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Catalano Chiuvé S, Momjian S, Wolff A, Corniola MV. Effectiveness and reliability of hypnosis in stereotaxy: a randomized study. Acta Neurochir (Wien) 2024; 166:112. [PMID: 38411747 PMCID: PMC10899299 DOI: 10.1007/s00701-024-05943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) may experience pain during stereotactic frame (SF) fixation in deep brain stimulation (DBS). We assessed the role of hypnosis during the SF fixation in PD patients undergoing awake bilateral subthalamic nucleus (STN) DBS. METHODS N = 19 patients were included (N = 13 males, mean age 63 years; N = 10 allocated to the hypnosis and N = 9 allocated to the control groups). Patients were randomly assigned to the interventional (hypnosis and local anesthesia) or non-interventional (local anesthesia only) groups. The primary outcome was the pain perceived (the visual analogue scale (VAS)). Secondary outcomes were stress, anxiety, and depression, as measured by the perceived stress scale (PSS) and hospital anxiety and depression scale (HADS). Procedural distress was measured using the peritraumatic distress inventory (PDI-13). RESULTS In the hypnosis group, VASmean was 5.6 ± 2.1, versus 6.4 ± 1.2 in the control group (p = 0.31). Intervention and control groups reported similar VASmax scores (7.6 ± 2.1 versus 8.6 ± 1.6 (p = 0.28), respectively). Both groups had similar HADS scores (6.2 ± 4.3 versus 6.7 ± 1.92, p = 0.72 (HADSa) and 6.7 ± 4.2 versus 7.7 ± 3, p = 0.58 (HADSd)), so were the PSS scores (26.1 ± 6.3 versus 25.1 ± 7, p = 0.75). Evolutions of VASmean (R2 = 0.93, 95% CI [0.2245, 1.825], p = 0.03) and PDI-13 scores (R2 = 0.94, 95% CI [1.006, 6.279], p = 0.02) significantly differ over follow-up with patients in the hypnosis groups showing lower scores. CONCLUSION In this unblinded, randomized study, hypnosis does not influence pain, anxiety, and distress during awake SF fixation but modulates pain memory over time and may prevent the integration of awake painful procedures as a bad experience into the autobiographical memory of patients suffering from PD. A randomized controlled study with more data is necessary to confirm our findings.
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Affiliation(s)
- Sabina Catalano Chiuvé
- Neurology Department, Neuropsychology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, Université of Genève, Geneva, Suisse
- Neurosurgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Adriana Wolff
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
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Zaccarini S, Fernandez A, Wolff A, Magnusson L, Rehberg-Klug B, Grape S, Schoettker P, Berna C. Hypnosis in the operating room: are anesthesiology teams interested and well-informed? BMC Anesthesiol 2023; 23:287. [PMID: 37620788 PMCID: PMC10464071 DOI: 10.1186/s12871-023-02229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff. DESIGN A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively. RESULTS Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training. CONCLUSION Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.
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Affiliation(s)
- Sonia Zaccarini
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Aurore Fernandez
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Adriana Wolff
- Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Lennart Magnusson
- Department of Anesthesiology, Cantons Hospital of Fribourg, Fribourg, Switzerland
| | - Benno Rehberg-Klug
- Department of Anesthesiology, University of Geneva Hospitals, Geneva, Switzerland
| | - Sina Grape
- Department of Anesthesiology, Valais Hospital, Sion, Switzerland
| | - Patrick Schoettker
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Chantal Berna
- Center for Complementary and Integrative Medicine, Department of Anesthesiology, Lausanne University Hospital (CHUV), and Lausanne University, Rue du Bugnon 46, Lausanne, 1011, Switzerland
- Pain Center, Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Wolff A, Münstermann N, Pretzer J, Redecker A, Jud T, Böthig R. [The neuro-urological expert opinion in statutory accident insurance : Consensual recommendations for diagnostics and for the assessment of reduction of earning capacity]. Urologie 2023; 62:229-240. [PMID: 36867214 PMCID: PMC9998578 DOI: 10.1007/s00120-023-02039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Previous assessment guidelines from standard sources for urologic expert opinions show considerable differences in the recommended percentages for the assessment of reduction of earning capacity (MdE) for accident sequelae in the neuro-urological specialty. OBJECTIVES To develop a "revised and standardized version of the MdE assessments of neuro-urological accident sequelae (in tabular form) as a guideline/manual" for expert opinions in the legal area of the German and Austrian Statutory Accident Insurance ( www.dguv.de , www.auva.at ). MATERIALS AND METHODS A working group of neuro-urologists from spinal cord injury centers of different BG ("Berufsgenossenschaft") clinics was formed within the working group Neuro-Urology of DMGP (German-speaking Medical Society for Paraplegiology; www.dmgp.de ). Between January 2017 and September 2022, a total of 7 working meetings and 2 video conferences were held. The consensus of the developed documents was reached by formal consensus finding in a nominal group process and in a final consensus conference. RESULTS The necessary bases for a targeted, legally sound diagnosis of accident consequences in the neuro-urological field were elaborated and, based on the experience of many years of expert opinion activity, a "matrix" for a uniform, graduated assessment of the level of reduction of earning capacity in the (neuro-)urological field in the case of confirmed neuro-urological accident consequences was created. CONCLUSION In the interest of equal treatment of all insured persons, it is of great importance to make a uniform and comprehensible assessment of the amount of the MdE on the basis of "table values" that reflect the available empirical values.
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Affiliation(s)
- A Wolff
- Abteilung Neuro-Urologie, BG-Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| | | | - J Pretzer
- BG Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - A Redecker
- Bergmannstrost BG Klinikum Halle, Halle, Deutschland
| | - T Jud
- AUVA Rehabilitationszentrum Häring, Bad Häring, Österreich
| | - R Böthig
- BG Klinikum Hamburg, Hamburg, Deutschland
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Imam S, Carpenter T, Wolff A, Khianey R, Capitle E. MRNA COVID-19 VACCINE-ASSOCIATED BULLOUS FIXED DRUG ERUPTION. Ann Allergy Asthma Immunol 2022. [PMCID: PMC9646440 DOI: 10.1016/j.anai.2022.08.764] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Fixed drug eruptions are unique cutaneous drug reactions that recur in the same location upon re-exposure to the offending agent. We report a dilemma of how to proceed with the vaccination after a rare complication of the mRNA covid-19 vaccine. Case Description A 47-year-old female referred to us after developing a rash to the mRNA covid-19 vaccine for evaluation of safety and plan on how to proceed with the booster vaccine. After the 1st dose on her left deltoid, she developed persistent right arm pruritus from mid-forearm to wrist that gradually became well-demarcated and erythematous by day four. Rash improved within seven days of using hydrocortisone but left hyperpigmentation of the skin. Two weeks after receiving her 2nd dose on her left deltoid, the same location on her right forearm flared up with more pronounced pruritus, erythema and a few bullous lesions. Rash improved after a week of using hydrocortisone leaving behind hyperpigmentation. The patient denied using any prior medications and had no other skin or mucosal involvement. We decided to proceed with another brand of mRNA covid-19 vaccine instead and prophylactically apply clobetasol twice daily to the affected area for 7-days post-vaccine. She tolerated the vaccine without any flare-up of the rash. Discussion Fixed drug eruptions more frequently occur with drugs including antimicrobials, NSAIDs, acetaminophen and anti-convulsants. Very rarely has it been reported in association with the administration of the Covid-19 vaccines. This case illustrates a unique predicament after an unusual complication of bullous fixed drug eruption after mRNA covid-19 vaccine administration.
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Darbellay C, Magnin S, Haidar Ahmad A, Wolff A, Serratrice J, Coen M. [Healing communication: Therapeutic communication in internal medicine]. Rev Med Suisse 2022; 18:2026-2029. [PMID: 36314093 DOI: 10.53738/revmed.2022.18.801.2026] [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: 06/16/2023]
Abstract
Caregiver-patient communication is a central element of the therapeutic relationship and a powerful placebo. While poorly adapted communication can have harmful effects, adequate communication offers many benefits for the patient and the caregiver. Therapeutic communication (TC), a set of strategies inspired by clinical hypnosis, is easy to learn and apply. In addition to reinforcing an empathetic attitude, TC appears to be effective in various clinical situations, particularly for its effects on pain and anxiety. In order to better understand the interest of CT in internal medicine, we have conducted a literature review on its efficacy during different medical procedures.
