1
|
Taraldsen K, Polhemus A, Engdal M, Jansen CP, Becker C, Brenner N, Blain H, Johnsen LG, Vereijken B. Evaluation of mobility recovery after hip fracture: a scoping review of randomized controlled studies. Osteoporos Int 2024; 35:203-215. [PMID: 37801082 PMCID: PMC10837269 DOI: 10.1007/s00198-023-06922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
Few older adults regain their pre-fracture mobility after a hip fracture. Intervention studies evaluating effects on gait typically use short clinical tests or in-lab parameters that are often limited to gait speed only. Measurements of mobility in daily life settings exist and should be considered to a greater extent than today. Less than half of hip fracture patients regain their pre-fracture mobility. Mobility recovery is closely linked to health status and quality of life, but there is no comprehensive overview of how gait has been evaluated in intervention studies on hip fracture patients. The purpose was to identify what gait parameters have been used in randomized controlled trials to assess intervention effects on older people's mobility recovery after hip fracture. This scoping review is a secondary paper that identified relevant peer-reviewed and grey literature from 11 databases. After abstract and full-text screening, 24 papers from the original review and 8 from an updated search and manual screening were included. Records were eligible if they included gait parameters in RCTs on hip fracture patients. We included 32 papers from 29 trials (2754 unique participants). Gait parameters were primary endpoint in six studies only. Gait was predominantly evaluated as short walking, with gait speed being most frequently studied. Only five studies reported gait parameters from wearable sensors. Evidence on mobility improvement after interventions in hip fracture patients is largely limited to gait speed as assessed in a controlled setting. The transition from traditional clinical and in-lab to out-of-lab gait assessment is needed to assess effects of interventions on mobility recovery after hip fracture at higher granularity in all aspects of patients' lives, so that optimal care pathways can be defined.
Collapse
Affiliation(s)
- K Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo, Norway.
| | - A Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Engdal
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - C-P Jansen
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - N Brenner
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital and Montpellier University MUSE, Montpellier, France
| | - L G Johnsen
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway
| | - B Vereijken
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| |
Collapse
|
2
|
Parhofer KG, Anastassopoulou A, Calver H, Becker C, Singh Rathore A. Estimating prevalence and characteristics of statin intolerance among high and very high cardiovascular risk patients in Germany between 2017–2020. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Statins remain the backbone of lipid management. Nevertheless, the degree to which statins can be used and dosed in clinical practice remains a great challenge, also due to statin intolerance (SI). The lack of widely accepted SI definition leads to poor understanding of the condition and SI patient profile
Purpose
To estimate the current SI prevalence and understand better the patient characteristics, using machine learning techniques
Methods
Retrospective cohort study, based on representative sample of electronic patient records from outpatient setting in Germany. Patients were included if they had high CV risk, atherosclerotic cardiovascular disease (ASCVD) or hypercholesterolemia (HC), between 2017 and 2020. Patients were categorized as having “absolute” (history of SI events and permanent statin discontinuation) or “partial” (history of SI events while treated with statins) SI. Machine learning techniques were utilized to calibrate the prevalence estimates and to identify patient clusters. Estimates of SI prevalence were derived based on different rules and confidence levels (high, moderate and low). The low confidence estimates contain the most uncertainty in identifying SI
Results
