1
|
Maas L, Joos A, Hiligsmann M. Pediatric Market Access: A Qualitative Study. Ther Innov Regul Sci 2024; 58:336-346. [PMID: 38172379 PMCID: PMC10850165 DOI: 10.1007/s43441-023-00601-6] [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] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES This qualitative study aims to analyze current PM regulation and market access requirements and proposes potential solutions to mitigate current challenges. METHODS Twenty-two semi-structured interviews were conducted with experts from pharmaceutical industry, regulatory authorities, national health technology assessment (HTA) bodies, pediatricians, and academia from the Netherlands (NL), Germany (DE), the United Kingdom (UK), and France (FR) to get insight into the pediatric research, the regulatory and reimbursement processes, challenges, and solutions. Themes for further testing were developed on how to facilitate pediatric market access. Atlas.ti 9 was used to analyze the findings. RESULTS Heterogeneity in requirements for the European Medicines Agency (EMA) and HTA approvals are noted. By example, DE grants direct reimbursement after regulatory approval, the other countries require additional reimbursement which generate delays and challenges in patient access after marketing authorization. Key components in facilitating PM market access include multi-stakeholder collaboration, transparency, patient representatives, informed consent guidance, real-world evidence, and appropriate clinical trial designs. Pricing models based on the economic capabilities of individual countries could further reduce delays and challenges in market access. The additional specific pediatric incentives should be taken as best practice to encourage innovation in pediatric conditions. CONCLUSION This study highlights differences in requirements for regulatory and reimbursement approval, along with international differences in pricing and reimbursement procedures for pediatric market access.
Collapse
Affiliation(s)
- Lieke Maas
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Angelika Joos
- Global Regulatory Policy, Merck Research Laboratories, MSD (Europe) Inc., Brussels, Belgium
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O Box 616, 6200 MD, Maastricht, The Netherlands
| |
Collapse
|
2
|
Van den Houte K, Colomier E, Routhiaux K, Mariën Z, Schol J, Van den Bergh J, Vanderstappen J, Pauwels N, Joos A, Arts J, Caenepeel P, De Clerck F, Matthys C, Meulemans A, Jones M, Vanuytsel T, Carbone F, Tack J. Efficacy and findings of a blinded randomized reintroduction phase for the low FODMAP diet in Irritable Bowel Syndrome. Gastroenterology 2024:S0016-5085(24)00170-7. [PMID: 38401741 DOI: 10.1053/j.gastro.2024.02.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIMS The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in Irritable Bowel Syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP-powders to objectively identify triggers and evaluated the effect on symptoms, quality of life (QoL), and psychosocial co-morbidities. METHODS Responders to a 6-week low-FODMAP diet, defined by a drop in IBS-symptom severity score (IBS-SSS) compared to baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP-trigger. Patients completed daily symptom diaries and questionnaires for QoL and psychosocial co-morbidities. RESULTS In 117 recruited IBS patients, IBS-SSS improved significantly after the elimination period compared to baseline (150±116 vs 301±97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5±2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides and day 3 for lactose. CONCLUSION We confirmed the significant benefit of the low-FODMAP diet in tertiary care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP-triggers; Clinicaltrial.gov number: NCT04373304.
Collapse
Affiliation(s)
- K Van den Houte
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium
| | - E Colomier
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Routhiaux
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium
| | - Z Mariën
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium
| | - J Schol
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium
| | - J Van den Bergh
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - J Vanderstappen
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - N Pauwels
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - A Joos
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - J Arts
- Department of Gastroenterology, Algemeen Ziekenhuis Sint Lucas, Brugge, Belgium
| | - Ph Caenepeel
- Department of Gastroenterology, Hospital Oost-Limburg, Genk, Belgium
| | - F De Clerck
- Department of Gastroenterology, AZ Sint-Lucas, Gent, Belgium
| | - C Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism KU Leuven, Leuven, Belgium
| | - A Meulemans
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism KU Leuven, Leuven, Belgium
| | - M Jones
- School of Psychological Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, NSW, Australia
| | - T Vanuytsel
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium
| | - F Carbone
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium
| | - J Tack
- Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium.
