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Bézay N, Hochreiter R, Kadlecek V, Wressnigg N, Larcher-Senn J, Klingler A, Dubischar K, Eder-Lingelbach S, Leroux-Roels I, Leroux-Roels G, Bender W. Safety and immunogenicity of a novel multivalent OspA-based vaccine candidate against Lyme borreliosis: a randomised, phase 1 study in healthy adults. Lancet Infect Dis 2023; 23:1186-1196. [PMID: 37419129 DOI: 10.1016/s1473-3099(23)00210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 03/20/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Lyme borreliosis, potentially associated with serious long-term complications, is caused by the species complex Borrelia burgdorferi sensu lato. We investigated a novel Lyme borreliosis vaccine candidate (VLA15) targeting the six most common outer surface protein A (OspA) serotypes 1-6 to prevent infection with pathogenic Borrelia spp prevalent in Europe and North America. METHODS This was a partially randomised, observer-masked, phase 1 study in healthy adults older than 18 years to younger than 40 years (n=179) done in trial sites in Belgium and the USA. Following a non-randomised run-in phase, a sealed envelope randomisation method was applied with a 1:1:1:1:1:1 ratio; three dose concentrations of VLA15 (12 μg, 48 μg, and 90 μg) were administered by intramuscular injection on days 1, 29, and 57. The primary outcome was safety (frequency of adverse events up to day 85) assessed in participants who received at least one vaccination. Immunogenicity was a secondary outcome. The trial is registered with ClinicalTrials.gov, NCT03010228, and is complete. FINDINGS Between Jan 23, 2017 and Jan 16, 2019, of 254 participants screened for eligibility, 179 were randomly assigned into six groups: alum-adjuvanted 12 μg (n=29), 48 μg (n=31), or 90 μg (n=31) and non-adjuvanted 12 μg (n=29 participants), 48 μg (n=29), or 90 μg (n=30). VLA15 was safe and well tolerated and the majority of adverse events were mild or moderate. Overall, adverse events were more frequent in the 48 μg and 90 μg groups (range 28-30 participants [94-97%]) when compared with the 12 μg group (25 [86%] participants, 95% CI 69·4-94·5) for adjuvanted and non-adjuvanted groups. Common local reactions were tenderness (151 [84%] participants; 356 events, 95% CI 78·3-89·4) and injection site pain (120 [67%]; 224 events, 59·9-73·5); most frequent systemic reactions were headache (80 [45%]; 112 events, 37·6-52·0), excessive fatigue (45 [25%]; 56 events, 19·4-32·0), and myalgia (45 [25%]; 57 events, 19·4-32·0). A similar safety and tolerability profile was observed between adjuvanted and non-adjuvanted formulations. The majority of solicited adverse events were mild or moderate. VLA15 was immunogenic for all OspA serotypes with higher immune responses induced in the adjuvanted higher dose groups (geometric mean titre range 90 μg with alum 61·3 U/mL-321·7 U/mL vs 23·8 U/mL-111·5 U/mL at 90 μg without alum). INTERPRETATION This novel multivalent vaccine candidate against Lyme borreliosis was safe and immunogenic and paves the way to further clinical development. FUNDING Valneva Austria.
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Affiliation(s)
- Nicole Bézay
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | | | - Vera Kadlecek
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | - Nina Wressnigg
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | | | - Anton Klingler
- Assign Data Management and Biostatistics, Innsbruck, Austria
| | | | | | - Isabel Leroux-Roels
- Center for Vaccinology (CEVAC), Ghent University Hospital, 9000 Ghent, Belgium
| | - Geert Leroux-Roels
- Center for Vaccinology (CEVAC), Ghent University Hospital, 9000 Ghent, Belgium
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Wressnigg N, Hochreiter R, Zoihsl O, Fritzer A, Bézay N, Klingler A, Lingnau K, Schneider M, Lundberg U, Meinke A, Larcher-Senn J, Čorbic-Ramljak I, Eder-Lingelbach S, Dubischar K, Bender W. Single-shot live-attenuated chikungunya vaccine in healthy adults: a phase 1, randomised controlled trial. The Lancet Infectious Diseases 2020; 20:1193-1203. [DOI: 10.1016/s1473-3099(20)30238-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/18/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
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Adlbrecht C, Wurm R, Depuydt P, Spapen H, Lorente JA, Staudinger T, Creteur J, Zauner C, Meier-Hellmann A, Eller P, Laenen MV, Molnár Z, Várkonyi I, Schaaf B, Héjja M, Šrámek V, Schneider H, Kanesa-Thasan N, Eder-Lingelbach S, Klingler A, Dubischar K, Wressnigg N, Rello J. Efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in mechanically ventilated intensive care patients-a randomized clinical trial. Crit Care 2020; 24:74. [PMID: 32131866 PMCID: PMC7057595 DOI: 10.1186/s13054-020-2792-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/17/2020] [Indexed: 01/09/2023]
Abstract
Background Pseudomonas aeruginosa infections are a serious threat in intensive care units (ICUs). The aim of this confirmatory, randomized, multicenter, placebo-controlled, double-blind, phase 2/3 study was to assess the efficacy, immunogenicity, and safety of IC43 recombinant Pseudomonas aeruginosa vaccine in non-surgical ICU patients. Methods Eight hundred patients aged 18 to 80 years admitted to the ICU with expected need for mechanical ventilation for ≥ 48 h were randomized 1:1 to either IC43 100 μg or saline placebo, given in two vaccinations 7 days apart. The primary efficacy endpoint was all-cause mortality in patients 28 days after the first vaccination. Immunogenicity and safety were also evaluated. Findings All-cause mortality rates at day 28 were 29.2% vs 27.7% in the IC43 and placebo groups, respectively (P = .67). Overall survival (Kaplan-Meier survival estimates, P = .46) and proportion of patients with ≥ one confirmed P. aeruginosa invasive infection or respiratory tract infection also did not differ significantly between both groups. The geometric mean fold increase in OprF/I titers was 1.5 after the first vaccination, 20 at day 28, after the second vaccination, and 2.9 at day 180. Significantly more patients in the placebo group (96.5%) had ≥ one adverse event (AE) versus the IC43 100 μg group (93.1%) (P = .04). The most frequently reported severe AEs in the IC43 and placebo groups were respiratory failure (6.9% vs 5.7%, respectively), septic shock (4.1% vs 6.5%), cardiac arrest (4.3% vs 5.7%), multiorgan failure (4.6% vs 5.5%), and sepsis (4.6% vs 4.2%). No related serious AEs were reported in the IC43 group. Interpretation The IC43 100 μg vaccine was well tolerated in this large population of medically ill, mechanically ventilated patients. The vaccine achieved high immunogenicity but provided no clinical benefit over placebo in terms of overall mortality. Trial registration https://clinicaltrials.gov (NCT01563263). Registration was sent to ClinicalTrials.gov on March 14, 2012, but posted by ClinicalTrials.gov on March 26, 2012. The first subject was included in the trial on March 22, 2012.
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Affiliation(s)
- Christopher Adlbrecht
- Department of Cardiology, Vienna North Hospital-Clinic Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and Critical Care Research, Vienna, Austria
| | | | | | | | - Jose A Lorente
- Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Universidad Europea, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Mária Héjja
- Országos Korányi TBC és Pulmonológiai Intézet, Budapest, Hungary
| | - Vladimír Šrámek
- Fakultní nemocnice U Svaté Anny v Brně, Brno, Czech Republic
| | - Hauke Schneider
- Technische Universität Dresden, Dresden, Germany.,University Hospital Augsburg, Augsburg, Germany
| | | | | | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Katrin Dubischar
- Valneva Austria GmbH, Campus Vienna Biocenter 3, 1030, Vienna, Austria
| | - Nina Wressnigg
- Valneva Austria GmbH, Campus Vienna Biocenter 3, 1030, Vienna, Austria.
| | - Jordi Rello
- Centro de Investigacion Biomedica en Red (CIBERES), Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Egle A, Melchardt T, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Voskova D, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Weiss L, Magnes T, Pleyer L, Klingler A, Mayer J, Greil R. Rituximab maintenance overcomes the negative prognostic factor of obesity in CLL: Subgroup analysis of the international randomized AGMT CLL-8a mabtenance trial. Cancer Med 2019; 8:1401-1405. [PMID: 30888118 PMCID: PMC6488104 DOI: 10.1002/cam4.1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022] Open
Abstract
No data are available regarding obesity and outcome in Chronic Lymphocytic Leukemia (CLL). We analyzed 263 patients from the AGMT CLL‐8a Mabtenance trial for the impact of obesity. The trial included patients after rituximab‐containing induction treatment in first or second line that had achieved at least a PR. A randomization to rituximab maintenance treatment (375 mg/m2 q3 months for 2 years) vs observation was performed. In this cohort 22% of the patients (58/263) were classified as obese. The baseline response to induction treatment was inferior in obese patients with a lower CR rate (43.1% vs 60.5% in obese vs non‐obese, P = 0.018) and with a lower rate of patients achieving MRD negativity after chemoimmunotherapy induction treatment (19.6% vs 35.8%, P = 0.02). The PFS outcome of obese patients was significantly worse in the observation group of the trial (24 vs 39 months median PFS, P = 0.03). However, in the rituximab maintenance group the outcome for obese vs non‐obese was not different (P = 0.4). In summary, obesity was overall associated with a worse outcome of chemoimmunotherapy induction. However, rituximab maintenance treatment seems to be able to overcome this negative effect.
