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Bechmann N, Moskopp ML, Constantinescu G, Stell A, Ernst A, Berthold F, Westermann F, Jiang J, Lui L, Nowak E, Zopp S, Pacak K, Peitzsch M, Schedl A, Reincke M, Beuschlein F, Bornstein SR, Fassnacht M, Eisenhofer G. Asymmetric Adrenals: Sexual Dimorphism of Adrenal Tumors. J Clin Endocrinol Metab 2024; 109:471-482. [PMID: 37647861 PMCID: PMC11032253 DOI: 10.1210/clinem/dgad515] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/03/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
CONTEXT Sexual dimorphism has direct consequences on the incidence and survival of cancer. Early and accurate diagnosis is crucial to improve prognosis. OBJECTIVE This work aimed to characterized the influence of sex and adrenal asymmetry on the emergence of adrenal tumors. METHODS We conducted a multicenter, observational study involving 8037 patients with adrenal tumors, including adrenocortical carcinoma (ACC), aldosterone-producing adenoma (APA), cortisol-secreting adrenocortical adenomas (CSAs), non-aldosterone-producing adrenal cortical adenoma (NAPACA), pheochromocytoma (PCC), and neuroblastoma (NB), and investigated tumor lateralization according to sex. Human adrenal tissues (n = 20) were analyzed with a multiomics approach that allows determination of gene expression, catecholamine, and steroid contents in a single sample. In addition, we performed a literature review of computed tomography and magnetic resonance imaging-based studies examining adrenal gland size. RESULTS ACC (n = 1858); CSA (n = 68), NAPACA (n = 2174), and PCC (n = 1824) were more common in females than in males (female-to-male ratio: 1.1:1-3.8:1), whereas NBs (n = 2320) and APAs (n = 228) were less prevalent in females (0.8:1). ACC, APA, CSA, NAPACA, and NB occurred more frequently in the left than in the right adrenal (left-to-right ratio: 1.1:1-1.8:1), whereas PCC arose more often in the right than in the left adrenal (0.8:1). In both sexes, the left adrenal was larger than the right adrenal; females have smaller adrenals than males. CONCLUSION Adrenal asymmetry in both sexes may be related to the pathogenesis of adrenal tumors and should be considered during the diagnosis of these tumors.
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Affiliation(s)
- Nicole Bechmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mats Leif Moskopp
- Department of Neurosurgery, Vivantes Friedrichshain Hospital, Charité Academic Teaching Hospital, 10249 Berlin, Germany
| | - Georgiana Constantinescu
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Anthony Stell
- School of Computing and Information Systems, University of Melbourne, 3052 Melbourne, Australia
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, 50931 Cologne, Germany
| | - Frank Berthold
- Children's Hospital, University of Cologne, 50735 Cologne, Germany
| | - Frank Westermann
- Hopp Children's Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, 200031 Shanghai, China
| | - Longfei Lui
- Department of Urology, Xiangya Hospital, Central South University, 410017 Changsha, China
| | - Elisabeth Nowak
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Stephanie Zopp
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20892, USA
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Andreas Schedl
- Université Côte d’Azur, Inserm, CNRS, Institut de Biologie Valrose, 06108 Nice, France
| | - Martin Reincke
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
| | - Felix Beuschlein
- Department of Medicine IV, University Hospital, Ludwig-Maximilians-Universität Munich, 80539 Munich, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), 8091 Zurich, Switzerland
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, 97080 Würzburg, Germany
| | - Graeme Eisenhofer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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Pickard Price P, Stell A, O'Neill D, Church D, Brodbelt D. Epidemiology and risk factors for mammary tumours in female cats. J Small Anim Pract 2023; 64:313-320. [PMID: 37012055 DOI: 10.1111/jsap.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 11/22/2022] [Accepted: 01/24/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES This study aimed to estimate the incidence and risk factors for mammary tumours in female cats attending UK primary-care practices. The study hypothesised that middle-aged, intact and certain breeds are associated with increased mammary tumour risk. MATERIALS AND METHODS A case-control study design identified mammary tumour cases by assessment of electronic patient records, nested within a denominator population of 259,869 female cats attending 886 primary-care VetCompass participating veterinary practices in the UK in 2016. RESULTS From 2858 potential mammary tumour cases identified within the denominator, 270 cats met the case definition, giving an incidence risk of 104 per 100,000 (0.104%, 95% confidence interval 0.092 to 0.117%) during 2016. In the risk factor analysis increasing age, purebred compared to crossbred and veterinary group were associated with increased odds of mammary tumour. Median survival after the diagnosis of mammary tumour cats was 18.7 months. CLINICAL SIGNIFICANCE The current study provides an updated estimate of the incidence of mammary cancer in cats seen in primary care veterinary practice in the UK with increasing risk seen in older cats and with purebred status. This study can aid veterinary surgeons to identify cats at greater risk of mammary tumour and advise on survival after diagnosis.
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Affiliation(s)
- P Pickard Price
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - A Stell
- Davies Veterinary Specialists, Manor Farm, Business Park, Higham Gobion, Hitchin, SG5 3HR, UK
| | - D O'Neill
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D Church
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D Brodbelt
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
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Wang Z, Stell A, Sinnott RO. A GDPR-Compliant Dynamic Consent Mobile Application for the Australasian Type-1 Diabetes Data Network. Healthcare (Basel) 2023; 11:healthcare11040496. [PMID: 36833030 PMCID: PMC9957235 DOI: 10.3390/healthcare11040496] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Australia has a high prevalence of diabetes, with approximately 1.2 million Australians diagnosed with the disease. In 2012, the Australasian Diabetes Data Network (ADDN) was established with funding from the Juvenile Diabetes Research Foundation (JDRF). ADDN is a national diabetes registry which captures longitudinal information about patients with type-1 diabetes (T1D). Currently, the ADDN data are directly contributed from 42 paediatric and 17 adult diabetes centres across Australia and New Zealand, i.e., where the data are pre-existing in hospital systems and not manually entered into ADDN. The historical data in ADDN have been de-identified, and patients are initially afforded the opportunity to opt-out of being involved in the registry; however, moving forward, there is an increased demand from the clinical research community to utilise fully identifying data. This raises additional demands on the registry in terms of security, privacy, and the nature of patient consent. General Data Protection Regulation (GDPR) is an increasingly important mechanism allowing individuals to have the right to know about their health data and what those data are being used for. This paper presents a mobile application being designed to support the ADDN data collection and usage processes and aligning them with GDPR. The app utilises Dynamic Consent-an informed specific consent model, which allows participants to view and modify their research-driven consent decisions through an interactive interface. It focuses specifically on supporting dynamic opt-in consent to both the registry and to associated sub-projects requesting access to and use of the patient data for research purposes.
