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Watson-Fargie T, Marshall V, Fullerton NE, Leach V, Pilz D, Hemingbrough CVY, Hopton S, Taylor RW, Ng YS, Schaefer A, Gorman GS, Farrugia ME. Leigh syndrome: an adult presentation of a paediatric disease. Pract Neurol 2024; 24:45-50. [PMID: 37567761 DOI: 10.1136/pn-2023-003862] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/13/2023]
Abstract
A previously healthy 27-year-old man was admitted to the acute neurology ward with events involving his face, throat and upper limb, which video telemetry later confirmed were refractory focal seizures. He also had progressive pyramidal features, dysarthria and ataxia. MR scans of the brain identified progressive bilateral basal ganglia abnormalities, consistent with Leigh syndrome. However, extensive laboratory and genetic panels did not give a unifying diagnosis. A skeletal muscle biopsy showed no histopathological abnormalities on routine stains. Sequencing of the entire mitochondrial genome in skeletal muscle identified a well-characterised pathogenic variant (m.10191T>C in MT-ND3; NC_012920.1) at 85% heteroplasmy in skeletal muscle. We discuss the clinical and molecular diagnosis of an adult presenting with Leigh syndrome, which is more commonly a paediatric presentation of mitochondrial disease, and how early recognition of a mitochondrial cause is important to support patient care.
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Affiliation(s)
| | | | | | - Veronica Leach
- Neurophysiology, Institute of Neurological Sciences, Glasgow, UK
| | - Daniela Pilz
- West of Scotland Genomics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Charlotte V Y Hemingbrough
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sila Hopton
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert W Taylor
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Yi S Ng
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Schaefer
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Gráinne S Gorman
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Abart T, Gross C, Kohout F, Schaefer A, Riebandt J, Laufer G, Wiedemann D, Zimpfer D, Schloeglhofer T. Early Markers for Hemocompatibility Related Adverse Events Based on Routinely Available Pump Parameters from HeartMate 3 Left Ventricular Assist Device Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1514] [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: 04/05/2023] Open
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Doherty JR, Schaefer A, Goodman DC. Texas Hospitals' Perspectives About NICU Performance Measures: A Mixed-Methods Study. Qual Manag Health Care 2023; 32:8-15. [PMID: 35383729 PMCID: PMC9530051 DOI: 10.1097/qmh.0000000000000347] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to assess Texas hospital leaders' perspectives about neonatal intensive care (NICU) performance measures. METHODS We conducted an explanatory mixed-methods study. First, we sent a survey and a copy of the Dartmouth Atlas of Neonatal Intensive Care to clinical and administrative leaders of 150 NICUs in Texas. We asked respondents to review the chapter that reported Texas-specific results and respond to a variety of open and closed-ended questions about the overall usefulness of the report. Second, we conducted semistructured qualitative interviews with a subset of survey respondents to better understand their perspectives. RESULTS The survey had a 50% hospital response rate. Respondents generally found the report to be interesting and useful, and 87.7% of all respondents reported being in favor of receiving future reports with their own hospital's data benchmarked against anonymous peers. All of the specific measures in the Atlas were found to be of interest and valuable, with NICU admissions and special care days rating among the most interesting and useful. In the semistructured interviews, respondents expressed that a report with performance data would serve as a mechanism to drive change by identifying opportunities for improvement. CONCLUSION Texas hospital NICU leaders are interested in routinely receiving more information about their own NICU's performance anonymously benchmarked against their peers. This would facilitate a greater understanding of a unit's functionality, as well as accelerate clinically appropriate quality improvement initiatives, which together have the potential to deliver better newborn care at lower costs for all Texans.
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Affiliation(s)
- Julie R Doherty
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
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Moen EL, Brooks GA, O’Malley AJ, Schaefer A, Carlos HA, Onega T. Use of a Novel Network-Based Linchpin Score to Characterize Accessibility to the Oncology Physician Workforce in the United States. JAMA Netw Open 2022; 5:e2245995. [PMID: 36525275 PMCID: PMC9856409 DOI: 10.1001/jamanetworkopen.2022.45995] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022] Open
Abstract
Importance Physician headcounts provide useful information about the cancer care delivery workforce; however, efforts to track the oncology workforce would benefit from new measures that capture how essential a physician is for meeting the multidisciplinary cancer care needs of the region. Physicians are considered linchpins when fewer of their peers are connected to other physicians of the same specialty as the focal physician. Because they are locally unique for their specialty, these physicians' networks may be particularly vulnerable to their removal from the network (eg, through relocation or retirement). Objective To examine a novel network-based physician linchpin score within nationwide cancer patient-sharing networks and explore variation in network vulnerability across hospital referral regions (HRRs). Design, Setting, and Participants This cross-sectional study analyzed fee-for-service Medicare claims and included Medicare beneficiaries with an incident diagnosis of breast, colorectal, or lung cancer from 2016 to 2018 and their treating physicians. Data were analyzed from March 2022 to October 2022. Exposures Physician characteristics assessed were specialty, rurality, and Census region. HRR variables assessed include sociodemographic and socioeconomic characteristics and use of cancer services. Main Outcomes and Measures Oncologist linchpin score, which examined the extent to which a physician's peers were connected to other physicians of the same specialty as the focal physician. Network vulnerability, which distinguished HRRs with more linchpin oncologists than expected based on oncologist density. χ2 and Fisher exact tests were used to examine relationships between oncologist characteristics and linchpin score. Spearman rank correlation coefficient (ρ) was used to measure the strength and direction of relationships between HRR network vulnerability, oncologist density, population sociodemographic and socioeconomic characteristics, and cancer service use. Results The study cohort comprised 308 714 patients with breast, colorectal, or lung cancer. The study cohort of 308 714 patients included 161 206 (52.2%) patients with breast cancer, 76 604 (24.8%) patients with colorectal cancer, and 70 904 (23.0%) patients with lung cancer. In our sample, 272 425 patients (88%) were White, and 238 603 patients (77%) lived in metropolitan areas. The cancer patient-sharing network included 7221 medical oncologists and 3573 radiation oncologists. HRRs with more vulnerable networks for medical oncology had a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.19; 95% CI, 0.08 to 0.29). HRRs with more vulnerable networks for radiation oncology had a higher percentage of beneficiaries living in poverty (ρ, 0.17; 95% CI, 0.06 to 0.27), and a higher percentage of beneficiaries eligible for Medicaid (ρ, 0.21; 95% CI, 0.09 to 0.31), and lower rates of cohort patients receiving radiation therapy (ρ, -0.18; 95% CI, -0.28 to -0.06; P = .003). The was no association between network vulnerability for medical oncology and percent of cohort patients receiving chemotherapy (ρ, -0.03; 95% CI, -0.15 to 0.08). Conclusions and Relevance This study found that patient-sharing network vulnerability was associated with poverty and lower rates of radiation therapy. Health policy strategies for addressing network vulnerability may improve access to interdisciplinary care and reduce treatment disparities.
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Affiliation(s)
- Erika L. Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Gabriel A. Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - A. James O’Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Heather A. Carlos
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tracy Onega
- Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Population Health Science, University of Utah, Salt Lake City
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Camm CF, Crawford W, Prachee I, Olivarius-McAllister J, Schaefer A, Raouf Z, Bello A, Ginks M, Nicol ED. Conflicts of interest in electrophysiology and devices presentations. Europace 2022; 25:660-666. [PMID: 36413616 PMCID: PMC9935044 DOI: 10.1093/europace/euac205] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/23/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Industry collaboration with arrhythmia and devices research is common. However, this results in conflicts of interest (CoI) for researchers that should be disclosed. This study aimed to examine the quality of CoI disclosures in arrhythmia and devices presentations. METHODS Recorded presentations from the Arrhythmia & Devices section of the ESC Annual Congress 2016-2020 were assessed. The number of words, conflicts, and time displayed was documented for CoI declarations. Meta-data including sponsorship by an industry partner, presenter sex, and institution were obtained. RESULTS Of 1153 presentations assessed, 999 were suitable for inclusion. CoI statements were missing from 7.2% of presentations, and 58% reported ≥1 conflict. Those with conflicts spent less time-per-word on their disclosures (median 150 ms, interquartile range [IQR] 83-273 ms) compared with those without conflicts (median 250 ms, IQR 125-375 ms). One-in-eight presentations were sponsored (12.8%, n = 128). CoI statements were more likely to be missing in sponsored presentations (14.8%, n = 19) compared with non-sponsored presentations (6.1%, n = 53), P = 0.0003. Sponsored presentations contained a greater median number of CoIs (10, IQR 6-18) compared with non-sponsored sessions (1, IQR 0-5), P < 0.0001. Time-per-word spent on COI disclosures was 50% lower in sponsored sessions (125 ms, IQR 75-231 ms) compared with non-sponsored sessions (250 ms, IQR 125-375 ms), P < 0.0001. CONCLUSION The majority of those presenting arrhythmia and devices research have CoIs to declare. Declarations were often missing or displayed for short periods of time. Presenters in sponsored sessions, while being more conflicted, had a lower standard of declaration suggesting a higher risk of potential bias which viewers had insufficient opportunity to assess.