| |
Collapse
|
3
|
Miletic N, Adam S, Acquah J, Aziz Z, Joos A, Mwangi JM. What makes joint assessment procedures attractive to the innovative industry: successes, challenges, and proposed improvements. Front Med (Lausanne) 2023; 10:1207954. [PMID: 37731723 PMCID: PMC10507468 DOI: 10.3389/fmed.2023.1207954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Regulatory harmonization and convergence have been identified as the key driver in promoting efficient evaluation of medicines, reducing workload, and supporting earlier access to medicines on the African continent. There has been great progress to date in enhancing regulatory harmonization and convergence on the African continent via the Regional Economic Communities (RECs) and with the establishment of the Africa Medicines Agency (AMA). In this article, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Africa Regulatory Network (ARN) presents its perspective based on the available literature review and results from a survey conducted with innovative biopharmaceutical companies to gather experiences using regional joint assessment procedures (JAPs) in Africa, such as the East African Community Medicines Regulatory Harmonization (EAC-MRH), the West African Medicines Regulatory Harmonization (WA-MRH), and the Southern African Development Community Medicines Regulatory Harmonization (SADC-MRH) initiative through the ZAZIBONA Collaborative Procedure for Medicines Registration (ZaZiBoNa), and provides best practices in this evolving landscape. The article also assesses other collaborative registration pathways available to facilitating registration of pharmaceutical products in African countries, such as WHO Collaborative Registration Procedures (CRP), Swissmedic's Marketing Authorisation for Global Health Products (MAGHP) and EU Medicines for All (EU-M4ALL). Benefits and challenges of each of the existing pathways are discussed in this article. Main benefits include building more expert capacity and improved collaboration amongst experts, as well as shorter review timelines in some cases. Key challenges include the lack of predictability in the adherence to procedural timelines as defined per guidelines, lengthy timeline to achieve national marketing authorization following joint assessment, the lack of dedicated personnel, administrative issues during the submission process as well as additional country-specific requirements on top of JAP-specific requirements. Our recommendations for improvements include harmonization of requirements across countries and regions and with international standards, appropriate resource allocation for JAP activities to ensure adherence to timelines, use of JAPs throughout the entire product lifecycle and all product categories, adequate use of digital technologies, and improved communication and transparency with applicants. These improvements will allow industry to better plan their filing strategies for the region which will lead to overall improved usability of the JAPs in Africa and enable faster patient access.
Collapse
Affiliation(s)
| | - Sarah Adam
- The International Federation of Pharmaceutical Manufacturers and Associations, Geneva, Switzerland
| | | | - Zainab Aziz
- Novartis South Africa (Pty) Ltd, Magwa Crescent West, Johannesburg, South Africa
| | | | | |
Collapse
|
4
|
Rei Bolislis W, Bejeuhr G, Benzaghou F, Corriol‐Rohou S, Herrero‐Martinez E, Hildebrand H, Hill‐Venning C, Hoogland H, Johnson C, Joos A, Vart R, Le Visage G, Kühler TC. Optimizing Pediatric Medicine Developments in the European Union Through Pragmatic Approaches. Clin Pharmacol Ther 2021; 110:871-879. [PMID: 33411346 PMCID: PMC8518420 DOI: 10.1002/cpt.2152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
The European Union's Pediatric Regulation has strengthened the development of medicines for children in Europe through its system of obligations and rewards. However, opportunities remain to further optimize pediatric medicine developments, notably in relation to the implementation of the regulatory framework. This paper therefore describes bottlenecks identified by industry that occur during the medicinal development process, including those relating to the scientific advice process, pediatric investigation plan (PIP) development, compliance checks, and study submissions, and offers some considerations and insights to address these. Considerations, which are workable within the current legislative framework, focus on an integrated scientific discussion, optimization of PIP procedures and compliance checks, and an alignment of study-reporting requirements.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Craig Johnson
- GlaxoSmithKline Research & Development Ltd.MiddlesexUK
| | | | | | | | | |
Collapse
|
5
|
Joos A, Halmer R, Leiprecht N, Schörner K, Lahmann C, Blahak C. [Functional neurological disorders: update and example of integrated inpatient treatment including mirror therapy]. Nervenarzt 2020; 91:252-256. [PMID: 31690969 DOI: 10.1007/s00115-019-00827-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- A Joos
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland.
| | - R Halmer
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - N Leiprecht
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - K Schörner
- Psychotherapeutische Neurologie, Kliniken Schmieder, Gailingen, Deutschland
| | - C Lahmann
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - C Blahak
- Klinik für Neurologie und Neurogeriatrie, Ortenau-Klinikum Lahr-Ettenheim, Lahr, Deutschland
- Neurologische Klinik, UniversitätsMedizin Mannheim, Universität Heidelberg, Mannheim, Deutschland
| |
Collapse
|
6
|
Joos A, Leiprecht N, Wiesand K, Schmidt R, Hartmann A. Integrated inpatient rehabilitation for patients with Functional Neurological Symptom Disorder (FNSD) - A specific group therapy. J Psychosom Res 2019; 120:102-104. [PMID: 30929699 DOI: 10.1016/j.jpsychores.2019.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Affiliation(s)
- A Joos
- Kliniken Schmieder, Departments of Psychotherapeutic Neurology in Gailingen and Konstanz, Auf dem Berg, 78262 Gailingen, Germany; Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104 Freiburg, Germany.