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Reel PS, Reel S, van Kralingen JC, Langton K, Lang K, Erlic Z, Larsen CK, Amar L, Pamporaki C, Mulatero P, Blanchard A, Kabat M, Robertson S, MacKenzie SM, Taylor AE, Peitzsch M, Ceccato F, Scaroni C, Reincke M, Kroiss M, Dennedy MC, Pecori A, Monticone S, Deinum J, Rossi GP, Lenzini L, McClure JD, Nind T, Riddell A, Stell A, Cole C, Sudano I, Prehn C, Adamski J, Gimenez-Roqueplo AP, Assié G, Arlt W, Beuschlein F, Eisenhofer G, Davies E, Zennaro MC, Jefferson E. Machine learning for classification of hypertension subtypes using multi-omics: A multi-centre, retrospective, data-driven study. EBioMedicine 2022; 84:104276. [PMID: 36179553 PMCID: PMC9520210 DOI: 10.1016/j.ebiom.2022.104276] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background Arterial hypertension is a major cardiovascular risk factor. Identification of secondary hypertension in its various forms is key to preventing and targeting treatment of cardiovascular complications. Simplified diagnostic tests are urgently required to distinguish primary and secondary hypertension to address the current underdiagnosis of the latter. Methods This study uses Machine Learning (ML) to classify subtypes of endocrine hypertension (EHT) in a large cohort of hypertensive patients using multidimensional omics analysis of plasma and urine samples. We measured 409 multi-omics (MOmics) features including plasma miRNAs (PmiRNA: 173), plasma catechol O-methylated metabolites (PMetas: 4), plasma steroids (PSteroids: 16), urinary steroid metabolites (USteroids: 27), and plasma small metabolites (PSmallMB: 189) in primary hypertension (PHT) patients, EHT patients with either primary aldosteronism (PA), pheochromocytoma/functional paraganglioma (PPGL) or Cushing syndrome (CS) and normotensive volunteers (NV). Biomarker discovery involved selection of disease combination, outlier handling, feature reduction, 8 ML classifiers, class balancing and consideration of different age- and sex-based scenarios. Classifications were evaluated using balanced accuracy, sensitivity, specificity, AUC, F1, and Kappa score. Findings Complete clinical and biological datasets were generated from 307 subjects (PA=113, PPGL=88, CS=41 and PHT=112). The random forest classifier provided ∼92% balanced accuracy (∼11% improvement on the best mono-omics classifier), with 96% specificity and 0.95 AUC to distinguish one of the four conditions in multi-class ALL-ALL comparisons (PPGL vs PA vs CS vs PHT) on an unseen test set, using 57 MOmics features. For discrimination of EHT (PA + PPGL + CS) vs PHT, the simple logistic classifier achieved 0.96 AUC with 90% sensitivity, and ∼86% specificity, using 37 MOmics features. One PmiRNA (hsa-miR-15a-5p) and two PSmallMB (C9 and PC ae C38:1) features were found to be most discriminating for all disease combinations. Overall, the MOmics-based classifiers were able to provide better classification performance in comparison to mono-omics classifiers. Interpretation We have developed a ML pipeline to distinguish different EHT subtypes from PHT using multi-omics data. This innovative approach to stratification is an advancement towards the development of a diagnostic tool for EHT patients, significantly increasing testing throughput and accelerating administration of appropriate treatment. Funding European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No. 633983, Clinical Research Priority Program of the University of Zurich for the CRPP HYRENE (to Z.E. and F.B.), and Deutsche Forschungsgemeinschaft (CRC/Transregio 205/1).
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Pommer G, Pamporaki C, Peitzsch M, Remde H, Deutschbein T, Nölting S, Müller LM, Braun L, Gruber S, Pecori A, Hampson S, Davies E, Stell A, Rossi GP, Lenzini L, Ceccato F, Timmers HJLM, Deinum J, Amar L, Blanchard A, Baron S, Fassnacht M, Dobrowolski P, Januszewicz A, Zennaro MC, Prejbisz A, Eisenhofer G. Preanalytical Considerations and Outpatient Versus Inpatient Tests of Plasma Metanephrines to Diagnose Pheochromocytoma. J Clin Endocrinol Metab 2022; 107:e3689-e3698. [PMID: 35767279 DOI: 10.1210/clinem/dgac390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Sampling of blood in the supine position for diagnosis of pheochromocytoma and paraganglioma (PPGL) results in lower rates of false positives for plasma normetanephrine than seated sampling. It is unclear how inpatient vs outpatient testing and other preanalytical factors impact false positives. OBJECTIVE We aimed to identify preanalytical precautions to minimize false-positive results for plasma metanephrines. METHODS Impacts of different blood sampling conditions on plasma metanephrines were evaluated, including outpatient vs inpatient testing, sampling of blood in semi- vs fully recumbent positions, use of cannulae vs direct venipuncture, and differences in outside temperature. A total of 3147 patients at 10 tertiary referral centers were tested for PPGL, including 278 with and 2869 without tumors. Rates of false-positive results were analyzed. RESULTS Outpatient rather than inpatient sampling resulted in 44% higher plasma concentrations and a 3.4-fold increase in false-positive results for normetanephrine. Low temperature, a semi-recumbent position, and direct venipuncture also resulted in significantly higher plasma concentrations and rates of false-positive results for plasma normetanephrine than alternative sampling conditions, although with less impact than outpatient sampling. Higher concentrations and rates of false-positive results for plasma normetanephrine with low compared with warm temperatures were only apparent for outpatient sampling. Preanalytical factors were without impact on plasma metanephrines in patients with PPGL. CONCLUSION Although inpatient blood sampling is largely impractical for screening patients with suspected PPGL, other preanalytical precautions (eg, cannulae, warm testing conditions) may be useful. Inpatient sampling may be reserved for follow-up of patients with difficult to distinguish true- from false-positive results.
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Affiliation(s)
- Georg Pommer
- Institute of Clinical Genetics, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christina Pamporaki
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hanna Remde
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97082 Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97082 Würzburg, Germany
- Medicover Oldenburg MVZ, 26122 Oldenburg, Germany
| | - Svenja Nölting
- Department of Medicine IV, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, CH-8091Zurich, Switzerland
| | - Lisa Marie Müller
- Department of Medicine IV, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Leah Braun
- Department of Medicine IV, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Sven Gruber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich, CH-8091Zurich, Switzerland
| | - Alessio Pecori
- Department of Medical Sciences, University of Torino, 10126 Turin, Italy
| | - Stephanie Hampson
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK
| | - Eleanor Davies
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, G12 8TA Glasgow, UK
| | - Anthony Stell
- School of Computing and Information Systems, University of Melbourne, Melbourne, 3052 Victoria, Australia
| | - Gian Paolo Rossi
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy
| | - Livia Lenzini
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy
| | - Filippo Ceccato
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Laurence Amar
- Université Paris Cité, PARCC, INSERM, F-75015 Paris, France
- Unité Hypertension artérielle - Centre de Reference en Maladies Rares des Surrénales, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Anne Blanchard
- Centre d'Investigations Cliniques, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Stephanie Baron
- Service de Physiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, 97082 Würzburg, Germany
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Maria-Christina Zennaro
- Université Paris Cité, PARCC, INSERM, F-75015 Paris, France
- Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Graeme Eisenhofer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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Economu L, Stell A, O'Neill DG, Schofield I, Stevens K, Brodbelt D. Incidence and risk factors for feline lymphoma in UK primary-care practice. J Small Anim Pract 2020; 62:97-106. [PMID: 33325082 PMCID: PMC7986087 DOI: 10.1111/jsap.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
Objectives The study aimed to estimate the incidence and prevalence of feline lymphoma in cats attending primary‐care practices across the UK and to identify patient‐based and environmental (radon and pesticide exposure) risk factors. Materials and Methods Case records from the VetCompass programme from primary‐care veterinary practices in the UK were searched for a diagnosis of lymphoma in cats in 2016. Cases were required to have had an external laboratory confirmed diagnosis based on cytology and/or histopathology. A nested case–control study design was used to identify risk factors for lymphoma using multivariable logistic regression. Results From a cohort of 562,446 cats under veterinary care at VetCompass participating practices in 2016, a total of 271 lymphoma cases were identified (prevalence: 48/100,000, 95% confidence interval (CI) 44 to 56/100,000; incidence 32/100,000, 95% CI 26 to 35/100,000). There were 180 incident lymphoma cases and 803 controls, all aged 2 years and older. Male (odds ratio (OR) 1.7, 95% CI 1.2 to 2.4), insured (OR 3.6, 95% CI 2.3 to 5.6) and older cats (compared to cats 2 to <5 years, OR 5.0, 95% CI 2.8 to 8.8) were associated with increased odds of lymphoma diagnosis. Vaccinated cats were associated with decreased odds (OR 0.7, 95% CI 0.5 to 1.0) compared to unvaccinated cats, although the type of vaccination received was not statistically significant. Breed and environmental factors studied were not associated with a diagnosis of lymphoma. Clinical Significance This is the first study to estimate the frequency and report risk factors for lymphoma in cats attending UK primary‐care practice.