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Affiliation(s)
- Alexander Egle
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine - Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Eva Mikušková
- Department of Hemato-oncology 2, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina Varna, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute Bratislava, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Vienna, Austria
| | - Daniela Voskova
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III., Linz, Austria
| | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta Banská Bystrica, Banska Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University Plovdiv, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Ordensklinikum Linz GmbH, Linz, Austria
| | - Georgi Mihaylov
- Hematological Clinic NSHATHD Sofia, Queen Joanna University Hospital, Sofia, Bulgaria
| | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy Sofia, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | - August Zabernigg
- Innere Medizin II, Bezirkskrankenhaus Kufstein, Kufstein, Austria
| | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | - Stanislav Palášthy
- Department of Clinical Hematology, FNsP, J A Reimana Prešov, Prešov, Slovakia
| | - Olga Stehlíková
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Michael Doubek
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Petra Altenhofer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Teresa Magnes
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
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Rello J, Krenn CG, Locker G, Pilger E, Madl C, Balica L, Dugernier T, Laterre PF, Spapen H, Depuydt P, Vincent JL, Bogár L, Szabó Z, Völgyes B, Máñez R, Cakar N, Ramazanoglu A, Topeli A, Mastruzzo MA, Jasovich A, Remolif CG, Del Carmen Soria L, Andresen Hernandez MA, Ruiz Balart C, Krémer I, Molnár Z, von Sonnenburg F, Lyons A, Joannidis M, Burgmann H, Welte T, Klingler A, Hochreiter R, Westritschnig K. A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients. Crit Care 2017; 21:22. [PMID: 28159015 PMCID: PMC5291979 DOI: 10.1186/s13054-017-1601-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022]
Abstract
Background Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients. Methods We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days. Results Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 µg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1–10.6%) was observed in the IC43 groups. Conclusion This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa infection rates did not differ significantly between groups. In the absence of any difference in immune response following administration of 100 μg IC43 without adjuvant compared with 200 μg IC43 with adjuvant, the 100 μg dose without adjuvant was considered for further testing of its possible benefit of improved outcomes. There were no safety or mortality concerns. Trial registration ClinicalTrials.gov, NCT00876252. Registered on 3 April 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1601-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordi Rello
- Hospital Universitari Joan XXIII, C. Dr. Mallafrè Guasch 4, 43007, Tarragona, Spain. .,CIBERES, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain. .,Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Claus-Georg Krenn
- Medical University of Vienna, Intensive Care 13C1, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Gottfried Locker
- Department of Internal Medicine I, Medical University of Vienna, Intensive Care 13I2, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Ernst Pilger
- Intensive Care, Department of Internal Medicine, University Hospital Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christian Madl
- Department of Internal Medicine III, Intensive Care 13H1, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Laura Balica
- Emergency Clinical Hospital Bucharest, Toxicology - ICU, 8 Floreasca Street, 01446, Bucharest, Romania
| | - Thierry Dugernier
- Clinique St. Pierre, Intensive Care Department, Avenue Reine Fabiola 9, 1340, Ottignies, Belgium
| | - Pierre-Francois Laterre
- Department of CCM, St. Luc University Hospital UCL, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Herbert Spapen
- University Hospital Vrije Universiteit Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | | | - Jean-Louis Vincent
- Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Lajos Bogár
- University of Pécs Anesthesiology and Intensive Care Department, Ifjúság ut 13, 7624, Pécs, Hungary
| | | | - Barbara Völgyes
- Bajcsy Zsilinszky Hospital and Polyclinic, Intensive Care Unit, Maglodi út 89-91, 1106, Budapest, Hungary
| | - Rafael Máñez
- Department for Critical Care Medicine, Bellvitge University Hospital, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, Istanbul University Capa Medical Faculty, 34390, Istanbul, Turkey
| | - Atilla Ramazanoglu
- Department of Anesthesiology, Dumlupinar Bulvari Kampus Antalya, Akdeniz University, Faculty of Medicine Hospital, 07070, Antalya, Turkey
| | - Arzu Topeli
- Department of Internal Medicine, Intensive Care Unit, Hacettepe University Hospital, 06100, Ankara, Turkey
| | - Maria A Mastruzzo
- Hospital Dr. Carlos Bocalandro, Ruta 8 No. 9100, B1657BHD Loma Hermosa, Partido 3 de Febrero, Buenos Aires, Argentina
| | - Abel Jasovich
- Sanatorio Güemes, Av. Roque Sanchez Pena 811 5°C, C1035AAP, Buenos Aires, Argentina
| | - Christian G Remolif
- Hospital "Heroes de Malvinas", Av. Ricardo Balbín 1910, B1721FJN Merlo, Buenos Aires, Argentina
| | | | - Max A Andresen Hernandez
- Hospital Clinico, Facultad de Medicina Pontificia, Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | - Carolina Ruiz Balart
- Hospital Dr. Sótero del Rio, Unidad de Cuidado Intensivo, Departamento de Medicina Intensiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, Santiago, Chile
| | - Ildikó Krémer
- Flor Ferenc County Hospital, Semmelweis tér 1, 2143, Kistarcsa, Hungary
| | - Zsolt Molnár
- Department of Anaesthesia and Intensive Care, University of Szeged, Semmelweis u. 6, 6720, Szeged, Hungary
| | - Frank von Sonnenburg
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Georgenstr. 5, 80799, Munich, Germany
| | - Arthur Lyons
- Clinical Research Department, Division of Virus Diseases, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Michael Joannidis
- Department of Internal Medicine, Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Heinz Burgmann
- Department of Internal Medicine I, Division of Infectious Diseases, Medical University of Vienna, Währinger Gürtel 18 - 20, 1090, Vienna, Austria
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Stadlweg 23, 6020, Innsbruck, Austria
| | - Romana Hochreiter
- Valneva Austria GmbH, Campus Vienna Biocenter 3, 1030, Vienna, Austria
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Mrak K, Uranitsch S, Pedross F, Heuberger A, Klingler A, Jagoditsch M, Weihs D, Eberl T, Tschmelitsch J. 315. Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.211] [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] Open
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7
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Greil R, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Fridrik M, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Pleyer L, Melchardt T, Klingler A, Mayer J, Egle A. Rituximab maintenance versus observation alone in patients with chronic lymphocytic leukaemia who respond to first-line or second-line rituximab-containing chemoimmunotherapy: final results of the AGMT CLL-8a Mabtenance randomised trial. Lancet Haematol 2016; 3:e317-29. [PMID: 27374465 DOI: 10.1016/s2352-3026(16)30045-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In many patients with chronic lymphocytic leukaemia requiring treatment, induction therapy with rituximab plus chemotherapy improves outcomes compared with chemotherapy alone. In this study we aimed to investigate the potential of rituximab maintenance therapy to prolong disease control in patients who respond to rituximab-containing induction regimens. METHODS In this randomised, international, multicentre, open-label, phase 3 clinical trial, we enrolled patients who had achieved a complete response (CR), CR with incomplete bone marrow recovery (CRi), or partial response (PR) to first-line or second-line rituximab-containing chemoimmunotherapy and randomly assigned them in a 1:1 ratio (central block randomisation in the electronic case report form system) to either intravenous rituximab 375 mg/m(2) every 3 months, or observation alone, for 2 years. Stratification was by country, line of treatment, type of chemotherapy added to the rituximab backbone, and degree of remission following induction. The primary endpoint was progression-free survival. Efficacy analysis was done in the intention-to-treat population. This is the final, event-triggered analysis. Final analysis was triggered by the occurrence of 92 events. This trial is registered with ClinicalTrials.gov, number NCT01118234. FINDINGS Between April 1, 2010, and Dec 23, 2013, 134 patients were randomised to rituximab and 129 to observation alone. Median observation times were 33·4 months (IQR 25·7-42·8) for the rituximab group and 34·0 months (25·4-41·9) for the observation group. Progression-free survival was significantly longer in the rituximab maintenance group (47·0 months, IQR 28·5-incalculable) than with observation alone (35·5 months, 95% CI 25·7-46·3; hazard ratio [HR] 0·50, 95% CI 0·33-0·75, p=0·00077). The incidence of grade 3-4 haematological toxicities other than neutropenia was similar in the two treatment groups. Grade 3-4 neutropenia occurred in 28 (21%) patients in the rituximab group and 14 (11%) patients in the observation group. Apart from neutropenia, the most common grade 3-4 adverse events were upper (five vs one [1%] patient in the observation group) and lower (three [2%] vs one [1%]) respiratory tract infection, pneumonia (nine [7%] vs two [2%]), thrombopenia (four [3%] vs four [3%]), neoplasms (five [4%] vs four [3%]), and eye disorders (four [3%] vs two [2%]). The overall incidence of infections of all grades was higher among rituximab recipients (88 [66%] vs 65 [50%]). INTERPRETATION Rituximab maintenance therapy prolongs progression-free survival in patients achieving at least a PR to induction with rituximab plus chemotherapy, and the treatment is well tolerated overall. Although it is associated with an increase in infections, there is no excess in infection mortality, suggesting that remission maintenance with rituximab is an effective and safe option in the management of chronic lymphocytic leukaemia in early treatment phases. FUNDING Arbeitsgemeinschaft Medikamentöse Tumortherapie gemeinnützige GmbH (AGMT), Roche.
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Affiliation(s)
- Richard Greil
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria.
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine-Hematology, University Hospital and Charles University in Prague, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine-Hematology, Univ Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Austria
| | - Johannes Andel
- Abteilung für Innere Medizin III, Landeskrankenhaus Steyr, Austria
| | - Sonja Burgstaller
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen GmbH, Austria
| | - Eva Mikušková
- Department of Hematooncology 2, National Cancer Institute, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Austria
| | - Michael Fridrik
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III, Linz, Austria
| | - Martin Pecherstorfer
- University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Department of Internal Medicine 2, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta, Banská Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | | | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Austria
| | | | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | | | - Olga Stehlíková
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Michael Doubek
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Petra Altenhofer
- Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Alexander Egle
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
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Mrak K, Uranitsch S, Pedross F, Heuberger A, Klingler A, Jagoditsch M, Weihs D, Eberl T, Tschmelitsch J. Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial. Surgery 2015; 159:1129-39. [PMID: 26706610 DOI: 10.1016/j.surg.2015.11.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/20/2015] [Accepted: 11/05/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study sought to determine whether a protective diverting ileostomy improves short-term outcomes in patients with rectal resection and colonic J-pouch reconstruction for low anastomoses. Criteria for the use of a proximal stoma in rectal resections with colonic J-pouch reconstruction have not been defined sufficiently. METHODS In a multicenter prospective study, rectal cancer patients with anastomoses below 8 cm treated with low anterior resection and colonic J-pouch were randomized to a defunctioning loop ileostomy or no ileostomy. The primary study endpoint was the rate of anastomotic leakage, and the secondary endpoints were surgical complications related to primary surgery, stoma, or stoma closure. RESULTS From 2004 to 2014, a total of 166 patients were randomized to 1 of the 2 study groups. In the intention-to-treat analysis, the overall leakage rate was 5.8% in the stoma group and 16.3% in the no stoma group (P = .0441). However, some patients were not treated according to randomization and only 70% of our patients with low anastomoses received a pouch. Therefore, we performed a second analysis as to actual treatment. In this analysis, as well, leakage rates (P = .044) and reoperation rates for leakage (P = .021) were significantly higher in patients without a stoma. In multivariate analysis, male gender (P = .0267) and the absence of a stoma (P = .0092) were significantly associated with anastomotic leakage. CONCLUSION Defunctioning loop ileostomy should be fashioned in rectal cancer patients with anastomoses below 6 cm, particularly in male patients, even if reconstruction was done with a J-pouch.
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Affiliation(s)
- Karl Mrak
- Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria
| | - Stefan Uranitsch
- Department of Surgery, Hospital of the Brothers of Mercy, Graz, Austria
| | - Florian Pedross
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | | | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Michael Jagoditsch
- Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria
| | - Dominik Weihs
- Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria
| | - Thomas Eberl
- Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria
| | - Jörg Tschmelitsch
- Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria.