The study population consisted of 292,603 patients (57.3% aged >70 years; 55.6% male). Of these, ∼24% had high CV risk, ∼56% had ASCVD, and ∼20% had HC. After deploying machine learning, the SI identification improved by ∼27% in absolute SI and by ∼57% in partial SI patients, resulting in a maximum estimate of 12.5% SI with high/moderate confidence and further 11.8% with low confidence (absolute SI 15.8%, partial SI 8.5%). The low confidence group may contain patients with insufficient statin treatment due to reasons other than SI (e.g. clinical inertia). Statistically significant risk factors for SI were hypothyroidism, vitamin D deficiency, liver and chronic kidney disease. Cramps, muscle spasms, myalgia and myopathy were the most common statin associated muscle symptoms (SAMS) observed in the SI population. Atorvastatin 40mg was the most frequently down-titrated statin, while simvastatin to atorvastatin was the most predominant class switch in SI patients. Machine learning techniques applied on high confidence SI patients characteristics and the most commonly observed cluster for patients over 60 years showed predominant musculoskeletal disorders, concomitant high SAMS incidence and high use of multiple statins. In males under 60 years, depression and somatoform disorders along with musculoskeletal disorders, pain, and gastric events were common, while females under 60 years had predominant depressive episodes, along with musculoskeletal, mental, and metabolic disorders
Conclusion
Addressing the complexity in defining SI using advanced analytics, this study provides prevalence estimates and describes distinct patients clusters that may inform diagnosis and optimal treatment pathways for SI patients in Germany
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH
Collapse
Affiliation(s)
- K G Parhofer
- Ludwig Maximilians University , Munich , Germany
| | | | | | - C Becker
- Daiichi Sankyo , Munich , Germany
| | | |
Collapse
|
3
|
Katzmann J, Becker C, Bilitou A, Laufs U. Simulation study on LDL cholesterol target attainment, ASCVD events, and treatment cost of bempedoic acid in a representative German cohort of high- and very-high-CV risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The LDL cholesterol (LDL-C) treatment goals recommended by the 2019 ESC/EAS guidelines are only achieved in a minority of patients. For patients above goal despite statins and ezetimibe, additional LDL-C lowering can be achieved by treatment with bempedoic acid (BA) or PCSK9 inhibitors (PCSK9i).
Purpose
Simulation of LDL-C target attainment with BA as additional lipid-lowering medication in a representative cohort of German outpatients at high or very-high cardiovascular (CV) risk, calculation of the number of prevented atherosclerotic cardiovascular disease (ASCVD) events and budget impact.
Methods
Data were obtained from IQVIA™ Disease Analyzer database containing a representative sample of German outpatients. We selected patients with high or very-high CV risk (based on ESC/EAS guidelines), diagnosed hypercholesterolaemia and treatment with lipid-lowering medication. In patients with uncontrolled LDL-C, sequentially adding ezetimibe and BA was simulated using a Monte Carlo approach. Drug costs to control LDL-C by adding BA vs. PCSK9i were calculated based on current pricing in Germany. Considered were a scenario without BA and one with BA, in which BA was replaced by PCSK9i if LDL-C was still not controlled. The number of prevented events was calculated based on simulated LDL-C reduction.
Results
105,577 patients met the inclusion criteria and entered the simulation model. 76,900 patients had very-high and 28,677 high CV risk. The baseline characteristics are depicted in Table 1. Only a minority of total patients (11.2%) achieved their risk-based LDL-C goal. Simulation of the sequential addition of ezetimibe to statins resulted in controlled LDL-C in 33.1% of total patients. Simulated addition of BA in patients with uncontrolled LDL-C despite statin and ezetimibe increased the percentage of controlled patients to 61.9% of total. The proportion of patients achieving LDL-C goals was higher in high- compared to very-high risk patients (Figure 1). Treatment with BA reduced the need for PCSK9i in patients on statin and ezetimibe from 66.6% to 37.8%. The considered scenario resulted in an anticipated reduction of drug costs by 35.9% per year on stable lipid-lowering medication. This effect was more pronounced in high-risk compared to very-high-risk patients (cost reductions of 40.6% and 34.4%, respectively). In this simulation model, the BA/PCSK9i strategy is projected to prevent 6,148 ASCVD events annually per 1 million patients on top of statin+ezetimibe, whereas LDL-C target achievement with PCSK9i alone would prevent 7,939 events.