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Affiliation(s)
- L Economu
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - A Stell
- Davies Veterinary Specialists, Manor Farm, Business Park, Higham Gobion, Hitchin, SG5 3HR, UK
| | - D G O'Neill
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - I Schofield
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - K Stevens
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - D Brodbelt
- Pathobiology and Population Science, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
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Eisenhofer G, Deutschbein T, Constantinescu G, Langton K, Pamporaki C, Calsina B, Monteagudo M, Peitzsch M, Fliedner S, Timmers HJLM, Bechmann N, Fankhauser M, Nölting S, Beuschlein F, Stell A, Fassnacht M, Prejbisz A, Lenders JWM, Robledo M. Plasma metanephrines and prospective prediction of tumor location, size and mutation type in patients with pheochromocytoma and paraganglioma. Clin Chem Lab Med 2020; 59:353-363. [PMID: 33001846 DOI: 10.1515/cclm-2020-0904] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 06/12/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
Objectives Plasma free metanephrines are commonly used for diagnosis of pheochromocytoma and paraganglioma (PPGLs), but can also provide other information. This multicenter study prospectively examined whether tumor size, location, and mutations could be predicted by these metabolites. Methods Predictions of tumor location, size, and mutation type, based on measurements of plasma normetanephrine, metanephrine, and methoxytyramine were made without knowledge of disease in 267 patients subsequently determined to have PPGLs. Results Predictions of adrenal vs. extra-adrenal locations according to increased plasma concentrations of metanephrine and methoxytyramine were correct in 93 and 97% of the respective 136 and 33 patients in who these predictions were possible. Predicted mean tumor diameters correlated positively (p<0.0001) with measured diameters; predictions agreed well for pheochromocytomas but were overestimated for paragangliomas. Considering only patients with mutations, 51 of the 54 (94%) patients with NF1 or RET mutations were correctly predicted with those mutations according to increased plasma metanephrine, whereas no or minimal increase in metanephrine correctly predicted all 71 patients with either VHL or SDHx mutations; furthermore, among the latter group increases in methoxytyramine correctly predicted SDHx mutations in 93% of the 29 cases for this specific prediction. Conclusions Extents and patterns of increased plasma O-methylated catecholamine metabolites among patients with PPGLs allow predictions of tumor size, adrenal vs. extra-adrenal locations and general types of mutations. Predictions of tumor location are, however, only possible for patients with clearly increased plasma methoxytyramine or metanephrine. Where possible or clinically relevant the predictions are potentially useful for subsequent clinical decision-making.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Georgiana Constantinescu
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katharina Langton
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christina Pamporaki
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Maria Monteagudo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Fliedner
- First Department of Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nicole Bechmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Experimental Diabetology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Maria Fankhauser
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Svenja Nölting
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Endocrinology, Diabetology and Clinical Nutrition, UniviersitätsSpital Zürich, Zurich, Switzerland
| | - Anthony Stell
- Department of Computing and Information, University of Melbourne, MelbourneAustralia
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.,Central Laboratory, University Hospital Würzburg, Würzburg, Germany
| | | | - Jacques W M Lenders
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre and Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
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Geroula A, Deutschbein T, Langton K, Masjkur J, Pamporaki C, Peitzsch M, Fliedner S, Timmers HJLM, Bornstein SR, Beuschlein F, Stell A, Januszewicz A, Prejbisz A, Fassnacht M, Lenders JWM, Eisenhofer G. Pheochromocytoma and paraganglioma: clinical feature-based disease probability in relation to catecholamine biochemistry and reason for disease suspicion. Eur J Endocrinol 2019; 181:409-420. [PMID: 31370000 DOI: 10.1530/eje-19-0159] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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] [Received: 03/04/2019] [Accepted: 07/31/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hypertension and symptoms of catecholamine excess are features of pheochromocytomas and paragangliomas (PPGLs). This prospective observational cohort study assessed whether differences in presenting features in patients tested for PPGLs might assist establishing likelihood of disease. DESIGN AND METHODS Patients were tested for PPGLs because of signs and symptoms, an incidental mass on imaging or routine surveillance due to previous history or hereditary risk. Patients with (n = 245) compared to without (n = 1820) PPGLs were identified on follow-up. Differences in presenting features were then examined to assess the probability of disease and relationships to catecholamine excess. RESULTS Hyperhidrosis, palpitations, pallor, tremor and nausea were 30-90% more prevalent (P < 0.001) among patients with than without PPGLs, whereas headache, flushing and other symptoms showed little or no differences. Although heart rates were higher (P < 0.0001) in patients with than without PPGLs, blood pressures were not higher and were positively correlated to BMI, which was lower (P < 0.0001) in patients with than without PPGLs. From these differences in clinical features, a score system was established that indicated a 5.8-fold higher probability of PPGLs in patients with high than low scores. Higher scores among patients with PPGLs were associated, independently of tumor size, with higher biochemical indices of catecholamine excess. CONCLUSIONS This study identifies a complex of five signs and symptoms combined with lower BMI and elevated heart rate as key features in patients with PPGLs. Prevalences of these features, which reflect variable tumoral catecholamine production, may be used to triage patients according to likelihood of disease.
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Affiliation(s)
- Aikaterini Geroula
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Langton
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jimmy Masjkur
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christina Pamporaki
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephanie Fliedner
- First Department of Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Endocrinology, Diabetology and Clinical Nutrition, UniviersitätsSpital Zürich, Zürich, Switzerland
| | - Anthony Stell
- Department of Computing and Information, University of Melbourne, Melbourne, Australia
| | | | | | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Jacques W M Lenders
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Rogowski-Lehmann N, Geroula A, Prejbisz A, Timmers HJLM, Megerle F, Robledo M, Fassnacht M, Fliedner SMJ, Reincke M, Stell A, Januszewicz A, Lenders JWM, Eisenhofer G, Beuschlein F. Missed clinical clues in patients with pheochromocytoma/paraganglioma discovered by imaging. Endocr Connect 2018; 7:/journals/ec/aop/ec-18-0318.xml. [PMID: 30352425 PMCID: PMC6215794 DOI: 10.1530/ec-18-0318] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/10/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT Pheochromocytomas and paragangliomas (PPGLs) are rare but potentially harmful tumors that can vary in their clinical presentation. Tumors may be found due to signs and symptoms, as part of a hereditary syndrome or following an imaging procedure. OBJECTIVE To investigate potential differences in clinical presentation between PPGLs discovered by imaging (iPPGLs), symptomatic cases (sPPGLs) and those diagnosed during follow-up because of earlier disease/known hereditary mutations (fPPGL). DESIGN Prospective study protocol, which has enrolled patients from 6 European centers with confirmed PPGLs. SETTING AND PATIENTS Data were analyzed from 235 patients (37% iPPGLs, 36% sPPGLs, 27% fPPGLs) and compared for tumor volume, biochemical profile, mutation status, presence of metastases and self-reported symptoms. RESULTS iPPGL patients were diagnosed at a significantly higher age than fPPGLs (p<0.001), found to have larger tumors (p=0.003) and higher metanephrine and normetanephrine levels at diagnosis (p=0.021). Significantly lower than in sPPGL, there was a relevant number of self-reported symptoms in iPPGL (2.9 vs. 4.3 symptoms, p<0.001). In 16.2% of iPPGL, mutations in susceptibility genes were detected, although this proportion was lower than in fPPGL (60.9%) and sPPGL (21.5%). CONCLUSIONS Patients with PPGLs detected by imaging were older, have higher tumor volume and more excessive hormonal secretion in comparison to those found as part of a surveillance program. Presence of typical symptoms indicates that in a relevant proportion of those patients the PPGL diagnosis had been delayed. Précis: Pheochromocytoma/paraganglioma discovered by imaging are often symptomatic and carry a significant proportion of germline mutations in susceptibility genes.