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Jaeger U, Trneny M, Melzer H, Praxmarer M, Nawarawong W, Ben Yehuda D, Goldstein D, Mihaljevic B, Ilhan O, Ballova V, Hedenus M, Hsiao LT, Au WY, Burgstaller S, Weidinger G, Keil F, Dittrich C, Skrabs C, Klingler A, Chott A, Fridrik MA, Greil R. Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial. Haematologica 2015; 100:955-63. [PMID: 25911553 PMCID: PMC4486230 DOI: 10.3324/haematol.2015.125344] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/21/2015] [Indexed: 12/22/2022] Open
Abstract
We investigated rituximab maintenance therapy in patients with diffuse large B-cell lymphoma (n=662) or follicular lymphoma grade 3b (n=21) in first complete remission. Patients were randomized to rituximab maintenance (n=338) or observation (n=345). At a median follow-up of 45 months, the event-free survival rate (the primary endpoint) at 3 years was 80.1% for rituximab maintenance versus 76.5% for observation. This difference was not statistically significant for the intent-to-treat population (likelihood ratio P=0.0670). The hazard ratio by treatment arm was 0.79 (95% confidence interval 0.57-1.08; P=0.1433). The secondary endpoint, progression-free survival was also not met for the whole statistical model (likelihood ratio P=0.3646). Of note, rituximab maintenance was superior to observation when treatment arms only were compared (hazard ratio: 0.62; 95% confidence interval 0.43-0.90; P=0.0120). Overall survival remained unchanged (92.0 versus 90.3%). In subgroup analysis male patients benefited from rituximab maintenance with regards to both event-free survival (84.1% versus 74.4%) (hazard ratio: 0.58; 95% confidence interval 0.36-0.94; P=0.0267) and progression-free survival (89.0% versus 77.6%) (hazard ratio: 0.45; 95% confidence interval 0.25-0.79; P=0.0058). Women had more grade 3/4 adverse events (P=0.0297) and infections (P=0.0341). Men with a low International Prognostic Index treated with rituximab had the best outcome. In summary, rituximab maintenance in first remission after R-CHOP-like treatment did not prolong event-free, progression-free or overall survival of patients with aggressive B-non-Hodgkin lymphoma. The significantly better outcome of men warrants further studies prior to the routine use of rituximab maintenance in men with low International Prognostic Index. This trial is registered under EUDRACT #2005-005187-90 and www.clinicaltrials.gov as #NCT00400478.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols
- Female
- Follow-Up Studies
- Humans
- Intention to Treat Analysis
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Remission Induction
- Rituximab/therapeutic use
- Sex Factors
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Ulrich Jaeger
- Medical University of Vienna, Dept. of Medicine I, Division of Hematology and Hemostaseology, Comprehensive Cancer Center, Vienna, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Marek Trneny
- Institute of Hematology and Blood Transfusion, 1st Dept. of Medicine, 1st Faculty of Medicine, Charles University, General Hospital, Czech Lymphoma Study Group, Praha, Czech Republic
| | - Helen Melzer
- Medical University of Vienna, Dept. of Medicine I, Division of Hematology and Hemostaseology, Comprehensive Cancer Center, Vienna, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Michael Praxmarer
- Assign Data Management and Biostatistics GmbH Assign Group, Innsbruck, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Weerasak Nawarawong
- Dept. of Internal Medicine, Faculty of Medicine, Chiang Mai University, Thailand
| | - Dina Ben Yehuda
- Dept. of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Goldstein
- Australasian Leukaemia & Lymphoma Group, East Melbourne, Australia
| | | | - Osman Ilhan
- Ankara University School of Medicine, Dept. of Hematology, Ankara, Turkey
| | | | | | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Dept. of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University, Taipei, Taiwan
| | - Wing-Yan Au
- University Medical Unit, Queen Mary Hospital, Hong Kong, China
| | - Sonja Burgstaller
- Dept. of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Gerhard Weidinger
- 1st Medical Dept., Landesklinikum Wiener Neustadt, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Felix Keil
- 3rd Medical Dept., Hanusch Hospital, Vienna, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Christian Dittrich
- LBI-ACR & ACR-ITR Vienna, Kaiser Franz Josef-Spital, Vienna, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Cathrin Skrabs
- Medical University of Vienna, Dept. of Medicine I, Division of Hematology and Hemostaseology, Comprehensive Cancer Center, Vienna, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH Assign Group, Innsbruck, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Andreas Chott
- Institute of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
| | - Michael A Fridrik
- 3rd Dept. of Medicine, AKH-Linz, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
| | - Richard Greil
- Dept. of Internal Medicine III, Private Medical University of Salzburg, Austria Arbeitsgemeinschaft Medikamentöse Tumortherapie, AGMT, Salzburg, Austria
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Schobersberger W, Hoffmann G, Fries D, Gunga HC, Greie S, Fuchs D, Klingler A, Humpeler E. AMAS (Austrian Moderate Altitude Study)-2000: Effects of Hiking Holidays at Moderate Altitude on Immune System Markers in Persons with Metabolic Syndrome. Pteridines 2013. [DOI: 10.1515/pteridines.2004.15.4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Recent studies have shown a strong association between indices of inflammation and metabolic Syndrome. Proinflammatory mediators like tumor necrosis factor-α may act as a trigger for insulin insensitivity. Therefore, patients with metabolic Syndrome might be at higher risk of insulin resistance when confronted with additional Stimuli of the immune system. These Stimuli are not restricted to the presence of pathogens but include environmental factors like physical exercise and hypoxemia as well. With respect to these interdependencies, one may assume higher risk for patients with metabolic Syndrome who perform physical exercise in alpine regions. We investigated the effects of a 3-weeks holiday with moderate sporting activities at moderate altitude (1700 m) on the conceiitrations of neopterin, tumor necrosis factor-α, serum soluble 75kD type TNF receptor (sTNF-R75), and interleukin-6 in vacationers with metabolic Syndrome. Only serum neopterin and sTNF-R75 concentrations transiently increased during the stay at moderate altitude compared to pre-altitude levels (P<0.05). Interestingly, after return to 500 m sea-level neopterin concentrations dropped beyond baseline concentrations (p<0.05). However, the variations in neopterin concentrations might not be of clinical relevance since they did not exceed the threshold indicating significant activation of the cellular immune system. We conclude that a 3-week sojourn at moderate altitude including individually adapted physical exercise does not represent accumulated risk factors in subjects with metabolic Syndrome.
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Affiliation(s)
- Wolfgang Schobersberger
- Universily of Helath Sciences, Medical Informatics and Technology Tyrol, Innsbruck, Austria
- IHS-Institute Humpeler Schobersherger GmbH, Research Institute for Leisure and Travel Medicine, Bregenz/Innsbruck, Austria
| | - Georg Hoffmann
- Universily of Helath Sciences, Medical Informatics and Technology Tyrol, Innsbruck, Austria
| | - Dietmar Fries
- Division for General and Surgical Intensive Care Medicine, Department for Anesthesia and IntensiveCare Medicine, Innsbruck, Austria
| | | | - Sven Greie
- Universily of Helath Sciences, Medical Informatics and Technology Tyrol, Innsbruck, Austria
| | - Dietmar Fuchs
- Institute for Medical Chemistry and Biochemistry, Innsbruck, Austria
| | | | - Egon Humpeler
- Universily of Helath Sciences, Medical Informatics and Technology Tyrol, Innsbruck, Austria
- IHS-Institute Humpeler Schobersherger GmbH, Research Institute for Leisure and Travel Medicine, Bregenz/Innsbruck, Austria
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Mrak K, Jagoditsch M, Eberl T, Klingler A, Tschmelitsch J. Long-term quality of life in pouch patients compared with stoma patients following rectal cancer surgery. Colorectal Dis 2011; 13:e403-10. [PMID: 21812896 DOI: 10.1111/j.1463-1318.2011.02740.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Low and ultralow anterior resection for rectal cancer with colorectal or coloanal anastomosis does not compromise oncological results compared with abdominoperineal excision. Although avoidance of a permanent colostomy is regarded as beneficial for a patient's quality of life (QoL), patients undergoing sphincter-sparing surgery may develop a number of functional problems. A colonic pouch significantly improves functional outcome after rectal resection and low anastomosis and may positively influence QoL. The aim of this study was to compare QoL in long-term survivors who underwent ultralow anterior resection with total mesorectal excision and colonic J-pouch anastomosis (CPA) with patients treated with abdominoperineal excision (APE) and end colostomy for rectal cancer. METHOD The medical records from our institution's prospectively maintained rectal cancer database of 151 patients who underwent surgery for ultralow rectal cancer from 2001 to 2007 were analysed. QoL in 59 eligible patients was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 core and Colorectal Cancer 29. Results were compared for patients with CPA and APE. RESULTS The median follow-up in the 59 patients was 74 (37-119) months. QoL was good in all patients, but it was better in CPA than in APE patients. Global health status (P = 0.009), physical functioning (P = 0.0002), role functioning (P = 0.03), cognitive functioning (P = 0.046), social functioning (P = 0.002), body image (P = 0.053), embarrassment (P = 0.002) and urinary frequency (P = 0.003) were significantly improved for patients with CPA. CONCLUSION QoL after rectal resection and CPA was better than after APE in several respects. However, QoL should not be regarded as an isolated concept but rather as one of several possible clinical outcomes of interest.
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Affiliation(s)
- K Mrak
- Department of Surgery, Hospital of Barmherzige Brüder, St Veit/Glan, Austria
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Schuller E, Klingler A, Dubischar-Kastner K, Dewasthaly S, Müller Z. Safety profile of the Vero cell-derived Japanese encephalitis virus (JEV) vaccine IXIARO®. Vaccine 2011; 29:8669-76. [DOI: 10.1016/j.vaccine.2011.08.117] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 08/22/2011] [Accepted: 08/28/2011] [Indexed: 11/16/2022]
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Weghuber D, Roden M, Franz C, Chmelik M, Torabia S, Nowotny P, Gruber S, Waldhäusl W, Klingler A, Bieglmayer C, Bischof M, Wolzt M, Schaller G, Widhalm K. Vascular function in obese children with non-alcoholic fatty liver disease. ACTA ACUST UNITED AC 2011; 6:120-7. [DOI: 10.3109/17477161003792580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dubischar-Kastner K, Kaltenboeck A, Klingler A, Jilma B, Schuller E. Safety analysis of a Vero-cell culture derived Japanese encephalitis vaccine, IXIARO (IC51), in 6 months of follow-up. Vaccine 2010; 28:6463-9. [PMID: 20673824 DOI: 10.1016/j.vaccine.2010.07.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 11/16/2022]
Abstract
Japanese encephalitis (JE) is the most common viral encephalitis in Asia. IXIARO is a Vero cell-derived, inactivated JE virus vaccine which has recently been approved in the US, Europe, Canada and Australia (trade name JESPECT). This overview of the safety and tolerability of IXIARO, for 6 months after the first vaccination in 7 Phase III trials, includes: 3558 subjects with at least one IXIARO vaccination, 435 subjects with a JE-VAX (manufactured by BIKEN, distributed by Sanofi Pasteur) vaccination, and 657 with phosphate-buffered saline solution with 0.1% Al(OH)(3) (PBS+Alum) control vaccination. The percentage of subjects reporting solicited local adverse events (AEs) with IXIARO (54%) was similar to PBS+Alum vaccination (56%) as were solicited systemic adverse events (40% IXIARO; 40% PBS+Alum vaccination). JE-VAX showed a higher frequency of subjects with solicited local adverse events (61%) but a slightly lower frequency of subjects with solicited systemic adverse events (36%). The frequency of subjects with any solicited and unsolicited AE with IXIARO (64%) was also similar to PBS+Alum vaccination (61%) and JE-VAX (64%); as for subjects with serious AEs (1% IXIARO; 2% PBS+Alum vaccination, 1% JE-VAX). No serious allergic reactions were observed in any group. This safety analysis indicates that IXIARO has a favorable safety profile, comparable to PBS+Alum control vaccination and appears to have a better local tolerability profile than JE-VAX.
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Mittermayr M, Velik-Salchner C, Stalzer B, Margreiter J, Klingler A, Streif W, Fries D, Innerhofer P. Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM): results of a pilot study. Anesth Analg 2009; 108:743-50. [PMID: 19224778 DOI: 10.1213/ane.0b013e31818657a3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Our goal of this study was to determine whether protamine's effects on coagulation can be detected and differentiated from those of heparin when using thrombelastometry (ROTEM). METHODS To reverse the effects of heparin after cardiopulmonary bypass (CPB), 22 consecutive patients undergoing aortocoronary bypass graft surgery were included. According to clinical routine, all patients received a first dose of protamine calculated from the total amount of heparin given; additional protamine (70 U/kg) was administered to patients with activated clotting time (ACT) above baseline and clinical signs of diffuse bleeding. Simultaneously, routine ACT measurements, ROTEM assays (heparin-sensitive INTEM, and heparinase-containing HEPTEM test) and standard coagulation tests were performed, and the activity of coagulation factors as well as antifactor Xa activity measured. RESULTS Administration of additional protamine (n = 16) resulted in a statistically significant increase in coagulation times on the intrinsically activated test (INTEM-CT), namely from (mean [+/-SD]) 219.8 (+/-19.1) s to 241.1 (+/-21.7) s (P < 0.001), and on the heparinase-containing test (HEPTEM-CT), namely from 210.2 (+/-19.9) s to 226.8 (+/-21.8) s (P < 0.001). These changes were not observed in patients receiving a single protamine dose (n = 6). The INTEM-CT:HEPTEM-CT ratio correctly identified 56 of the 58 samples as not containing residual heparin and correctly detected residual heparin in 3 of the only 6 samples showing elevated antifactor Xa values after CPB. CONCLUSION Our preliminary data show that at termination of CPB administration of additional protamine results in a brief prolongation of coagulation times on the INTEM and HEPTEM test and that ROTEM might be useful in excluding residual heparin in cases showing prolonged ACT.