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Affiliation(s)
- C F Camm
- Corresponding author. Tel: +44 1865 272727. E-mail address:
| | | | - I Prachee
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Broomhall, Sheffield S10 2JF, UK
| | | | - A Schaefer
- Keble College, University of Oxford, Parks Road, Oxford OX1 3PG, UK
| | - Z Raouf
- Keble College, University of Oxford, Parks Road, Oxford OX1 3PG, UK
| | - A Bello
- Keble College, University of Oxford, Parks Road, Oxford OX1 3PG, UK
| | - M Ginks
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - E D Nicol
- Cardiology Department, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK,School of Biomedical Engineering and Imaging Sciences, Kings College, Strand, London WC2R 2LS, UK
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Zipkin RJ, Schaefer A, Wang C, Loehrer AP, Kapadia NS, Brooks GA, Onega T, Wang F, O'Malley AJ, Moen EL. Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries. Ann Surg Oncol 2022; 29:5759-5769. [PMID: 35608799 PMCID: PMC9128633 DOI: 10.1245/s10434-022-11834-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delays between breast cancer diagnosis and surgery are associated with worsened survival. Delays are more common in urban-residing patients, although factors specific to surgical delays among rural and urban patients are not well understood. METHODS We used a 100% sample of fee-for-service Medicare claims during 2007-2014 to identify 238,491 women diagnosed with early-stage breast cancer undergoing initial surgery and assessed whether they experienced biopsy-to-surgery intervals > 90 days. We employed multilevel regression to identify associations between delays and patient, regional, and surgeon characteristics, both in combined analyses and stratified by rurality of patient residence. RESULTS Delays were more prevalent among urban patients (2.5%) than rural patients (1.9%). Rural patients with medium- or high-volume surgeons had lower odds of delay than patients with low-volume surgeons (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.58-0.88; OR = 0.74, 95% CI = 0.61-0.90). Rural patients whose surgeon operated at ≥ 3 hospitals were more likely to experience delays (OR = 1.29, 95% CI = 1.01-1.64, Ref: 1 hospital). Patient driving times ≥ 1 h were associated with delays among urban patients only. Age, black race, Hispanic ethnicity, multimorbidity, and academic/specialty hospital status were associated with delays. CONCLUSIONS Sociodemographic, geographic, surgeon, and facility factors have distinct associations with > 90-day delays to initial breast cancer surgery. Interventions to improve timeliness of breast cancer surgery may have disparate impacts on vulnerable populations by rural-urban status.
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Affiliation(s)
- Ronnie J Zipkin
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Changzhen Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew P Loehrer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Alistair J O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Moe A, Schaefer A, Gorman G, Ng YS. Changing phenotypes, a spectrum over 10 years. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our patient first presented with progressive unsteadiness and slurred speech at the age of 67 years. The initial working diagnosis was progressive ataxia. There were minimal cerebellar changes on MRI head and extensive laboratory tests including common spinocerebellar ataxia screen was negative. He sub- sequently developed distal muscle wasting and weakness, and pathologically brisk reflexes, with normal CK levels. Motor neuron disease (MND) was then clinically suspected, however, further neurophysiologi- cal studies and a nerve biopsy revealed changes consistent with an axonal neuropathy. Generalised muscle wasting, bilateral scapular winging, eyelid ptosis and complex ophthalmoplegia were identified eight years after initial clinic review. The complex evolving neurological phenotype prompted a muscle biopsy to investigate for mitochondrial disease. Whilst some evidence of mitochondrial dysfunction was identified, the mitochondrial DNA maintenance nuclear gene panel was negative. He was enrolled to the 100k genome project which revealed a heterozygous KIF5A pathogenic variant. Mutations in KIF5A are associated with a wide phenotypic spectrum including CMT neuropathy, hereditary spastic paraplegia and MND-like syndrome. Our case highlights the diagnostic conundrum of evolving neurological mani- festations of KIF5A disease that demonstrates overlapping cardinal features with mitochondrial disease.
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Streckenbach A, Sinn M, Brandi L, Ludwig S, Linder M, Schofer N, Seiffert M, Lund G, Schaefer A, Tahir E, Adam G, Meyer M. 483 High-pitch Non-ecg-gated Ct Angiography Fortranscatheter Aortic Valvereplacement Planning: A Comparison To A Ecg-gated Cta Protocol And Impact On Clinical Outcome. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Beneke K, Grammatika Pavlidou N, Schaefer A, Reichenspurner H, E Molina C. GPCR-dependent pathways promote nanodomain-specific cAMP signaling in human cardiomyocytes, which is severely remodeled in atrial fibrillation. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft, German Centre for Cardiovascular Research (DZHK)
Background
Cardiac arrhythmias, such as atrial fibrillation (AF), have been linked to the remodeling of membrane receptors and alterations in cAMP-dependent regulation of calcium handling mechanisms. For instance, decreased L-type calcium channel (LTCC) current density but upregulated ryanodine receptor 2 (RyR2) are major hallmarks of AF. Furthermore, adenosine A2A receptor (A2AR) stimulation increases calcium waves without affecting LTCC and serotonin (5-HT) receptors activation exerts stronger control over myofilaments than over RyR2 function. However, up to date no study has elucidated how the increase on cAMP upon different G-protein-coupled receptors (GPCR) stimulation can lead to different physiological compartmentalized responses. The aim of this study was to investigate the effects of various GPCRs on cAMP levels in different cellular compartments in human atrial myocytes from control patients in sinus rhythm (Ctl), and how these compartmentalized effects are altered in AF. Furthermore, alterations in downstream cAMP level control by phosphodiesterases (PDEs) between patient groups were investigated to further elucidate functional differences.
Methods
Atrial myocytes were isolated from tissues of 66 AF and 80 Ctl patients. Cells were then transduced with adenoviruses (Epac1-camps, pm-Epac1-camps and Epac1-JNC) and cultured for 48 hours to express the Förster-resonance energy transfer (FRET)-based cAMP sensor in the cytosolic, membrane and RyR2 nanodomains, respectively. FRET was then used to measure cAMP in 532 isolated human atrial myocytes. Stimulation with β-adrenergic agonist Isoprenaline (ISO, 100nM) was used and compared with 5-HT (100µM) and A2AR (with CGS, 200nM) stimulation. Additionally, a nonspecific PDE inhibitor (IBMX, 100µM) was applied, as well as PDE3 (Cilostamide, 1µM) and PDE4 (Ro 20-1724, 10µM) specific inhibitors.
Results
A desensitization to β-adrenergic receptor stimulation in AF myocytes was exclusively found in the cytosol, while no difference was seen in neither the RyR2 nor LTCC compartment in AF versus Ctl. Similar effects were observed upon 5-HT stimulation with a significant desensitization in the cytosol, and no difference in the RyR2 compartment. On the contrary, AF myocytes displayed a significantly higher increase in cAMP levels compared to Ctl myocytes in the cytosol upon A2ARs stimulation. Importantly, no effect on cAMP levels was observed in the LTCC compartment after A2ARs or 5-HT stimulation. However, PDE3 inhibition on top of 5-HT stimulation showed a significantly smaller effect on cAMP levels in AF myocytes within the LTCC compartment.
Conclusions
Collectively, our data show that cAMP levels are highly compartmentalized in human atrial myocytes and differentially regulated by different GPCRs. Furthermore, PDEs are to a certain extent responsible for the compartmentalized effects of the different GPCRs.
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Affiliation(s)
- K Beneke
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | | | - A Schaefer
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - H Reichenspurner
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - C E Molina
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Moen EL, Chen Z, Schaefer A, Bhimani A, O'Malley J, Dragnev KH. Characterizing node-negative non-small cell lung cancer patients with similarity networks: A CancerLinQ Discovery analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20585] [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
e20585 Background: Patients with node-negative non-small cell lung cancer (NSCLC) whose tumors are completely resected account for approximately 17% of all patients with lung cancer, and disease recurrence occurs in approximately 1 in 5 of these patients. The lack of consensus on factors associated with risk of disease recurrence among node-negative NSCLC patients is a significant barrier to applying precision medicine strategies in this patient population. Clustering similar patients based on distances between various features of data is an emerging topic in precision medicine. Patient similarity networks represent a new model for clustering patients based on heterogeneous data, whereby any data type is converted into a similarity network by defining a similarity measure. The objective of this study was to examine the utility of patient similarity networks to identify NSCLC patients at higher risk of adverse outcomes. Methods: We conducted a retrospective, observational study of 6,020 node-negative NSCLC patients with an initial diagnosis in 2011-2014 in the CancerLinQ Discovery database. A patient similarity network was assembled based on comorbidities and network communities of patients with similar comorbidities at diagnosis were identified. Using Cox proportional-hazards modeling, we examined the extent to which patient age, sex, race, ethnicity, and network community predicted 2-year disease recurrence and 2-year mortality. Results: In the adjusted analyses, patients in the network community enriched for renal disease and congestive heart failure had an 83% increased risk of mortality (95% CI = 1.39-2.41). Patients in the network community enriched for pulmonary disease had a 37% increased risk of mortality (95% CI = 1.06-1.74) yet a lower risk of recurrence (HR = 0.5, 95% CI = 0.34-0.75). After adjusting for comorbidity network community, male patients had a 14% increased risk of mortality (95%CI = 1.02-1.28) and a 21% increased risk of recurrence (95% CI = 1.05-1.40) and black patients had a lower mortality risk (HR = 0.71, 95% CI = 0.58-0.86). Conclusions: Future studies applying patient similar networks to integrate additional diverse and high dimensional data types may afford more clarity in assigning risk of adverse outcomes.