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Affiliation(s)
| | - Aikaterini Geroula
- Institut für Klinische Chemie und LaboratoriumsmedizinUniversitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | | | - Henri J L M Timmers
- Section of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Felix Megerle
- Medizinische Klinik und Poliklinik I des Universitätsklinikums WürzburgWürzburg, Germany
| | - Mercedes Robledo
- Hereditary Endocrine Cancer GroupHuman Cancer Genetics Programme, Spanish National Cancer Research Centre, Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Martin Fassnacht
- Medizinische Klinik und Poliklinik I des Universitätsklinikums WürzburgWürzburg, Germany
| | - Stephanie M J Fliedner
- First Department of MedicineUniversity Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, Germany
| | - Anthony Stell
- Department of Computing and InformationUniversity of Melbourne, Melbourne Australia
| | | | - Jacques W M Lenders
- Section of EndocrinologyDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Medizinische Klinik IIIUniversitätsklinikum Carl Gustav Carus an der Technische Universität Dresden, Dresden, Germany
| | - Graeme Eisenhofer
- Institut für Klinische Chemie und LaboratoriumsmedizinUniversitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
- Medizinische Klinik IIIUniversitätsklinikum Carl Gustav Carus an der Technische Universität Dresden, Dresden, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, Germany
- Klinik für EndokrinologieDiabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland
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Donald R, Howells T, Piper I, Enblad P, Nilsson P, Chambers I, Gregson B, Citerio G, Kiening K, Neumann J, Ragauskas A, Sahuquillo J, Sinnott R, Stell A. Forewarning of hypotensive events using a Bayesian artificial neural network in neurocritical care. J Clin Monit Comput 2018; 33:39-51. [DOI: 10.1007/s10877-018-0139-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
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An Y, Reimann M, Masjkur J, Langton K, Peitzsch M, Deutschbein T, Fassnacht M, Rogowski-Lehmann N, Beuschlein F, Fliedner S, Stell A, Prejbisz A, Januszewicz A, Lenders J, Bornstein SR, Eisenhofer G. Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours. Int J Obes (Lond) 2018; 43:263-275. [PMID: 29717268 DOI: 10.1038/s41366-018-0054-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/10/2018] [Accepted: 01/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obesity-associated activation of sympathetic nervous outflow is well documented, whereas involvement of dysregulated adrenomedullary hormonal function in obesity is less clear. This study assessed relationships of sympathoadrenal function with indices of obesity and influences of circulating catecholamines on body mass. METHODS Anthropometric and clinical data along with plasma and 24-h urine samples were collected from 590 volunteers and 1368 patients tested for phaeochromocytoma and paraganglioma (PPGL), among whom tumours were diagnosed in 210 individuals. RESULTS Among patients tested for PPGL, those with tumours less often had a body mass index (BMI) above 30 kg/m2 (12 vs. 31%) and more often a BMI under 25 kg/m2 (56 vs. 32%) than those without tumours (P < 0.0001). Urinary outputs of catecholamines in patients with PPGL were negatively related to BMI (r = -0.175, P = 0.0133). Post-operative weight gain (P < 0.0001) after resection of PPGL was positively related to presurgical tumoural catecholamine output (r = 0.257, P = 0.0101). Higher BMI in men and women and percent body fat in women of the volunteer group were associated with lower plasma concentrations and urinary outputs of adrenaline and metanephrine, the former indicating obesity-related reduced adrenaline secretion and the latter obesity-related reduced adrenomedullary adrenaline stores. Daytime activity was associated with substantial increases in urinary adrenaline and noradrenaline excretion, with blunted responses in obese subjects. CONCLUSIONS The findings in patients with PPGL support an influence of high circulating catecholamines on body weight. Additional associations of adrenomedullary dysfunction with obesity raise the possibility of a permissive influence of the adrenal medulla on the regulation of body weight.
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Affiliation(s)
- Yaxin An
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manja Reimann
- Department of Neurology, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jimmy Masjkur
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katharina Langton
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Deutschbein
- Department of Internal Medicine, Division of Endocrinology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Natalie Rogowski-Lehmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Endocrinology, Diabetology and Clinical Nutrition, UnviersitätsSpital Zürich, Zurich, Switzerland
| | - Stephanie Fliedner
- Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Anthony Stell
- Department of Computing and Information, University of Melbourne, Melbourne, Australia
| | | | | | - Jacques Lenders
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Stefan R Bornstein
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Graeme Eisenhofer
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Zambetti M, Montemurro F, Morandi P, Zamagni C, Stell A, Rozzi A, Gianni L. Abstract P1-13-06: Safety of trastuzumab in the subcutaneous formulation for the treatment of HER2 positive early breast cancer (eBC) patients: Primary results of SCHEARLY trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:: This study in Italian breast cancer patients is part of a phase IIIB, open-label, multinational umbrella study (UmbHER1), assessing the safety and tolerability of the subcutaneous (SC) formulation of Trastuzumab as primary end point. Present analysis is relative to the safety during the treatment period, with a major focus to side effects associated with the Trastuzumab SC administration.
Methods: Patients with HER2-positive eBC and LABC were eligible and included in two sequential cohorts: 120 patients treated with Trastuzumab SC by handheld syringe (Cohort A), and 120 with Trastuzumab SC by single-use injection device (SID, Cohort B). All the patients received adjuvant or neo-adjuvant treatment (clinician choice) with Anthracycline-containing regimens (FEC/EC/AC) followed by Trastuzumab SC in combination with taxanes (weekly Paclitaxel or Docetaxel) and then in monotherapy for a total of 18 cycles. Safety clinical and instrumental evaluations were planned at definite time points.
Results: 240 patients were enrolled and 202 patients (82.6% in cohort A and 84.9% in cohort B) completed the treatment. Reasons for discontinuation were the following: 7.9% AE/intercurrent illness, 3.3% withdrew consent, 1.7% recurrence of disease, 1.7% refused treatment, 0.9% violation of inclusion criteria, 0.9% other reasons. In the safety population, 98.2% of patients experienced at least one adverse event from the start of the Anthracycline treatment until the Safety Follow-up visit. Patients experiencing a Treatment Emergent (from Trastuzumab start date) AEs defined as Grade ≥3 were 26.8%; of these, 3.9% were considered related to study drug; Treatment Emergent Serious Adverse Events appeared in 7.5% of the safety population, of which 0.9% were considered related to study drug: one pleuropericarditis and one anaphylactic shock, both resolved.
The frequency of systemic administration-related reactions, ARRs (pyrexia 25%, erythema 20,2%, rash 7,0%, chest pain 7,0%, pruritus 6,6%, chills 1,3%, anaphylactic shock 0,9%) and local injection site reactions, ISRs (pain 6,6%, injection site reactions 3,9%, subcutaneous abscess 0,9%, administration site oedema 0,4%) potentially related to the subcutaneous formulation is cumulatively reported below.
% all / G≥3% related to IMP% related cohort A% related cohort B% during Tax+Trast all/ G≥3% during Trast only all/ G≥3Systemic ARRs68,0 / 2,28,85,33,916.7 / 0.425.0 / 0.4Local ISRs21,9 / 0,97,04,81,36.6 / 0.43.1 / 0.0
The mean reduction of Left Ventricular Ejection Fraction (LVEF) at the end of 1 year treatment from screening was 2.9%. 8.8% of patients experienced a decrease in LVEF, in most cases defined related to study drug (18 patients out of 20); no cases of CHF were reported.
Conclusion: Local and systemic tolerability of subcutaneous Trastuzumab administration is good in both groups and there is no evidence of increased incidence and severity of IMP-related systemic side effects in comparison with the standard intravenous route.
Citation Format: Zambetti M, Montemurro F, Morandi P, Zamagni C, Stell A, Rozzi A, Gianni L. Safety of trastuzumab in the subcutaneous formulation for the treatment of HER2 positive early breast cancer (eBC) patients: Primary results of SCHEARLY trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-06.