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Affiliation(s)
- Markus Mittermayr
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.
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Velik-Salchner C, Maier S, Innerhofer P, Streif W, Klingler A, Kolbitsch C, Fries D. Point-of-care whole blood impedance aggregometry versus classical light transmission aggregometry for detecting aspirin and clopidogrel: the results of a pilot study. Anesth Analg 2008; 107:1798-806. [PMID: 19020120 DOI: 10.1213/ane.0b013e31818524c1] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We determined whether whole blood impedance aggregometry using the Multiplate detects the effects of antiplatelet drugs as reliably as does classical light transmission aggregometry (LTA) or the platelet function analyzer PFA-100(R). METHODS Multiplate (M) assays, measuring changes in electrical resistance as aggregation units over time (AU*min), and LTA assays induced by collagen (COL), adenosine diphosphate (ADP) or arachidonic acid (AA) and PFA-100 testing, using epinephrine (PFA100-EPI) or ADP (PFA100-ADP) cartridges, were performed simultaneously using arterial blood samples obtained before induction of anesthesia in 70 consecutive patients scheduled for elective coronary artery bypass grafting. Patients in group A (n = 48) served as controls, patients in group B (n = 11) received aspirin 100 mg/d and those in group C (n = 11) aspirin 100 mg/d and clopidogrel 75 mg/d until the day before surgery. RESULTS In controls the median (1st, 3rd quartiles) change in impedance AU*min for M-COL (374 [231-469]) was significantly greater than in patients receiving aspirin (164 [86-211], P = 0.0009) or receiving aspirin and clopidogrel (118 [101-244], P = 0.004). M-ADP values in controls were 258 (158-389), in patients receiving aspirin 261 (159-393), and in patients receiving aspirin and clopidogrel 88 (48-231, P = 0.054). M-AA values were significantly lower in patients receiving aspirin alone (45 [28-60], P = 0.0004) or aspirin and clopidogrel (44 [26-221], P = 0.008) than in controls (200 [86-345]). The areas under the receiver operating characteristic curves indicating the ability to discriminate patients taking aspirin from those not taking aspirin were comparable for COL and AA assays using whole blood impedance aggregometry or classical LTA (M-COL 0.84 [P = 0.001], LTA-COL 0.85 [P = < .001], M-AA 0.84 [P = < .001] and LTA-AA 0.87 [P = < .001]), but only 0.74 for PFA-100-EPI (P = 0.03). Similarly, for discrimination of patients not taking antiplatelet drugs from patients taking clopidogrel and aspirin the areas under the receiver operating characteristic curve were also comparable for both aggregometry methods M-COL 0.77 (P = 0.006), LTA-COL 0.78 (P = 0.004), M-ADP 0.74 (P = 0.015), LTA-ADP 0.73 (P = 0.018). CONCLUSION Results achieved with the bedside Multiplate assays were not different than those obtained with classical aggregometry for detecting the effects of aspirin and clopidogrel in preoperative patients scheduled for elective cardiac surgery.
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Affiliation(s)
- Corinna Velik-Salchner
- Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Skoumal M, Haberhauer G, Fink A, Steiner A, Klingler A, Varga F, Klaushofer K. Increased serum levels of cartilage oligomeric matrix protein in patients with psoriasis vulgaris: a marker for unknown peripheral joint involvement? Clin Exp Rheumatol 2008; 26:1087-1090. [PMID: 19210875] [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: 05/27/2023]
Abstract
OBJECTIVE Cartilage oligomeric matrix protein (COMP) is a parameter for the current extent of cartilage destruction. It has been shown that the release pattern of cartilage oligomeric matrix protein in serum reflects cartilage turnover. The aim of our study was to explore the utility of sCOMP as a marker for disease activity in patients with active psoriatic arthritis (PsA) in comparison to a control group only with psoriasis vulgaris (PV). METHODS Serum levels of COMP were measured in 64 patients with PsA and psoriasis vulgaris. The control group consisted of a population with PV from a dermatological outpatient clinic. ELISA-tests were used to detect sCOMP levels according to the manufacturer instructions. RESULTS In our 64 patients with PsA, we found increased sCOMP levels, which correlated significantly with inflammatory parameters and the number of swollen joints. Patients with active PsA had significantly higher sCOMP levels (p<0.0001) than the 39 patients with a low inflammatory status. In our control group with PV we also found elevated sCOMP levels, which correlated significantly with the increased C-reactive protein (CRP) levels in this group. The difference between the PsA and the PV group was not significant (p=0.092). CONCLUSION In our study, sCOMP has been demonstrated to be an indicator for disease activity in patients with PsA. Patients with active PsA showed significantly elevated sCOMP levels compared to the patients with low clinical and laboratory disease activity. The increased sCOMP levels in our control group with PV indicate that all patients with psoriatic lesions should be screened for additional joint involvement and should lead to an exact joint examination.
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Affiliation(s)
- M Skoumal
- Institute for Rheumatology of the Kurstadt Baden in Cooperation with the Danube, University Krems, Baden, Austria
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Koller A, Sumann G, Griesmacher A, Falkensammer G, Klingler A, Fliri G, Greie S, Schobersberger W. Cardiac troponins after a downhill marathon. Int J Cardiol 2008; 129:449-52. [PMID: 17689705 DOI: 10.1016/j.ijcard.2007.06.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 06/30/2007] [Indexed: 01/10/2023]
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Haas T, Fries D, Velik-Salchner C, Reif C, Klingler A, Innerhofer P. The In Vitro Effects of Fibrinogen Concentrate, Factor XIII and Fresh Frozen Plasma on Impaired Clot Formation After 60% Dilution. Anesth Analg 2008; 106:1360-5, table of contents. [DOI: 10.1213/01.ane.0b013e3181684339] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haas T, Fries D, Holz C, Innerhofer P, Streif W, Klingler A, Hanke A, Velik-Salchner C. Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution. Anesth Analg 2008; 106:1078-86, table of contents. [PMID: 18349176 DOI: 10.1213/ane.0b013e318165df18] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All i.v. fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation. METHODS Using thrombelastometry (ROTEM), we studied 30 pigs (weighing 35-45 kg) after withdrawal of 60% of blood volume [1484 mL (1369-1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, alpha angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured. RESULTS Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures. CONCLUSIONS Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.
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Affiliation(s)
- Thorsten Haas
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Assadian A, Knöbl P, Hübl W, Senekowitsch C, Klingler A, Pfaffelmeyer N, Hagmüller GW. Safety and efficacy of intravenous enoxaparin for carotid endarterectomy: A prospective randomized pilot trial. J Vasc Surg 2008; 47:537-42. [DOI: 10.1016/j.jvs.2007.10.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 10/19/2007] [Accepted: 10/27/2007] [Indexed: 11/25/2022]
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Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, Innerhofer P. Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo. Br J Anaesth 2008; 100:307-14. [DOI: 10.1093/bja/aem363] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Függer R, Scheyer M. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 2008; 12:385-9. [PMID: 18283518 DOI: 10.1007/s10029-008-0357-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 01/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. METHODS Patients with primary unilateral inguinal hernias were randomized to Shouldice repair, Bassini operation, tension-free hernioplasty (Lichtenstein repair), laparoscopic transabdominal extraperitoneal hernioplasty (TEP), or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). The primary outcome parameter was the rate of recurrence at 3 years. The secondary outcome was the rate of intraoperative, perioperative, and long-term complications. Follow-up comprised of clinical examination after 1, 2, and 3 years. RESULTS Three hundred and sixty-five patients were randomly assigned to one of the five procedures. The intention-to-treat analysis showed that the cumulative 3-year recurrence rate was 3.4% in the Bassini group, 4.7% in the Shouldice group, 0% in the Lichtenstein group, 4.7% in the TAPP group, and 5.9% in the TEP group (p = 0.48). Comparing open (Bassini, Shouldice, Lichtenstein) versus laparoscopic (TAPP, TEP) techniques (p = 0.29) and comparing the use of mesh prostheses (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) (p = 0.74) showed no significance in the rate of recurrence. The rates of intraoperative (p = 0.15), perioperative (p = 0.09), and long-term complications (p = 0.13) were without significance between the five groups. Comparing mesh techniques (Lichtenstein, TAPP, TEP) versus suturing techniques (Bassini, Shouldice) showed no significance in the rate of complications. The per-protocol analysis for the comparison of mesh (Lichtenstein, TAPP, TEP) versus suturing (Bassini, Shouldice) techniques revealed that recurrences (p = 0.74), intraoperative (p = 0.64), perioperative (p = 0.27), and long-term complications (p = 0.91) were evenly distributed. CONCLUSIONS In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.
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Affiliation(s)
- H Pokorny
- Department of Surgery, University Hospital of Vienna, Vienna, Austria.
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Tauber E, Kollaritsch H, Korinek M, Rendi-Wagner P, Jilma B, Firbas C, Schranz S, Jong E, Klingler A, Dewasthaly S, Klade CS. Safety and immunogenicity of a Vero-cell-derived, inactivated Japanese encephalitis vaccine: a non-inferiority, phase III, randomised controlled trial. Lancet 2007; 370:1847-53. [PMID: 18061060 DOI: 10.1016/s0140-6736(07)61780-2] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Japanese encephalitis virus (JEV) is the leading cause of viral encephalitis in southeast Asia. Although no treatment is currently available, vaccination effectively prevents the disease. In a non-inferiority study, we aimed to compare the safety and immunogenicity of a novel, second-generation, inactivated candidate vaccine for JEV with a licensed, mouse-brain-derived vaccine. METHODS We included 867 adults in a multicentre, multinational, observer-blinded, randomised controlled phase III trial. Study sites were located in the USA, Germany, and Austria. Volunteers received either the JEV test vaccine intramuscularly on a two-dose schedule (on days 0 and 28; n=430) or the licensed vaccine subcutaneously according to its recommended three-dose schedule (on days 0, 7, and 28; n=437). The primary endpoint was immunogenicity, with respect to neutralising JEV-specific antibodies assessed by a plaque-reduction neutralisation test, which was assessable in 725 patients in the per-protocol population. This trial is registered as a clinical trial, EudraCT number 2004-002474-36. FINDINGS The safety profile of the test vaccine was good, and its local tolerability profile was more favourable than that of the licensed vaccine. Frequency of adverse events was similar between treatment groups, and vaccine-related adverse events were generally mild. The seroconversion rate of the test vaccine was 98% compared with 95% for the licensed vaccine on day 56 (95% CI for the difference -1.33 to 3.43). Geometric mean titre for recipients of the test vaccine was 244 (range 5-19 783), compared with 102 (5-1864) for the licensed vaccine (ratio 2.3 [95% CI 1.967-2.75]). INTERPRETATION The test JEV vaccine has a promising immunogenicity and safety profile.