Conclusions
A considerable larger proportion of high- and very-high-risk patients can achieve guideline-recommended LDL-C targets with escalated lipid-lowering medication. BA is projected to substantially decrease the need for PCSK9i treatment to achieve LDL-C targets which reduces drug costs compared to PCSK9i. LDL-C target attainment is projected to markedly reduce ASCVD events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Deutschland GmbH
Collapse
Affiliation(s)
- J Katzmann
- University Hospital Leipzig , Leipzig , Germany
| | - C Becker
- Daiichi Sankyo Deutschland GmbH , München , Germany
| | - A Bilitou
- Daiichi Sankyo Europe GmbH , München , Germany
| | - U Laufs
- University Hospital Leipzig , Leipzig , Germany
| |
Collapse
|
4
|
Becker C. [Eisenberger scholarships 2022]. Urologie 2022; 61:1133-1136. [PMID: 36074135 DOI: 10.1007/s00120-022-01928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Affiliation(s)
- C Becker
- Ressort Forschungsförderung, Deutsche Gesellschaft für Urologie e. V., Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| |
Collapse
|
5
|
Kunath F, Burger M, Becker C. [Research is an indispensable component of urology]. Urologie 2022; 61:713-714. [PMID: 35925252 DOI: 10.1007/s00120-022-01855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Affiliation(s)
- F Kunath
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - M Burger
- Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Landshuter Str. 65, 93053, Regensburg, Deutschland.
| | - C Becker
- Forschungskoordination, Deutsche Gesellschaft für Urologie e. V., Geschäftsstelle Düsseldorf, Uerdinger Str. 64, 40474, Düsseldorf, Deutschland.
| |
Collapse
|
6
|
Bellomo T, Fokas J, Tsao N, Anderson C, Becker C, Gioscia-Ryan R, Meurer W. Ethical Considerations during the Informed Consent Process for Acute Ischemic Stroke in International Clinical Trials. Ethics Hum Res 2022; 44:14-25. [PMID: 35802793 DOI: 10.1002/eahr.500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-to-treatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process.
Collapse
Affiliation(s)
- Tiffany Bellomo
- Vascular surgery resident at the Massachusetts General Hospital
| | - Jennifer Fokas
- Neurology resident at McGaw Medical Center of Northwestern University
| | - Noah Tsao
- Medical student at the University of Rochester
| | | | | | | | - William Meurer
- Associate professor of emergency medicine at the University of Michigan
| |
Collapse
|
7
|
Becker C, As-Sanie S, Abrao M, Brown E, Arjona Ferreira J, Wagman R, Wang F, Perry J, Johnson N, Giuduce L. O-305 SPIRIT long-term extension study: two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
To assess the long-term efficacy and safety of once-daily Relugolix combination therapy (Relugolix-CT) in the treatment of endometriosis-associated pain over two years.
Summary answer
Relugolix-CT previously demonstrated sustained improvement of endometriosis-associated pain and was generally well tolerated over 52 weeks. Research is ongoing: two-year results will be reported.
What is known already
SPIRIT 1&2 were international, Phase 3, replicate, randomized, double-blind, placebo-controlled studies of Relugolix-CT (relugolix 40mg, estradiol 1mg, norethisterone acetate 0.5mg) in premenopausal women with moderate-to-severe endometriosis-associated pain, which were followed by the open-label, 80-week, long-term extension. 52-week results showed sustained improvement in dysmenorrhea and non-menstrual pelvic pain (NMPP) with 84.8% and 73.3% of responders, respectively. Efficacy was evidenced by reductions in dysmenorrhea (82.8%,) NMPP (62.9%,) proportion of women using opioids, and improvements in function. Relugolix-CT was generally well tolerated. Bone mineral density (BMD) assessment showed minimal initial decline (<1%) from baseline followed by stabilization from Week 24 to 52.
Study design, size, duration
Women who completed the 24-week pivotal studies (SPIRIT 1&2) were eligible to enroll in an 80-week open-label, single-arm, long-term extension study of safety and efficacy, representing up to 104 weeks of treatment in total. All women enrolled in the long-term extension study received once-daily oral Relugolix-CT. Analyses were performed based on the initial randomized treatment groups in pivotal studies: Relugolix-CT, delayed Relugolix-CT (relugolix 40mg alone for 12 weeks, then Relugolix-CT for 12 weeks), or placebo.