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Affiliation(s)
- Chloé Darbellay
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Simon Magnin
- Faculté de médecine, Université de Genève, 1211 Genève 4
| | | | - Adriana Wolff
- Service d'anesthésiologie, Département d'anesthésiologie, de pharmacologie et des soins intensifs, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jacques Serratrice
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Matteo Coen
- Service de médecine interne générale, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
- Unité de développement et de recherche en éducation médicale, Faculté de médecine, Université de Genève, 1211 Genève 4
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Gruene B, Kugler S, Kuefer-Weiß A, Wolff A, Kossow A, Nießen J, Neuhann F, Ginzel S, Buess M. Public Health benefits by implementing digital symptom diaries for COVID patients from Cologne. Eur J Public Health 2022. [PMCID: PMC9594271 DOI: 10.1093/eurpub/ckac131.049] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background High rate of people infected with SARS-CoV-2 and their contacts in Cologne, Germany required innovative tools for notification, monitoring and reporting. The digital tool for COVID19 (DiKoMa) provides self-service symptom diaries allowing (a) the stratification for prioritized telephone contact by the health authority and (b) training a machine learning (ML) model that predicts infections with prevailing dominant variant (PDV) from early symptom profiles (SP). Methods Pseudononymized SP covering the first week of diary recordings were included for training (16646 index, 11582 contacts). A balanced random forest (BRF) model was trained to differentiate early predictive symptom patterns of different PDV and contact persons. Model evaluation was performed using sex and age stratified cross validation (CV), the model was validated on SP recorded from days 1 and 6. Results From 03/20 to 02/22, 90478 indeces and 75444 contact persons reported symptoms and health status, covering 46% and 42% of all reported cases, respectively. Diaries contained between 1-52 entries (566791, median 2). Daily analysis of entries, prioritized according to age, prevalent co-morbidities and detoriation of symptoms allowed risk adjusted follow up even during phases with high case notification rates. The top 5 predictive factors of the BRF were immunization, cough, dysgeusia and dysnosmia, fatigue, and sniffles to differentiate infection between wildtype, three PDV and contact persons (CV AUC 80.6%, Validation AUC 77.1%). Conclusions The use of digital symptom diary surveillance helps to provide appropriate medical support for patients on a large scale. Machine learning shows potential for symptom based risk assessment to differentiate PDV for future outbreaks and can thus become a valuable tool alongside specific laboratory diagnostics. Key messages • Digital symptom diaries are a powerful and widely accepted tool to attend COVID19 patients in isolation. They allow risk stratification for follow up and are a low-threshold service. • Machine learning supports index case identification by symptom analysis and can thus become a valuable tool alongside specific laboratory diagnostics.
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Affiliation(s)
- B Gruene
- Health Department Cologne , Cologne, Germany
| | - S Kugler
- Fraunhofer Institute for Intelligent Analysis , Sankt Augustin, Germany
| | | | - A Wolff
- Health Department Cologne , Cologne, Germany
| | - A Kossow
- Health Department Cologne , Cologne, Germany
- Institut for Hygiene, University of Muenster , Muenster, Germany
| | - J Nießen
- Health Department Cologne , Cologne, Germany
| | - F Neuhann
- Health Department Cologne , Cologne, Germany
- Institut for Global Health, University of Heidelberg , Heidelberg, Germany
| | - S Ginzel
- Fraunhofer Institute for Intelligent Analysis , Sankt Augustin, Germany
| | - M Buess
- Health Department Cologne , Cologne, Germany
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Zafar S, Wolff A. M225 A RARE CASE OF EOSINOPHILIC GASTROENTERITIS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Houmøller SS, Wolff A, Möller S, Narne VK, Narayanan SK, Godballe C, Hougaard DD, Loquet G, Gaihede M, Hammershøi D, Schmidt JH. Prediction of successful hearing aid treatment in first-time and experienced hearing aid users: Using the International Outcome Inventory for Hearing Aids. Int J Audiol 2021; 61:119-129. [PMID: 34032544 DOI: 10.1080/14992027.2021.1916632] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Primarily to understand whether clinically relevant factors affect the International Outcome Inventory (IOI-HA) scores and to examine if IOI-HA scores improve when renewing the hearing aids (HA) for experienced users. Secondly, to estimate the overall HA effectiveness using the IOI-HA. DESIGN A prospective observational study. STUDY SAMPLE In total, 1961 patients with hearing loss were included. All patients underwent a hearing examination, were fitted with HAs, and answered the IOI-HA. Factor analysis of IOI-HA separated the items into a Factor 1 (use of HA, perceived benefits, satisfaction, and quality of life) and Factor 2 (residual activity limitation, residual participation restriction and impact on others) score. RESULTS Degree of hearing loss, word recognition score, motivation, HA usage time, tinnitus, asymmetry, and sex were significantly associated with total IOI-HA, Factor 1, or Factor 2 scores. The seven IOI-HA items increased on average by 0.4 (p < 0.001) when renewing HAs. The total median IOI-HA score at follow-up was 29 (7) for experienced (n = 460) and first-time users (n = 1189), respectively. CONCLUSIONS Degree of hearing loss, word recognition score, motivation, tinnitus, asymmetry, and sex may be used to identify patients who require special attention to become successful HA users.
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Affiliation(s)
- S S Houmøller
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - A Wolff
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - S Möller
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - V K Narne
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - S K Narayanan
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | - C Godballe
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - D D Hougaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - G Loquet
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M Gaihede
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - D Hammershøi
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | - J H Schmidt
- Research Unit for ORL - Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Johne R, Wolff A, Gadicherla AK, Filter M, Schlüter O. Stability of hepatitis E virus at high hydrostatic pressure processing. Int J Food Microbiol 2020; 339:109013. [PMID: 33340943 DOI: 10.1016/j.ijfoodmicro.2020.109013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/26/2023]
Abstract
Hepatitis E virus (HEV) is the causative agent of acute and chronic hepatitis in humans. The zoonotic HEV genotype 3 is the main genotype in Europe. The foodborne transmission via consumption of meat and meat products prepared from infected pigs or wild boars is considered the major transmission route of this genotype. High hydrostatic pressure processing (HPP) is a technique, which can be used for inactivation of pathogens in food. Here, preparations of a cell culture-adapted HEV genotype 3 strain in phosphate-buffered saline (PBS) were subjected to HPP and the remaining infectivity was titrated in cell culture by counting fluorescent foci of replicating virus. A gradual decrease in infectivity was found by application of 100 to 600 MPa for 2 min. At 20 °C, infectivity reduction of 0.5 log10 at 200 MPa and 1 log10 at 400 MPa were observed. Slightly higher infectivity reduction of 1 log10 at 200 MPa and 2 log10 at 400 MPa were found by application of the pressure at 4 °C. At both temperatures, the virus was nearly completely inactivated (>3.5 log10 infectivity decrease) at 600 MPa; however, low amounts of remaining infectious virus were observed in one of three replicates in both cases. Transmission electron microscopy showed disassembled and distorted particles in the preparations treated with 600 MPa. Time-course experiments at 400 MPa showed a continuous decline of infectivity from 30 s to 10 min, leading to a 2 log10 infectivity decrease at 20 °C and to a 2.5 log10 infectivity decrease at 4 °C for a 10 min pressure application each. Predictive models for inactivation of HEV by HPP were generated on the basis of the generated data. The results show that HPP treatment can reduce HEV infectivity, which is mainly dependent on pressure height and duration of the HPP treatment. Compared to other viruses, HEV appears to be relatively stable against HPP and high pressure/long time combinations have to be applied for significant reduction of infectivity.
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Affiliation(s)
- R Johne
- German Federal Institute for Risk Assessment, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany.
| | - A Wolff
- German Federal Institute for Risk Assessment, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - A K Gadicherla
- German Federal Institute for Risk Assessment, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - M Filter
- German Federal Institute for Risk Assessment, Max-Dohrn-Straße 8-10, 10589 Berlin, Germany
| | - O Schlüter
- Leibniz Institute for Agricultural Engineering and Bioeconomy, Quality and Safety of Food and Feed, Germany
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Abbassi S, Wolff A. M551 EOSINOPHILIC CELLULITIS: A TREATMENT REFRACTORY CASE. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.378] [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: 10/23/2022]
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Wolff A, Günther T, Albert T, Schilling-Loeffler K, Gadicherla AK, Johne R. Stability of hepatitis E virus at different pH values. Int J Food Microbiol 2020; 325:108625. [PMID: 32361052 DOI: 10.1016/j.ijfoodmicro.2020.108625] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022]
Abstract
Infection with the hepatitis E virus (HEV) can cause acute and chronic hepatitis in humans. The zoonotic HEV genotype 3 is mainly transmitted by consumption of raw and fermented meat products prepared from infected pigs or wild boars. Lowering of pH during fermentation is one of the microbiological hurdles considered to inhibit growth of certain pathogens. However, no data are currently available on pH stability of HEV. As a reliable and reproducible measurement of HEV infectivity in meat products is not established so far, the stability of the cell culture-adapted HEV genotype 3 strain 47832c was analyzed here in phosphate-buffered saline (PBS) at different pH values. Only a minimal decrease of infectivity (up to 0.6 log10 focus forming units) was found after treatment at pH 2 to 9 for 3 h at room temperature. At pH 10, a decrease of about 3 log10 was evident, whereas no remaining virus (>3.5 log10 decrease) was detected at pH 1. The conditions usually achieved during curing of raw sausages were simulated using D/L-lactic acid added to PBS resulting in pH 4.5 to 6.5. After incubation at 4 °C for 7 days at these conditions, no significant differences as compared to a standard PBS solution at pH 7.7 were evident. At room temperature, a 0.8 log10 decrease was found at pH 4.7 after 7 days incubation compared to pH 7.7, but less at the other pH values. In conclusion, only minimal inactivating effects were found at pH conditions commonly occurring during food processing. Therefore, remaining infectious virus might be present in fermented meat products if HEV-contaminated starting material was used. Additional effects of other factors like high salt concentrations and low aw values should be investigated in future studies.