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Affiliation(s)
- E Tauber
- Institute of Specific Prophylaxis and Tropical Medicine, Centre for Physiology and Pathophysiology, Medical University of Vienna, Vienna, Austria
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Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, Oswald E, Bach C, Schnapka-Koepf M, Innerhofer P. Hemostatic Changes After Crystalloid or Colloid Fluid Administration During Major Orthopedic Surgery: The Role of Fibrinogen Administration. Anesth Analg 2007; 105:905-17, table of contents. [PMID: 17898365 DOI: 10.1213/01.ane.0000280481.18570.27] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND To explore whether disturbed fibrin polymerization is the main problem underlying dilutional coagulopathy and can be reversed by fibrinogen administration, we conducted a prospective study using modified thrombelastography (ROTEM). METHODS Sixty-six orthopedic patients randomly received modified gelatin solution, hydroxyethyl starch 130/0.4, or exclusively Ringer lactate solution. ROTEM analysis was performed, concentrations of coagulation factors and markers of thrombin generation were measured. Fibrinogen concentrate (Hemocomplettan) was administered (30 mg/kg) when thrombelastographically measured fibrinogen polymerization was critically decreased. RESULTS The alpha angle, clot firmness, and fibrinogen polymerization (median [min to max]) significantly decreased in the patients receiving hydroxyethyl starch (area under the curve minus baseline (-5 [-9 to -2]), followed by gelatin solution (-3 [-8 to 0]), with the least reductions seen for Ringer lactate solution (-2 [- 4 to 1]) (colloids versus Ringer lactate P < 0.0001). Thirteen patients in the colloid groups but none in the Ringer lactate group needed fibrinogen concentrate to maintain borderline clot firmness. Activity of FVII, FVIII, FIX, and von Willebrand ristocetin activity decreased significantly with colloids. Thrombelastographically measured coagulation time, molecular markers of thrombin generation, and activity of all other coagulation factors were comparable in all groups. CONCLUSION Disturbance of fibrinogen/fibrin polymerization is the primary problem triggering dilutional coagulopathy during major orthopedic surgery. The magnitude of clot firmness reduction is determined by the type of fluid used, with hydroxyethyl starch showing the most pronounced effects. These undesirable effects of intravascular volume therapy can be reversed by increasing fibrinogen concentration by administering fibrinogen concentrate, even during continuing blood loss and intravascular volume replacement.
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Affiliation(s)
- Markus Mittermayr
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
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Sumann G, Fries D, Griesmacher A, Falkensammer G, Klingler A, Koller A, Streif W, Greie S, Schobersberger B, Schobersberger W. Blood coagulation activation and fibrinolysis during a downhill marathon run. Blood Coagul Fibrinolysis 2007; 18:435-40. [PMID: 17581317 DOI: 10.1097/mbc.0b013e328136c19b] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Prolonged physical exercise is associated with multiple changes in blood hemostasis. Eccentric muscle activation induces microtrauma of skeletal muscles, inducing an inflammatory response. Since there is a link between inflammation and coagulation we speculated that downhill running strongly activates the coagulation system. Thirteen volunteers participated in the Tyrolean Speed Marathon (42,195 m downhill race, 795 m vertical distance). Venous blood was collected 3 days (T1) and 3 h (T2) before the run, within 30 min after finishing (T3) and 1 day thereafter (T4). We measured the following key parameters: creatine kinase, myoglobin, thrombin-antithrombin complex, prothrombin fragment F1 + 2, D-dimer, plasmin-alpha(2)-antiplasmin complexes, tissue-type plasminogen activator antigen, plasminogen-activator-inhibitor-1 antigen and thrombelastography with ROTEM [intrinsic pathway (InTEM) clotting time, clot formation time, maximum clot firmness, alpha angle]. Thrombin generation was evaluated by the Thrombin Dynamic Test and the Technothrombin TGA test. Creatine kinase and myoglobin were elevated at T3 and further increased at T4. Thrombin-antithrombin complex, prothrombin fragment F1 + 2, D-dimer, plasmin-alpha(2)-antiplasmin complexes, tissue-type plasminogen activator antigen and plasminogen-activator-inhibitor-1 antigen were significantly increased at T3. ROTEM analysis exhibited a shortening of InTEM clotting time and clot formation time after the marathon, and an increase in InTEM maximum clot firmness and alpha angle. Changes in TGA were indicative for thrombin generation after the marathon. We demonstrated that a downhill marathon induces an activation of coagulation, as measured by specific parameters for coagulation, ROTEM and thrombin generation assays. These changes were paralleled by an activation of fibrinolysis indicating a preserved hemostatic balance.
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Affiliation(s)
- Günther Sumann
- Division for General and Surgical Intensive Care Medicine, Clinic for Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Velik-Salchner C, Haas T, Innerhofer P, Streif W, Nussbaumer W, Klingler A, Klima G, Martinowitz U, Fries D. The effect of fibrinogen concentrate on thrombocytopenia. J Thromb Haemost 2007; 5:1019-25. [PMID: 17461931 DOI: 10.1111/j.1538-7836.2007.02481.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The hypothesis that the administration of fibrinogen concentrate enables restoration of impaired clot formation and increased bleeding in severe thrombocytopenia was tested. METHODS Thirty pigs were anesthetized, instrumented for blood sampling (routine coagulation tests, modified thrombelastography ROTEM, hemodynamic monitoring and platelet apheresis to a target below 30 x 10(9) L(-1) after splenectomy. Thereafter 10 each of the animals randomly received two apheresis platelet concentrates, 250 mg kg(-1) fibrinogen concentrate or normal saline solution. A standardized liver injury was subsequently inflicted to induce uncontrolled hemorrhage. RESULTS Median (Q1, Q3) clot firmness increased significantly more in thrombocytopenic pigs after fibrinogen administration (42 mm (41, 43) to 60 mm (57, 63)) than following platelet transfusion (40 mm (37, 45) to 52 mm (48, 55), P = 0.0004) or placebo (45 mm (41, 48) to 45 mm (43, 46), P = 0.0002). Median blood loss velocity after liver injury was significantly less with fibrinogen (33 mL min(-1), P = 0.005) than with platelets (62 mL min(-1), P = 0.037) or saline (84 mL min(-1), P = 0.005), and median survival time after liver injury was 55 min in the fibrinogen, 26 min in the platelet (P = 0.035) and 19 min in the saline group (P = < 0.0001). CONCLUSIONS These data show for the first time that impaired clot formation during thrombocytopenia improves with administration of fibrinogen concentrate, which results in a slowdown of blood loss and prolonged survival.
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Affiliation(s)
- C Velik-Salchner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Mair J, Hammerer-Lercher A, Mittermayr M, Klingler A, Humpeler E, Pachinger O, Schobersberger W. 3-week hiking holidays at moderate altitude do not impair cardiac function in individuals with metabolic syndrome. Int J Cardiol 2007; 123:186-8. [PMID: 17316842 DOI: 10.1016/j.ijcard.2006.11.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 11/12/2006] [Indexed: 10/23/2022]
Abstract
We studied the influence of a 3-week hiking vacation at moderate altitude on cardiac pump and endocrine function. 18 males (mean age: 55 years, range 36-60) with metabolic syndrome participated in a 3-week structured guided hiking vacation program (4 times per week at 55-65% of maximal heart rate, total exercise time 29 h). Echocardiography, B-type natriuretic peptide (BNP), NT-proBNP, and endothelin-1 measurements were performed at baseline in Innsbruck (576 m a.s.l., Austria), on the first day at moderate altitude (Obertauern, 1700 m a.s.l., Austria), after 3 weeks in Obertauern, and at follow-up in Innsbruck. We found no adverse cardiovascular effects and no significant changes in echocardiographic measures of systolic or diastolic function, estimated systolic pulmonary artery pressure, exercise capacities, BNP and NT-proBNP, or endothelin-1 concentrations. The blood pressure at rest significantly decreased from baseline to follow-up.
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Mittermayr M, Fries D, Gruber H, Peer S, Klingler A, Fischbach U, Gunga HC, Koralewski E, Faulhaber M, Simmer M, Schobersberger W. Leg edema formation and venous blood flow velocity during a simulated long-haul flight. Thromb Res 2007; 120:497-504. [PMID: 17250877 DOI: 10.1016/j.thromres.2006.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/11/2006] [Accepted: 12/11/2006] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Long-distance traveling in a sitting position may be associated with an increased incidence for venous thromboembolism. As major contributing factors immobility and compression of leg veins are discussed. At present no studies have been performed measuring the time course of lower limb blood flow, leg volume and leg tissue thickness during a long-haul flight. MATERIALS AND METHODS We measured limb volumes (plethysmographic method), lower leg tissue thickness and lower limb venous hemodynamics before, during and after 10 h sitting in modern aircraft chairs under normobaric hypoxia in healthy volunteers (n=12). RESULTS Lower leg volume was already significantly increased after 4 h sitting (+109 ml) reaching its maximum after 10 h (+145 ml). These changes were accompanied by an increased body weight, total body water, extracellular water and tissue thickness of the tibia. No significant changes were measured for leg vessel cross-section diameters and maximal flow velocities in superficial femoral veins. After 10 h sitting core temperature, overall surface temperature and skin temperatures in front of the tibia were significantly increased. All parameters returned to baseline one day after sitting. CONCLUSIONS Prolonged sitting in modern aircraft seats is associated with a remarkable fluid accumulation in the lower legs which mainly occurred during the first hours. These fluid shifts were independent of lower limb venous hemodynamics and vessel cross-sectional diameters.
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Affiliation(s)
- Markus Mittermayr
- Department for General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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Schobersberger W, Mittermayr M, Fries D, Innerhofer P, Klingler A, Faulhaber M, Gunga HC, Streif W. Changes in blood coagulation of arm and leg veins during a simulated long-haul flight. Thromb Res 2007; 119:293-300. [PMID: 16630648 DOI: 10.1016/j.thromres.2006.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Revised: 02/23/2006] [Accepted: 03/07/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Long-haul flights are associated with an increased incidence for venous thromboembolic events. At present, markers of coagulation and fibrinolysis were only analyzed from arm veins after long distance travel. Respective data from leg veins are missing. MATERIALS AND METHODS Here, we measured these parameters in healthy volunteers (n=12) before and after 10 h sitting in modern aircraft chairs under normobaric hypoxia (corresponding to 2400 m altitude). Blood was collected from arm and leg veins before, immediately after and 1 day after sitting in the hypoxic chamber. RESULTS We did not find any evidence for a significant intravasal thrombin and fibrin formation and a changed fibrinolytic activity, neither in arm nor in leg vein blood. TAT, PAP, and PAI-1 remained unchanged, and the increases of F1+2 in arm veins and of d-dimer in leg veins were within the upper reference limits. Moreover, there was no evidence of activation of coagulation as measured by thrombelastography (ROTEM(R)) and the new Thrombin Dynamic Test at both locations. There was no evidence of arm or leg hemoconcentration. CONCLUSIONS In healthy volunteers, prolonged sitting in ergonomically superior aircraft seats does not induce significant changes in blood coagulation and fibrinolysis in venous blood of arm or leg. Since this study was performed under moderate hypoxia, reduction in oxygen pressure seems not to be a crucial factor for venous thrombosis at long-haul flights.
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Affiliation(s)
- Wolfgang Schobersberger
- Institute for Leisure, Travel and Alpine Medicine, University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum 1, A-6060 Hall/Tyrol, Austria.