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Affiliation(s)
- Erika L Moen
- Dartmouth College Geisel School of Medicine, Lebanon, NH
| | | | | | | | - James O'Malley
- Dartmouth College Geisel School of Medicine, Lebanon, NH
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Zipkin RJ, Schaefer A, Wang C, Loehrer AP, Kapadia NS, Brooks GA, Onega T, Wang F, O'Malley AJ, Moen EL. ASO Visual Abstract: Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries. Ann Surg Oncol 2022. [PMID: 35552923 DOI: 10.1245/s10434-022-11877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ronnie J Zipkin
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Changzhen Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew P Loehrer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Department of Surgery, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Population Sciences, University of Utah, Salt Lake City, UT, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, USA
| | - Alistair J O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. .,Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Maw M, Schloeglhofer T, Widhalm G, Wittmann F, Schlein J, Schaefer A, Riebandt J, Stadler R, Moscato F, Marko C, Zimpfer D, Schima H. Modular Physiological Control for Left Ventricular Assist Devices: A Clinical Pilot Trial. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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13
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Wittmann F, Schlöglhofer T, Riebandt J, Schaefer A, Wiedemann D, Laufer G, Zimpfer D. Off-Pump Implantation of Left Ventricular Assist Devices - A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Ludwig S, Sedighian S, Weimann J, Koell B, Waldschmidt L, Schaefer A, Seiffert M, Westermann D, Reichenspurner H, Blankenberg S, Schofer N, Lubos E, Conradi L, Kalbacher D. Outcomes of patients with severe mitral regurgitation treated with transcatheter mitral valve implantation or medical therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with severe mitral regurgitation (MR) unsuitable for standard therapy (i.e., open-heart surgery and transcatheter edge-to-edge repair [TEER]), often remain on medical therapy (MT) alone. Transcatheter mitral valve implantation (TMVI) may represent an alternative treatment option for these patients.
Purpose
We aimed to investigate differences in anatomical baseline characteristics and echocardiographic outcomes between MR patients unsuitable for standard therapy, that were either treated with TMVI or remained on MT.
Methods
Between 05/2016-02/2021, 121 high-risk patients with severe MR were evaluated for TMVI. Clinical, echocardiographic and functional outcomes between the subgroups of patients treated with TMVI and MT were compared. The primary combined endpoint was all-cause death or heart failure (HF) hospitalization at 1 year. Subgroup analyses were performed to define specific patient subsets favouring either TMVI or MT.
Results
At baseline, there were no differences between the TMVI group (n = 38) and the MT group (n = 44) regarding age (all TMVI vs. MT: 77.0 years [IQR 72.9, 80.1] vs. 79.0 [IQR 76.0, 81.7], p = 0.13), gender (42.1% female vs. 56.8% female, p = 0.27) and estimated surgical risk (EuroSCORE II 4.4% [IQR 2.8, 13.6] vs. 6.4 [IQR 3.4, 10.1], p = 0.72). Patients undergoing TMVI were more frequently treated for secondary MR (68.4%), while primary MR was the most prevalent MR etiology in patients remaining on medical therapy (50.0%). Left ventricular (LV) end-diastolic diameters (LVEDD) were larger and LV ejection fraction (LVEF) was lower in the TMVI group (LVEDD 58.0mm [IQR 51.4, 65.0], LVEF 37.0% [IQR 31.4, 51.2]) compared to the MT group (LVEDD 52.0mm [IQR 46.2, 58.8], LVEF 54.5% [IQR 40.8, 60.0]) (p = 0.02 for LVEDD, p < 0.001 for LVEF). MR was effectively reduced to ≤ mild MR in all patients undergoing TMVI. In the MT group, MR remained severe in 90% of patients after 1 year. The primary composite endpoint occurred numerically more often in the MT group (72.2%) compared to the TMVI group (51.6%, p = 0.061). Regarding the primary endpoint, the subgroups of patients with LVEF 30-49% (HR 0.28 [95%-CI 0.11-0.67], p = 0.004), effective regurgitant orifice area (EROA) <0.4 cm2 (HR 0.30 [95%-CI 0.13-0.71], p = 0.006), tricuspid annular plane systolic excursion (TAPSE) ≥17mm (HR 0.27 [95%-CI 0.11-0.67], p = 0.005) and New York Heart Association functional class III (HR 0.38 [95%-CI 0.18-0.81], p = 0.012) were more likely to benefit from TMVI compared to MT.
Conclusions
In patients with severe MR unsuitable for standard therapy, TMVI represents a reasonable therapeutic alternative yielding effective elimination of MR. While most patients eligible for TMVI suffer from secondary MR, the majority of patients remaining on MT has primary MR. The primary endpoint occurred numerically, yet not statistically, more often in patients on MT. Baseline echocardiography was able to identify subgroups of patients with beneficial outcome after TMVI.
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Affiliation(s)
- S Ludwig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Sedighian
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Waldschmidt
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Schaefer
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Seiffert
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - S Blankenberg
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - E Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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15
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Schaefer A, Huang Y, Kittai A, Maakaron JE, Saygin C, Brammer J, Penza S, Saad A, Jaglowski SM, William BM. Cytopenias After CD19 Chimeric Antigen Receptor T-Cells (CAR-T) Therapy for Diffuse Large B-Cell Lymphomas or Transformed Follicular Lymphoma: A Single Institution Experience. Cancer Manag Res 2021; 13:8901-8906. [PMID: 34876852 PMCID: PMC8643129 DOI: 10.2147/cmar.s321202] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) have poor outcomes. Treatment with CD19 chimeric antigen receptor (CAR-T) cells, tisagenlecleucel and axicabtagene ciloleucel, has been associated with improved outcomes. Cytopenias were observed in clinical trials with both products; however, little is known regarding the patterns and outcomes of these cytopenias. SUBJECTS AND METHODS We reviewed DLBCL patients (n=32) receiving either product between January and September 2018 at our institution. RESULTS Median duration of leukopenia, neutropenia, lymphopenia, anemia, and thrombocytopenia was 49, 9, 117.5, 125, and 95.5 days after CAR-T infusion, respectively. Filgrastim was used in 63% of patients, and 50% of patients received red cell or platelet transfusions. With the exception of neutropenia, increase in the duration of cytopenia of any lineage was associated with improvement in progression-free survival, and in overall survival in case of anemia. There was no association between the duration of cytopenias with either cytokine release syndrome or neurotoxicity. DISCUSSION Our data suggest a correlation between cytopenias and survival outcomes after CD19 CAR-T therapy. If validated, cytopenia may be proven useful as a biomarker of response and survival after CAR-T therapy.
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Affiliation(s)
- Andrew Schaefer
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Ying Huang
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Adam Kittai
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph E Maakaron
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Caner Saygin
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Brammer
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sam Penza
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ayman Saad
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Basem M William
- OhioHealth Blood and Marrow Transplant Program, Columbus, OH, USA
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16
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Grundmann D, Linder M, Gossling A, Voigtlaender L, Ludwig S, Waldschmidt L, Demal T, Bhadra O, Seiffert M, Schaefer A, Reichenspurner H, Blankenberg S, Westermann D, Conradi L, Schofer N. Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown.
Purpose
We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS.
Methods
This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software.
Results
Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p<0.001) and ET (Spearman: r=0.18; p<0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT < CD (ET ≥ vs. < CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p<0.001; AT ≥ vs < CD: mortality at 1-year: 15.5 vs. 25.9%, p<0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p<0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses.
Conclusion
T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Grundmann
- University Heart Center Hamburg, Hamburg, Germany
| | - M Linder
- University Heart Center Hamburg, Hamburg, Germany
| | - A Gossling
- University Heart Center Hamburg, Hamburg, Germany
| | | | - S Ludwig
- University Heart Center Hamburg, Hamburg, Germany
| | | | - T Demal
- University Heart Center Hamburg, Hamburg, Germany
| | - O Bhadra
- University Heart Center Hamburg, Hamburg, Germany
| | - M Seiffert
- University Heart Center Hamburg, Hamburg, Germany
| | - A Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - D Westermann
- University Heart Center Hamburg, Hamburg, Germany
| | - L Conradi
- University Heart Center Hamburg, Hamburg, Germany
| | - N Schofer
- University Heart Center Hamburg, Hamburg, Germany
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17
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Camm CJF, Crawford W, Olivarius-Mcallister J, Prachee I, Schaefer A, Raouf Z, Bello A, Ginks M, Nicol E. Does industry funding differ between men and women in electrophysiology and devices research? Europace 2021. [DOI: 10.1093/europace/euab116.526] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A significant gender bias has been identified in cardiology. Industry funding may be important developing electrophysiology (EP) and devices research. Such funding leads to potential conflicts of interest (COI) which must be disclosed on research presentations. There is limited evidence whether the gender bias in cardiology extends to industry funding of research.
Purpose
To assess whether COI disclosures in EP and devices presentations at the ESC Annual Congress differ between men and women.
Methods
Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, it was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Presentations with multiple speakers were also excluded. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively.
Results
Of 1,153 presentations assessed, 999 were suitable for inclusion. Women made up 22% (n = 221) of presenters. There was no difference in whether COI declaration slides were missing between women (5.9%, n = 13) and men (7.6%, n = 56), p = 0.38. In those with COI disclosure slides (n = 927), women declared significantly lower median number of COIs (0, IQR 0-3) compared with men (2, IQR 0-8), p < 0.0001. In contrast, women spent a greater time-per-word on their COI disclosure slides (250ms, IQR 125-375ms) compared with men (200ms, IQR 118-333ms), p < 0.0001.
Conclusions
Women made up a minority of presenters in EP/devices talks at the ESC annual congress. Women were less likely to have COIs which may suggest that they are less likely to receive industry funding. Despite this, women spent a greater amount of time-per-word on their COI slides. The lower number of declared COIs in women highlights another potential area of gender bias in cardiology that needs further investigation so that it can be addressed.