| | - N Leiprecht
- Kliniken Schmieder, Departments of Psychotherapeutic Neurology in Gailingen and Konstanz, Auf dem Berg, 78262 Gailingen, Germany
| | - K Wiesand
- Kliniken Schmieder, Departments of Psychotherapeutic Neurology in Gailingen and Konstanz, Auf dem Berg, 78262 Gailingen, Germany
| | - R Schmidt
- Kliniken Schmieder, Departments of Psychotherapeutic Neurology in Gailingen and Konstanz, Auf dem Berg, 78262 Gailingen, Germany
| | - A Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104 Freiburg, Germany
| |
Collapse
|
7
|
Raynor DK, Myers L, Blackwell K, Kress B, Dubost A, Joos A. Clinical Trial Results Summary for Laypersons: A User Testing Study. Ther Innov Regul Sci 2018; 52:606-628. [DOI: 10.1177/2168479017753129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Eichler HG, Bedlington N, Boudes M, Bouvy JC, Broekmans AW, Cerreta F, Faulkner SD, Forda SR, Joos A, Le Cam Y, Mayer MH, Pirard V, Corriol-Rohou S. Medicines Adaptive Pathways to Patients: Why, When, and How to Engage? Clin Pharmacol Ther 2018; 105:1148-1155. [PMID: 29901216 PMCID: PMC6585618 DOI: 10.1002/cpt.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/22/2018] [Accepted: 05/01/2018] [Indexed: 12/30/2022]
Abstract
Medicines Adaptive Pathways to Patients (MAPPs) seeks to foster access to novel beneficial treatments for the right patient groups at the earliest appropriate time in the product life-span, in a sustainable fashion. We summarize the MAPPs engagement process and critical questions to be asked at each milestone of the product life-span. These considerations are of relevance for regulatory and access pathways that strive to address the "evidence vs. access" conundrum.
Collapse
Affiliation(s)
| | | | | | - Jacoline C Bouvy
- National Institute for Health and Care Excellence (NICE), London, UK
| | | | | | - Stuart D Faulkner
- Centre for the Advancement of Sustainable Medical Innovation (CASMI), Headington Oxford, UK
| | | | | | - Yann Le Cam
- EURORDIS-Rare Diseases Europe, Paris, France
| | - Mark H Mayer
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | |
Collapse
|
9
|
Abstract
Patient history taking and semiology provide seminal clues to the diagnosis of dissociative seizures. Openness and alertness of the treating physician are essential. Video-electroencephalogram(EEG)-based analyses of the events are crucial to establish the correct diagnosis, particularly in complex cases. The patient-doctor relationship is of particular importance in order to successfully motivate the patient for psychotherapeutic treatment. Coexisting psychiatric morbidity as well as other functional somatic symptoms must be actively explored. Current changes in the established diagnostic manuals, including ICD-11, reflect the ongoing vivid interest and controversial discussions in the field of dissociative disorders.
Collapse
Affiliation(s)
- A Joos
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland.
- Kliniken Schmieder, Psychotherapeutische Neurologie, Gailingen, Deutschland.
| | - K Baumann
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland
| | - C E Scheidt
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland
| | - C Lahmann
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland
| | - R König
- Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - A Schulze-Bonhage
- Epilepsiezentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| |
Collapse
|
10
|
Daves M, Blecken J, Matthias T, Frey A, Perkmann V, Dall Acqua A, Joos A, Platzgummer S. New automated indirect immunofluorescent antinuclear antibody testing compares well with established manual immunofluorescent screening and titration for antinuclear antibody on HEp-2 cells. Immunol Res 2016; 65:370-374. [PMID: 27743128 DOI: 10.1007/s12026-016-8874-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/20/2022]
Abstract
The IIF using the HEp-2 cell substrate should be still considered the "gold standard" techniques for determination of antinuclear antibody (ANA). Standardization and automation can be considered to be still in progress. Aim of this study was to evaluate the performance of the commercially automated indirect immunofluorescent antinuclear HEp-2 antibody assay. The study was designed to compare two commercially available HEp-2 ANA by indirect immunofluorescent antibody assays using a sensitivity panel (120 clinically determined patients) and a specificity panel consisting of 78 clinically confirmed negative patients. We compared the NOVA View® system [INOVA Diagnostics San Diego, USA] with the new HELIOS Processor from AESKU Systems/AESKU.Diagnostics (Wendelsheim, Germany) to assess their capability for screening, pattern recognition and titration of the samples. These automated methods were directly compared to manual reading of the same processed slides on respective microscopes and also compared with the known clinical information. The results of the two automated methods were in very good agreement with recognizing negative and positive samples. The HELIOS system detected 188 samples correctly as negative or positive versus 187 detected by the NOVA View® system. The diagnostic sensitivity of the systems was 95.8 versus 96.7 % for HELIOS and NOVA View®, respectively. The systems exhibited a diagnostic specificity of 93.5 % for the HELIOS system and 91.0 % for the NOVA View®. Both systems are suitable for fast and reliable detection of positivity/negativity due to their high sensitivity and will lead to a further increase of standardization in autoimmunity.