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Affiliation(s)
- A Wolff
- German Federal Institute for Risk Assessment, Department of Biological Safety, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - T Günther
- German Federal Institute for Risk Assessment, Department of Biological Safety, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - T Albert
- University of Leipzig, Institute for Food Hygiene, An den Tierkliniken 1, 04103 Leipzig, Germany
| | - K Schilling-Loeffler
- German Federal Institute for Risk Assessment, Department of Biological Safety, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - A K Gadicherla
- German Federal Institute for Risk Assessment, Department of Biological Safety, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - R Johne
- German Federal Institute for Risk Assessment, Department of Biological Safety, Diedersdorfer Weg 1, 12277 Berlin, Germany.
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Gosseries O, Fecchio M, Wolff A, Sanz LRD, Sombrun C, Vanhaudenhuyse A, Laureys S. Behavioural and brain responses in cognitive trance: A TMS-EEG case study. Clin Neurophysiol 2019; 131:586-588. [PMID: 31843502 DOI: 10.1016/j.clinph.2019.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.
| | - M Fecchio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Wolff
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L R D Sanz
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Sombrun
- TranceScience Research Institute, Paris, France
| | - A Vanhaudenhuyse
- Algology Department & Sensation & Perception Research Group, GIGA consciousness, University and University Hospital of Liège, Liège, Belgium
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
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Zellars R, Shah A, Young M, Wright J, de Souza Lawrence L, Stearns V, Wolff A. Outcomes from Two Phase I/II Trials of Partial-Breast Irradiation (PBI) and Concurrent Chemotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.703] [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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Laurent O, Bodmer A, Wolff A. [Hypnotherapy in psycho-oncology : clinical benefits and future prospects]. Rev Med Suisse 2019; 15:1007-1009. [PMID: 31091033] [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: 06/09/2023]
Abstract
After a cancer diagnosis, emotional distress is common. We currently have many conventional treatments such as radiotherapy, surgery, chemotherapy, targeted therapies and immunotherapy to fight cancer. However, these treatments are associated with significant adverse effects, which may themselves be the cause of psychic suffering. Hypnosis has been shown to be effective in relieving some of these symptoms, but its practice is still limited in oncology. This is as much related to ignorance about the discipline as to a lack of large randomized prospective studies. This article provides an overview of hypnotherapy and its benefits in the field of psycho-oncology and discusses the prospects for the future.
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Affiliation(s)
| | - Alexandre Bodmer
- Service d'oncologie médicale - Centre du sein, Département d'oncologie, HUG, 1211 Genève 14
| | - Adriana Wolff
- Service d'anesthésiologie, Département d'anesthésiologie, de pharmacologie et des soins intensifs, HUG, 1211 Genève 14
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Schräder N, Duipmans J, Molenbuur B, Wolff A, Jonkman M. THC 联合 CBD 治疗 EB 疼痛. Br J Dermatol 2019. [DOI: 10.1111/bjd.17678] [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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Wolff A, Joshi RK, Ekström J, Aframian D, Pedersen AML, Proctor G, Narayana N, Villa A, Sia YW, Aliko A, McGowan R, Kerr R, Jensen SB, Vissink A, Dawes C. [Medicaments and oral healthcare. Systematic review of the -literature assessing the effect of drugs on the salivary glands]. Ned Tijdschr Tandheelkd 2018; 125:593-601. [PMID: 30457580 DOI: 10.5177/ntvt.2018.11.18203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Evidence-based reviews of drugs causing medication-induced salivary gland dysfunction, such as xerostomia (sensation of oral dryness) and subjective sialorrhea are lacking. To compile a list of medicaments that influence salivary gland function, electronic databases were searched for relevant articles published up to June 2013. A total of 269 papers out of 3,867 records located satisfied the inclusion criteria (relevance, quality of methodology, strength of evidence). A total of 56 active substances with a higher level of evidence and 50 active substances with a moderate level of evidence of causing salivary gland dysfunction are described in this article. While xerostomia was a commonly reported outcome, the objective effect on salivary secretion was rarely measured. Xerostomia was, moreover, mostly reported as a negative side effect instead of the intended effect of that drug. A comprehensive list of medications having documented effects on salivary gland function or symptoms was compiled, which may assist practitioners in assessing patients who complain of dry mouth while taking medications.
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Ugalde A, Aranda S, Paul C, Orellana L, Plueckhahn I, Segan C, Baird D, Otmar R, Brown S, Armstrong P, Wolff A, Shee AW, Livingston P. Improving Health Outcomes for People With Cancer in Rural and Regional Areas by Embedding Evidence-Based Smoking-Cessation Strategies Into Usual Care: A Study Protocol. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Smoking following a diagnosis of cancer is a powerful clinical risk indicator, with known poorer health outcomes and associated health care costs. In Australia, smoking rates are higher in rural and regional areas. There are established and effective interventions to promote smoking cessation after a diagnosis of cancer yet these are not in routine practice. Aim: This protocol paper reports on a study that aims to embed evidence-based smoking cessation strategies for people with cancer who are current smokers into routine care, resulting in in system wide improvements, an implemented program and model for further dissemination. Methods: Across three rural/regional sites, and with partners Quit Victoria and Western Alliance, this study employs a variety of methodologies to embed smoking cessation support to improve outcomes for people with cancer who currently smoke. Specifically, the project will embed a system of responsibilities and training in rural and regional health services to routinely engage people with cancer who smoke in support services. The program will: · Promote routine delivery of smoking cessation care by trained oncology staff (oncologists/nurses/ allied health) · Establish referral pathways to Quitline · Correspond with general practitioners, to: i) outline the benefits of quitting in this context, ii) promote access to nicotine replacement therapy and iii) support quitting in the community. · Improve routine recording of smoking status and documentation of provision of brief intervention (personalised advice given, resources provided) and outcomes. Participants: are oncology staff and general practitioners across three health services: Ballarat Health Service, East Grampians Health Service (Ararat), Wimmera Health Care Group (Horsham), all located in Victoria, Australia. Data collection will occur across four sources: 1) Oncology staff: qualitative and quantitative data collection understanding confidence and views on provision on cessation advice; 2) Monitoring Quitline calls, 3) Interview with local general practitioners and 4) Medical record reviews to explore frequency of recording of smoking status. Data will be collected pre/postintervention. Results: The project is underway with the intervention manuals in development. The project is due for completion in 2020. Conclusion: This project takes a health services approach to integration of smoking cessation support in routine care for people with cancer in rural and regional areas. This program of work has capacity to determine best approaches to integrate smoking cessation into routine care, resulting in reduced mortality and morbidity, improved effectiveness of anticancer treatments, and reduced health care costs; by establishing internationally relevant, embedded health care interventions.
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Affiliation(s)
- A. Ugalde
- Deakin University, Melbourne, Australia
| | - S. Aranda
- Deakin University, Melbourne, Australia
| | - C. Paul
- Deakin University, Melbourne, Australia
| | | | | | - C. Segan
- Deakin University, Melbourne, Australia
| | - D. Baird
- Deakin University, Melbourne, Australia
| | - R. Otmar
- Deakin University, Melbourne, Australia
| | - S. Brown
- Deakin University, Melbourne, Australia
| | | | - A. Wolff
- Deakin University, Melbourne, Australia
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Wolff A, Koray M, Campisi G, Strietzel FP, Lafaurie GI, Beiski BZ, Ekström J. Electrostimulation of the lingual nerve by an intraoral device may lead to salivary gland regeneration: A case series study. Med Oral Patol Oral Cir Bucal 2018; 23:e552-e559. [PMID: 30148471 PMCID: PMC6167107 DOI: 10.4317/medoral.22597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/30/2018] [Accepted: 06/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Salivary gland function is controlled by the salivary reflex, whose efferent arm is composed by the parasympathetic and the sympathetic divisions of the autonomic nervous system. Parenchymal injury is the main salivary gland involvement of Sjögren’s syndrome and head and neck radiotherapy, but neural damage has been reported as well. Recently an intraoral device for electrostimulation of the lingual nerve in vicinity to the lower third molar has been introduced. At this point this nerve carries efferent fibers for the innervation of the submandibular, sublingual and several minor salivary glands and afferent fibers of the salivary reflex. Therefore, excitation of these fibers potentially leads to increased secretion of all salivary glands. Thus, the study objective was to assess whether comprehensive neural activation by electrostimulation of the lingual nerve carries the potential to induce the regeneration of damaged salivary glands. Material and Methods The device was tested on three patients with no collectable resting and stimulated secretion of saliva during a double blind, sham controlled period of two months and nine open-label months. Results All three subjects developed the capacity to spit saliva, not only in direct response to the electrostimulation but also after free intervals without electrostimulation. In addition, their symptoms of dry mouth severity and frequency improved. Conclusions This recovery is probably due to the combined effect of increase in secretory functional gland mass and regain of nervous control of the secretory elements and blood vessels. Both are phenomena that would contribute to gland regeneration. Key words:Xerostomia, dry mouth, saliva, electrostimulation, regeneration.