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Affiliation(s)
- CJF Camm
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - W Crawford
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - I Prachee
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Schaefer
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - Z Raouf
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Bello
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Ginks
- Oxford University Hospitals NHS Foundation Trust, Cardiology Department, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - E Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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18
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Zipkin R, Schaefer A, Chamberlin M, Onega T, O'Malley AJ, Moen EL. Surgeon and medical oncologist peer network effects on the uptake of the 21-gene breast cancer recurrence score assay. Cancer Med 2021; 10:1253-1263. [PMID: 33455068 PMCID: PMC7926024 DOI: 10.1002/cam4.3720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Drivers behind the adoption of gene expression profiling in breast cancer oncology have been shown to include exposure to physician colleagues' use of a given genomic test. We examined adoption of the Oncotype DX 21-gene breast cancer recurrence score assay (ODX) in the United States after its incorporation into clinical guidelines. The influence of patient-sharing ties and co-location with prior adopters and the role of these potential exposures across medical specialties on peers' adoption of the test were examined. METHODS We conducted a retrospective cohort study of women with incident breast cancer using a 100% sample of fee-for-service Medicare enrollee claims over 2008-2011. Peer networks connecting medical oncologists and surgeons treating these patients were constructed using patient-sharing and geographic co-location. The impact of peer connections on the adoption of ODX by physicians and testing of patients was modeled with multivariable hierarchical regression. RESULTS Altogether, 156,229 women identified with incident breast cancer met criteria for cohort inclusion. A total of 7689 ODX prescribing physicians were identified. Co-location with medical oncologists who adopted the test in the early period (2008-2009) was associated with a 1.38-fold increase in the odds of a medical oncologist adopting ODX in 2010-2011 (95% CI = 1.04-1.83), as was co-location with early-adopting surgeons (odds ratio [OR] = 1.25, 95% CI = 1.00-1.58). Patients whose primary medical oncologist was linked to an early-adopting surgeon through co-location (OR = 1.17, 95% CI = 1.04-1.32) or both patient-sharing and co-location (OR = 1.17, 95% CI = 1.03-1.34) were more likely to receive ODX. CONCLUSIONS Exposure to surgeon early adopters through peer networks and co-location was predictive of ODX uptake by medical oncologists and testing of patients. Interventions focused on the role of surgeons in molecular testing may improve the implementation of best practices in breast cancer care.
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Affiliation(s)
- Ronnie Zipkin
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNHUSA
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNHUSA
| | - Mary Chamberlin
- Department of MedicineGeisel School of Medicine at DartmouthLebanonNHUSA
- Department of Hematology‐OncologyDartmouth‐Hitchcock Medical CenterLebanonNHUSA
- Norris Cotton Cancer CenterDartmouth‐Hitchcock Medical CenterLebanonNHUSA
- Comprehensive Breast ProgramNorris Cotton Cancer CenterGeisel School of Medicine at DartmouthLebanonNHUSA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNHUSA
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUTUSA
- Department of Population SciencesUniversity of UtahSalt Lake CityUTUSA
- Department of EpidemiologyGeisel School of Medicine at DartmouthLebanonNHUSA
| | - Alistair J. O'Malley
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNHUSA
- The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNHUSA
- Norris Cotton Cancer CenterDartmouth‐Hitchcock Medical CenterLebanonNHUSA
| | - Erika L. Moen
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNHUSA
- The Dartmouth Institute for Health Policy and Clinical PracticeLebanonNHUSA
- Norris Cotton Cancer CenterDartmouth‐Hitchcock Medical CenterLebanonNHUSA
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19
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Bhadra OD, Demal TJ, Schneeberger Y, Ludwig S, Waldschmidt L, Grundmann D, Voigtlaender L, Linder M, Schofer N, Blankenberg S, Reichenspurner H, Seiffert M, Conradi L, Westermann D, Schaefer A. Comparison of Two Contemporary Balloon-Expandable Transcatheter Heart Valves: Sapien 3 versus Sapien 3 Ultra. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Waldschmidt L, Gossling A, Ludwig S, Linder M, Voigtlaender L, Schaefer A, Bhadra O, Schirmer J, Reichenspurner H, Blankenberg S, Westermann D, Seiffert M, Conradi L, Schofer N. Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort.
Methods
In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. >10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years.
Results
Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p<0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p<0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups.
Conclusions
Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients.
Figure 1. 1-year mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Waldschmidt
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Gossling
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Ludwig
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Linder
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Voigtlaender
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Schaefer
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - O Bhadra
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Schirmer
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Reichenspurner
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Blankenberg
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Westermann
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Seiffert
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Conradi
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Schofer
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schwedhelm TM, Rees JR, Onega T, Zipkin RJ, Schaefer A, Celaya MO, Moen EL. Patient and physician factors associated with Oncotype DX and adjuvant chemotherapy utilization for breast cancer patients in New Hampshire, 2010-2016. BMC Cancer 2020; 20:847. [PMID: 32883270 PMCID: PMC7650301 DOI: 10.1186/s12885-020-07355-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/27/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Oncotype DX® (ODX) is used to assess risk of disease recurrence in hormone receptor positive, HER2-negative breast cancer and to guide decisions regarding adjuvant chemotherapy. Little is known about how physician factors impact treatment decisions. The purpose of this study was to examine patient and physician factors associated with ODX testing and adjuvant chemotherapy for breast cancer patients in New Hampshire. METHODS We examined New Hampshire State Cancer Registry data on 5630 female breast cancer patients diagnosed from 2010 to 2016. We performed unadjusted and adjusted hierarchical logistic regression to identify factors associated with a patient's receipt of ODX, being recommended and receiving chemotherapy, and refusing chemotherapy. We calculated intraclass correlation coefficients (ICCs) to examine the proportion of variance in clinical decisions explained by between-physician and between-hospital variation. RESULTS Over the study period, 1512 breast cancer patients received ODX. After adjustment for patient and tumor characteristics, we found that patients seen by a male medical oncologist were less likely to be recommended chemotherapy following ODX (OR = 0.50 (95% CI = 0.34-0.74), p < 0.01). Medical oncologists with more clinical experience (reference: less than 10 years) were more likely to recommend chemotherapy (20-29 years: OR = 4.05 (95% CI = 1.57-10.43), p < 0.01; > 29 years: OR = 4.48 (95% CI = 1.68-11.95), p < 0.01). A substantial amount of the variation in receiving chemotherapy was due to variation between physicians, particularly among low risk patients (ICC = 0.33). CONCLUSIONS In addition to patient clinicopathologic characteristics, physician gender and clinical experience were associated with chemotherapy treatment following ODX testing. The significant variation between physicians indicates the potential for interventions to reduce variation in care.
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Affiliation(s)
- Thomas M Schwedhelm
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Judy R Rees
- New Hampshire State Cancer Registry, Lebanon, NH, USA
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Tracy Onega
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Ronnie J Zipkin
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Andrew Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Maria O Celaya
- New Hampshire State Cancer Registry, Lebanon, NH, USA
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
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Schaefer A, Ferdinands RED, O'Dwyer N, Edwards S. A biomechanical comparison of conventional classifications of bowling action-types in junior fast bowlers. J Sports Sci 2020; 38:1085-1095. [PMID: 32281483 DOI: 10.1080/02640414.2020.1741972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fast bowling is categorised into four action types: side-on, front-on, semi-open and mixed; however, little biomechanical comparison exists between action types in junior fast bowlers. This study investigated whether there are significant differences between action-type mechanics in junior fast bowlers. Three-dimensional kinematic and kinetic analyses were completed on 60 junior male fast bowlers bowling a five-over spell. Mixed-design factorial analyses of variance were used to test for differences between action-type groups across the phases of the bowling action. One kinetic difference was observed between groups, with a higher vertical ground reaction force loading rate during the front-foot contact phase in mixed and front-on compared to semi-open bowlers; no other significant group differences in joint loading occurred. Significant kinematic differences were observed between the front-on, semi-open and mixed action types during the front-foot contact phase for the elbow and trunk. Significant kinematic differences were also present for the ankle, T12-L1, elbow, trunk and pelvis during the back-foot phase. Overall, most differences in action types for junior fast bowlers occurred during the back-foot contact phase, particularly trunk rotation and T12-L1 joint angles/ranges of motion, where after similar movement patterns were utilized across groups during the front-foot contact phase.
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Affiliation(s)
- Andrew Schaefer
- School of Exercise Science, Sport and Health, Charles Sturt University , Australia
| | - Rene E D Ferdinands
- Discipline of Exercise and Sport Science, The University of Sydney , Australia
| | - Nicholas O'Dwyer
- Discipline of Exercise and Sport Science, The University of Sydney , Australia
| | - Suzi Edwards
- School of Environmental and Life Sciences, University of Newcastle , Ourimbah, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan, Australia
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23
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Kipper K, Hecht M, Antunes NJ, Fairbanks LD, Levene M, Kalkan Uçar S, Schaefer A, Blakely EL, Bax BE. Quantification of Plasma and Urine Thymidine and 2'-Deoxyuridine by LC-MS/MS for the Pharmacodynamic Evaluation of Erythrocyte Encapsulated Thymidine Phosphorylase in Patients with Mitochondrial Neurogastrointestinal Encephalomyopathy. J Clin Med 2020; 9:jcm9030788. [PMID: 32183169 PMCID: PMC7141342 DOI: 10.3390/jcm9030788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 02/05/2023] Open
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an ultra-rare disorder caused by mutations in TYMP, leading to a deficiency in thymidine phosphorylase and a subsequent systemic accumulation of thymidine and 2'-deoxyuridine. Erythrocyte-encapsulated thymidine phosphorylase (EE-TP) is under clinical development as an enzyme replacement therapy for MNGIE. Bioanalytical methods were developed according to regulatory guidelines for the quantification of thymidine and 2'-deoxyuridine in plasma and urine using liquid chromatography-tandem mass spectrometry (LC-MS/MS) for supporting the pharmacodynamic evaluation of EE-TP. Samples were deproteinized with 5% perchloric acid (v/v) and the supernatants analyzed using a Hypercarb column (30 × 2.1 mm, 3 µm), with mobile phases of 0.1% formic acid in methanol and 0.1% formic acid in deionized water. Detection was conducted using an ion-spray interface running in positive mode. Isotopically labelled thymidine and 2'-deoxyuridine were used as internal standards. Calibration curves for both metabolites showed linearity (r > 0.99) in the concentration ranges of 10-10,000 ng/mL for plasma, and 1-50 µg/mL for urine, with method analytical performances within the acceptable criteria for quality control samples. The plasma method was successfully applied to the diagnosis of two patients with MNGIE and the quantification of plasma metabolites in three patients treated with EE-TP.