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Abstract
PURPOSE This study was designed to determine whether type or number of blood units transfused affected short-term and long-term outcome in patients undergoing surgery for rectal cancer. The number of perioperative blood units is associated with postoperative mortality and overall survival by some authors. In addition, allogenic perioperative blood transfusion has been postulated to produce host immunosuppression and has been reported to result in adverse outcome in patients with colorectal cancer. Autologous blood transfusion might improve results compared with allogenic transfusion. METHODS Clinical outcome for 597 patients undergoing surgery for rectal cancer was analyzed according to their transfusion status. Results for type (autologous or allogenic) and number of blood units transfused were recorded. RESULTS Blood transfusion was associated with increased postoperative mortality at 60 days. Patients who received > 3 units had a postoperative mortality of 6 percent compared with 1 percent for patients who received 1 to 3 units and 0 percent for patients who did not require transfusions. No difference was found between patients who received autologous or allogenic blood. Blood transfusions were also associated with impaired overall survival in a univariate analysis, but this finding was not confirmed in the multivariate analysis. The number or type of blood units transfused did not influence oncologic results. Local recurrence rates, distant metastases rates, and disease-free survival were not influenced by transfusion in our patients. CONCLUSIONS Increased numbers of blood units were associated with postoperative mortality. However, there is no reason, with respect to cancer recurrence or disease-free survival, to use a program of transfusion with autologous blood in patients undergoing surgery for rectal cancer.
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Affiliation(s)
- Michael Jagoditsch
- Department of Surgery, Hospital of Barmherzige Brüder, St. Veit/Glan, Austria
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Fries D, Haas T, Klingler A, Streif W, Klima G, Martini J, Wagner-Berger H, Innerhofer P. Efficacy of fibrinogen and prothrombin complex concentrate used to reverse dilutional coagulopathy--a porcine model. Br J Anaesth 2006; 97:460-7. [PMID: 16885172 DOI: 10.1093/bja/ael191] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This study was conducted to assess whether the combined administration of fibrinogen and prothrombin complex concentrate (PCC) enables the reversal of dilutional coagulopathy resulting from intended blood loss and fluid replacement, and whether this treatment reduces further blood loss and mortality. METHODS In 20 anaesthetized pigs, approximately 65% of the estimated blood volume was withdrawn and replaced with the same amount of hydroxyethyl starch (6% HES 130/0.4) to mimic blood loss and to develop a dilutional coagulopathy. Pigs (randomized) received either fibrinogen (200 mg kg(-1)) and PCC (35 IU kg(-1)) (n=10), or placebo (n=10). Thereafter, a standard liver laceration was performed to induce uncontrolled haemorrhage. The subsequent blood loss and survival time were determined as primary outcome variables. Throughout the experiment serial blood samples were obtained to assess the competence of the haemostatic system using standard coagulation tests, modified Thrombelastograph measurements (ROTEM) and electron microscopy clot imaging. RESULTS As compared with baseline, after haemodilution both groups showed statistically significant impairment of haemostasis as measured with standard coagulation tests and thrombelastography. These parameters significantly improved after administration of the study drugs while aPPT measurements remained unchanged. Blood loss after liver injury was significantly less in the treatment group as compared with placebo: 240 ml (50-830) vs 1800 ml (1500-2500) (P<0.0001). All treated animals survived, whereas 80% of the placebo group died (P<0.0001). CONCLUSION During haemodilution, substitution of fibrinogen and PCC causes an enhancement of coagulation and final clot strength. This reversal of dilutional coagulopathy may reduce blood loss and mortality when large amounts of colloids are needed to maintain normovolaemia during huge blood losses.
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Affiliation(s)
- D Fries
- Division of General and Surgical Intensive Care Medicine, Innsbruck Medical University Anichstrasse 35, 6020 Innsbruck, Austria.
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Pokorny H, Klingler A, Scheyer M, Függer R, Bischof G. Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial. Hernia 2006; 10:331-7. [PMID: 16819563 DOI: 10.1007/s10029-006-0105-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2005] [Accepted: 04/27/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND As part of a large prospective randomized Austrian multicenter trial evaluating recurrence rates and complications of open and laparoscopic unilateral inguinal hernia repairs we assessed postoperative pain and quality of life. METHODS Approximately 151 patients were randomized to Shouldice repair, Bassini operation, or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). Pain was recorded preoperatively and on the first four postoperative days. Quality of life was recorded preoperatively and 1 month postoperatively. RESULTS Patients having Shouldice repairs had significantly higher visual analog-scale scores for pain on the fourth postoperative day (P=0.048) and significantly higher scores in McGill pain questionnaires on the first four postoperative days (P=0.046) compared with the other groups. Apart from a significantly lower score in postoperative bodily pain in the Shouldice group (P=0.039), no significant differences in quality of life were apparent among the three methods. CONCLUSIONS The TAPP and Bassini repairs result in less short-term postoperative pain.
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Affiliation(s)
- H Pokorny
- Department of Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Ciovica R, Gadenstätter M, Klingler A, Lechner W, Riedl O, Schwab GP. Quality of life in GERD patients: medical treatment versus antireflux surgery. J Gastrointest Surg 2006; 10:934-9. [PMID: 16843863 DOI: 10.1016/j.gassur.2006.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 12/20/2005] [Revised: 03/15/2006] [Accepted: 04/05/2006] [Indexed: 02/07/2023]
Abstract
Medical and surgical treatments are able to improve symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the outcome in GERD patients without therapy, under continuous medical treatment, and after laparoscopic antireflux surgery. Five hundred seventy-nine consecutive patients underwent medical or surgical treatment for GERD-induced symptoms. Patients were studied in detail before and after treatment by means of a symptom questionnaire, endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and a barium esophagogram. In addition, quality of life was measured by the means of the Gastrointestinal Quality of Life Index (GIQLI) and the Health-Related Quality of Life (HRQL) questionnaire. Surgery was indicated and performed in 351 patients with persistent or recurrent GERD symptoms and/or complications, and in patients preferring surgery to medical treatment, despite the use of an adequate medication. The remaining 228 patients were treated with proton pump inhibitors (PPI) in the standard dose, or if required, the double dose. The outcome was assessed 3 and 12 months after treatment. While symptoms and quality of life were highly impaired in GERD patients without therapy compared with normal people, a significant improvement was obtained by PPI therapy. Following surgery, quality of life was normalized in all subsections and was significantly higher compared with the medically treated group. These results stayed constant in short-term and intermediate follow-up. Medical and surgical therapies are both able to improve symptoms and quality of life in GERD patients. Nevertheless, the outcome is significantly better following surgery. It can be suggested that surgical treatment may be the more successful therapy in the long-term.
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Greie S, Humpeler E, Gunga HC, Koralewski E, Klingler A, Mittermayr M, Fries D, Lechleitner M, Hoertnagl H, Hoffmann G, Strauss-Blasche G, Schobersberger W. Improvement of metabolic syndrome markers through altitude specific hiking vacations. J Endocrinol Invest 2006; 29:497-504. [PMID: 16840826 DOI: 10.1007/bf03344138] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To study the influence of a 3-week hiking vacation at moderate (1700 m) and low altitude (LA) (200 m) on key-markers of the metabolic syndrome, 71 male volunteers (age 36-66 yr old) with the metabolic syndrome [according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) - or World Health Organization (WHO) - definition] participated in the study and were randomly assigned into a moderate altitude (MA) group (1700 m, no. 36) and a low altitude (LA) group (200 m, no. 35). The 3-week vacation program included 12 moderate- intensity guided hiking tours [4 times/week, 55-65% heart rate maximum (HRmax)] with a total exercise time of 29 h plus moderate recreational activities. Both study groups had a comparable and balanced nutrition with no specific dietary restrictions. Anthropometric, metabolic and cardiovascular parameters were measured 10-14 days before vacation, several times during the 3-week vacation, 7-10 days and 6-8 weeks after return. All participants tolerated the vacation without any adverse effects. Body weight, body fat, waist-circumference, fasting glucose, total cholesterol, LDL-cholesterol (LDL-C), plasma fibrinogen, resting systolic and diastolic blood pressure were significantly decreased over time in both study groups. In the LA group, fasting insulin and homeostasis model assessment (HOMA)-index were significantly decreased one week after return. Relative cycle ergometry performance was significantly increased after return compared to baseline. In both study groups, waist-to-hip ratio (WHR), 2-h oral glucose tolerance test (OGTT), HDL-cholesterol (HDL-C), and triglycerides remained unchanged. The 3-week vacation intervention at moderate and LA had a positive influence on all key-markers of the metabolic syndrome. No clinically relevant differences could be detected between the study groups. A hiking vacation at moderate and LA can be recommended for people with stable, controlled metabolic and cardiovascular risk factors.
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Affiliation(s)
- S Greie
- University for Health Sciences, Medical Informatics and Technology Tyrol, Institute for Leisure, Travel and Alpine Medicine, A-6060 Hall in Tirol, Austria
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Hertling I, Ramskogler K, Dvorak A, Klingler A, Saletu-Zyhlarz G, Schoberberger R, Walter H, Kunze M, Lesch OM. Craving and other characteristics of the comorbidity of alcohol and nicotine dependence. Eur Psychiatry 2006; 20:442-50. [PMID: 16095883 DOI: 10.1016/j.eurpsy.2005.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [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] [Received: 09/21/2004] [Accepted: 06/17/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study. SUBJECTS AND METHODS Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking). RESULTS The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving ("depressive mood", "stimulation", "relaxation", "socially triggered tension") were significantly increased in alcohol-dependent patients (P<0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control. DISCUSSION Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers. Conclusions. - It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.
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Affiliation(s)
- Ines Hertling
- Department of Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Fries D, Innerhofer P, Reif C, Streif W, Klingler A, Schobersberger W, Velik-Salchner C, Friesenecker B. The Effect of Fibrinogen Substitution on Reversal of Dilutional Coagulopathy: An In Vitro Model. Anesth Analg 2006; 102:347-51. [PMID: 16428520 DOI: 10.1213/01.ane.0000194359.06286.d4] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Colloids and crystalloids are usually administered as treatment for hypovolemia in severely injured patients. However, dilution of clotting factors and platelets together with impaired fibrinogen polymerization are associated with fluid therapy and may aggravate hemorrhage, thus worsening final outcome of these patients. We investigated, in an in vitro model, whether the addition of fibrinogen to diluted blood samples can reverse dilutional coagulopathy. Blood from 5 healthy male volunteers was diluted by 60% using lactated Ringer's solution, 4% modified gelatin solution, or 6% hydroxyethyl starch 130/0.4, as well as the combination of lactated Ringer's solution with either of the 2 colloid solutions. Thereafter, aliquots of diluted blood samples were incubated with 3 different concentrations of fibrinogen (0.75, 1.5, and 3.0 mg/mL). Measurements were performed by modified thrombelastography (ROTEM; Pentapharm, Munich, Germany). After 60% dilution, clotting times increased, whereas clot firmness and fibrin polymerization decreased significantly. After administration of fibrinogen, clotting times decreased and clot firmness, as well as fibrin polymerization, increased in all diluted blood samples. The effect of in vitro fibrinogen substitution on ROTEM variables was dependent on the fibrinogen dosage and the type of solution used to dilute the blood samples.