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Affiliation(s)
- M Zambetti
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - F Montemurro
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - P Morandi
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - C Zamagni
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - A Stell
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - A Rozzi
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
| | - L Gianni
- Ospedale San Raffaele, Milano, Italy; Istituto di Candiolo IRCCS, Candiolo, Italy; Ospedale dell'Angelo, Venezia, Italy; Policlinico S.Orsola-Malpighi, Bologna, Italy; Roche SpA, Monza, Italy
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Rao D, Peitzsch M, Prejbisz A, Hanus K, Fassnacht M, Beuschlein F, Brugger C, Fliedner S, Langton K, Pamporaki C, Gudziol V, Stell A, Januszewicz A, Timmers HJLM, Lenders JWM, Eisenhofer G. Plasma methoxytyramine: clinical utility with metanephrines for diagnosis of pheochromocytoma and paraganglioma. Eur J Endocrinol 2017; 177:103-113. [PMID: 28476870 PMCID: PMC5488393 DOI: 10.1530/eje-17-0077] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT Measurements of plasma methoxytyramine, the O-methylated dopamine metabolite, are useful for detecting rare dopamine-producing pheochromocytomas and paragangliomas (PPGLs) and head and neck paragangliomas (HNPGLs), but utility for screening beyond that achieved using standard measurements of normetanephrine and metanephrine is unclear. OBJECTIVE Evaluation of the additional utility of methoxytyramine compared to plasma normetanephrine and metanephrine for diagnosis of PPGLs and HNPGLs. DESIGN Comparative prospective study. METHODS Comparison of mass spectrometric-based measurements of plasma methoxytyramine, normetanephrine and metanephrine in 1963 patients tested for PPGLs at six tertiary medical centers according to reference intervals verified in 423 normotensive and hypertensive volunteers. RESULTS Of the screened patients, 213 had PPGLs and 38 HNPGLs. Using an upper cut-off of 0.10 nmol/L for methoxytyramine, 0.45 nmol/L for metanephrine and age-specific upper cut-offs for normetanephrine, diagnostic sensitivity with the addition of methoxytyramine increased from 97.2% to 98.6% for patients with PPGLs and from 22.1% to 50.0% for patients with HNPGLs, with a small decrease in specificity from 95.9% to 95.1%. Addition of methoxytyramine did not significantly alter areas under receiver operating characteristic curves for patients with PPGLs (0.984 vs 0.991), but did increase (P < 0.05) areas for patients with HNPGLs (0.627 vs 0.801). Addition of methoxytyramine also increased the proportion of patients with PPGLs who showed highly positive predictive elevations of multiple metabolites (70.9% vs 49.3%). CONCLUSIONS While the benefit of additional measurements of plasma methoxytyramine for the detection of PPGLs is modest, the measurements do assist with positive confirmation of disease and are useful for the detection of HNPGLs.
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Affiliation(s)
- Dipti Rao
- Department of Internal MedicineRadboud University Medical Centre, Nijmegen, The Netherlands
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Katarzyna Hanus
- Department of HypertensionInstitute of Cardiology, Warsaw, Poland
| | - Martin Fassnacht
- Department of EndocrinologyUniversity Hospital Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Department of EndocrinologyUniversity Hospital München, München, Germany
| | - Christina Brugger
- Department of EndocrinologyUniversity Hospital München, München, Germany
| | - Stephanie Fliedner
- First Department of MedicineUniversity Medical Center Schleswig-Holstein, Lübeck, Germany
| | | | | | - Volker Gudziol
- Departments of OtorhinolaryngologyUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anthony Stell
- Melboune eResearch GroupUniversity of Melbourne, Melbourne, Australia
| | | | - Henri J L M Timmers
- Department of Internal MedicineRadboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacques W M Lenders
- Department of Internal MedicineRadboud University Medical Centre, Nijmegen, The Netherlands
- Departments of Medicine III
- Correspondence should be addressed to J W M Lenders;
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory MedicineUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Departments of Medicine III
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Libé R, Borget I, Ronchi CL, Zaggia B, Kroiss M, Kerkhofs T, Bertherat J, Volante M, Quinkler M, Chabre O, Bala M, Tabarin A, Beuschlein F, Vezzosi D, Deutschbein T, Borson-Chazot F, Hermsen I, Stell A, Fottner C, Leboulleux S, Hahner S, Mannelli M, Berruti A, Haak H, Terzolo M, Fassnacht M, Baudin E. Prognostic factors in stage III-IV adrenocortical carcinomas (ACC): an European Network for the Study of Adrenal Tumor (ENSAT) study. Ann Oncol 2016; 26:2119-25. [PMID: 26392430 DOI: 10.1093/annonc/mdv329] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [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: 01/27/2023] Open
Abstract
BACKGROUND The clinical course of advanced adrenocortical carcinoma (ACC) is heterogeneous. Our study aimed primarily to refine and make headway in the prognostic stratification of advanced ACC. PATIENTS AND METHODS Patients with advanced ENSAT ACC (stage III or stage IV) at diagnosis registered between 2000 and 2009 in the ENSAT database were enrolled. The primary end point was overall survival (OS). Parameters of potential prognostic relevance were selected. Univariate and multivariate analyses were carried out: model 1 'before surgery'; model 2 'post-surgery'. RESULTS Four hundred and forty-four patients with advanced ENSAT ACC (stage III: 210; stage IV: 234) were analyzed. After a median follow-up of 55.2 months, the median OS was 24 months. A modified ENSAT (mENSAT) classification was validated: stage III (invasion of surrounding tissues/organs or the vena renalis/cava) and stage IVa, IVb, IVc (2, 3 or >3 metastatic organs, including N, respectively). Two- or 5-year OS was 73%, 46%, 26% and 15% or 50%, 15%, 14% and 2% for stages III, IVa, IVb and IVc, respectively. In the multivariate analysis, mENSAT stages (stages IVa, IVb, or IVc, respectively) were significantly correlated with OS (P < 0.0001), as well as additional parameters: age ≥ 50 years (P < 0.0001), tumor- or hormone-related symptoms (P = 0.01 and 0.03, respectively) in model 1 but also the R status (P = 0.001) and Grade (Weiss >6 and/or Ki67 ≥ 20%, P = 0.06) in model 2. CONCLUSION The mENSAT classification and GRAS parameters (Grade, R status, Age and Symptoms) were found to best stratify the prognosis of patients with advanced ACC.
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Affiliation(s)
- R Libé
- French Adrenal Cancer Network, Institut National du Cancer, Paris
| | - I Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy and University Paris-Sud, Villejuif, France
| | - C L Ronchi
- Central Laboratory, Research Unit, University Hospital Wurzburg, Wurzburg, Germany
| | - B Zaggia
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Kroiss
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - T Kerkhofs
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - J Bertherat
- Endocrinology Unit, Cochin Hospital, Paris, France
| | - M Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Turin, Italy
| | - M Quinkler
- Clinical Endocrinology, Charit Campus Mitte, Charitί University Medicine Berlin, Germany
| | - O Chabre
- Endocrinology Unit, University Hospital of Grenoble, France
| | - M Bala
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - A Tabarin
- Department of Endocrinology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - F Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - D Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse
| | - T Deutschbein
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - F Borson-Chazot
- Nuclear Medicine Unit, University of Lyon 1, Hospices Civils de Lyon Bron, France
| | - I Hermsen
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - A Stell
- Melbourne eResearch Group Level 3, Doug McDonell Building, University of Melbourne, Melbourne, Australia
| | - C Fottner
- Department of Medicine 1, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - S Leboulleux
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
| | - S Hahner
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - M Mannelli
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Florence
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - H Haak
- Internal Medicine, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - M Terzolo
- Internal Medicine, San Luigi Hospital, University of Turin, Italy
| | - M Fassnacht
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - E Baudin
- Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Villejuif, France
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15
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Beuschlein F, Weigel J, Saeger W, Kroiss M, Wild V, Daffara F, Libé R, Ardito A, Al Ghuzlan A, Quinkler M, Oßwald A, Ronchi CL, de Krijger R, Feelders RA, Waldmann J, Willenberg HS, Deutschbein T, Stell A, Reincke M, Papotti M, Baudin E, Tissier F, Haak HR, Loli P, Terzolo M, Allolio B, Müller HH, Fassnacht M. Major prognostic role of Ki67 in localized adrenocortical carcinoma after complete resection. J Clin Endocrinol Metab 2015; 100:841-9. [PMID: 25559399 DOI: 10.1210/jc.2014-3182] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [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: 01/04/2023]
Abstract
BACKGROUND Recurrence of adrenocortical carcinoma (ACC) even after complete (R0) resection occurs frequently. OBJECTIVE The aim of this study was to identify markers with prognostic value for patients in this clinical setting. DESIGN, SETTING, AND PARTICIPANTS From the German ACC registry, 319 patients with the European Network for the Study of Adrenal Tumors stage I-III were identified. As an independent validation cohort, 250 patients from three European countries were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical, histological, and immunohistochemical markers were correlated with recurrence-free (RFS) and overall survival (OS). RESULTS Although univariable analysis within the German cohort suggested several factors with potential prognostic power, upon multivariable adjustment only a few including age, tumor size, venous tumor thrombus (VTT), and the proliferation marker Ki67 retained significance. Among these, Ki67 provided the single best prognostic value for RFS (hazard ratio [HR] for recurrence, 1.042 per 1% increase; P < .0001) and OS (HR for death, 1.051; P < .0001) which was confirmed in the validation cohort. Accordingly, clinical outcome differed significantly between patients with Ki67 <10%, 10-19%, and ≥20% (for the German cohort: median RFS, 53.2 vs 31.6 vs 9.4 mo; median OS, 180.5 vs 113.5 vs 42.0 mo). Using the combined cohort prognostic scores including tumor size, VTT, and Ki67 were established. Although these scores discriminated slightly better between subgroups, there was no clinically meaningful advantage in comparison with Ki67 alone. CONCLUSION This largest study on prognostic markers in localized ACC identified Ki67 as the single most important factor predicting recurrence in patients following R0 resection. Thus, evaluation of Ki67 indices should be introduced as standard grading in all pathology reports of patients with ACC.