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Affiliation(s)
- Karin Kipper
- Analytical Services International Ltd., St George’s University of London, Cranmer Terrace, London SW17 0RE, UK; (K.K.); (M.H.); (N.J.A.)
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Max Hecht
- Analytical Services International Ltd., St George’s University of London, Cranmer Terrace, London SW17 0RE, UK; (K.K.); (M.H.); (N.J.A.)
- University of Tartu, Institute of Chemistry, 14a Ravila Street, 50411 Tartu, Estonia
| | - Natalicia J. Antunes
- Analytical Services International Ltd., St George’s University of London, Cranmer Terrace, London SW17 0RE, UK; (K.K.); (M.H.); (N.J.A.)
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP 13083-881, Brazil
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Michelle Levene
- Molecular and Clinical Sciences, St George’s University of London, London SW17 0RE, UK;
| | - Sema Kalkan Uçar
- Division of Inborn Error of Metabolism, Ege University Medical Faculty, 35100 Izmir, Turkey;
| | - Andrew Schaefer
- The NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK; (A.S.); (E.L.B.)
| | - Emma L. Blakely
- The NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK; (A.S.); (E.L.B.)
| | - Bridget E. Bax
- Molecular and Clinical Sciences, St George’s University of London, London SW17 0RE, UK;
- Correspondence: ; Tel.: +0044(0)208-266-6836
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24
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Ozga MP, Schaefer A, Huang Y, Parekh H, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Grieselhuber N, Wall SA, Lozanski G, Jaglowski S, Saad A, William BM. Predictors of Relapse after Haploidentical Hematopoietic Progenitor Cell Transplantation (Haplo-HCT); A Single-Institution Experience. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Ng SP, Ajayi T, Schaefer A, Pollard C, Bahig H, Garden AS, Rosenthal DI, Gunn GB, Frank SJ, Phan J, Morrison WH, Johnson JM, Mohamed A, Sturgis EM, Fuller CD. Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model. Cancer 2020; 126:749-756. [PMID: 31725906 PMCID: PMC8439665 DOI: 10.1002/cncr.32597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/24/2019] [Revised: 09/04/2019] [Accepted: 09/24/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND A possible surveillance model for patients with head and neck cancer (HNC) who received definitive radiotherapy was created using a partially observed Markov decision process. The goal of this model is to guide surveillance imaging policies after definitive radiotherapy. METHODS The partially observed Markov decision process model was formulated to determine the optimal times to scan patients. Transition probabilities were computed using a data set of 1508 patients with HNC who received definitive radiotherapy between the years 2000 and 2010. Kernel density estimation was used to smooth the sample distributions. The reward function was derived using cost estimates from the literature. Additional model parameters were estimated using either data from the literature or clinical expertise. RESULTS When considering all forms of relapse, the model showed that the optimal time between scans was longer than the time intervals used in the institutional guidelines. The optimal policy dictates that there should be less time between surveillance scans immediately after treatment compared with years after treatment. Comparable results also held when only locoregional relapses were considered as relapse events in the model. Simulation results for the inclusive relapse cases showed that <15% of patients experienced a relapse over a simulated 36-month surveillance program. CONCLUSIONS This model suggests that less frequent surveillance scan policies can maintain adequate information on relapse status for patients with HNC treated with radiotherapy. This model could potentially translate into a more cost-effective surveillance program for this group of patients.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Temitayo Ajayi
- Department of Computational and Applied Mathematics, Rice University, Houston, Texas, USA
| | - Andrew Schaefer
- Department of Computational and Applied Mathematics, Rice University, Houston, Texas, USA
| | - Courtney Pollard
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Houda Bahig
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
- Department of Radiation Oncology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
| | - Adam S Garden
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - David I Rosenthal
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - G Brandon Gunn
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Steven J Frank
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Jack Phan
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - William H. Morrison
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Abdallah Mohamed
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
| | - Clifton D Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas USA
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26
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Seidl S, Bischoff P, Schaefer A, Esser M, Janzen V, Kovács A. TACE in colorectal liver metastases – different outcomes in right-sided and left-sided primary tumour location. ACTA ACUST UNITED AC 2020. [DOI: 10.15761/icst.1000328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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27
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Baumann S, Werner N, Al-Rashid F, Schaefer A, Bauer T, Sotoudeh R, Bojara W, Shamekhi J, Sinning JM, Becher T, Eder F, Akin I. P962Follow-up of protected high-risk percutaneous coronary intervention with microaxial Impella pump. Results from the retrospective German Impella Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention (PCI) presents a relevant alternative to coronary bypass surgery for the treatment of patients with complex coronary artery disease and high perioperative risk. By temporary implantation of a percutaneous ventricular assist devices (pVAD) interventionalists attempt to anticipate the hemodynamic risk of those high-risk patients in a so-called protected PCI. The Impella® system presents the currently most common device for protected PCI and could show hemodynamic stability in earlier trials.
Methods
This study is a retrospective, observational multi-center registry of ten hospitals in Germany. We included patients undergoing protected high-risk PCI with Impella® support. The primary endpoint was defined as major adverse cardiac events (MACE) during a 180-day follow-up and consisted of all-cause mortality, myocardial infarction (MI) and stroke.
Results
Six of the participating hospitals performed a follow-up. In total, 157 patients (80.3% male; mean age 71.8±10.8 years) were included in the present study. Prior to PCI, median left ventricular ejection fraction was 39.0% (25.0%-50.0%) and median SYNTAX-Score I was 33.0 (24.0–40.5). The 180-day follow-up was available for 149 patients (94.9%). Eight patients (5.1%) were lost to follow-up. During the follow-up period, 34 patients (22.8%) suffered from a MACE. A total of 27 patients (18.1%) died. Nine patients (6.0%) sustained a MI, while 4 patients (2.7%) had a stroke.
Kaplan-Meier curves for primary endpoint
Conclusions
Patients undergoing protected high-risk PCI with Impella® support show a good 180-day clinical outcome regarding rates of MACE and mortality. However, a head-to-head comparison of Impella supported patients to protected PCI with other pVADs is pending.
Acknowledgement/Funding
S.B., N.W., F.A.-R., J.-M.S., A.S., R.S., I.A. receive consulting fees/honoraria from Abiomed (Danvers, MA, USA).
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Affiliation(s)
- S Baumann
- University Medical Centre of Mannheim, First Department of Medicine - Cardiology, Faculty of Medicine Mannheim, Mannheim, Germany
| | - N Werner
- University Hospital Bonn, Department of Internal Medicine II, Bonn, Germany
| | - F Al-Rashid
- University Clinic Essen, The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center, Essen, Germany
| | - A Schaefer
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - T Bauer
- University Hospital Giessen and Marburg, Department of Cardiology, Giessen, Germany
| | - R Sotoudeh
- Hospital Foundation Mittelrhein GmbH, Department of Internal Medicine/Cardiology, Koblenz, Germany
| | - W Bojara
- Hospital Foundation Mittelrhein GmbH, Department of Internal Medicine/Cardiology, Koblenz, Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Internal Medicine II, Bonn, Germany
| | - J.-M Sinning
- University Hospital Bonn, Department of Internal Medicine II, Bonn, Germany
| | - T Becher
- University Medical Centre of Mannheim, First Department of Medicine - Cardiology, Faculty of Medicine Mannheim, Mannheim, Germany
| | - F Eder
- University Medical Centre of Mannheim, First Department of Medicine - Cardiology, Faculty of Medicine Mannheim, Mannheim, Germany
| | - I Akin
- University Medical Centre of Mannheim, First Department of Medicine - Cardiology, Faculty of Medicine Mannheim, Mannheim, Germany
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28
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Akin M, Garcheva V, Sieweke JT, Tongers J, Napp LC, Flierl U, Bauersachs J, Schaefer A. P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.
Methods
Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.
Results
Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.
Conclusion
Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.
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Affiliation(s)
- M Akin
- Hannover Medical School, Hannover, Germany
| | - V Garcheva
- Hannover Medical School, Hannover, Germany
| | | | - J Tongers
- Hannover Medical School, Hannover, Germany
| | - L C Napp
- Hannover Medical School, Hannover, Germany
| | - U Flierl
- Hannover Medical School, Hannover, Germany
| | | | - A Schaefer
- Hannover Medical School, Hannover, Germany
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Schaefer A, Werner N, Westenfeld R, Moller JE. P5736Mortality in infarct-related cardiogenic shock patients treated with an microaxial pump: influence of timing and predicted risk. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In-hospital mortality in acute myocardial infarction-related cardiogenic shock (AMI-CS) remains high at ∼40%. No prospective trials have been finished investigating the influence of mechanical support in AMI-CS. We compared observed to individually predicted mortality using CardShock-, Shock II-, and SAVE-scores in AMI-CS patients treated between 2013 and 2017 with an Impella microaxial pump, who met the IABP-Shock II-trials inclusion/exclusion criteria in order to determine whether standardised use of an Impella microaxial flow-pump in AMI-CS is associated with lower than predicted mortality rates and whether timing of implantation or selecting patients based on predicted risk is meaningful.