Collapse
Affiliation(s)
- M Daves
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy.
| | - J Blecken
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - T Matthias
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - A Frey
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - V Perkmann
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - A Dall Acqua
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - A Joos
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - S Platzgummer
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| |
Collapse
|
11
|
Blecken J, Matthias T, Frey A, Daves M, Joos A, Platzgummer S. SAT0560 Automated Ifa Methods Compare Well with Established Manual IFA Screening and Titration for ANA HEp-2. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3958] [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: 11/04/2022]
|
12
|
Hoos A, Anderson J, Boutin M, Dewulf L, Geissler J, Johnston G, Joos A, Metcalf M, Regnante J, Sargeant I, Schneider RF, Todaro V, Tougas G. Partnering With Patients in the Development and Lifecycle of Medicines: A Call for Action. Ther Innov Regul Sci 2015; 49:929-939. [PMID: 26539338 PMCID: PMC4616907 DOI: 10.1177/2168479015580384] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [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: 02/04/2015] [Accepted: 03/11/2015] [Indexed: 11/21/2022]
Abstract
The purpose of medicines is to improve patients' lives. Stakeholders involved in the development and lifecycle management of medicines agree that more effective patient involvement is needed to ensure that patient needs and priorities are identified and met. Despite the increasing number and scope of patient involvement initiatives, there is no accepted master framework for systematic patient involvement in industry-led medicines research and development, regulatory review, or market access decisions. Patient engagement is very productive in some indications, but inconsistent and fragmentary on a broader level. This often results in inefficient drug development, increasing evidence requirements, lack of patient-centered outcomes that address unmet medical needs and facilitate adherence, and consequently, lack of required therapeutic options and high costs to society and involved parties. Improved patient involvement can drive the development of innovative medicines that deliver more relevant and impactful patient outcomes and make medicine development faster, more efficient, and more productive. It can lead to better prioritization of early research; improved resource allocation; improved trial protocol designs that better reflect patient needs; and, by addressing potential barriers to patient participation, enhanced recruitment and retention. It may also improve trial conduct and lead to more focused, economically viable clinical trials. At launch and beyond, systematic patient involvement can also improve the ongoing benefit-risk assessment, ensure that public funds prioritize medicines of value to patients, and further the development of the medicine. Progress toward a universal framework for patient involvement requires a joint, precompetitive, and international approach by all stakeholders, working in true partnership to consolidate outputs from existing initiatives, identify gaps, and develop a comprehensive framework. It is essential that all stakeholders participate to drive adoption and implementation of the framework and to ensure that patients and their needs are embedded at the heart of medicines development and lifecycle management.
Collapse
Affiliation(s)
- Anton Hoos
- M4P (Medicines 4 Patients) Consulting, London, UK
| | | | - Marc Boutin
- National Health Council, Washington, DC, USA
| | | | - Jan Geissler
- European Patients’ Academy on Therapeutic Innovation, Brussels, Belgium
| | | | - Angelika Joos
- Global Regulatory Policy, MSD (Europe) Inc, Brussels, Belgium
| | - Marilyn Metcalf
- Chief Medical Office, GlaxoSmithKline, Raleigh-Durham, NC, USA
| | | | | | | | - Veronica Todaro
- Parkinson’s Disease Foundation/Clinical Trials Transformation Initiative, New York, NY, USA
| | - Gervais Tougas
- Chief Medical Office, Novartis Pharma AG, Basel, Switzerland
| |
Collapse
|
13
|
Vershenya S, Klotz J, Joos A, Bussen D, Herold A. Combined approach in the treatment of chronic anal fissures. Updates Surg 2015; 67:83-9. [DOI: 10.1007/s13304-015-0290-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
|
14
|
Scheidt CE, Hofmeier M, Kraft J, Geigges W, Joos A, Niemann R, Stegner H, Unterbrink T, Franck M. [Ways to psychosomatic rehabilitation--differential treatment selection between psychosomatic acute care and rehabilitation]. REHABILITATION 2015; 54:74-80. [PMID: 25719994 DOI: 10.1055/s-0034-1398516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Consecutive admissions to the psychosomatic departments of 5 hospital units in southwest Germany registered between October 2012 and October 2013 were asked to participate in a study investigating the treatment selection process for psychosomatic rehabilitation. 527 patients were included in the study, 269 outpatients and 258 inpatients at the end of their inpatient treatment. 52 patients (10.1%) received the recommendation for rehabilitation. 47 (90.4%) could be followed up 3 months later. 22 patients had applied for a rehabilitation treatment, 11 (50%) had obtained an approval for their rehabilitation, 5 had still no answer and for 6 patients the request was refused. 4 of the latter had objected their refusal and were still waiting for an answer. Only one patient was already admitted to a rehabilitation center. Possible reasons for the low permeability at the interface between hospital care and rehabilitation are discussed.