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Affiliation(s)
- Felix Beuschlein
- Medizinische Klinik and Poliklinik IV (F.B., A.O., M.R., M.F.), Ludwig-Maximilians-Universität München, D-80336 Germany; Department of Medicine I, Endocrine and Diabetes Unit (J.W., C.L.R., T.D., B.A., M.F.), University Hospital, University of Würzburg, D-97080 Germany; Department of Pathology (W.S.), University of Hamburg, D-20246 Germany; Comprehensive Cancer Center Mainfranken (M.K., M.F.), University of Würzburg, D-97080 Germany; Institute of Pathology (V.W.), University of Würzburg, D-97080 Germany; Medicina Interna 1 (F.D., A.A., M.T.), Azienda Ospedalier Universitaria San Luigi and University of Turin, I-10043, Italy; Département d'Endocrinologie (R.L.), Groupe hospitalier Cochin, F-75104, France; Institut Gustave Roussy (A.A.G., E.B.), F-94805, France; Clinical Endocrinology (M.Q.), Campus Mitte, University Hospital Charité, D-10117, Germany; Department of Pathology (R.D.K.), Erasmus Medical Center, N-3000, Netherlands; Department of Internal Medicine (R.A.B.), Erasmus Medical Center, N-3000, Netherlands; Department of Visceral, Thoracic and Vascular Surgery (J.W.), University Hospital Giessen and Marburg, Campus Marburg, D-35033 Marburg; Department of Endocrinology and Diabetology (H.S.W.), University of D-40225 Düsseldorf, Germany; Melbourne eResearch Group (D.A.S.), University of Melbourne, VIC 3010 Melbourne; Anatomia Patologica (M.P.), Azienda Ospedalier Universitaria San Luigi and University of Turin, I-10043, Italy; Department of Pathology (F.T.), Pitié-Salpêtrière, AP-HP, Pierre and Marie Curie University, Sorbonne Universités; Inserm U1016, Institut Cochin, UMR8104, Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris; Máxima Medisch Centrum (H.R.H.), N-5600, Netherlands; Ospedale Niguarda Cà Granda (P.L.), I-20122, Italy; Institute for Medical Informatics, Biometry and Epidemiology (H.-H.M.), Ludwig-Maximilians-Universität München, D-81377 München; Central laboratory (M.F.), University Hospital Würzburg, University of
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16
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Eisenhofer G, Brown S, Peitzsch M, Pelzel D, Lattke P, Glöckner S, Stell A, Prejbisz A, Fassnacht M, Beuschlein F, Januszewicz A, Siegert G, Reichmann H. Levodopa therapy in Parkinson's disease: influence on liquid chromatographic tandem mass spectrometric-based measurements of plasma and urinary normetanephrine, metanephrine and methoxytyramine. Ann Clin Biochem 2013; 51:38-46. [PMID: 23873873 DOI: 10.1177/0004563213487894] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medication-related interferences with measurements of catecholamines and their metabolites represent important causes of false-positive results during diagnosis of phaeochromocytomas and paragangliomas (PPGLs). Such interferences are less troublesome with measurements by liquid chromatography with tandem mass-spectrometry (LC-MS/MS) than by other methods, but can still present problems for some drugs. Levodopa, the precursor for dopamine used in the treatment of Parkinson's disease, represents one potentially interfering medication. METHODS Plasma and urine samples, obtained from 20 Parkinsonian patients receiving levodopa, were analysed for concentrations of catecholamines and their O-methylated metabolites by LC-MS/MS. Results were compared with those from a group of 120 age-matched subjects and 18 patients with PPGLs. RESULTS Plasma and urinary free and deconjugated (free + conjugated) methoxytyramine, as well as urinary dopamine, showed 22- to 148-fold higher (P < 0.0001) concentrations in patients receiving levodopa than in the reference group. In contrast, plasma normetanephrine, urinary noradrenaline and urinary free and deconjugated normetanephrine concentrations were unaffected. Plasma free metanephrine, urinary adrenaline and urinary free and deconjugated metanephrine all showed higher (P < 0.05) concentrations in Parkinsonian patients than the reference group, but this was only a problem for adrenaline. Similar to normetanephrine, plasma and urinary metanephrine remained below the 97.5 percentiles of the reference group in almost all Parkinsonian patients. CONCLUSIONS These data establish that although levodopa treatment confounds identification of PPGLs that produce dopamine, the therapy is not a problem for use of LC-MS/MS measurements of plasma and urinary normetanephrine and metanephrine to diagnose more commonly encountered PPGLs that produce noradrenaline or adrenaline.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University of Dresden, Dresden, Germany
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17
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Donald R, Howells T, Piper I, Chambers I, Citerio G, Enblad P, Gregson B, Kiening K, Mattern J, Nilsson P, Ragauskas A, Sahuquillo J, Sinnott R, Stell A. Early warning of EUSIG-defined hypotensive events using a Bayesian Artificial Neural Network. Acta Neurochir Suppl 2012. [PMID: 22327662 DOI: 10.1007/978-3-7091-0956-48] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hypotension is recognized as a potentially damaging secondary insult after traumatic brain injury. Systems to give clinical teams some early warning of likely hypotensive instability could be added to the range of existing techniques used in the management of this group of patients. By using the Edinburgh University Secondary Insult Grades (EUSIG) definitions for -hypotension (systolic arterial pressure <90 mmHg OR mean arterial -pressure <70 mmHg) we collected a group of ∼2,000 events by analyzing the Brain-IT database. We then constructed a Bayesian Artificial Neural Network (an advanced statistical modeling technique) that is able to provide some early warning when trained on this previously collected demographic and physiological data. MATERIALS AND METHODS Using EUSIG defined event data from the Brain-IT database, we identified a Bayesian artificial neural network (BANN) topology and constructed a series of datasets using a group of clinically guided input variables. This allowed us to train a BANN, which was then tested on an unseen set of patients from the Brain-IT database. The initial tests used a particularly harsh assessment criterion whereby a true positive prediction was only allowed if the BANN predicted an upcoming event to the exact minute. We have now developed the system to the point where it is about to be used in a two-stage Phase II clinical trial and we are also researching a more realistic assessment technique. KEY RESULTS We have constructed a BANN that is able to provide early warning to the clinicians based on a model that uses information from the physiological inputs; systolic and mean arterial pressure and heart rate; and demographic variables age and gender. We use 15-min SubWindows starting at 15 and 30 min before an event and process mean, slope and standard deviations. Based on 10 simulation runs, our current sensitivity is 36.25% (SE 1.31) with a specificity of 90.82% (SE 0.85). Initial results from a Phase I clinical study shows a model sensitivity of 40.95% (SE 6%) and specificity of 86.46% (SE 3%) Although this figure is low it is considered clinically useful for this dangerous condition, provided the false positive rate can be kept sufficiently low as to be practical in an intensive care environment. CONCLUSION We have shown that using advanced statistical modeling techniques can provide clinical teams with useful information that will assist clinical care.
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Affiliation(s)
- Rob Donald
- University of Glasgow, Glasgow, Scotland, UK.
