere Medizin III (Kardiologie, Angiologie, Pneumologie)
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Reiss N, Kristen A, Schoenland S, Hegenbart U, Buss S, Sack FU, Schnabel P, Roecken C, Dengler T, Ho A, Ruhparwar A, Karck M, Katus H. 443 Is Heart Transplantation a Reasonable Concept in Patients with Severe Cardiac Amyloidosis? J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.454] [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: 11/25/2022] Open
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Doesch AO, Mueller S, Konstandin M, Celik S, Erbel C, Kristen A, Frankenstein L, Koch A, Dengler TJ, Ehlermann P, Zugck C, De Geest S, Katus HA. Increased adherence after switch from twice daily calcineurin inhibitor based treatment to once daily modified released tacrolimus in heart transplantation: a pre-experimental study. Transplant Proc 2011; 42:4238-42. [PMID: 21168673 DOI: 10.1016/j.transproceed.2010.09.074] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/02/2010] [Accepted: 09/20/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Modified release tacrolimus (TAC) is a new, once-daily oral formulation of the established immunosuppressive agent TAC. Simplification of regimen has been associated with better adherence. This study evaluated patient adherence, as well as safety and efficacy among chronic stable heart transplantation (HT) patients switched from a conventional twice daily calcineurin inhibitor-based regimen (TAC or cyclosporine A [CsA]) to (once daily) modified release TAC. METHODS We switched 54 chronic stable patients (41 males and 13 females) from twice daily dosing with conventional TAC or CsA to once daily dosing with modified release TAC. Self-reported adherence was assessed at baseline and at 4 months after the switch using the Basel Assessment of Adherence with Immunosuppressive Medication Scale [BAASIS]), a 4-item validated questionnaire including also a Visual Analogue Scale (VAS). Nonadherence was defined as any self-reported nonadherence on any item. RESULTS Modified release TAC was discontinued in 4 patients because of diarrhea (n = 1) or gastrointestinal discomfort (n = 3) leaving 50 evaluable patients. Overall nonadherence at baseline for any of the 4 items was 74% versus 38% after 4 months (P = .0001). Thereafter, adherence improved in 28 patients (56.0%), was unchanged in 18 (36.0%), and decreased in 4 subjects (8.0%). The VAS score improved from 82.3% ± 2.6% to 97.5% ± 4.8% (P < .0001). No significant changes were observed after 4 months regarding hematologic, renal, or liver function parameters (all P = NS). CONCLUSIONS Therapeutic regimens for transplant recipients are often complex, contributing to a high incidence of medication nonadherence. This study in chronic, stable, heart transplantation patients demonstrated a significant improvement in patient adherence after a switch to modified release TAC, which was generally well tolerated.
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Affiliation(s)
- A O Doesch
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
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Doesch AO, Müller S, Konstandin M, Celik S, Kristen A, Frankenstein L, Ehlermann P, Sack FU, Katus HA, Dengler TJ. Malignancies after heart transplantation: incidence, risk factors, and effects of calcineurin inhibitor withdrawal. Transplant Proc 2011; 42:3694-9. [PMID: 21094840 DOI: 10.1016/j.transproceed.2010.07.107] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/04/2010] [Accepted: 07/15/2010] [Indexed: 01/04/2023]
Abstract
The objectives of the present study were to evaluate the incidence of malignancies and to describe the effects of immunosuppression on survival and recurrence of malignancies after heart transplantation (HTX). Data were analyzed in 211 cardiac allograft recipients, in whom HTX was performed between 1989 and 2005. All of these patients survived for more than 2 years after HTX and received induction therapy with antithymocyte globulin (RATG) guided by T-cell monitoring since 1994. An immunosuppressive regimen consisting of cyclosporine A (CsA) combined with azathioprine was followed by CsA and mycophenolate mofetil (MMF) in 2001; mammalian target of rapamycin (mTOR) inhibitors (everolimus/sirolimus) were used since 2003. Mean patient age at HTX was 51.4 ± 10.5 years; mean follow-up time after HTX 9.2 ± 4.7 years. Overall incidence of neoplasias was 30.8%. Individual risk factors associated with a higher risk of malignancy after HTX were higher age at transplantation (P = .003), male gender (P = .005) and ischemic cardiomyopathy before HTX (P = .04). Administration of azathioprine (P < .0001) or a calcineurin inhibitor (CNI) (P = .02) for more than 1 year was associated with development of malignancy, whereas significantly fewer malignancies were noticed in patients receiving an mTOR-inhibitor (P < .0001). Kaplan-Meier analysis demonstrated a strong statistical trend toward an improved survival in patients with a noncutaneous neoplasia switched to a CNI-free protocol (P = .05). This study demonstrated the impact of a variety of individual risk factors and immunosuppressive drugs on development of malignancy after HTX. Markedly fewer patients with noncutaneous malignancies died after switch to a CNI-free regimen, not quite reaching statistical significance by Kaplan-Meier analysis, however.
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Affiliation(s)
- A O Doesch
- Department of Cardiology, University of Heidelberg, Germany.