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Affiliation(s)
- Dietmar Fries
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
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Ferenci P, Formann E, Laferl H, Gschwantler M, Hackl F, Brunner H, Hubmann R, Datz C, Stauber R, Steindl-Munda P, Kessler HH, Klingler A, Gangl A. Randomized, double-blind, placebo-controlled study of peginterferon alfa-2a (40KD) plus ribavirin with or without amantadine in treatment-naïve patients with chronic hepatitis C genotype 1 infection. J Hepatol 2006; 44:275-82. [PMID: 16338019 DOI: 10.1016/j.jhep.2005.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [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: 06/29/2005] [Revised: 09/07/2005] [Accepted: 09/20/2005] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Amantadine may augment virological response rates to interferon-based therapy in chronic hepatitis C patients. Using a novel design, amantadine was studied in naïve genotype 1 patients treated in combination with peginterferon alfa-2a (40KD)/ribavirin. METHODS Patients enrolled in this randomized, placebo-controlled multicenter trial were stratified by single-dose interferon sensitivity (stratum I, 24-h HCV-RNA decline >1.4-log10; II, 0.8-1.39-log10; III, <0.8-log10; a reliable means of identifying nonresponders to interferon/ribavirin) and fibrosis grade (F0/1/2 vs. F3/4) at baseline. All patients received peginterferon alfa-2a (40KD) 180 microg/week plus ribavirin 1000-1200 mg/day and were randomized to receive amantadine 100 mg twice daily (N = 114) or placebo (N = 95) for 48 weeks. RESULTS Week-24 virological response rates in strata II and III, the primary outcome, were similar in patients treated with amantadine (63.7%) or placebo (65.7%), as were sustained virological response rates at week 72 (46.5 and 51.6%, respectively). Adverse event profiles were similar and amantadine did not improve health-related quality of life compared with placebo. Interferon sensitivity was the only significant predictor of treatment outcome. CONCLUSIONS Adding amantadine to peginterferon alfa-2a (40KD)/ribavirin combination therapy does not augment virological response rates in genotype 1 patients. Virological response was almost exclusively determined by interferon sensitivity at baseline.
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Affiliation(s)
- Peter Ferenci
- Department of Internal Medicine IV, Medical University, Vienna, Austria.
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Mittermayr M, Margreiter J, Velik-Salchner C, Klingler A, Streif W, Fries D, Innerhofer P. Effects of protamine and heparin can be detected and easily differentiated by modified thrombelastography (Rotem ® ): an in vitro study. Br J Anaesth 2005; 95:310-6. [PMID: 16024582 DOI: 10.1093/bja/aei197] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Precise coagulation monitoring might help prevent heparin-protamine mismatch and thus decrease postoperative blood loss. We therefore measured coagulation time (CT) by modified thrombelastography (Rotem) as a possible differential monitor of the effects of heparin and protamine. METHODS Undiluted and diluted blood samples from 26 healthy volunteers were spiked with increasing concentrations of heparin (0.1, 0.2, 0.4, 0.8 and 1 U ml(-1)). In addition, undiluted blood was spiked with protamine hydrochloride (0.1, 0.2, 0.4, 0.8 and 1.6 U ml(-1)), and we tested the effect of protamine on the reversal of heparin 0.4 U ml(-1). Heparin-containing samples were analysed using the heparin-sensitive INTEM test and the heparinase-containing HEPTEM test; protamine series were also analysed with the EXTEM test (tissue factor activation). RESULTS CT by the INTEM test [CT-INTEM; median (min/max)] increased significantly and dose-dependently with increasing concentrations of heparin [control, 175 s (146/226); heparin, 1.0 U ml(-1) 1320 s (559/2100); P<0.001] and protamine [control, 172 s (150/255); protamine, 1.6 U ml(-1) 527 s (300/1345); P<0.0001]. Up to heparin concentrations of 0.4 U ml(-1), results were similar in undiluted and diluted blood samples. As expected, CT-HEPTEM remained within the normal range for all tested heparin concentrations (median 180-183 s), but increased similarly to CT-INTEM for increasing protamine concentrations. CONCLUSION CT measurement using the Rotem technique appears to be a valuable tool for heparin-protamine management. For detection of heparin alone, protamine alone and the two combined, the ratio of CT-INTEM:CT-HEPTEM can be used to distinguish the effects of heparin excess (CT-INTEM:CT-HEPTEM>1) from those of protamine excess (CT-INTEM:CT-HEPTEM=1).
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Affiliation(s)
- M Mittermayr
- Clinic for Anaesthesia and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
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Fries D, Krismer A, Klingler A, Streif W, Klima G, Wenzel V, Haas T, Innerhofer P. Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine model. Br J Anaesth 2005; 95:172-7. [PMID: 15923269 DOI: 10.1093/bja/aei160] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study was conducted to determine whether replacement of fibrinogen is useful in reversing dilutional coagulopathy following severe haemorrhage and administration of colloids. METHODS In 14 anaesthetized pigs, approximately 65% of the estimated blood volume was withdrawn and replaced with the same amount of gelatin solution to achieve dilutional coagulopathy. Animals were randomized to receive either 250 mg kg(-1) fibrinogen (n=7) or normal saline (n=7). A standardized liver injury was then inflicted to induce uncontrolled haemorrhage. Modified thrombelastography and standard coagulation tests were performed at baseline, after blood withdrawal, after dilution, after injection of the study drugs, and on conclusion of the protocol. Further, electron microscopy imaging of the blood clots was performed and blood loss after liver injury was determined. RESULTS Severely impaired haemostasis was observed after haemodilution with gelatin substitution. With administration of fibrinogen, clot firmness and dynamics of clot formation reached baseline values. Median blood loss following liver injury was significantly less (P=0.018) in the fibrinogen-treated animals (1100 ml; 800-1400 ml) than in the placebo group (2010 ml; 1800-2200 ml). CONCLUSIONS Replacing 65% of the estimated blood volume with gelatin in swine resulted in dilutional coagulopathy; subsequent fibrinogen administration improved clot formation and reduced blood loss significantly.
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Affiliation(s)
- D Fries
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria.
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Wykypiel H, Kamolz T, Steiner P, Klingler A, Granderath FA, Pointner R, Wetscher GJ. Austrian experiences with redo antireflux surgery. Surg Endosc 2005; 19:1315-9. [PMID: 16206012 DOI: 10.1007/s00464-004-2208-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 05/10/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND From 1996, the entire number of fundoplications performed in Austria increased dramatically, favoring the laparoscopic technique. Despite good results, some patients experience failure of antireflux surgery and therefore require redo surgery if medical therapy fails to control symptoms. The aim of the study was to describe the refundoplication policy in Austria with evaluation of the postoperative results. METHODS A questionnaire was sent to all Austrian surgical departments at the beginning of 2003 with questions about redo fundoplications (number, techniques, intraoperative complications, history, migration of patients, preoperative workup, mortality, and postoperative long-term complaints). It also included questions about primary fundoplications (number, technique, postoperative symptoms). RESULTS Out of 4,504 primary fundoplications performed in Austria since 1990, 3,952 have been carried out laparoscopically. In a median of 31 months after the primary operation, 225 refundoplications have been performed, laparoscopically in the majority of patients. The Nissen and the partial posterior fundoplication were the preferred techniques. The conversion rate in these was 10.8%, mainly because of adhesions and lacerations of the spleen, the stomach, and the esophagus. The mortality rate after primary fundoplications was 0.04%, whereas the rate after refundoplications was 0.4%, all resulting from an open approach. CONCLUSION Laparoscopic refundoplications are widely accepted as a treatment option after failed primary antireflux surgery in Austria. However, the conversion rate is 6 times higher and the mortality rate is 10 times higher than for primary antireflux surgery. Therefore, redo fundoplications should be performed only in departments with large experience.
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Affiliation(s)
- H Wykypiel
- Department of General and Transplant Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Schobersberger W, Greie S, Humpeler E, Mittermayr M, Fries D, Schobersberger B, Artner-Dworzak E, Hasibeder W, Klingler A, Gunga HC. Austrian Moderate Altitude Study (AMAS 2000): Erythropoietic Activity and Hb–O2 Affinity During a 3-Week Hiking Holiday at Moderate Altitude in Persons with Metabolic Syndrome. High Alt Med Biol 2005; 6:167-77. [PMID: 16060851 DOI: 10.1089/ham.2005.6.167] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Moderate altitude hypoxia (1500 to 2500 m) is known to stimulate erythropoiesis and to improve oxygen transport to tissue by a reduction of Hb-O(2) affinity. Whether this adaptation also occurs in tourists with metabolic syndrome has not yet been investigated sufficiently. Thus, we performed a prospective field study to measure erythropoietic parameters and oxygen transport properties in 24 male volunteers with metabolic syndrome during a 3- week holiday program at 1700 m consisting of four guided, individually adapted hiking tours per week. The following examinations were performed: baseline investigations at 500 m (T1); examinations at moderate altitude on day 1 (T2), day 4 (T3), day 9 (T4), and day 19 (T5); and postaltitude tests (T6) 7 to 10 days after return. On day 1 and day 19, a walk on a standardized hiking test route with oxygen saturation (SpO(2)) measure points was performed. Hemoglobin, packed cell volume, and red cell count showed changes over time, with higher values at T5 as compared to baseline. Reticulocyte count and erythropoietin (EPO) were increased at T2 and increased further until T5. EPO declined toward prealtitude values. P50-value (blood PO(2) at 50% hemoglobin oxygen saturation at actual pH) increased during the altitude sojourn (maximum increase at T5 by +0.40 kPa). At T5 all volunteers had a higher SpO(2) before, during, and at the end of the test route compared to T1. During adaptation to moderate altitude, persons with metabolic syndrome exhibit an increase in EPO and a rightward shift of the oxygen dissociation curve that is similar to healthy subjects.
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Affiliation(s)
- Wolfgang Schobersberger
- University for Health Sciences, Medical Informatics and Technology Tyrol, Institute for Leisure,- Travel- and Alpine Medicine, Tyrol, Austria
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Tamme C, Garde N, Klingler A, Hampe C, Wunder R, Köckerling F. Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results. Surg Endosc 2005; 19:1125-9. [PMID: 16021367 DOI: 10.1007/s00464-004-8219-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2004] [Accepted: 12/16/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND This prospective study of a new titanium-coated low-weight polypropylene (PP) mesh (16 g PP/m2) was designed to investigate the clinical efficacy and safety of totally extraperitoneal endoscopic hernioplasty (TEP). METHODS In this study, 400 patients (average age, 53.5 years; range, 19-80 years) with a total of 588 inguinal hernias underwent surgery with the TEP technique between September 2002 and October 2003. Of these patients, 12.4% had experienced recurrent hernias after open suture herniotomy. In 92% of the cases (368 patients with 540 hernias), a lightweight (16 g PP/m2) titanium-coated polypropylene mesh was implanted without fixation, and in 8% (32 patients with 48 hernias) an identical medium-weight (35 g PP/m2) mesh was implanted. The first follow-up examination was scheduled for postoperative week 6. RESULTS In the lightweight mesh group, the mean group, operating time per patient was 61 min, corresponding to a calculated time per hernia of 41 min. Two intraoperative major complications occurred: an injury to the cecum and an injury to the bladder. In 12 cases (2%), bleeding from epigastric, testicular, or pubic bone vessels was observed. No injuries to pelvic vessels were seen. One patient was underwent an endoscopic revision to deal with an anticoagulation-related bleed. The mortality rate was 0%. In 12 patients, postoperative hematomas developed. One preperitoneal lipoma had to be extirpated. No infections of the mesh occurred. The median follow-up period for 371 patients (92.3%) was 7.2 weeks (range, 4-14 weeks). These 343 patients (with 504 hernias) had been provided with a lightweight titanium-coated polypropylene mesh (16 g PP/m2) (follow-up rate, 93.2%). Of these patients, 3.5% reported persistent ingunial pain, 1.7% described a sensation of rigidity in the region of the groin, and 3.2% reported dysesthesia. The early recurrence rate was 0.2%. CONCLUSIONS The TEP procedure can be performed safely and effectively with the appreciably material-reduced and titanium-coated polypropylene mesh without the need for fixation of the implant. The low early recurrence rate of 0.2% is evidence that the posterior wall of the inguinal canal is adequately augmented. The question whether the material reduction and the titanium coating of the mesh may bring about a reduction in postoperative chronic pain and the sensation of rigidity in the inguinal area via an improvement in biocompatibility must await the results of the scheduled follow-up examination 1 year after the surgical procedure.