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Affiliation(s)
- A Wolff
- 65 Hatamar St., Harutzim 60917, Israel,
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Wolff A, Klingner N, Thompson W, Zhou Y, Lin J, Peng YY, Ramshaw JAM, Xiao Y. Modelling of focused ion beam induced increases in sample temperature: a case study of heat damage in biological samples. J Microsc 2018; 272:47-59. [PMID: 30019759 DOI: 10.1111/jmi.12731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022]
Abstract
Ion beam induced heat damage in soft materials and biological samples is not yet well understood in Focused Ion Beam systems (FIBs). The work presented here discusses the physics behind the ion beam - sample interactions and the effects which lead to increases in sample temperature and potential heat damage. A model by which heat damage can be estimated and which allows parameters to be determined that reduce/prevent heat damage was derived from Fourier's law of heat transfer and compared to finite element simulations, numerical modelling results and experiments. The results suggests that ion beam induced heat damage can be prevented/minimised by reducing the ion beam current (local dose rate), decreasing the beam overlap (reduced local ion dose) and by introducing a blur (increased surface cross-section area, reduced local dose) while sputtering, patterning or imaging soft material and nonresin-embedded biological samples using FIBs. LAY DESCRIPTION FIB/SEMs, which combine a scanning electron microscope with a focused ion beam in a single device, have found increasing interest biological research. The device allows to cut samples at precisely selected areas and reveal sub surface information as well as preparing transmission electron microscope samples from bulk materials. Preparing biological samples has proven to be challenging due to the induced heat damage. This work explores the physics behind the sample cutting and proposes a model and a method, based on physical principles which allows the user to estimate the induced heat during the cutting process and to select cutting parameters which avoid heat damage in the sample.
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Affiliation(s)
- A Wolff
- Central Analytical Research Facility, Institute for Future Environments, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - N Klingner
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - W Thompson
- Heelionics LLC, Los Altos, California, U.S.A
| | - Y Zhou
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,The Australia-China Centre for Tissue Engineering and Regenerative Medicine (ACCTERM), Queensland University of Technology, Brisbane, Queensland, Australia
| | - J Lin
- Department of Implantology, Affiliated Stomatological Hospital of Xiamen Medical College, Fujan, China.,The Australia-China Centre for Tissue Engineering and Regenerative Medicine (ACCTERM), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Y Y Peng
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria, Australia
| | - J A M Ramshaw
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria, Australia.,Department of Surgery, St. Vincent's Hospital, University of Melbourne, Victoria, Australia
| | - Y Xiao
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,The Australia-China Centre for Tissue Engineering and Regenerative Medicine (ACCTERM), Queensland University of Technology, Brisbane, Queensland, Australia
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Vidula N, Goga A, Krummel M, Hwang J, Liu M, Park BH, Nanda R, Pohlmann P, Storniolo AM, Van Poznak C, Brufsky A, Abramson V, Wolff A, Rugo HS. Abstract OT1-02-03: TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-03] [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
Background: Patients with breast cancer (BC) and chest wall disease have limited treatment options. We hypothesize that checkpoint inhibition may be an effective treatment approach due to the inflammatory nature of chest wall infiltration, and the association of PD-1 expression with lymphocytic infiltration. Platinum chemotherapy may facilitate anti-tumor immunity in a synergistic manner, and clinical studies of the PD-1 inhibitor pembrolizumab with platinum combinations have been effective in the treatment of advanced lung cancer. In this study, we will evaluate the combination of carboplatin and pembrolizumab in BC patients with chest wall disease.
Methods: This is a randomized phase II multicenter study in the TBCRC including patients with advanced, unresectable BC with hormone resistant or triple negative chest wall disease. Patients may have had prior surgery, prior chest wall radiation is not required, and other sites of distant metastases are allowed. Eighty-four patients at TBCRC sites will be randomized 2:1 to receive pembrolizumab and carboplatin (n=56, Arm A) or carboplatin alone (n=28, Arm B) until disease progression. Patients randomized to Arm B may cross-over following progression to pembrolizumab alone (Arm Bx). Patients in Arm A will be treated with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks for at least 6 cycles followed by maintenance pembrolizumab 200 mg IV every 3 weeks if stable or responding disease. Patients in Arm B will be treated with carboplatin AUC 5 IV every 3 weeks until progression, then may cross-over to pembrolizumab 200 mg IV every 3 weeks alone (Arm Bx). An interim analysis for futility will be performed after 18 patients are enrolled into Arm B to allow early closure of that arm for lack of efficacy. The primary endpoint is disease control rate at 18 weeks of treatment; the study is powered to detect a 20% difference in disease control rates between arms (hazard ratio 0.52, α= 0.10, β= 0.20). Secondary endpoints include progression free survival, toxicity, and response based on PD-L1 expression and irRECIST. Exploratory endpoints include association of response with a number of biomarkers including tumor PD-L1 gene expression, tumor and peripheral blood immune composition and cytokine expression, peripheral T-cell PD-1 expression, circulating tumor DNA, circulating tumor cells, and tumor MYC genomic expression using tumor biopsy and peripheral blood testing before and after treatment. This study should be open to accrual by August of 2017. (NCT03095352)
Citation Format: Vidula N, Goga A, Krummel M, Hwang J, Liu M, Park BH, Nanda R, Pohlmann P, Storniolo AM, Van Poznak C, Brufsky A, Abramson V, Wolff A, Rugo HS. TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-03.
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Affiliation(s)
- N Vidula
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Goga
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - M Krummel
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - J Hwang
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - M Liu
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - BH Park
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - R Nanda
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - P Pohlmann
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - AM Storniolo
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - C Van Poznak
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Brufsky
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - V Abramson
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Wolff
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - HS Rugo
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
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Mayer E, DeMichele A, Gnant M, Barry W, Pfeiler G, Metzger O, Burstein H, Miller K, Rastogi P, Loibl S, Goulioti T, Zardavas D, Fesl C, Koehler M, Huang-Bartlett C, Huang X, Piccart M, Winer E, Wolff A. Abstract OT3-05-08: PALLAS: PALbociclib CoLlaborative Adjuvant Study: A randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-05-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background:
Cell cycle inhibition is a proven target for novel cancer therapeutics. Palbociclib (P) is an orally active inhibitor of CDK4/6, and arrests the cell cycle at the G1-S transition. P in combination with endocrine therapy (ET) has demonstrated efficacy in phase II and III randomized trials for patients with newly diagnosed and recurrent hormone receptor positive/HER2 negative (HR+/HER2-) metastatic breast cancer (MBC), and is approved in these settings. Given confirmed benefits of P and ET for MBC, the PALLAS study was designed to determine if the addition of P to adjuvant ET improves outcomes over ET alone in HR+/HER2- early breast cancer.
Trial Design:
PALLAS is an international open-label phase III trial randomizing (1:1) patients (pts) to 2 years of P (125 mg daily, 21 days on 7 days off in a 28-day cycle) combined with at least 5 years of provider choice ET (AI, tamoxifen, +/- LHRH agonist), versus ET alone. The primary objective of the study is to compare invasive disease-free survival (iDFS) for the combination of P and ET, versus ET alone. Secondary objectives include comparison of iDFS excluding cancer of non-breast origin, DRFS, LRRFS, OS, as well as safety. The principal objective of the translational investigations is to determine the predictive or prognostic utility of defined genomic subgroups with respect to iDFS and OS. Additional objectives include evaluation of cfDNA and tissue biomarkers predictive of benefit or resistance, pharmacogenomics, adherence, and patient-reported QOL. Eligible pts are pre- or post-menopausal women or men with stage II-III, HR+/HER2- breast cancer. Patients may have already initiated ET, but must be randomized within 12 months of diagnosis and 6 months of initiation of adjuvant ET. Trial sample size is 4600 pts and stage IIA pts will be capped at a total accrual of 1000 pts. Interim analyses for safety, futility/efficacy and sample size re-estimation are planned. PALLAS opened in 9/2015 and accrual is ongoing. Contact information: emayer@partners.org
Key words: palbociclib, CDK4/6 inhibition, HR+/HER2- early breast cancer, adjuvant endocrine therapy.
Citation Format: Mayer E, DeMichele A, Gnant M, Barry W, Pfeiler G, Metzger O, Burstein H, Miller K, Rastogi P, Loibl S, Goulioti T, Zardavas D, Fesl C, Koehler M, Huang-Bartlett C, Huang X, Piccart M, Winer E, Wolff A. PALLAS: PALbociclib CoLlaborative Adjuvant Study: A randomized phase 3 trial of palbociclib with standard adjuvant endocrine therapy versus standard adjuvant endocrine therapy alone for HR+/HER2- early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-08.
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Affiliation(s)
- E Mayer
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - A DeMichele
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Gnant
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - W Barry
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - G Pfeiler
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - O Metzger
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - H Burstein
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - K Miller
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - P Rastogi
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - S Loibl
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - T Goulioti
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - D Zardavas
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - C Fesl
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Koehler
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - C Huang-Bartlett
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - X Huang
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - M Piccart
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - E Winer
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
| | - A Wolff
- Dana Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Medical University of Vienna, Vienna, Austria; Austrian Breast&Colorectal Cancer Study Group, Vienna, Austria; UT M.D. Anderson Cancer Center, Houston, TX; Indiana University, Indianapolis, IN; National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA; German Breast Group, Neu-Isenberg, Germany; Elisabeth Krankenhaus Kassel Brustzentrum, Kassel, Germany; Breast International Group, Brussels, Belgium; Pfizer, New York, NY; Johns Hopkins, Baltimore, MD; Jules Bordet Institute, Brussels, Belgium
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23
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Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Abstract P3-04-01: Molecular determinants of post-mastectomy breast cancer recurrence. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-04-01] [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
Introduction
The management of breast cancer (BC) patients who undergo mastectomy in the setting of 1-3 positive lymph nodes has been controversial. This retrospective Translational Breast Cancer Research Consortium study evaluated the molecular aberrations associated with locoregional recurrence (LRR) or distant metastasis (DM) compared to controls in an effort to identify molecular predictors associated with recurrence.