Collapse
Affiliation(s)
- C E Scheidt
- Zentrum für psychische Erkrankungen, Universitätsklinikum Freiburg und Thure von Uexkuell-Klinik, Freiburg
| | - M Hofmeier
- Zentrum für psychische Erkrankungen, Universitätsklinikum Freiburg und Thure von Uexkuell-Klinik, Freiburg
| | - J Kraft
- Zentrum für psychische Erkrankungen, Universitätsklinikum Freiburg
| | - W Geigges
- Rehabilitationsklinik Glotterbad, Glottertal
| | - A Joos
- Zentrum für psychische Erkrankungen, Universitätsklinikum Freiburg
| | - R Niemann
- Ortenau Klinikum Offenburg-Gengenbach und Lahr-Ettenheim
| | - H Stegner
- Rehabilitationsklinik Kandertal, Malsburg-Marzell
| | | | - M Franck
- Kur+Reha GmbH des Paritätischen BW, Freiburg
| |
Collapse
|
15
|
Garbe JHO, Ausborn S, Beggs C, Bopst M, Joos A, Kitashova AA, Kovbasenco O, Schiller CD, Schwinger M, Semenova N, Smirnova L, Stodart F, Visalli T, Vromans L. Historical data analyses and scientific knowledge suggest complete removal of the abnormal toxicity test as a quality control test. J Pharm Sci 2014; 103:3349-3355. [PMID: 25209378 PMCID: PMC4278562 DOI: 10.1002/jps.24125] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 12/30/2022]
Abstract
In the early 1900s, the abnormal toxicity test (ATT) was developed as an auxiliary means to ensure safe and consistent antiserum production. Today, the ATT is utilized as a quality control (QC) release test according to pharmacopoeial or other regulatory requirements. The study design has not been changed since around 1940. The evidence of abnormal toxicity testing as a prediction for harmful batches is highly questionable and lacks a scientific rationale. Numerous reviews of historical ATT results have revealed that no reliable conclusions can be drawn from this QC measure. Modern pharmaceutical manufacturers have thorough control of the manufacturing process and comply with good manufacturing practice rules. Contaminants are appropriately controlled by complying with the validated manufacturing processes and strict QC batch release confirming batch-to-batch consistency. Recognizing that product safety, efficacy, and stability can be ensured with strict QC measures, nowadays most regulatory authorities do not require the ATT for most product classes. In line with the replacement, reduction, and refinement (3Rs) initiative, the test requirement has been deleted from approximately 80 monographs of the European Pharmacopoeia and for the majority of product classes in the United States. For these reasons, it is recommended that the ATT should be consistently omitted world-wide and be removed from pharmacopoeias and other regulatory requirements.
Collapse
Affiliation(s)
- Joerg H O Garbe
- F. Hoffmann-La Roche Ltd., Pharma Global Technical Operations, Basel, Switzerland.
| | - Susanne Ausborn
- F. Hoffmann-La Roche Ltd., Pharma Global Technical Operations, Basel, Switzerland
| | | | - Martin Bopst
- F. Hoffmann-La Roche Ltd., Roche Pharma and Early Development, Roche Innovation Center, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Abstract. Originally designed for atmospheric boundary layer research, the MASC (Multipurpose Airborne Sensor Carrier) RPA (Remotely Piloted Aircraft, also known as Unmanned Aerial Vehicle, UAV) is capable of making in-situ measurements of temperature, humidity and wind in high resolution and precision. The autopilot system ROCS (Research Onboard Computer System) enables the aircraft to fly pre-defined routes between waypoints at constant altitude and airspeed. The system manages to operate in wind speeds up to 15 m s−1 safely. It is shown that a MASC can fly as close as one rotor diameter upstream and downstream of running wind turbines at these wind speeds and take valuable data of incoming flow and wake. The flexible operation of an RPA at the size of a MASC can be a major advantage of the system compared to tower measurements and remote sensing in wind energy research. In the project "Lidar Complex" comparisons of RPA measurements with lidar systems and tower measurements are carried out at two different test sites. First results, including turbulence and wake measurements, from a campaign in autumn 2013 are presented.