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18
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Donald R, Howells T, Piper I, Chambers I, Citerio G, Enblad P, Gregson B, Kiening K, Mattern J, Nilsson P, Ragauskas A, Sahuquillo J, Sinnott R, Stell A. Early warning of EUSIG-defined hypotensive events using a Bayesian Artificial Neural Network. Acta Neurochir Suppl 2012; 114:39-44. [PMID: 22327662 DOI: 10.1007/978-3-7091-0956-4_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Hypotension is recognized as a potentially damaging secondary insult after traumatic brain injury. Systems to give clinical teams some early warning of likely hypotensive instability could be added to the range of existing techniques used in the management of this group of patients. By using the Edinburgh University Secondary Insult Grades (EUSIG) definitions for -hypotension (systolic arterial pressure <90 mmHg OR mean arterial -pressure <70 mmHg) we collected a group of ∼2,000 events by analyzing the Brain-IT database. We then constructed a Bayesian Artificial Neural Network (an advanced statistical modeling technique) that is able to provide some early warning when trained on this previously collected demographic and physiological data. MATERIALS AND METHODS Using EUSIG defined event data from the Brain-IT database, we identified a Bayesian artificial neural network (BANN) topology and constructed a series of datasets using a group of clinically guided input variables. This allowed us to train a BANN, which was then tested on an unseen set of patients from the Brain-IT database. The initial tests used a particularly harsh assessment criterion whereby a true positive prediction was only allowed if the BANN predicted an upcoming event to the exact minute. We have now developed the system to the point where it is about to be used in a two-stage Phase II clinical trial and we are also researching a more realistic assessment technique. KEY RESULTS We have constructed a BANN that is able to provide early warning to the clinicians based on a model that uses information from the physiological inputs; systolic and mean arterial pressure and heart rate; and demographic variables age and gender. We use 15-min SubWindows starting at 15 and 30 min before an event and process mean, slope and standard deviations. Based on 10 simulation runs, our current sensitivity is 36.25% (SE 1.31) with a specificity of 90.82% (SE 0.85). Initial results from a Phase I clinical study shows a model sensitivity of 40.95% (SE 6%) and specificity of 86.46% (SE 3%) Although this figure is low it is considered clinically useful for this dangerous condition, provided the false positive rate can be kept sufficiently low as to be practical in an intensive care environment. CONCLUSION We have shown that using advanced statistical modeling techniques can provide clinical teams with useful information that will assist clinical care.
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Affiliation(s)
- Rob Donald
- University of Glasgow, Glasgow, Scotland, UK.
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19
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Donald R, Howells T, Piper I, Chambers I, Citerio G, Enblad P, Gregson B, Kiening K, Mattern J, Nilsson P, Ragauskas A, Sahuquillo J, Sinnott R, Stell A. Trigger characteristics of EUSIG-defined hypotensive events. Acta Neurochir Suppl 2012; 114:45-49. [PMID: 22327663 DOI: 10.1007/978-3-7091-0956-4_9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hypotension is a recognized -secondary insult after traumatic brain injury (TBI). There are many definitions of hypotension, an often cited example being the Brain Trauma Foundation's current (2007) "Guidelines for the Management of Severe Traumatic Brain Injury," which defines hypotension as systolic pressure <90 mmHg. However, this same document declares "The importance of mean arterial pressure, as opposed to systolic pressure should also be stressed, …." Our work shows that when using the Edinburgh University Secondary Insult Grades (EUSIG) definitions, which require monitoring of both systolic and mean arterial pressures, that most hypotensive events are in fact triggered by a breach of the mean arterial level of 70 mmHg. We suggest that close monitoring of mean arterial pressure would enable clinical teams to avoid more potentially damaging hypotensive events. MATERIALS AND METHODS An analysis of 100 patients from the Brain-IT database was performed. Using the EUSIG definitions, 2,081 events can be obtained by analyzing the systolic and mean blood pressures on a minute by minute basis. A software program was written to identify and classify the trigger pattern for each event. A categorical analysis of these triggering patterns has been carried out. KEY RESULTS Our analysis shows that most events are triggered by a drop in mean arterial pressure. In fact a large number of events (91%) occur where the mean arterial pressure is below the threshold limits whereas the systolic pressure does not cross the 90 mmHg limit at all. CONCLUSION We suggest that more emphasis should be placed on closely monitoring mean arterial pressure as well as systolic pressure when trying to guard against hypotensive problems in traumatically brain injured patients. In future work we will study the underlying physiological mechanisms and attempt to further classify concomitant conditions that may be contributing to the onset of a hypotensive event.
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Affiliation(s)
- Rob Donald
- University of Glasgow, Glasgow, Scotland, UK.
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20
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Stell A, Sinnott R. The ENSAT registry: a digital repository supporting adrenal cancer research. Stud Health Technol Inform 2012; 178:207-212. [PMID: 22797043] [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: 06/01/2023]
Abstract
The very nature of rare diseases means that information is often sparse and highly distributed, and as a result progress in the field is more challenging to conduct. ENSAT-CANCER is an EU-FP7 funded initiative to develop a virtual research environment (VRE) offering a digitally interconnected infrastructure for distributed clinicians specialising in rare adrenal tumours to communicate and collaborate with distributed biomedical research communities. The core of the VRE is a registry that holds vital patient information from specialist centres around Europe, covering different types of adrenal tumours. The VRE also hosts a range of other enabling services including sample barcoding, bio-sample exchange mechanisms, an integrated linkage scheme to other trials and studies, summary statistics and report generation, image hosting - all of which are available in a seamless, security-driven environment. This paper presents the key challenges of this endeavour, the technical solutions that have been developed to address them and reporting the uptake and adoption of the work (currently at 2472 patient records and rising).
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21
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Stell A, Sinnott R, Jiang J. Enabling secure, distributed collaborations for adrenal tumor research. Stud Health Technol Inform 2010; 159:259-263. [PMID: 20543447] [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: 05/29/2023]
Abstract
Many e-Health strategies rely on the secure integration of datasets that have previously resided in isolated locations, but can now in principle be accessed over the Internet. Of paramount importance in the health domain is the need for the security and privacy of data that is transmitted across these networks. One such collaboration, which spans several specialist centres across France, Germany, Italy and the UK, is ENSAT - the European Network for the Study of Adrenal Tumors. The rarity of the tumors under study means the value of accessing, aggregating and comparing data from many centres is great indeed. However this is especially challenging given that ENSAT require clinical and genomic data to be seamlessly linked, but in such a way that the information governance, ethics and privacy concerns of the patients and associated stakeholders involved are visibly satisfied. Key to this is the clear separation of clinical and genomic data sets and support for rigorous patient-identity protecting access control. This is especially challenging when such data sets exist across different organisational boundaries. In this paper we describe a prototype solution offering a security-oriented tailored portal supported by a layered encryption-driven linkage technology (VANGUARD) that offers precisely such patient-privacy protecting capabilities. We describe the architecture, implementation and use to date of this facility to support the ENSAT adrenal cancer research network.
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Affiliation(s)
- Anthony Stell
- National e-Science Centre, University of Glasgow, UK
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22
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Stell A, Sinnott R, Jiang J, Donald R, Chambers I, Citerio G, Enblad P, Gregson B, Howells T, Kiening K, Nilsson P, Ragauskas A, Sahuquillo J, Piper I. Federating distributed clinical data for the prediction of adverse hypotensive events. Philos Trans A Math Phys Eng Sci 2009; 367:2679-2690. [PMID: 19487204 DOI: 10.1098/rsta.2009.0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The ability to predict adverse hypotensive events, where a patient's arterial blood pressure drops to abnormally low (and dangerous) levels, would be of major benefit to the fields of primary and secondary health care, and especially to the traumatic brain injury domain. A wealth of data exist in health care systems providing information on the major health indicators of patients in hospitals (blood pressure, temperature, heart rate, etc.). It is believed that if enough of these data could be drawn together and analysed in a systematic way, then a system could be built that will trigger an alarm predicting the onset of a hypotensive event over a useful time scale, e.g. half an hour in advance. In such circumstances, avoidance measures can be taken to prevent such events arising. This is the basis for the Avert-IT project (http://www.avert-it.org), a collaborative EU-funded project involving the construction of a hypotension alarm system exploiting Bayesian neural networks using techniques of data federation to bring together the relevant information for study and system development.