Methods/Materials
We identified 115 HER2 negative, therapy naïve, T 1-3 and N 0-1 BC patients treated with mastectomy and no post mastectomy radiation therapy from 1997 to present with available FFPE tissue blocks. The cohort included 32 patients with LRR, 34 with DM, and 49 controls (without recurrence) who were matched for stage, grade, hormone receptor status, age ≤ or > 50, chemotherapy receipt, and margin status. Matched primary and recurrent LRR samples were available for 3 patients. Hybrid capture next generation sequencing (NGS) of 142 cancer related genes and RNAseq were performed to identify DNA/RNA alterations associated with LRR or DM. The frequency of common alterations on NGS was compared with Fisher's exact test. Expression of each gene from mRNA-Seq was treated as an explanatory variable. Immunohistochemistry (IHC) was performed for PTEN, Ki-67 and cleaved caspase 3 (CC3). PTEN loss and percentage of Ki-67 and CC3 positive cells were compared between groups with Fisher's exact test and nonparametric methods, respectively.
Results
RNAseq was performed on 115 patients; there was no difference in RNA expression levels between the groups. DNA analysis was performed on 57 patients (17 LRR, 15 DM and 25 controls), NF1 mutation rate was significantly elevated in both the LRR (24%) and DM (27%) samples compared to controls 0%; (p=0.0070). The mitogen activated protein kinase (MAPK) pathway was significantly mutated in both LRR (47%) and DM (40%) samples compared to the controls 0%; (p<0.0001). There was no significant difference in the rate of alterations of the PI3K/Akt/mTOR pathway among the three groups. Of three patients with matched primary vs LRR samples, one had concordant mutations. The second patient had additional mutations in the LRR, including gain of a NF1 mutation. The third patient had complete discordance of mutations identified in primary and LRR and had gain of HER2 amplification, suggestive of a new primary. There was no significant association between the groups and the loss of PTEN expression or CC3 expression. There was a significant difference between Ki 67 positive cells in patients with LRR (mean 29%), DM (mean 26%) versus controls (mean 14%, p= 0.0011). HR+ patients were significantly more likely to have a positive PTEN, lower Ki-67 and lower CC3 expression, p=0.0004, p<0.0001, and p<0.0001 respectively.
Conclusions
In this matched cohort analysis, mutations in the MAPK pathway, specifically NF1, were associated with both LRR and DM, suggesting that alterations in this pathway are associated with a more aggressive tumor phenotype. However, there were no molecular features that discriminated between those likely to recur locally alone versus distantly. Further study is needed to validate these findings, and to determine whether targeting alterations in this pathway could decrease the risk of recurrence.
Citation Format: Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Molecular determinants of post-mastectomy breast cancer recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-01.
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Affiliation(s)
- KS Keene
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - T King
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - ES Hwang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - B Peng
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - K McGuire
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Tapia
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - H Zhang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - S Bae
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Nakhlis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - N Klauber-Demore
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - I Meszoely
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - MS Sabel
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - SC Willey
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - KA Eterovic
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Hudis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Wolff
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - J De Los Santos
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Thompson
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - GB Mills
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Meric-Bernstam
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
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24
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Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Abstract P5-23-01: Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-23-01] [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
BACKGROUND: Through the International Male Breast Cancer Program, a prospective registry for male BC was created with the goals of evaluating 1) the clinical and biological features of this disease and 2) assessing feasibility of a prospective therapeutic clinical trial.
METHODS: All men, with any stage histologically proven invasive breast cancer, age 3 18 years, and newly presenting at the participating institutions (within 3 months prior) were eligible. Patients were enrolled for 30 months after activation of the first center, through February 2017. Per the study design, if <100 men enrolled, the study would be considered a failure and therapeutic trials would not be pursued through this network. Epidemiologic data, staging, pathologic features, and BRCA status were collected. Treatment and outcome data collection is ongoing. Optional collection of FFPE tumor samples, blood, and QOL were performed in the US, the Netherlands, and Latin America. Clinical database lock for this report was May 30, 2017. We currently report patient and disease characteristics and will update with patterns of treatment for the presentation. Outcomes and biological samples will be analyzed in the future.
RESULTS: 557 patients were enrolled: 75% in Europe, 20% in United States, 5% in other countries. 6.3% of patients had missing forms. Median age was 67 years (range 26-92). 93% were diagnosed 2010-2017. Among patients with complete data, 79% presented with a breast mass. 88% were M0 and 12% M1. Among M0 patients: 47%, 39%, 2%, and 11% had T1, T2, T3, and T4 disease respectively; 52% were N0. Overall, 98% had ER+ disease and 11% had HER2+ cancer. 14% had grade 1, 56% had grade 2, and 30% had grade 3 tumors. Among 112 men who underwent BRCA1 testing, 1 was positive. Among 118 men who had BRCA2 testing, 18 (15%) were positive. 21% of men had prior or concurrent malignancies, with the following most common sites: prostate, non-melanoma skin, colorectal, and melanoma. The prevalence of previously identified possible risk factors for male breast cancer were: overweight/obesity (72%), former/current smoker (51%), current alcohol 31 drink daily (41%), family history of breast cancer (35%), gynecomastia (16%), history radiation exposure (8%), use of anti-androgens (1%), and use of estrogens (1%).
CONCLUSION: Through an international collaborative effort, we were able to prospectively accrue 557 patients to a male breast cancer registry. These results demonstrate feasibility of pursuing a therapeutic clinical trial in men with breast cancer. In addition, this study shows the relatively low uptake of BRCA testing, high rates of concurrent/prior malignancy, and the rates of potentially modifiable risk factors in this patient population.
Funding from Breast Cancer Research Foundation, Susan G. Komen, Dutch Pink Ribbon Foundation, Swedish Breast Cancer Association (BRO) and EBCC Council.
Citation Format: Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-01.
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Affiliation(s)
- SH Giordano
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CP Schröder
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Poncet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - E van Leeuwen-Stok
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - B Linderholm
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MH Abreu
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Rubio
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Van Poznak
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Morganstern
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Cameron
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MM Vleugel
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - TJ Smilde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Bozovic-Spasojevic
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - L Korde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - NS Russell
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - IDM den Hoed
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AH Honkoop
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AWG van der Velden
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - M van 't Riet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - N Dijkstra
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - O Bogler
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - T Goulioti
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - S Hilsenbeck
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - KJ Ruddy
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - A Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CHM van Deurzen
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - J Martens
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - JMS Bartlett
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Aalders
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Tryfonidis
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - F Cardoso
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
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Abstract
SummaryThe HL7 Clinical Document Architecture (CDA) is an important XML-based standard for the representation of clinical documents.
Objectives:
The use of Markup Languages could satisfy the demands of involved healthcare staff as well as the needs of patients, to receive an overview of the patient’s treatment during the hospital stay. The standardization efforts of different groups dealing with this problem have demonstrated progress, but have not, as yet, achieved a routinely usable result. In particular, differentiating information according to a hierarchical order has not been published to date.
Methods:
A retrospective analysis of 60 discharge letters from a cardiology ward (ward A) as well as 60 discharge letters from a gastroenterology ward (ward B) were extracted from the central hospital information system, by taking every fifth discharge letter issued over a one year period.
Results:
An XML-based prototype for medical discharge letters has been put in place representing the required information units and information elements. By means of an XSL-stylesheet, a detailed representation of the conventional discharge letter has been produced that is platform independent and permits the recurrent use of information units.
Conclusions:
Through the introduction of definitions like information elements and information units, progress in the development of CDA level two and three might be realized. We present a method by which discharge letters can be used by an Internal Medicine Department. This concept is implemented in a XML-based prototype allowing a special view on XML data to generate this document type.