Methods
We analyzed data from 166 consecutive AMI-CS patients meeting the inclusion/exclusion criteria of the IABP-Shock II-trial (age 65±12 years), who received an Impella microaxial pump and compared observed vs. individually predicted mortality using CardShock-, Shock II-, and SAVE-scores. 39% (n=65) had been resuscitated before Impella implantation.
Results
Overall 30-day mortality was 43%. Mortality was higher in resuscitated patients (50% vs. 36%, p=0.0324) and when Impella was implanted post-PCI (Impella-pre-PCI: 29%, Impella-post-PCI: 50%, p=0.0130). In all score systems predicted mortality was significantly higher than observed mortality on Impella support for individuals with highest predicted risk (IABP-Shock II predicted 77% vs observed 44%, p=0.010; CardShock predicted 77% vs observed 51%, p=0.017; SAVE predicted 81% vs observed 56%, p<0.001).
Conclusion
In the absence of prospective trials, our retrospective analysis encourages the use of active mechanical circulatory support by Impella microaxial pumps in high-risk patients with AMI-CS and supports the concept of early implantation prior to PCI.
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Affiliation(s)
- A Schaefer
- Hannover Medical School, Hannover, Germany
| | - N Werner
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Cardiology, Dusseldorf, Germany
| | - J E Moller
- Odense University Hospital, Odense, Denmark
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30
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Schaefer A, Saygin C, Maakaron J, Hoelscher T, Purdin Z, Robinson J, Lamprecht M, Penza S, Brammer JE, Efebera YA, Benson DM, Vasu S, Mims A, Blaser B, Choe H, Larkin K, Long M, Rosko A, Grieselhuber N, Wall S, Jaglowski S, William BM. Cytopenias after Chimeric Antigen Receptor T-Cells (CAR-T) Infusion; Patterns and Outcomes. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.311] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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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31
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John A, Sun R, Maillart L, Schaefer A, Hamilton Spence E, Perrin MT. Macronutrient variability in human milk from donors to a milk bank: Implications for feeding preterm infants. PLoS One 2019; 14:e0210610. [PMID: 30682200 PMCID: PMC6347243 DOI: 10.1371/journal.pone.0210610] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/30/2018] [Indexed: 12/26/2022] Open
Abstract
Background and objective The composition of human milk varies widely and impacts the ability to meet nutrient requirements for preterm infants. The purpose of this study is to use a large dataset of milk composition from donors to a milk bank to: (1) describe the macronutrient variability in human milk and how it contributes to the ability to meet the protein and calorie targets for the preterm infant using fortification with commercially available multi-nutrient fortifiers; (2) assess how temporal versus subject effects explain macronutrient variability; (3) determine how macronutrient variability contributes to the nutrient distribution in pooled donor milk. Methods This is a retrospective, observational study that analyzes the macronutrient data of 1,119 human milk samples from 443 individual donors to a milk bank. We test fortification strategies with potential basic, intermediate, and high protein and calorie commercial fortifiers. Additionally, we simulate the random pooling of multiple donors to model the impact of macronutrient variability on pooled donor milk. Results Fat was the most variable nutrient and accounted for 80% of the difference in calories. A subject-effect predicted more of the variability after 4 weeks postpartum in all macronutrients (R2 > = 0.50) than a time-effect (R2 < = 0.28). When pooling multiple donors, variability was reduced by increasing the number of donors randomly selected for a pool or targeted pooling based on macronutrient analysis of donor pools. Over 75% of mature milk samples fortified with a basic protein fortifier did not meet daily protein targets of 3.5 g/kg without exceeding volumes of 160 ml/kg/day. Conclusion There is a strong individual signature to human milk that impacts the pooling of donor milk, and the ability to meet protein and energy requirements for the preterm infant with basic and intermediate protein and calorie fortifiers.
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Affiliation(s)
- Ashley John
- Department of Industrial Engineering, University of Pittsburgh, Department of Industrial Engineering, Pittsburgh, Pennsylvania, United States of America
| | - Ruichen Sun
- Department of Industrial Engineering, University of Pittsburgh, Department of Industrial Engineering, Pittsburgh, Pennsylvania, United States of America
| | - Lisa Maillart
- Department of Industrial Engineering, University of Pittsburgh, Department of Industrial Engineering, Pittsburgh, Pennsylvania, United States of America
| | - Andrew Schaefer
- Department of Computational and Applied Mathematics, Rice University, Houston, Texas, United States of America
| | | | - Maryanne T. Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, United States of America
- * E-mail:
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32
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Schaefer A, Sarwari H, Deuschl F, Schirmer J, Schofer N, Schneeberger Y, Schoen G, Blankenberg S, Reichenspurner H, Schäfer U, Conradi L. Transcatheter Aortic Valve Implantation in Patients with Mitral Annular Calcification or Mitral Stenosis: Analysis of Acute Hemodynamic Changes and Acute and Long-Term Outcomes. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | - H. Sarwari
- University Heart Center Hamburg, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Hamburg, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | - N. Schofer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - G. Schoen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - U. Schäfer
- University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- University Heart Center Hamburg, Hamburg, Germany
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33
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Schneeberger Y, Schaefer A, Schofer N, Deuschl F, Schirmer J, Blankenberg S, Westermann D, Reichenspurner H, Schaefer U, Conradi L. Balloon- and Mechanical-Expandable Transcatheter Heart Valves for Mitral Valve-in-Valve and Valve-in-Ring Procedures. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - A. Schaefer
- University Heart Center Eppendorf, Hamburg, Germany
| | - N. Schofer
- University Heart Center Eppendorf, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Eppendorf, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Eppendorf, Hamburg, Germany
| | | | | | | | - U. Schaefer
- University Heart Center Eppendorf, Hamburg, Germany
| | - L. Conradi
- University Heart Center Eppendorf, Hamburg, Germany
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34
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Schaefer A, Schirmer J, Schofer N, Schneeberger Y, Deuschl F, Blankenberg S, Reichenspurner H, Conradi L, Schäfer U. Transaxillary Transcatheter Aortic Valve Implantation Utilizing a Novel Vascular Closure Device with Resorbable Collagen Material: A Feasibility Study. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | - N. Schofer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - F. Deuschl
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - L. Conradi
- University Heart Center Hamburg, Hamburg, Germany
| | - U. Schäfer
- University Heart Center Hamburg, Hamburg, Germany
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35
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Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Ominski K. PSIX-14 Impact of needle-free injection device on injection-site tissue damage in beef sub-primals. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithaca, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC,Carrington, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre, 6000 C & E Trail,Lacombe, Alberta, Canada T4L 1W1
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
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Maharjan D, Rodas-González A, Tanner A, Kennedy V, Kirsch J, Gaspers J, Negrin-Pereira N, Fontoura A, Bauer M, Swanson K, Reynolds L, Stokka G, Ward A, Dahlen C, Neville B, Wittenberg K, McGeough E, Vonnahme K, Schaefer A, López-Campos Ó, Aalhus J, Gardiner P, Ominski K. PSI-35 Corn supplementation of beef cows and its impact on growth performance and carcass outcomes of their progeny. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A Tanner
- North Dakota State University,Fargo, ND, United States
| | - V Kennedy
- North Dakota State University,Fargo, ND, United States
| | - J Kirsch
- North Dakota State University,Fargo, ND, United States
| | - J Gaspers
- North Dakota State University,Fargo, ND, United States
| | | | - A Fontoura
- Cornell University,Ithica, NY, United States
| | - M Bauer
- North Dakota State University,Fargo, ND, United States
| | - K Swanson
- North Dakota State University,Fargo, ND, United States
| | - L Reynolds
- North Dakota State University,Fargo, ND, United States
| | - G Stokka
- North Dakota State University,Fargo, ND, United States
| | - A Ward
- North Dakota State University,Fargo, ND, United States
| | - C Dahlen
- North Dakota State University,Fargo, ND, United States
| | - B Neville
- Carrington REC, Foster County, ND, United States
| | | | - E McGeough
- University of Manitoba, Winnipeg, MB, Canada
| | - K Vonnahme
- North Dakota State University,Fargo, ND, United States
| | - A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - Ó López-Campos
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - J Aalhus
- Agriculture and Agri-Food Canada, Lacombe Research and Development Centre,Lacombe, AB, Canada
| | - P Gardiner
- University of Manitoba, Winnipeg, MB, Canada
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
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37
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Schaefer A, Bench C, Bollum R, Cook N, Crow G, Maharjan D, Ominski K, Rodas-González A, Thompson S, von Gaza H. PSXVII-1 Real time determination of metabolic efficiency in cattle with infrared thermography. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Schaefer
- University of Alberta,Lacombe, AB, Canada
| | - C Bench
- University of Alberta,Edmonton, AB, Canada
| | - R Bollum
- R and R Acres,Airdrie, AB, Canada
| | - N Cook
- Alberta Agriculture,Edmonton, AB, Canada
| | - G Crow
- University of Manitoba, Winnipeg, MB, Canada
| | - D Maharjan
- University of Manitoba, Winnipeg, MB, Canada
| | - K Ominski
- University of Manitoba, Winnipeg, MB, Canada
| | | | - S Thompson
- University of Saskatchewan,Saskatoon, SK, Canada
| | - H von Gaza
- HVG Software Solutions,Edmonton, AB, Canada
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Abstract
Preparing an anatase TiO2(101) surface with a high density of oxygen vacancies and associated reduced Ti species in the near-surface region results in drastic changes in the water adsorption chemistry compared to adsorption on a highly stoichiometric surface. Using synchrotron radiation excited photoelectron spectroscopy, we observe a change in the water growth mode, from layer-by-layer growth on the highly stoichiometric surface to bilayer growth on the reduced surface. Furthermore, we have been able to observe Ti3+ enrichment at the surface upon water adsorption. The Ti3+ enrichment occurs concomitant with effective water dissociation into hydroxyls with a very high thermal stability. The water bilayer on the reduced surface is thermally more stable than that on the stoichiometric surface, and it is more efficient in promoting further water dissociation upon heating. The results thus show how the presence of subsurface defects can alter the wetting mechanism of an oxide surface.