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Affiliation(s)
- C Tamme
- Department of Surgery, Center for Minimally Invasive Surgery, Hanover, Hospital, Roesebeckstrasse 15 (Siloah), 30449 Hanover, Germany.
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Skoumal M, Kolarz G, Haberhauer G, Woloszczuk W, Hawa G, Klingler A. Osteoprotegerin and the receptor activator of NF-kappa B ligand in the serum and synovial fluid. A comparison of patients with longstanding rheumatoid arthritis and osteoarthritis. Rheumatol Int 2005; 26:63-9. [PMID: 15889303 DOI: 10.1007/s00296-004-0579-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 11/20/2004] [Indexed: 01/06/2023]
Abstract
We examined OPG and soluble RANKL in the serum (sOPG, sRANKL) and synovial fluid (synOPG, synRANKL) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). OPG and RANKL were measured in 85 patients (44 with RA, 41 patients with OA) in serum and synovial fluid as well. For measuring of OPG and RANKL ELISA tests were used. The results of OPG and RANKL were compared with clinical and radiological scores. We found a negative correlation for OPG and RANKL in synovial fluids: not only for the whole group of patients (P < 0.003, r = -0.32), but also for the subgroups (RA: P < 0.04, r = -0.28, OA: P < 0.002, r = -0.54). SRANKL and synRANKL were positively correlated in the whole group (P < 0.01, r = 0.25) and in the OA group (P < 0.02, r = 0.35); the RA group was showing a trend (P < 0.063, r = 0.24), however. Serum OPG was lower in RA, synOPG higher in OA. The difference between the two patient groups was only significant for synOPG (P < 0.03, r = 0.056), but not for sOPG (P < 0.09, r = 0.19), sRANKL (P < 0.43, r = 0.85) or synRANKL (P < 0.11, r = 0.22). The synOPG:synRANKL ratio was significantly correlated with the Larsen score (P < 0.004, r = 0.38). Synovial OPG is significantly decreased in rheumatoid joints, whereby synovial RANKL is increased. Lower synOPG could reflect a lower protective effect on bone, thus leading to an earlier and more pronounced bone destruction in RA. However, the effect of different mediators for joint destruction in RA and OA seems not to be important to the pathophysiological changes in the joints. The upregulation of serum OPG might be the result of the inflammation; in contrast, an upregulation of RANKL could not be found in the serum of patients with RA and OA.
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Affiliation(s)
- M Skoumal
- Institut für Rheumatologie der Kurstadt Baden in Kooperation mit der Donauuniversität Krems, Austria.
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Ciovica R, Gadenstätter M, Klingler A, Neumayer C, Schwab GP. Laparoscopic antireflux surgery provides excellent results and quality of life in gastroesophageal reflux disease patients with respiratory symptoms. J Gastrointest Surg 2005; 9:633-7. [PMID: 15862256 DOI: 10.1016/j.gassur.2005.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 12/21/2004] [Revised: 02/10/2005] [Accepted: 02/14/2005] [Indexed: 01/31/2023]
Abstract
Medical and surgical treatment are able to improve symptoms in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the outcome following laparoscopic antireflux surgery in GERD patients with primary respiratory-related symptoms and to investigate the quality of life index before and after therapy. Three hundred thirty-eight consecutive patients underwent surgical treatment for GERD-induced symptoms. Of this group 126 patients had primary respiratory symptoms related to GERD. All patients were studied by means of a symptom questionnaire, endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and a barium esophagogram. In addition, the quality of life was measured by the means of the Gastrointestinal Quality of Life Index (GIQLI). All patients had medical therapy with proton pump inhibitors preoperatively. A laparoscopic fundoplication was performed in all patients. The outcome was assessed 3 and 12 months postoperatively. Following surgery, all respiratory symptoms were significantly improved. While GIQLI was highly impaired before surgical therapy, a significant improvement of quality of life was obtained. Because medical treatment is likely to fail in GERD patients with respiratory symptoms, the need for surgery arises and may be the only successful treatment in the long term. Quality of life was significantly improved by surgical treatment.
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Affiliation(s)
- Ruxandra Ciovica
- Department of Surgery, Austria, General Hospital of Krems, Krems, Austria.
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Innerhofer P, Klingler A, Klimmer C, Fries D, Nussbaumer W. Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. Transfusion 2005; 45:103-10. [PMID: 15647025 DOI: 10.1111/j.1537-2995.2005.04149.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components prepared according to current standards. STUDY DESIGN AND METHODS A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee replacement surgery were enrolled in a prospective observational study of the incidence of postoperative infection. Patients with contraindications for PAD or with any infectious disease were not included in the study. To identify probably confounding factors, differences between patient groups were analyzed first. Identified factors, which differed between groups, and variables describing blood supply were further tested in uni- and multivariate logistic regression analysis for their independent influence on development of postoperative infection. Infection rates were compared on the basis of actual transfusion groups. RESULTS Of the 308 study patients, 101 were not transfused, 85 received their PAD, 100 received allogeneic WBC-filtered red blood cells (RBCs), and 22 were given autologous RBCs and additionally allogeneic WBC-filtered RBCs. Overall the infection rate was 6.82 percent (21/308). Infection rates varied significantly between transfusion groups (no transfusion, 6.9%; autologous RBCs, 1.2%; allogeneic WBC-filtered RBCs, 12.0%; both transfusion types, 4.6%; p = 0.03). Allogeneic recipients showed significantly more infections compared to autologous recipients (p = 0.0053). Multivariate regression analysis confirmed transfusion of allogeneic WBC-filtered RBCs as an independent variable predicting postoperative infection (odds ratio, 23.65; confidence interval, 1.3-422.1; p = 0.01). CONCLUSION Differences in postoperative infection rates between allogeneic and autologous recipients are still observable, although universal WBC filtration has been introduced into clinical practice.
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Affiliation(s)
- Petra Innerhofer
- Department of Anesthesia and Critical Care Medicine, University of Innsbruck, Innsbruck, Austria
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Fries D, Haas T, Streif W, Ebert K, Klingler A, Innerhofer P. Crit Care 2005; 9:P342. [DOI: 10.1186/cc3405] [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: 11/10/2022] Open
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Skoumal M, Haberhauer G, Kolarz G, Hawa G, Woloszczuk W, Klingler A. Serum cathepsin K levels of patients with longstanding rheumatoid arthritis: correlation with radiological destruction. Arthritis Res Ther 2004; 7:R65-70. [PMID: 15642144 PMCID: PMC1064888 DOI: 10.1186/ar1461] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 10/03/2004] [Accepted: 10/11/2004] [Indexed: 11/15/2022] Open
Abstract
Cathepsin K is a cysteine protease that plays an essential role in osteoclast function and in the degradation of protein components of the bone matrix by cleaving proteins such as collagen type I, collagen type II and osteonectin. Cathepsin K therefore plays a role in bone remodelling and resorption in diseases such as osteoporosis, osteolytic bone metastasis and rheumatoid arthritis. We examined cathepsin K in the serum of 100 patients with active longstanding rheumatoid arthritis. We found increased levels of cathepsin K compared with a healthy control group and found a significant correlation with radiological destruction, measured by the Larsen score. Inhibition of cathepsin K may therefore be a new target for preventing bone erosion and joint destruction in rheumatoid arthritis. However, further studies have to be performed to prove that cathepsin K is a valuable parameter for bone metabolism in patients with early rheumatoid arthritis.
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Affiliation(s)
- Martin Skoumal
- Institut für Rheumatologie der Kurstadt Baden in Kooperation mit der Donauuniversität Krems, Austria.
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Lesch OM, Dvorak A, Hertling I, Klingler A, Kunze M, Ramskogler K, Saletu-Zyhlarz G, Schoberberger R, Walter H. The Austrian multicentre study on smoking: subgroups of nicotine dependence and their craving. Neuropsychobiology 2004; 50:78-88. [PMID: 15179025 DOI: 10.1159/000077945] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The misconception of tobacco smoking as a 'bad habit' has been replaced by a diagnosis of addiction. Although help to quit is offered by nicotine replacement, antidepressants and psychotherapeutic support, there is no cure yet. One cause of impediment might be psychiatric comorbidity. Therefore, we searched for smoker subgroups, needing different treatments. AIM OF THE STUDY The study aimed at subtyping smokers in an attempt to better understand the phenomenon of resistant smokers and provide more information that could potentially become useful to treatment centres assuming the subtypes correlate directly with outcomes of different smoking cessation treatments, tailor-made according to subtypes. METHODS 330 out of 430 recruited smokers were classified as nicotine dependent (ICD-10) and tobacco dependent (DSM-IV) and remained in the study. They were investigated with different diagnostic assessments: Fagerström Test (FT), Lübeck Craving Risk Relapse Questionnaire and Lesch Typology Questionnaire (the last two being modified for smoking). RESULTS Dependence severity degree is reflected by the FT. FT scores >/=5 indicated higher conspicuousness. Four clusters for nicotine craving were found: (1) 'depressed', (2) 'stimulated', (3) 'relaxed mood state' and (4) 'socially triggered tensed mood'. In contrast to alcoholism, 'stimulation' was one of the major craving conditions in smokers. The decision tree, consisting of the FT and the Lesch Typology Questionnaire, distinguishes four subgroups of nicotine-dependent persons. CONCLUSION The subgroups reflect different reinforcement and psychosocial disturbances. They match treatment and can be applied as outcome predictors in controlled treatment and relapse prevention studies.
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Schobersberger W, Mittermayr M, Innerhofer P, Sumann G, Schobersberger B, Klingler A, Simmer M, Streif W, Fischbach U, Fries D. Coagulation changes and edema formation during long-distance bus travel. Blood Coagul Fibrinolysis 2004; 15:419-25. [PMID: 15205591 DOI: 10.1097/01.mbc.0000114438.81125.cf] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Long-distance travel in a cramped position by aircraft or by bus and car has been suggested to be associated with an increased risk for thromboembolic events. Recently, we demonstrated moderate activation of coagulation after a long-haul flight. At present the single contributing factors (i.e. hypoxia and low humidity on board an aircraft and prolonged sitting in an aircraft, car or bus inducing venous stasis) have not yet been investigated. Therefore we measured markers of coagulation and fibrinolysis as well as functional parameters of coagulation using activated thrombelastography in 19 healthy volunteers before, during and after a real 10-h bus journey. In addition, changes in leg volume were measured. Thrombelastography revealed moderate activation of coagulation in all travelers, which was accompanied by a significant increase in prothrombin fragment F1 + 2. Thrombin-antithrombin III complexes and D-dimer remained unchanged, and tissue-type plasminogen activator and plasminogen-activator inhibitor 1 decreased after travel. After the travel we found a significant increase in leg volume that was exclusively distributed in the calf. We conclude that beside long-haul flights also long-distance bus travel induces a certain activation of the coagulation system. Thus, it is questionable whether hypoxia is the crucial risk factor for thromboembolic events after long-haul flights.
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Affiliation(s)
- Wolfgang Schobersberger
- University for Health Sciences, Medical Informatics and Technology Tyrol, Institute for Leisure, Travel and Alpine Medicine, Innsbruck, Austria.
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