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Paulitschke M, Mall J, Büttemeyer R, Meyer R, Wolff A, Rademacher A. Vascular PTFE Grafts Endothelialised under Defined Flow: From in Vitro Data to Clinical Use. Int J Artif Organs 2018. [DOI: 10.1177/039139880202500735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - J. Mall
- Charité Medical School, Berlin
| | | | | | - A. Wolff
- BioTissue Technologies, Freiburg - Germany
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27
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Lambertini M, Campbell C, Bines J, Korde L, Izquierdo Delso M, Fumagalli D, Pritchard K, Wolff A, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Barrios C, Baselga J, Moreno-Aspitia A, Piccart M, Gelber R, De Azambuja E. Adjuvant anti-HER2 therapy, treatment-induced amenorrhea (TIA) and survival in premenopausal patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Analysis from the ALTTO trial (BIG 2-06). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lukosius M, Dabrowski J, Kitzmann J, Fursenko O, Akhtar F, Lisker M, Lippert G, Schulze S, Yamamoto Y, Schubert MA, Krause HM, Wolff A, Mai A, Schroeder T, Lupina G. Metal-Free CVD Graphene Synthesis on 200 mm Ge/Si(001) Substrates. ACS Appl Mater Interfaces 2016; 8:33786-33793. [PMID: 27960421 DOI: 10.1021/acsami.6b11397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Good quality, complementary-metal-oxide-semiconductor (CMOS) technology compatible, 200 mm graphene was obtained on Ge(001)/Si(001) wafers in this work. Chemical vapor depositions were carried out at the deposition temperatures of 885 °C using CH4 as carbon source on epitaxial Ge(100) layers, which were grown on Si(100), prior to the graphene synthesis. Graphene layer with the 2D/G ratio ∼3 and low D mode (i.e., low concentration of defects) was measured over the entire 200 mm wafer by Raman spectroscopy. A typical full-width-at-half-maximum value of 39 cm-1 was extracted for the 2D mode, further indicating that graphene of good structural quality was produced. The study also revealed that the lack of interfacial oxide correlates with superior properties of graphene. In order to evaluate electrical properties of graphene, its 2 × 2 cm2 pieces were transferred onto SiO2/Si substrates from Ge/Si wafers. The extracted sheet resistance and mobility values of transferred graphene layers were ∼1500 ± 100 Ω/sq and μ ≈ 400 ± 20 cm2/V s, respectively. The transferred graphene was free of metallic contaminations or mechanical damage. On the basis of results of DFT calculations, we attribute the high structural quality of graphene grown by CVD on Ge to hydrogen-induced reduction of nucleation probability, explain the appearance of graphene-induced facets on Ge(001) as a kinetic effect caused by surface step pinning at linear graphene nuclei, and clarify the orientation of graphene domains on Ge(001) as resulting from good lattice matching between Ge(001) and graphene nucleated on such nuclei.
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Affiliation(s)
- M Lukosius
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - J Dabrowski
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - J Kitzmann
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - O Fursenko
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - F Akhtar
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - M Lisker
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - G Lippert
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - S Schulze
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - Y Yamamoto
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - M A Schubert
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - H M Krause
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - A Wolff
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - A Mai
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
| | - T Schroeder
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
- BTU Cottbus-Senftenberg , Konrad Zuse Str. 1, 03046 Cottbus, Germany
| | - G Lupina
- IHP , Im Technologiepark 25, 15236 Frankfurt (Oder), Germany
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29
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Muglia C, Nagella N, Wolff A. P113 Congenital bronchial atresia mimicking asthma and causing a 28 year delay in correct diagnosis. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.123] [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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30
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Canali C, Mazzoni C, Larsen LB, Heiskanen A, Martinsen ØG, Wolff A, Dufva M, Emnéus J. An impedance method for spatial sensing of 3D cell constructs--towards applications in tissue engineering. Analyst 2016. [PMID: 26198701 DOI: 10.1039/c5an00987a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present the characterisation and validation of multiplexed 4-terminal (4T) impedance measurements as a method for sensing the spatial location of cell aggregates within large three-dimensional (3D) gelatin scaffolds. The measurements were performed using an array of four rectangular chambers, each having eight platinum needle electrodes for parallel analysis. The electrode positions for current injection and voltage measurements were optimised by means of finite element simulations to maximise the sensitivity field distribution and spatial resolution. Eight different 4T combinations were experimentally tested in terms of the spatial sensitivity. The simulated sensitivity fields were validated using objects (phantoms) with different conductivity and size placed in different positions inside the chamber. This provided the detection limit (volume sensitivity) of 16.5%, i.e. the smallest detectable volume with respect to the size of the measurement chamber. Furthermore, the possibility for quick single frequency analysis was demonstrated by finding a common frequency of 250 kHz for all the presented electrode combinations. As final proof of concept, a high density of human hepatoblastoma (HepG2) cells were encapsulated in gelatin to form artificial 3D cell constructs and detected when placed in different positions inside large gelatin scaffolds. Taken together, these results open new perspectives for impedance-based sensing technologies for non-invasive monitoring in tissue engineering applications providing spatial information of constructs within biologically relevant 3D environments.
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Affiliation(s)
- C Canali
- Department of Micro- and Nanotechnology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.
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Villa A, Wolff A, Narayana N, Dawes C, Aframian DJ, Lynge Pedersen AM, Vissink A, Aliko A, Sia YW, Joshi RK, McGowan R, Jensen SB, Kerr AR, Ekström J, Proctor G. World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction. Oral Dis 2016; 22:365-82. [PMID: 26602059 DOI: 10.1111/odi.12402] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/11/2015] [Accepted: 11/14/2015] [Indexed: 12/11/2022]
Abstract
The aim of this paper was to perform a systematic review of the pathogenesis of medication-induced salivary gland dysfunction (MISGD). Review of the identified papers was based on the standards regarding the methodology for systematic reviews set forth by the World Workshop on Oral Medicine IV and the PRISMA statement. Eligible papers were assessed for both the degree and strength of relevance to the pathogenesis of MISGD as well as on the appropriateness of the study design and sample size. A total of 99 papers were retained for the final analysis. MISGD in human studies was generally reported as xerostomia (the sensation of oral dryness) without measurements of salivary secretion rate. Medications may act on the central nervous system (CNS) and/or at the neuroglandular junction on muscarinic, α-and β-adrenergic receptors and certain peptidergic receptors. The types of medications that were most commonly implicated for inducing salivary gland dysfunction were those acting on the nervous, cardiovascular, genitourinary, musculoskeletal, respiratory, and alimentary systems. Although many medications may affect the salivary flow rate and composition, most of the studies considered only xerostomia. Thus, further human studies are necessary to improve our understanding of the association between MISGD and the underlying pathophysiology.
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Affiliation(s)
- A Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - A Wolff
- Tel-Aviv Sourasky Medical Center and Saliwell Ltd., Harutzim, Israel
| | - N Narayana
- Department of Oral Biology, UNMC College of Dentistry, Lincoln, NE, USA
| | - C Dawes
- Department of Oral Biology, University of Manitoba, Winnipeg, MB, Canada
| | | | - A M Lynge Pedersen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Vissink
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - A Aliko
- Faculty of Dental Medicine, University of Medicine, Tirana, Albania.,Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Y W Sia
- McGill University, Montreal, QC, Canada
| | - R K Joshi
- DAPMRV Dental College, Bangalore, India
| | - R McGowan
- New York University College of Dentistry, New York, NY, USA
| | - S B Jensen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A R Kerr
- New York University College of Dentistry, New York, NY, USA
| | - J Ekström
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - G Proctor
- Division of Mucosal & Salivary Biology, Dental Institute, King's College London, London, UK
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Wilson L, Gross J, Gallagher G, Wolff A. Comparing trends in the use and outcomes of non invasive ventilation (NIV) in a general intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4797481 DOI: 10.1186/2197-425x-3-s1-a675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kozlovsky A, Wolff A, Saminsky M, Mazor Y, Venezia E, Bar-Ness Greenstein R. Effect ofAggregatibacter actinomycetemcomitansfrom Aggressive Periodontitis patients onStreptococcus mutans. Oral Dis 2015; 21:955-61. [DOI: 10.1111/odi.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 06/24/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A Kozlovsky
- Department of Periodontology and Implant Dentistry; The Maurice and Gabriela Goldschleger School of Dental Medicine; Tel Aviv University; Tel Aviv Israel
| | - A Wolff
- Department of Oral & Maxillofacial Surgery; Rambam Health Care Campus; Haifa Israel
| | - M Saminsky
- Department of Periodontology; Rambam Health Care Campus; Haifa Israel
| | - Y Mazor
- Department of Oral Biology; The Maurice and Gabriela Goldschleger School of Dental Medicine; Tel Aviv University; Tel Aviv Israel
| | - E Venezia
- Periodontology Unit; Department of Oral & Maxillofacial Surgery; Rabin Medical Center; Beilinson Campus; Petach Tikva Israel
| | - R Bar-Ness Greenstein
- Department of Oral Biology; The Maurice and Gabriela Goldschleger School of Dental Medicine; Tel Aviv University; Tel Aviv Israel
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Shantsila E, Wolff A, Lip GYH, Lane DA. Gender differences in stroke prevention in atrial fibrillation in general practice: using the GRASP-AF audit tool. Int J Clin Pract 2015; 69:840-5. [PMID: 25752615 DOI: 10.1111/ijcp.12625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/30/2022] Open
Abstract
BACKGROUND Women represent a large proportion of patients with atrial fibrillation (AF) and tend to have higher risk of stroke. AIMS This study examines gender differences in the utilisation of oral anticoagulation (OAC) and prognosis (i.e. stroke and death) in AF patients in UK general practice. DESIGN Retrospective observational study. METHODS The Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) tool was employed to identify AF patients from 11 general practices in Darlington, England. RESULTS Two thousand two hundred and fifty-nine AF patients (mean±SD age 76 ± 12 years; 46% female) were identified. Based on CHA2 DS2 -VASc score 95% of women and 90% of men were at moderate-high risk of stroke. Women with moderate-high risk of stroke were treated with OAC less frequently than men (47% vs. 52%, p = 0.006). Overall rates of stroke and all-cause mortality were higher among women than men (p = 0.02 and p < 0.001). However, there was no significant gender difference in these outcomes in patients receiving OAC (p = 0.52 for stroke, p = 0.18 for death). Among people not receiving OAC where indicated, female gender was associated with an increased risk of stroke before (p = 0.01), and after (p = 0.04), adjustment for stroke risk factors. Women not receiving OAC had a higher risk of death on univariate regression analysis (p = 0.002), but not after adjustment for stroke risk factors (p = 0.53). CONCLUSION Women with AF are at higher risk of stroke than men without OAC. The gender-related differences in risk of stroke disappear if OAC is used. Despite this, women are more likely not to receive OAC.