Collapse
|
17
|
Ommer A, Herold A, Joos A, Schmidt C, Weyand G, Bussen D. Gore BioA Fistula Plug in the treatment of high anal fistulas--initial results from a German multicenter-study. Ger Med Sci 2012; 10:Doc13. [PMID: 22984363 PMCID: PMC3440842 DOI: 10.3205/000164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/05/2012] [Indexed: 12/13/2022]
Abstract
Background: Treatment of high anal fistulas may be associated with a high risk of continence disorders. Beside traditional procedure of flap-reconstruction the occlusion of the fistula tract using fistula-plugs offers a new sphincter-saving treatment option. In this study for the first time results from Germany are described. Patients and method: 40 patients (30 male, 10 female, age 51±12 years) underwent closure of a high trans-sphincteric (n=28) or supra-sphincteric (n=12) fistula with Gore BioA Fistula Plug® in three surgical departments. The surgical procedures had been performed by five colorectal surgeons. Four patients had Crohn’s disease. Preoperatively 33 patients were completely continent; seven patients complained of minor continence disorders. Treatment of the patients was performed on a intent-to-treat basis and evaluation of the results was retrospective using pooled data from each center. Results: Postoperatively one patient developed an abscess, which had to be managed surgically. In two patients the plug had fallen out within the first two weeks postoperatively. Six months after surgery the fistula has been healed in 20 patients (50.0%). Three additional fistulas healed after 7, 9 rsp. 12 months. The overall healing-rate was 57.5% (23/40). The healing rate differs considerably between the surgeons from 0 to 75% and depends on the number of previous interventions. In patients having only drainage of the abscess success occurred in 63.6% (14/22) whereas in patients after one or more flap fistula reconstruction the healing rate decreased slightly to 50% (9/18). No patient complained about any impairment of his preoperative continence status. Conclusion: By occlusion of high anal fistulas with a plug technique definitive healing could be achieved in nearly every second patients. Previous surgery seems to have a negative impact on success rate. We have not observed any negative impact on anal continence. From that point of view anal fistula plugs might be discussed as a treatment option for high anal fistulas, but further studies are needed to gain conclusive evidence.
Collapse
Affiliation(s)
- A Ommer
- End- und Dickdarmpraxis Essen, Germany.
| | | | | | | | | | | |
Collapse
|
18
|
Palma P, Horisberger K, Joos A, Rothenhoefer S, Willeke F, Post S. Local excision of early rectal cancer: is transanal endoscopic microsurgery an alternative to radical surgery? Rev Esp Enferm Dig 2009; 101:172-8. [PMID: 19388797 DOI: 10.4321/s1130-01082009000300003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal neoplasms and provides an alternative to conventional surgery for benign tumours. However, its role in the curative treatment of invasive carcinoma is controversial. This paper examines the results of TEM compared with radical surgery (RS) for T1 rectal cancer. METHODS 51 patients with T1 rectal tumours treated by RS, or local excision by means of TEM were included. The following parameters were evaluated: operating time, blood loss, hospital stay and complications, as well as local recurrence rate and survival. RESULTS 17 patients were treated by RS and 34 by TEM. Operative time, blood loss, and duration of hospitalization were significantly lower in the TEM group compared with the RS group. In the RS group there were 4 patients with complications which required an operative revision (23.5%), compared to 1 reintervention (2.9%) in the TEM group. Local recurrence was 5.88% (n = 2) in the TEM group compared with none after RS (p = 0.547). The overall survival and disease-free survival showed not significant statistical differences between both groups (p = 0.59; p = 1.000, resp.). CONCLUSIONS Although local recurrence was only observed after local excision, patients treated with TEM showed no significant differences in terms of overall survival and disease-free survival compared with patients who underwent RS. Inasmuch as local excision represents a minimally invasive technique in terms of morbidity, mortality and functional outcome, TEM should be offered as a valid option for well selected patients with early rectal cancer.
Collapse
Affiliation(s)
- P Palma
- Division of Colorectal Surgery, Department of Surgery, Medical School Mannheim, University of Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
19
|
Preiss A, Bauer A, Berstermann HM, Gerling S, Haas R, Joos A, Lehmann A, Schmalz L, Steinbach K. Advanced high-performance liquid chromatography method for highly polar nitroaromatic compounds in ground water samples from ammunition waste sites. J Chromatogr A 2009; 1216:4968-75. [DOI: 10.1016/j.chroma.2009.04.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 04/15/2009] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
|
20
|
Zoller S, Joos A, Dinter D, Back W, Horisberger K, Post S, Palma P. Retrorectal tumors: excision by transanal endoscopic microsurgery. Rev Esp Enferm Dig 2008; 99:547-50. [PMID: 18052651 DOI: 10.4321/s1130-01082007000900011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tumours within the retrorectal space are uncommon. Due to their rarity and diverse symptoms they are often misdiagnosed or mistreated. We report three cases of women presenting a variety of symptoms including increased rectal pain, recurrent abscesses/fistulas and constipation. Upon clinical examination and further investigations using MR scan, endorectal ultrasound and endoscopy, a retrorectal mass was suspected in all three cases. In order to achieve a complete excision of the tumor while minimizing trauma, transanal endoscopic microsurgery (TEM) was performed. The histology of the multicystic tumor revealed in all three cases a tailgut cyst. As far as we know this is the first report describing the use of TEM for surgical treatment of tumors located in the retrorectal space.