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Affiliation(s)
- A Schaefer
- Department of Chemistry and Chemical Engineering, and Competence Centre for Catalysis , Chalmers University of Technology , 41296 Gothenburg , Sweden
| | - V Lanzilotto
- Department of Physics and Astronomy , Uppsala University , P.O. Box 516, SE-75120 Uppsala , Sweden
| | - U B Cappel
- Department of Physics and Astronomy , Uppsala University , P.O. Box 516, SE-75120 Uppsala , Sweden
| | - P Uvdal
- Chemical Physics, Department of Chemistry , Lund University , P.O. Box 124, SE-221 00 Lund , Sweden
| | - A Borg
- Department of Physics , NTNU - Norwegian University of Science and Technology , NO-7491 Trondheim , Norway
| | - A Sandell
- Department of Physics and Astronomy , Uppsala University , P.O. Box 516, SE-75120 Uppsala , Sweden
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Baumann S, Werner N, Ibrahim K, Westenfeld R, Al-Rashid F, Sinning JM, Westermann D, Schaefer A, Karatolios K, Bauer T, Becher T, Akin I. P1643Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella pump. Results from the German Impella registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Baumann
- University Medical Centre of Mannheim, First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - N Werner
- University Hospital Bonn, Department of Internal Medicine II, Bonn, Germany
| | - K Ibrahim
- University Hospital Dresden, Heart Center Dresden, Dresden, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - F Al-Rashid
- University Hospital of Essen (Ruhr), Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen, Germany
| | - J.-M Sinning
- University Hospital Bonn, Department of Internal Medicine II, Bonn, Germany
| | - D Westermann
- University Heart Centre Hamburg Eppendorf, Department of General and Interventional Cardiology, Hamburg, Germany
| | - A Schaefer
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - K Karatolios
- Philipps University of Marburg, Department of Internal Medicine-Cardiology, Marburg, Germany
| | - T Bauer
- University Clinic Giessen, Deparment of Cardiology, Giessen, Germany
| | - T Becher
- University Medical Centre of Mannheim, First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - I Akin
- University Medical Centre of Mannheim, First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), Mannheim, Germany
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Napp LC, Moeller JE, Ibrahim K, Uwarow A, Sieweke JT, O'Neill W, Schaefer A, Bauersachs J, Burkhoff D, Westenfeld R. P5691First series of Impella mechanical circulatory support for takotsubo syndrome with shock. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L C Napp
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - J E Moeller
- Odense University Hospital, Director, Heart Failure Research, Odense, Denmark
| | - K Ibrahim
- University Hospital Dresden, Dept. of Cardiology, Dresden, Germany
| | - A Uwarow
- Medical Faculty, Heinrich-Heine-University, Division of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - J T Sieweke
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - W O'Neill
- Henry Ford Hospital, Department of Interventional Cardiology and Structural Heart, Detroit, United States of America
| | - A Schaefer
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - J Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - D Burkhoff
- Cardiovascular Research Foundation, New York, United States of America
| | - R Westenfeld
- Medical Faculty, Heinrich-Heine-University, Division of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
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Napp LC, Akin M, Vogel-Claussen J, Sieweke JT, Bauersachs J, Schaefer A. P4661Routine computed tomography after out-of-hospital cardiac arrest. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L C Napp
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - M Akin
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - J Vogel-Claussen
- Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Hannover, Germany
| | - J T Sieweke
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - J Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - A Schaefer
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
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Steele CJ, Anwander A, Bazin PL, Trampel R, Schaefer A, Turner R, Ramnani N, Villringer A. Human Cerebellar Sub-millimeter Diffusion Imaging Reveals the Motor and Non-motor Topography of the Dentate Nucleus. Cereb Cortex 2018; 27:4537-4548. [PMID: 27600851 DOI: 10.1093/cercor/bhw258] [Citation(s) in RCA: 26] [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: 07/27/2016] [Accepted: 07/18/2016] [Indexed: 12/26/2022] Open
Abstract
The reciprocal cortico-cerebellar loops that underlie cerebellar contributions to motor and cognitive behavior form one of the largest systems in the primate brain. Work with non-human primates has shown that the dentate nucleus, the major output nucleus of the cerebellum, contains topographically distinct connections to both motor and non-motor regions, yet there is no evidence for how the cerebellar cortex connects to the dentate nuclei in humans. Here we used in-vivo sub-millimeter diffusion imaging to characterize this fundamental component of the cortico-cerebellar loop, and identified a pattern of superior motor and infero-lateral non-motor connectivity strikingly similar to that proposed by animal work. Crucially, we also present first evidence that the dominance for motor connectivity observed in non-human primates may be significantly reduced in man - a finding that is in accordance with the proposed increase in cerebellar contributions to higher cognitive behavior over the course of primate evolution.
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Affiliation(s)
- C J Steele
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
| | - A Anwander
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Sachsen, Germany
| | - P-L Bazin
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
| | - R Trampel
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
| | - A Schaefer
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
| | - R Turner
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
| | - N Ramnani
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig , Sachsen, Germany
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Reichart D, Brand C, Bernhardt A, Schmidt S, Schaefer A, Blankenberg S, Reichenspurner H, Wagner F, Deuse T, Barten M. Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation – A Single-Center Experience. Thorac Cardiovasc Surg 2018; 67:170-175. [DOI: 10.1055/s-0038-1649493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).
Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.
Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48).
Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.
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Affiliation(s)
- D. Reichart
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - C.F. Brand
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - A.M. Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Schmidt
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - A. Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - F.M. Wagner
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - T. Deuse
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - M.J. Barten
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
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Schaefer A, Kiss A, Oszwald A, Hackl M, Kain R, Podesser B. S-Nitroso-Human-Serum-Albumin Administration to Donor Prior to Organ Procurement Attenuates Cardiac Isograft Fibrosis and Alters Myocardial Micro-RNA-126-3p Expression in a Murine Heterotopic Heart Transplant Model. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Schaefer A, Kehr MS, Giannetti BM, Bulitta M, Staiger C. A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575 ®) vs. placebo in the treatment of adults with acute cough. Pharmazie 2018; 71:504-509. [PMID: 29441845 DOI: 10.1691/ph.2016.6712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
This randomized, placebo-controlled, double-blind trial was conducted to assess the efficacy and safety of ivy leaves cough liquid in the treatment of acute cough. A total of 181 adult patients with acute cough were treated with either ivy leaves cough liquid containing EA 575® or with placebo three times a day for one week. The primary efficacy outcome was cough severity (CS) assessed by Visual Analogue Scale (VAS) over the whole treatment period (area-under-the-curve (AUC0-168 h) over 7 days (visit (V)1, V2, V3, V4, and V5). The secondary endpoints were defined as the CS assessed by VAS over the whole observation period (V1 - V6) and by Bronchitis Severity Score (BSS) and Verbal Category Descriptive (VCD) score. The evaluation of the VAS, BSS and VCD score revealed that subjects treated with ivy leaves cough liquid showed statistically significant and clinically relevant reductions in CS, severity of symptoms associated with cough and bronchitis compared to the placebo group. Furthermore, a remarkable early onset of efficacy was observed as significant reductions of cough severity were detected within 48 hours after the first drug intake. At all following visits and even 7 days after the end of treatment (V6) this significant treatment advantage was detected in comparison to placebo. All adverse events (AEs) in this clinical trial were non-serious, mild or of moderate severity and not drug-related. This clinical trial proved consistent superiority of the ivy leaves cough liquid treatment versus placebo and confirmed the EA 575® preparation to be a safe and efficacious option for the treatment of acute cough.
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Chapot C, Schaefer A, Donsch P, Kirsch CM, Seifert H. Die Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Ziel: Ziel war die Bestimmung der Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT. Methode und Material: Simultan zur Emissionsmessung (Tc-99m-MIBI, A = 500 MBq) erfolgt bei der Myokardperfusions-SPECT eine Transmissionsmessung mit Hilfe einer Am-241-Linienquelle (A = 5550 MBq). Bei der Simulation der Myokardperfusions-SPECT (ohne Tc-99m-MIBI) wurden Dosismessungen mit Thermolumineszenzdosimetem unter Verwendung eines Thoraxphantoms durchgeführt. Ergebnisse: Bei einer Aufnahmedauer von 20 min ergaben sich folgende Energiedosen: Oberfläche (Xyphoid) 30 μGy, Herz 25 μGy, Lunge 14 μGy, 2. BWK 16 μGy, oberes anteriores Mediastinum 16 μGy, Leber 0 μGy. Eine Abschätzung des Verhältnisses zwischen den effektiven Dosen durch Transmissions- und Emissionsmessung (3,6 x 10-3 bzw. 4,1 mSv) ergab einen Wert von 9 x 10-4. Schlußfolgerung: Die Strahlenexposition des Patienten durch die Transmissionsmessung ist vernachlässigbar gering und damit kein limitierender Faktor im Hinblick auf die generelle Anwendung der Transmissionsmessung bei der klinischen Myokardperfusions-SPECT.