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Affiliation(s)
- E Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - A Wolff
- Whinfield Medical Practice, Darlington, UK
| | - G Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - D A Lane
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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Dawes C, Pedersen A, Villa A, Ekström J, Proctor G, Vissink A, Aframian D, McGowan R, Aliko A, Narayana N, Sia Y, Joshi R, Jensen S, Kerr A, Wolff A. The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI. Arch Oral Biol 2015; 60:863-74. [DOI: 10.1016/j.archoralbio.2015.03.004] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/22/2022]
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Rütten A, Wolff A, Streber A. [Sustainable Implementation of Evidence-Based Programmes in Health Promotion: A Theoretical Framework and Concept of Interactive Knowledge to Action]. Gesundheitswesen 2015; 78:139-45. [PMID: 25985226 DOI: 10.1055/s-0035-1548883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This article discusses 2 current issues in the field of public health research: (i) transfer of scientific knowledge into practice and (ii) sustainable implementation of good practice projects. It also supports integration of scientific and practice-based evidence production. Furthermore, it supports utilisation of interactive models that transcend deductive approaches to the process of knowledge transfer. METHODS Existing theoretical approaches, pilot studies and thoughtful conceptual considerations are incorporated into a framework showing the interplay of science, politics and prevention practice, which fosters a more sustainable implementation of health promotion programmes. The framework depicts 4 key processes of interaction between science and prevention practice: interactive knowledge to action, capacity building, programme adaptation and adaptation of the implementation context. RESULTS Ensuring sustainability of health promotion programmes requires a concentrated process of integrating scientific and practice-based evidence production in the context of implementation. Central to the integration process is the approach of interactive knowledge to action, which especially benefits from capacity building processes that facilitate participation and systematic interaction between relevant stakeholders. Intense cooperation also induces a dynamic interaction between multiple actors and components such as health promotion programmes, target groups, relevant organisations and social, cultural and political contexts. The reciprocal adaptation of programmes and key components of the implementation context can foster effectiveness and sustainability of programmes. CONCLUSION Sustainable implementation of evidence-based health promotion programmes requires alternatives to recent deductive models of knowledge transfer. Interactive approaches prove to be promising alternatives. Simultaneously, they change the responsibilities of science, policy and public health practice. Existing boundaries within disciplines and sectors are overcome by arranging transdisciplinary teams as well as by developing common agendas and procedures. Such approaches also require adaptations of the structure of research projects such as extending the length of funding.
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Affiliation(s)
- A Rütten
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - A Wolff
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - A Streber
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
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Rütten A, Wolff A, Streber A. [Interactive Knowledge to Action in Health Promotion: The GESTALT Project. Initial Results of a Pilot Study on Sustainable Implementation of an Evidence-Based Programme]. Gesundheitswesen 2015; 78:359-66. [PMID: 25985225 DOI: 10.1055/s-0035-1548882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The present article outlines a pilot study to demonstrate the concept of the interactive knowledge to action approach in order to foster sustainable implementation of an evidence-based physical activity programme for dementia prevention into practice. The approach and procedures will be introduced, and initial results of the pilot study "GESTALT", with special regard to the interplay of science, politics and prevention practice, will be outlined. METHODS In the GESTALT project (2011-2014) the concept of interactive knowledge to action was realised through a cooperative planning approach that systematically engaged and involved stakeholders from science, politics and practice. Evaluation of the project's sustainability focused on 3 dimensions: target group, organisations and context. Target group analysis included assessment of changes in physical activity behaviour (n=75). Organisational and context evaluations included an analysis of relevant documentation of cooperative planning meetings, conduction of the programme, bilateral talks and further meetings. RESULTS In relation to the target group, the majority of participants (60%) were committed to an active lifestyle 6 months after completion of the GESTALT programme. Regarding organisations and context, 14 partner organisations maintained active engagement in cooperative planning processes. After adapting the GESTALT programme to the context and needs of the organisations and participants, 5 organisations were able to implement it. These same organisations also continued to provide exercise classes for ex-participants of the initial GESTALT programme. Through developing partnerships, increasing publicity and attracting policy makers, resources for the sustainable implementation of the GESTALT project were obtained. CONCLUSION The pilot study GESTALT shows that the concept of interactive knowledge to action has substantially contributed to the sustainability of a physical activity programme in the field of dementia prevention. For this purpose changes in local structures, as well as adaptations of the GESTALT programme to the existing structures of prevention practice had to be made. The approach of cooperative planning proved to be appropriate for the generation of knowledge in terms of practice-based evidence, and it favoured the reciprocal adaptation of the GESTALT programme and implementation contexts.
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Affiliation(s)
- A Rütten
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - A Wolff
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - A Streber
- Institut für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg
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Kistrup K, Poulsen CE, Hansen MF, Wolff A. Ultrasonic welding for fast bonding of self-aligned structures in lab-on-a-chip systems. Lab Chip 2015; 15:1998-2001. [PMID: 25806857 DOI: 10.1039/c5lc00174a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ultrasonic welding is a rapid, promising bonding method for the bonding of polymer chips; yet its use is still limited. We present two lab-on-a-chip applications where ultrasonic welding can be preferably applied: (1) self-aligned gapless bonding of a two-part chip with a tolerance of 50 μm; (2) bonding of a large area shallow chamber (1.8 cm(2) × 150 μm). Using injection moulding combined with ultrasonic welding we achieved a total production and bonding time of 60 s per chip, and a batch of chips could be produced within a day going from design to finished chips. We believe that the technical solutions offered here can significantly help bridge the gap between academia and industry, where the differences in production methods and materials pose a challenge when transferring technology.
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Affiliation(s)
- K Kistrup
- Department of Micro- and Nanotechnology, Technical University of Denmark, DTU Nanotech, Building 345 East, DK-2800 Kongens Lyngby, Denmark.
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Brück S, Trautner H, Wolff A, Hain J, Mols G, Pakos P, Roewer N, Lange M. Comparison of the C-MAC®and GlideScope®videolaryngoscopes in patients with cervical spine disorders and immobilisation. Anaesthesia 2014; 70:160-5. [DOI: 10.1111/anae.12858] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S. Brück
- Department of Anaesthesia and Critical Care; University Hospital of Würzburg; Würzburg Germany
- Department of Cardioanaesthesia; University Hospital of Ulm; Ulm Germany
| | - H. Trautner
- Department of Anaesthesia and Critical Care; University Hospital of Würzburg; Würzburg Germany
| | - A. Wolff
- Department of Anaesthesia and Critical Care; University Hospital of Würzburg; Würzburg Germany
| | - J. Hain
- Department of Mathematics; University of Würzburg; Würzburg Germany
| | - G. Mols
- Department of Anaesthesia and Critical Care; Ortenau Klinikum Lahr-Ettenheim; Lahr Germany
| | - P. Pakos
- Department of Neurosurgery; University Hospital of Würzburg; Würzburg Germany
| | - N. Roewer
- Department of Anaesthesia and Critical Care; University Hospital of Würzburg; Würzburg Germany
| | - M. Lange
- Department of Anaesthesia and Critical Care; University Hospital of Würzburg; Würzburg Germany
- Department of Anaesthesia and Critical Care; Mathias-Spital-Rheine; Rheine Germany
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Wolff A, Majzik Z, Frahsa A, Rütten A. Wissenschafts-Praxis-Partnerschaften – was stärkt wen? Welche Strukturentwicklung findet statt? Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387069] [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: 10/24/2022]
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Agbahiwe H, Kanarek N, Jeter S, Lansey D, Stearns V, Wolff A, Zellars R. Increased African-American Enrollment in Breast Cancer Clinical Trials: A Single-Institution Experience. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1790] [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: 10/24/2022]
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Teschke R, Wolff A, Frenzel C, Schulze J. Letter: Herbal hepatotoxicity--an update on traditional Chinese medicine preparations; authors' reply. Aliment Pharmacol Ther 2014; 40:738-40. [PMID: 25123394 DOI: 10.1111/apt.12887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, Hanau, Germany.