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Doesch A, Mueller S, Konstandin M, Celik S, Erbel C, Kristen A, Frankenstein L, Koch A, Ehlermann P, Zugck C, Katus H. Proton Pump Inhibitor Co-medication Reduces Active Drug Exposure in Heart Transplant Recipients Receiving Mycophenolate Mofetil. Transplant Proc 2010; 42:4243-6. [DOI: 10.1016/j.transproceed.2010.09.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/09/2010] [Indexed: 01/23/2023]
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Histing T, Kristen A, Roth C, Holstein J, Garcia P, Matthys R, Menger M, Pohlemann T. In vivo gait analysis in a mouse femur fracture model. J Biomech 2010; 43:3240-3. [DOI: 10.1016/j.jbiomech.2010.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 06/25/2010] [Accepted: 07/24/2010] [Indexed: 11/25/2022]
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Doesch A, Mueller S, Celik S, Konstandin M, Ehlermann P, Kristen A, Sack FU, Katus H, Dengler T. 44: Malignancies after Heart Transplantation: Incidence, Risk Factors, and Effects of Calcineurin Inhibitor Withdrawal. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.051] [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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Doesch A, Konstandin M, Celik S, Kristen A, Schnitzler P, Koch A, Schnabel P, Katus H, Dengler T. 124: Epstein-Barr Virus and Post-Transplant Lymphoproliferative Disease in Stable Heart Transplantation (HTX) Follow-Up Patients. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dabelstein D, Kubiak T, Kristen A, Schiel R. Entwicklung einer modifizierten Fassung des Problem Areas in Diabetes (PAID) Fragebogens für Jugendliche mit Typ 1 Diabetes – psychometrische Überprüfung und erste Ergebnisse. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hosch W, Kristen A, Ley S, Katus H, Kauffmann GW, Longerich T. Histopathologische Korrelation des late enhancements bei cardialer Amyloidose. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kristen A, Kramer G, Radón S, Kubiak T, Schiel R. Veränderung psychologischer Parameter vor und nach einem erlebnispädagogisch orientierten strukturierten Behandlungs- und Schulungsprogramms bei Kindern und Jugendlichen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943875] [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]
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Kristen A, Kramer G, Radón S, Vollmann M, Kubiak T, Schiel R. Assoziation zwischen der Qualität der Stoffwechseleinstellung und Behandlungszufriedenheit bei Kindern und Jugendlichen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943939] [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]
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Kristen A, Kramer G, Radón S, Kubiak T, Schiel R. Depressivität und Ängstlichkeit bei jugendlichen Patienten mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944107] [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]
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Hosch W, Kristen A, Bock M, Libicher M, Ley S, Katus H, Kauczor HU, Kauffmann GW. Erhöhung der T1-Relaxationszeit bei kardialer Amyloidose – Erweiterung des Spektrums morphologischer und funktioneller Kriterien bei der MRT des Herzens. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Radón S, Kristen A, Kramer G, Schiel R. Komorbidität von Depression und allgemeines Wohlbefinden bei Kindern und Jugendlichen mit Übergewicht und Adipositas. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944057] [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]
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Haake C, Kristen A, Kramer G, Schiel R. Veränderung der körperlichen Leistungsfähigkeit bei Kindern und Jugendlichen mit Übergewicht und Adipositas im Rahmen eines strukturierten Behandlungs- und Schulungsprogramms (SBSP). DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944054] [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]
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Kristen A, Kramer G, Radón S, Salewski C, Kubiak T, Schiel R. Assoziation zwischen der Qualität der Stoffwechseleinstellung und den subjektiven Krankheitsannahmen bei Jugendlichen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944121] [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]
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Schiel R, Kristen A, Kubiak T, Kramer G, Ahrendt E, Perenthaler T, Kovar F, Beltschikow W. Motivationale Probleme bei Kindern und Jugendlichen mit Typ-1-Diabetes mellitus. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944119] [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]
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Kristen A, Szalai P, Preusch M, Dengler TJ, Katus HA, Borst MM, Meyer FJ. Dysfunktion der Atemmuskulatur bei Leichtkettenamyloidose. Pneumologie 2005. [DOI: 10.1055/s-2005-864263] [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]
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Kristen A, Szalai P, Celik S, Lutz M, Dengler TJ, Katus HA, Borst MM, Meyer FJ. Ventilatorische Ineffizienz unter Belastung bei Patienten mit kardialer Amyloidose. Pneumologie 2005. [DOI: 10.1055/s-2005-864264] [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]
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Abstract
Unstable pelvic girdle injury combined with severe pelvis related haemorrhage has a high mortality rate. This prognosis can be improved by using the C-clamp according to Ganz. This can be applied while the life saving measures are in progress, and should, if necessary, be combined with a pelvic tamponade. Due to the limited number of patients, trauma centres have the most experience with this technique. In this contribution, we present our standardised application technique, which allows the use of the procedure through well defined clinically recognisable orientation points in the emergency room.
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Affiliation(s)
- T Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
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