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Affiliation(s)
- Anthony Stell
- National e-Science Centre, University of Glasgow, Glasgow G12 8QQ, UK.
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23
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Sinnott R, Ajayi O, Stell A, Young A. Towards a virtual anonymisation grid for unified access to remote clinical data. Stud Health Technol Inform 2008; 138:90-101. [PMID: 18560111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Grid technologies provide an infrastructure through which, amongst other things, data access and integration is facilitated across highly distributed and heterogeneous resources. Different domains have their own requirements on the nature of this data access and integration. The clinical domain offers arguably the greatest challenges facing the roll-out and adoption of Grid technologies to meet the changing face of post-genomic clinical research, especially with regard to information governance, ethics and hence security solutions. This paper outlines a novel system design for secure anonymous data access and linkage that meets the needs of key stakeholders in this space including end user researchers, data providers and owners and ethical oversight bodies amongst others. We identify how existing solutions developed within the Medical Research Council funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) project are being re-factored to meet the needs of these players and to address information governance criteria.
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Affiliation(s)
- R Sinnott
- National e-Science Centre, University of Glasgow, UK.
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Abstract
Albinism comprises a heterogeneous group of nonprogressive genetic disorders characterized by the absence of pigmentation in the skin, hair, and/or eyes. Hypopigmentation or complete lack of pigmentation is caused by an enzyme deficiency involving the production, metabolism, or distribution of melanin. Clinically, oculocutaneous and ocular types, as well as syndromes associated with albinism resulting from mutations in at least 14 genes, are distinguishable. Most frequent is oculocutaneous albinism (OCA), which is subdivided nowadays into four forms, OCA 1-OCA 4. OCA is inherited as an autosomal recessive trait. Clinical differentiation of OCA types is difficult due to the observed range of phenotypic variation. Thus, genetic analysis may be helpful with respect to a precise diagnosis. Sequencing of the four genes associated with OCA detects variations in approximately 60-70% of German patients with albinism. The majority of German patients are affected by OCA 1 resulting from mutations in the gene for tyrosinase, the key enzyme in the synthesis of melanin pigment. Worldwide, OCA2 is the most frequent form of albinism.
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Affiliation(s)
- C Zühlke
- Institut für Humangenetik, Universität Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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25
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Stell A, Belcredito S, Ramachandran B, Biserni A, Rando G, Ciana P, Maggi A. Multimodality imaging: novel pharmacological applications of reporter systems. Q J Nucl Med Mol Imaging 2007; 51:127-38. [PMID: 17420714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The development of novel drugs is a lengthy process requiring years of preclinical research and many steps indispensable to ensure that the molecule of interest can be administered to humans with a minimal risk of toxic effects. Even a minimal reduction in the initial stages of drug development would result in a tremendous saving in time; therefore, pharmaceutical companies are eager to apply novel methodologies that shorten the time required for pharmacodynamic, pharmacokinetic and toxicological studies to be carried out in vitro and in animal systems. Currently, quantitative analysis of molecular events in living organisms is done with the combined application of imaging and genetic engineering technologies. In vivo imaging provides surrogate endpoints that can improve the identification of new drug candidates and speed up their research at preclinical stages. The integration of reporter systems in animal models of human diseases represents a reachable frontier that will dramatically advance drug development in terms of costs, time and efficacy. The present review outlines the applicability of imaging technologies for drug development and presents a panorama on the state of the art of currently available imaging technologies suitable for preclinical studies, with particular focus on bioluminescence and fluorescence as the methodologies of election.
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Affiliation(s)
- A Stell
- Center of Excellence on Neurodegenerative Diseases, Department of Pharmacological Sciences, University of Milan, Milan, Italy
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26
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Ciana P, Della Torre S, Stell A, Biserni A, Rando G, Maggi A. S8 The story of steroid hormone receptors: polymorphisms and endocrine responsiveness. Breast 2007. [DOI: 10.1016/s0960-9776(07)70031-0] [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: 11/26/2022] Open
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27
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Sinnott R, Stell A, Ajayi O. Development of grid frameworks for clinical trials and epidemiological studies. Stud Health Technol Inform 2006; 120:117-30. [PMID: 16823129] [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: 05/10/2023]
Abstract
E-Health initiatives such as electronic clinical trials and epidemiological studies require access to and usage of a range of both clinical and other data sets. Such data sets are typically only available over many heterogeneous domains where a plethora of often legacy based or in-house/bespoke IT solutions exist. Considerable efforts and investments are being made across the UK to upgrade the IT infrastructures across the National Health Service (NHS) such as the National Program for IT in the NHS (NPFIT) [1]. However, it is the case that currently independent and largely non-interoperable IT solutions exist across hospitals, trusts, disease registries and GP practices - this includes security as well as more general compute and data infrastructures. Grid technology allows issues of distribution and heterogeneity to be overcome, however the clinical trials domain places special demands on security and data which hitherto the Grid community have not satisfactorily addressed. These challenges are often common across many studies and trials hence the development of a re-usable framework for creation and subsequent management of such infrastructures is highly desirable. In this paper we present the challenges in developing such a framework and outline initial scenarios and prototypes developed within the MRC funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) project [2].
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Affiliation(s)
- Richard Sinnott
- National e-Science Centre, University of Glasgow, United Kingdom
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Stell A, Dobson J, Catchpole B. Identification of a Splice Variant of gp100 Expressed in Canine Melanoma Tumours. Vet Comp Oncol 2005. [DOI: 10.1111/j.1476-5810.2005.064al.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A 13-year-old, male cocker spaniel presented with a history of inappetence, depression and reluctance to stand. The dog had multiple, ulcerated skin lesions which were diagnosed as panniculitis by histopathology. A diagnosis of pancreatitis was made on the basis of markedly elevated serum lipase concentrations, abdominal ultrasonography which showed an abnormal lobulated area of hypoechoic tissue in the body and right lobe of the pancreas, and a fine needle biopsy from this area which revealed large numbers of degenerate neutrophils. After treatment with antibiotics and prednisolone, the dog made a full clinical recovery and was free of clinical signs for four months. The dog was euthanased five months later and postmortem examination revealed chronic, active pancreatitis and a pancreatic adenoma. This is the first report of antemortem diagnosis of pancreatitis and panniculitis in a dog.
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Affiliation(s)
- R J Mellanby
- Queen's Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge, CB3 0ES
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Abstract
To clarify the clinical and bacteriological correlates of urinary-tract infection (UTI) due to Escherichia coli O15:K52:H1, during a 1-year surveillance period we prospectively screened all 1, 871 significant E. coli urine isolates at the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, for this serotype and assessed the epidemiological features of community-acquired UTI due to E. coli O15:K52:H1 versus other E. coli serotypes. We also compared the 25 O15:K52:H1 UTI isolates from the present study with 22 O15:K52:H1 isolates from other, diverse geographic locales and with 23 standard control strains (8 strains from the ECOR reference collection and 15 strains of nonpathogenic O:K:H serotypes) with respect to multiple phenotypic and genotypic traits. Although E. coli O15:K52:H1 caused only 1.4% of community-acquired E. coli UTIs during the surveillance period, these UTIs were more likely to present as pyelonephritis and to occur in younger hosts, with similar risk factors, than were UTIs due to other E. coli serotypes. Irrespective of geographic origin, E. coli O15:K52:H1 strains exhibited a comparatively restricted repertoire of distinctive virulence factor profiles (typically, they were positive for papG allele II, papA allele F16, and aer and negative for sfa, afa, hly, and cnf1), biotypes, ribotypes, and amplotypes, consistent with a common clonal origin. In contrast, their antimicrobial resistance profiles were more extensive and more diverse than those of control strains. These findings indicate that E. coli O15:K52:H1 constitutes a broadly distributed and clinically significant uropathogenic clone with fluid antimicrobial resistance capabilities.
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Affiliation(s)
- G Prats
- Departament de Microbiologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, 08025 Barcelona, Spain.
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