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Seifert H, Donsch P, Kirsch CM, Schaefer A. Radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: The aim of the study was the determination of the radiation exposure to the patient caused by singlephoton transmission mesasurement for 3D whole-body PET. Material and Method: Single-photon-transmission measurement is performed using two Cs-137 pointsources (Eγ = 662 keV, A = 2*614 MBq) on a 3D PET scanner (ECAT ART). During a simulation of a whole body transmission scan (axial length: 75 cm, 6 contigous bed positions) dose measurements with thermoluminescent dosimeters were carried out using a thorax and an abdomen phantom. Following the guidelines of the ICRU report No. 60 an estimation of the effective dose caused by a single-photon transmission measurement was calculated. Results: For a total acquisition time of 360 min (6 beds with an acquisition time of 60 min per bed) the absorbed doses amounted to: surface (xyphoid) 189 μGy, heart 196 μGy, lungs 234 μGy, vertebra 240 μGy, liver 204 μGy, gonads 205 μGy, thyroid 249 μGy and bladder 185 μGy resulting in a conversion factor of 1.7*10–4 mSv/( h*MBq). The estimation of the effective dose for a patient’s transmission (acquisition time of 3.2 min per bed) yields a value of 11 μSv. An estimation of the ratio of the conversion factors for transmission measurements in single-photonand in coincidence mode (two Ge-68/Ga-68 rod sources of 40 MBq each), respectively, resulted in a value of 0.18. The comparison of the effective doses caused by single-photon transmission and by emission measurement (injection of 250 MBq of FDG) yields a ratio of 2.3*10–3. Conclusion: The radiation exposure of the patient caused by the transmission measurement for 3D whole-body-PET can be neglected. In comparison with the coincidence-transmission using uncollimated line sources of low activity the radiation exposure is still reduced using single photon transmission with collimated point sources of high activity.
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Geworski L, Schaefer A, Knoop BO, Pinkert J, Plotkin M, Kirsch CM. Physical aspects of scintigraphybased dosimetry for nuclear medicine therapy. Nuklearmedizin 2018; 49:85-95. [PMID: 20505893 DOI: 10.3413/nukmed-0283] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 04/14/2010] [Indexed: 11/20/2022]
Abstract
SummaryIn nuclear medicine therapy the treatment of tumours by radiation exposure from internally deposited labelled antibodies or labelled peptides is currently an active field of investigation. To permit the efficient delivery of high amounts of radiation dose to tumours while limiting the radiation dose to critical organs dosimetry calculations have to be performed. These are relying on scintigraphic data being input to the well known MIRD formalism.This paper focuses on the methods and the difficulties associated with the scintigraphic determination of organ kinetics. The physical properties of the well-known scintigraphic imaging modalities, PET, SPECT and planar scintigraphy, are discussed thereby taking into account the properties of the appropriate radionuclides currently being available for therapy and dosimetry. Several arguments are given and disputed for the limited clinical use of PET and SPECT in dosimetry and the ongoing preference of planar whole-body imaging as the method of choice. The quantitative restrictions still inherent to this method are also discussed in detail. Procedural recommendations are proposed covering all processes related to data acquisition, data correction and data analysis which finally lead to reliable estimations of organ dose.
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Affiliation(s)
- L Geworski
- Department of Radiation Protection and Medical Physics, Hannover Medical School, Hannover, 30625 Hannover, Germany.
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Gouverneur E, Schaefer A, Raedle J, Menges M, Kirsch CM, Samnick S, Hellwig D. Para-[123I]iodo-L-phenylalanine in patients with pancreatic adenocarcinoma. Nuklearmedizin 2018. [DOI: 10.3413/nukmed-0152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryRecently, p-[123I]iodo-L-phenylalanine (IPA) was clinically validated for brain tumour imaging. Preclinical studies demonstrated uptake of IPA into pancreatic adenocarcinoma suggesting its diagnostic application in patients with pancreatic tumours. The aim was to study the tumour uptake of IPA in patients with pancreatic adenocarcinoma and to analyse its biodistribution and dosimetry to assess the radiation dose resulting from its diagnostic use. Patients, methods: Seven patients with pancreatic adenocarcinoma underwent whole-body scintigraphies and SPECT up to 24 h after administration of 250 MBq of IPA. Tumour uptake of IPA was assessed visually. Time activity curves and the corresponding residence times were determined for whole-body, kidneys, liver, spleen, lung, heart content, brain, and testes. Mean absorbed doses for various organs and the effective dose were assessed based on the MIRD formalism using OLINDA/EXM. Results: IPA exhibited no accumulation in proven manifestations of pancreatic adenocarcinomas. IPA was exclusively eliminated by the urine and showed a delayed clearance from blood. Residence times were 0.26 ± 0.09 h for kidneys, 0.38 ± 0.19 h for liver, 0.15 ± 0.07 h for spleen, 0.51 ± 0.20 h for lungs, 0.22 ± 0.07 h for heart content, 0.11 ± 0.05 h for brain, 0.014 ± 0.005 h for testes and 6.4 ± 2.2 h for the remainder. The highest absorbed doses were determined in the urinary bladder wall and in the kidneys. According to the ICRP 60 the effective dose resulting from 250 MBq IPA was 3.6 ± 0.7 mSv. Conclusion: Para-[123I]iodo-L-phenylalanine can be used in diagnostic nuclear medicine with acceptable radiation doses. Besides its proven validity for brain tumour imaging, IPA does not appear to be suitable as tracer for pancreatic cancer.
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Matthews E, Neuwirth C, Jaffer F, Scalco RS, Fialho D, Parton M, Raja Rayan D, Suetterlin K, Sud R, Spiegel R, Mein R, Houlden H, Schaefer A, Healy E, Palace J, Quinlivan R, Treves S, Holton JL, Jungbluth H, Hanna MG. Atypical periodic paralysis and myalgia: A novel RYR1 phenotype. Neurology 2018; 90:e412-e418. [PMID: 29298851 PMCID: PMC5791790 DOI: 10.1212/wnl.0000000000004894] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 06/09/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To characterize the phenotype of patients with symptoms of periodic paralysis (PP) and ryanodine receptor (RYR1) gene mutations. Methods Cases with a possible diagnosis of PP but additional clinicopathologic findings previously associated with RYR1-related disorders were referred for a tertiary neuromuscular clinical assessment in which they underwent detailed clinical evaluation, including neurophysiologic assessment, muscle biopsy, and muscle MRI. Genetic analysis with next-generation sequencing and/or targeted Sanger sequencing was performed. Results Three cases with episodic muscle paralysis or weakness and additional findings compatible with a RYR1-related myopathy were identified. The McManis test, used in the diagnosis of PP, was positive in 2 of 3 cases. Genetic analysis of known PP genes was negative. RYR1 analysis confirmed likely pathogenic variants in all 3 cases. Conclusions RYR1 mutations can cause late-onset atypical PP both with and without associated myopathy. Myalgia and cramps are prominent features. The McManis test may be a useful diagnostic tool to indicate RYR1-associated PP. We propose that clinicopathologic features suggestive of RYR1-related disorders should be sought in genetically undefined PP cases and that RYR1 gene testing be considered in those in whom mutations in SCN4A, CACNA1S, and KCNJ2 have already been excluded.
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Affiliation(s)
- Emma Matthews
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK.
| | - Christoph Neuwirth
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Fatima Jaffer
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Renata S Scalco
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Doreen Fialho
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Matt Parton
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Dipa Raja Rayan
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Karen Suetterlin
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Richa Sud
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Roland Spiegel
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Rachel Mein
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Henry Houlden
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Andrew Schaefer
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Estelle Healy
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Jacqueline Palace
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Ros Quinlivan
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Susan Treves
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Janice L Holton
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Heinz Jungbluth
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
| | - Michael G Hanna
- From the MRC Centre for Neuromuscular Diseases (E.M., F.J., R.S.S., D.F., M.P., D.R.R., K.S., H.H., E.H., R.Q., J.L.H., M.G.H.), Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Neuromuscular Diseases Unit/ALS Clinic (C.N.), Kantonsspital St. Gallen, Switzerland; Neurogenetics Unit (R.S., H.H.) and Department of Neuropathology (J.L.H.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Human Genetics Laboratory Genetica (R.S.), Zurich, Switzerland; Genetics Department (R.M.), Viapath, Guy's Hospital, London; Wellcome Trust Centre for Mitochondrial Research (A.S.), University of Newcastle, Framlington Place, Newcastle Upon Tyne, UK; Institute of Pathology (E.H.), Belfast Health and Social Care Trust, Northern Ireland; Department of Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Departments of Biomedicine and Anesthesia (S.T.), Basel University Hospital, Switzerland; Department of Life Sciences (S.T.), Microbiology and Applied Pathology Section, University of Ferrara, Italy; Department of Paediatric Neurology (H.J.), Neuromuscular Service, Evelina Children's Hospital, St. Thomas' Hospital; and Department of Basic and Clinical Neuroscience (H.J.), Institute of Psychiatry, Psychology and Neuroscience, and Randall Division of Cell and Molecular Biophysics (H.J.), Muscle Signalling Section, King's College, London, UK
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