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Teschke R, Wolff A, Frenzel C, Schulze J. Review article: Herbal hepatotoxicity--an update on traditional Chinese medicine preparations. Aliment Pharmacol Ther 2014; 40:32-50. [PMID: 24844799 DOI: 10.1111/apt.12798] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [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] [Received: 03/24/2014] [Revised: 04/09/2014] [Accepted: 04/28/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although evidence for their therapeutic efficacy is limited, herbal traditional Chinese medicine (TCM) preparations increasingly gain popularity. In contrast to other herbal products, adverse effects by herbal TCM including liver toxicity were rarely reported. In recent years, more cases were published, providing new clinical challenges. AIM To summarise comprehensively the literature on herbal TCM hepatotoxicity since 2011. METHODS PubMed was searched using key words related to TCM, the results were restricted to full English-language publications and abstracts published since 2011. In addition, the database of the National Institutes of Health (NIH) and LiverTox was accessed under the topic 'Drug record: Chinese and other Asian herbal medicines'. RESULTS Since 2011, new case reports and case series provided evidence for herbal hepatotoxicity by TCM, focusing on nine TCM herbal mixtures and four individual TCM herbs with potential health hazards. These were the TCM products Ban Tu Wan, Chai Hu, Du Huo, Huang Qin, Jia Wei Xia Yao San, Jiguja, Kamishoyosan, Long Dan Xie Gan Tang, Lu Cha, Polygonum multiflorum products, Shan Chi, 'White flood' containing the herbal TCM Wu Zhu Yu and Qian Ceng Ta, and Xiao Chai Hu Tang. Other developments include the establishment of a new and early diagnostic serum marker for hepatotoxicity caused by pyrrolizidine alkaloids, assessed using ultra performance liquid chromatography-mass spectrometry analysis, and new regulatory details to improve herbal TCM product quality and safety. CONCLUSION Stringent evaluation of the risk/benefit ratio is essential to protect traditional Chinese medicines users from health hazards including liver injury.
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Affiliation(s)
- R Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, Hanau, Germany
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Thynn M, Wolff A, Gorge E, Werner D. Low Concentrations of Phytoalexins Correlate with Resistance in Regenerated Plants from Meristem Cultures of Vicia faba L. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znc-1989-3-411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In tissue cultures from shoot apex meristems with leaf primordias of Vicia faba cv. TP667, addition of low concentration of auxins (0.01 mg ・1-1) induced regeneration of whole plants at high frequency (100%). The combination of NAA and kinetin or GA , also induced a high yield of plant regeneration. Regenerated plants from various cultivars on a medium with 2 ,4 D (0.01 mg ・1-1) were infected with Botrytis cinerea, Phytophthora megasperma and R hizoctonia solani. Accumulation of phytoalexins, ethylene production and the resistance to fungal diseases were studied. In general, production of phytoalexins occurred at a high level in all cultivars infected with B. cinerea. Ethylene production varied more in the seven cultivars studied than phytoalexin accumulation. No cultivar was resistant to B. cinerea. The highest resistance and the low est concentration of phytoalexin was found after infection by R. solani, and phytoalexin accumulation and resistance were interm ediate in plants infected by P. megasperma. The data suggest that only low to medium concentrations of phytoalexin in faba beans are correlated with resistance of regenerated plants.
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Affiliation(s)
- M. Thynn
- Fachbereich Biologie, Botanisches Institut der Philipps Universität, Karl-von-Frisch-Straße, D -3550 Marburg, Bundesrepublik Deutschland
| | - A. Wolff
- Fachbereich Biologie, Botanisches Institut der Philipps Universität, Karl-von-Frisch-Straße, D -3550 Marburg, Bundesrepublik Deutschland
| | - E. Gorge
- Fachbereich Biologie, Botanisches Institut der Philipps Universität, Karl-von-Frisch-Straße, D -3550 Marburg, Bundesrepublik Deutschland
| | - D. Werner
- Fachbereich Biologie, Botanisches Institut der Philipps Universität, Karl-von-Frisch-Straße, D -3550 Marburg, Bundesrepublik Deutschland
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Adelborg K, Bjørnshave K, Mortensen MB, Espeseth E, Wolff A, Løfgren B. A randomised crossover comparison of mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation by surf lifeguards in a manikin. Anaesthesia 2014; 69:712-6. [PMID: 24773395 DOI: 10.1111/anae.12669] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 12/01/2022]
Abstract
Thirty surf lifeguards (mean (SD) age: 25.1 (4.8) years; 21 male, 9 female) were randomly assigned to perform 2 × 3 min of cardiopulmonary resuscitation on a manikin using mouth-to-face-shield ventilation (AMBU LifeKey) and mouth-to-pocket-mask ventilation (Laerdal Pocket Mask). Interruptions in chest compressions, effective ventilation (visible chest rise) ratio, tidal volume and inspiratory time were recorded. Interruptions in chest compressions per cycle were increased with mouth-to-face-shield ventilation (mean (SD) 8.6 (1.7) s) compared with mouth-to-pocket-mask ventilation (6.9 (1.2) s, p < 0.0001). The proportion of effective ventilations was less using mouth-to-face-shield ventilation (199/242 (82%)) compared with mouth-to-pocket-mask ventilation (239/240 (100%), p = 0.0002). Tidal volume was lower using mouth-to-face-shield ventilation (mean (SD) 0.36 (0.20) l) compared with mouth-to-pocket-mask ventilation (0.45 (0.20) l, p = 0.006). No differences in inspiratory times were observed between mouth-to-face-shield ventilation and mouth-to-pocket-mask ventilation. In conclusion, mouth-to-face-shield ventilation increases interruptions in chest compressions, reduces the proportion of effective ventilations and decreases delivered tidal volumes compared with mouth-to-pocket-mask ventilation.
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Affiliation(s)
- K Adelborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Lamers-Kuijper E, Franssen G, Mourik van A, Perik T, Dewit L, Wolff A, Vliet van-Vroegindeweij C, Damen E. EP-1401: First experience with Elekta Flattening Filter Free beams for stereotactic irradiation of brain metastases. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31519-x] [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]
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Abstract
OBJECTIVES This study was designed to determine the effect of using a tensioning device and various winding techniques on the tension of a polytetrafluorethylene (PTFE) floss in a multiuse holder. The hypothesis of this study is that the use of a tensioning device improves the handling and mechanical properties of floss holders. MATERIALS AND METHODS The floss holder was modified so that four different degrees of tension (single-/double-wound; with/without tensioning device) were obtained and tested in an in vitro model approximating dental proximal contact resistance. The following parameters were measured: (I) the force (N) necessary to pass through the proximal contact after the 30th passage, (II) the displacement of the floss (mm), (III) the loosening of the floss (offset, mm), (IV) the change in distance between the branches (mm). RESULTS (I) passage force. All modifications reached 11 N (median). For the double-wound modification using the tensioning device, the smallest displacement (II) was 3.6 mm; the single-wound modification without the tensioning device had the highest displacement (7.6 mm, medians) (III). The offset of all four different modifications ranged between 0 and -2 mm (medians). For the modification without the tensioning device, there was a difference in offset of -2 mm (single-wound) and 0.5 mm (double-wound) (medians). Modifications with the tensioning device did not produce any offset differences. (IV) A change in distance between the branches between -3 mm and -2 mm, respectively (with the tensioning device), and 0 mm (without the tensioning device) was observed (median). The results indicated that double-wound floss and the use of a tensioning device both lead to a constant tension of the floss in the floss holder. CONCLUSIONS Technical modifications such as those shown in this study should improve the mechanical properties of multiuse floss holders, which, in turn, could lead to more user-friendly floss holders and hence to higher user acceptance.
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Affiliation(s)
- A Wolff
- Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
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Jensen V, Wolff A. Congenital Intralobar Pulmonary Sequestration with Anomalous Artery from the Aorta. Acta Radiol 2013. [DOI: 10.1177/028418515604500503] [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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Bissar A, Schiller P, Wolff A, Niekusch U, Schulte AG. Factors contributing to severe early childhood caries in south-west Germany. Clin Oral Investig 2013; 18:1411-8. [PMID: 24114252 DOI: 10.1007/s00784-013-1116-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the contribution of selected variables to the occurrence of severe early childhood caries (S-ECC) in 3- to 5-year-old kindergarten children. METHODS A cross-sectional study was conducted in 2010 in 30 randomly selected kindergartens in the German Rhein-Neckar district. After informed consent, parents were asked to complete a questionnaire. The oral examinations took place in the selected kindergartens and the WHO methods as well as the criteria proposed by the American Academy of Pediatric Dentistry were followed. Logistic regression was applied to explore the main factors contributing to S-ECC in a multivariate model. RESULTS In all, 1,007 children aged 3 to 5 years with an average age of 4.1 (SD = 0.8) years were examined. Five variables were associated significantly with the occurrence of S-ECC: breastfeeding for more than 12 months (OR = 3.27), use of the nursing bottle in bed (OR = 3.08), start of tooth brushing after the first anniversary (OR = 2.42), regular visits at the dentists (OR = 0.14) and mother with immigration background (OR = 4.05). Prevalence rate of S-ECC was 9.5 %. The mean d(3+4)mft values were 5.69 (S-ECC group) and 0.23 (non-S-ECC group). CONCLUSION These results show that occurrence of S-ECC is a complex interaction between socioeconomic, psychological and behavioural factors of parents. New and specific ways to provide preventive dental care for toddlers and infants of caries risk groups have to be developed. CLINICAL RELEVANCE Parents of newborn children have to receive information about timely start of tooth brushing and adequate use of nursing bottles.
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Affiliation(s)
- A Bissar
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany,
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