Collapse
Affiliation(s)
- S Zoller
- Department of Surgery, University Hospital Mannheim, Germany
| | | | | | | | | | | | | |
Collapse
|
21
|
Saum B, Joos A, Freyer T, Perlov E, Glauche V, Tebartz van Elst L, Zeeck A. Neurobiologische Korrelate bei Essstörungen: eine explorative fMRT-Längsschnittstudie. Psychother Psych Med 2007. [DOI: 10.1055/s-2007-970702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Zeeck A, Birindelli E, Sandholz A, Joos A, Herzog T, Hartmann A. Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder. Eur Eat Disorders Rev 2007; 15:430-8. [PMID: 17726661 DOI: 10.1002/erv.824] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There are contradictory results concerning the frequency of borderline personality disorder (BPD) in bulimic patients and its impact on eating pathology and treatment outcome. We evaluated 240 patients with bulimia nervosa using EDI-2, SIAB and SCL-90-R. Only a minority of patients had a BPD (13.8%). There were no differences in binging or purging behaviour between patients with and without BPD, but borderline patients had significantly more feelings of ineffectiveness and more disturbances in interoceptive awareness. Bulimic patients with BPD showed significantly more general psychopathology. Although, BPD patients started with higher levels of pathology, there were similar reductions of symptoms over the course of treatment in both groups. Psychotherapy in bulimic patients with a BPD has to focus not only on eating pathology but also on aspects that are caused by the severe personality disturbance.
Collapse
Affiliation(s)
- A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
Die Bulimia nervosa ist durch Essanfälle und Verhaltensweisen gekennzeichnet, welche einer Gewichtszunahme entgegensteuern sollen (Erbrechen, Laxantienabusus, Hungerphasen u.a.). Sie ist eine multifaktoriell bedingte psychische Erkrankung, welche vor allem junge Frauen betrifft. Die Bulimie kann zu gravierendem Folgen auf körperlicher, psychischer und sozialer Ebene führen und bedarf in der Regel einer spezialisierten, psychotherapeutischen Behandlung. Diese kann in den meisten Fällen ambulant erfolgen, es muss jedoch die häufige Komorbidität mit weiteren psychischen Erkrankungen berücksichtigt werden. Auch eine psychopharmakologische Mitbehandlung kann hilfreich sein. Nach 5–10 Jahren zeigen rund 50% der Patientinnen eine Vollremission, 30% Teilremissionen und etwa 20% einen chronischen Verlauf. Hausärzte, Zahnärzte und Gynäkologen sollten über Anzeichen einer oft von den Betroffenen selbst aus Schamgefühl verheimlichten Bulimia nervosa informiert sein.
Collapse
Affiliation(s)
- A Zeeck
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinik Freiburg.
| | | | | | | |
Collapse
|
24
|
Joos A, Hetzel A. Schlaganfall und Epilepsie. Akt Neurol 2005. [DOI: 10.1055/s-2004-834779] [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: 10/25/2022]
|
25
|
Abstract
We are reporting about a 35 year old female forensic patient who has a double diagnosis of anorexia nervosa, bingeeating/purging type, and schizophrenia, paranoid type. She repeatedly attacked her therapists and physicians violently. Her aggressive state is a result of her psychotic interpretation of her constant preoccupation with her body image. We discuss problems concerning antipsychotic medication in her case specifically. Furthermore epidemiological aspects of the comorbidity of eating disorders and schizophrenia are considered; the incidence of schizophrenia in eating disorders seems to be 1-3%, affective and transient psychosis being more common; the comorbidity of schizophrenia and bulimia nervosa is very rare.
Collapse
Affiliation(s)
- A Joos
- Zentrum für Psychiatrie, Die Weissenau, Psychiatrie I der Universitt Ulm
| | | |
Collapse
|
26
|
Teyssen S, Chari ST, Joos A, Singer MV. Effect of a 28-day therapy with famotidine on blood levels of alcohol and gastrin and intragastric pH in healthy human subjects. Scand J Gastroenterol 1994; 29:398-405. [PMID: 8036454 DOI: 10.3109/00365529409096829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a randomized, placebo-controlled study of 10 healthy human subjects blood alcohol levels after consumption of beer, 24-h intragastric pH, and serum gastrin concentrations were serially measured during a 28-day therapy with famotidine. The subjects consumed placebo or famotidine (40 mg at 1830 h) and beer (500 ml at 1900 h) every day for 28 days. On days 1, 7, and 28 of the study 24-h intragastric pH-metry and blood alcohol and gastrin estimations were performed. Famotidine did not significantly alter either the peak or the 2-h integrated blood alcohol response to beer. The median intragastric pH on days 1, 7, and 28 was significantly (p < 0.006) increased by famotidine. After 7 days of famotidine therapy, however, the pH was significantly (p < 0.03) lower than on day 1 (4.0 versus 2.4); this effect persisted on day 28 (2.3). Whereas basal plasma levels of gastrin were not significantly altered by famotidine, the 2-h integrated plasma gastrin response to beer was significantly (p < 0.05) higher with famotidine than with placebo. We conclude that 1) a 28-day therapy with famotidine does not alter blood alcohol levels in response to social consumption of beer; 2) after 7 days of therapy tolerance to its gastric acid-inhibitory effect is seen; and 3) an exaggerated postprandial release of gastrin may be involved in the development of this tolerance.
Collapse
Affiliation(s)
- S Teyssen
- Dept. of Medicine IV (Gastroenterology), University Hospital of Heidelberg at Mannheim, Germany
| | | | | | | |
Collapse
|
27
|
Würtemberger G, Dinkel E, Joos A, Matthys H. [Pulmonary hypertension. Clinical picture and therapy]. Radiologe 1989; 29:263-6. [PMID: 2662241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pulmonary hypertension occurs frequently in patients with chronic lung disease and contributes to morbidity and mortality. The most common symptoms are dyspnea, fatigue, chest pain, and syncope; sudden death can occur. Signs of pulmonary hypertension include prominent a-waves in the jugular venous pulse, a prominent P2 and murmur of tricuspid regurgitation. Introduced in 1964, cardiac catheterization is still required for the clinical assessment. Many patients reveal a vasoconstrictive component in their lung vessels that is potentially reversible therapeutically. Accurate noninvasive diagnostic methods and an understanding of the mechanisms causing pulmonary hypertension are necessary, as is appropriate therapy based upon the results.
Collapse
|
28
|
Abstract
Fatal pancreatic necrosis, secondary to extensive acute arteritic changes, is reported in a case of progressive systemic sclerosis. The patient presented first with hypertension and renal involvement, with active vascular lesions demonstrated by biopsy. The renal lesion at necropsy was inactive, showing the characteristic concentric fibrosis only, while the pancreatic vascular lesions were both chronic proliferative and acute in type.
Collapse
|
29
|
Abstract
8 children with precocious puberty were treated with cyproterone acetate (CPA). During treatment there were no definite clinical signs of depressed adrenocortical function. The plasma cortisol concentrations were grossly depressed and the diurnal cortisol rhythm was abolished. Two months after discontinuation of CPA treatment the adrenocortical function had greatly improved. The lysin-vasopressin stimulation test revealed in one child a normal, in another child an exaggerated ACTH response during CPA therapy. Fasting plasma ACTH concentrations were elevated compared with normal controls, but they were very low compared with patients with Addison's disease. The results suggest that CPA has a twofold effect leading to adrenocortical insufficiency: i.e., inhibition of cortisol secretion by the adrenals themselves and inhibition of ACTH secretion at the hypothalamopitiuitary level.
Collapse
|
30
|
Kadar A, Joos A, Jellinek H. Influence of beta-amino-propionitrile on elastogenesis in the chick embryo (light and electron microscopic study). Paroi Arterielle 1978; 4:165-75. [PMID: 673467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beta-amino-propionitrile was administered in a single dose into the chorioallantoic cavity of 14 days old chick embryos. The effects on the elastic fibre production were examined on the 3rd or 7th day following the injection. By light microscopy dissecting aneurysm, aortic ruptures were found. The elastic fibres were poorly developed and exhibited irregularities and structural anomalies. Electron microscopically we observed reduction of the number or complete absence of elastic aggregates and fibres. The elastic structures exhibited abnormal phosphotungstic acid binding. This was considered as a sign for disturbances in the development of cross linkages and in the incorporation of elastin into the elastic fibres.
Collapse
|
31
|
|
32
|
Westphal O, Joos A. Synthesis of New Thiazolo-[3,2-a]pyridinium Salts. Angew Chem Int Ed Engl 1969. [DOI: 10.1002/anie.196900741] [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: 11/06/2022]
|
33
|
|
34
|
|
35
|
Joos A. [Treatment of leg diseases with a new angiodynamic drug]. Landarzt 1968; 44:1638-41. [PMID: 5717137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|