Participants/materials, setting, methods
Primary endpoints are proportion of dysmenorrhea and NMPP responders at Weeks 52 and 104 based on daily Numerical Rating Scale (NRS) scores (0=no pain, 10=worst pain imaginable) and analgesic use. Responders are women who achieved a predefined, clinically meaningful reduction from baseline in NRS score and no increase in analgesic use. Secondary efficacy endpoints include change in Endometriosis Health Profile-30 pain domain scores, use of opioids/analgesics. Safety endpoints include adverse events and BMD (percent change).
Main results and the role of chance
Of 1251 randomized patients in SPIRIT 1&2, 1044 (83.4%) completed the pivotal studies; 802 (76.8%) enrolled in the long-term extension, and 681 (84.9%) completed 52 weeks of treatment. Baseline demographics and clinical characteristics of the long-term extension population were consistent with those of the pivotal study population. The study remains ongoing at the time of writing. Efficacy and safety data with Relugolix-CT for up to Week 104, will be presented at the scientific session of the 2022 congress.
Limitations, reasons for caution
The study was conducted as an open-label study without a control group over the 80 weeks of the extension period.
Wider implications of the findings
Through 52 weeks of treatment, Relugolix-CT demonstrated sustained improvement of dysmenorrhea, NMPP, function, and reduced need for opiates in women with endometriosis-associated pain. No new safety concerns were identified, and treatment was associated with BMD loss <1%. Data from 104 weeks of treatment will be presented at the 2022 congress.
Trial registration number
NCT03654274
Collapse
Affiliation(s)
- C Becker
- University of Oxford, Nuffield Department of Women's and Reproductive Health, Headington- Oxford , United Kingdom
| | - S As-Sanie
- University of Michigan Medical Center, Obstetrics and Gynecology , Michigan, U.S.A
| | - M.S Abrao
- São Paulo University , Ob/Gyn, São Paulo, Brazil
| | - E Brown
- Medi-Sense- Inc.-, Medi-Sense- Inc .-, Atlanta- Georgia, U.S.A
| | | | - R.B Wagman
- Myovant Sciences Inc., Myovant Sciences Inc ., Brisbane- California, U.S.A
| | - F Wang
- Myovant Sciences Inc., Myovant Sciences Inc ., Brisbane- California, U.S.A
| | - J.S Perry
- Myovant Sciences Inc., Myovant Sciences Inc ., Brisbane- California, U.S.A
| | - N Johnson
- University of Adelaide, Robinson Research Institute , Adelaide, Australia
| | - L.C Giuduce
- University of California San Francisco, Department of Obstetrics- Gynecology and Reproductive Sciences , San Francisco- California, U.S.A
| |
Collapse
|
8
|
Nazri H, Heilig R, Fischer R, Kessler B, Subramaniam K, Becker C, Tapmeier T. O-027 Small extracellular vesicle (sEV) protein cargo as potential biomarker for endometriosis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Can an endometriosis-specific protein signature in small extracellular vesicles (sEV) from peritoneal fluid (PF) be utilised as a non-invasive biomarker of the condition?
Summary answer
Yes, potentially. We found differences in the concentrations and protein cargo of PF-derived sEV between controls and endometriosis samples, most notably in CD44 expression.
What is known already
Endometriosis, defined as endometrial-like tissue outside the uterus, causes pain and/or subfertility in 10% of reproductive age women. The cause is unknown, resulting in inadequate diagnostic methods and treatment options. There is no clinically relevant biomarker for endometriosis yet. Small extracellular vesicles (sEV), produced by virtually every cell, have been described in diseases such as cancer, diabetes, and pre-eclampsia, and could similarly be important in endometriosis. We previously identified sEV in PF of women with endometriosis, and here investigated the protein cargo of PF sEV as biomarker of the disease.
Study design, size, duration
PF samples were obtained from participants in the ENDOX study, Endometriosis CaRe Centre, Nuffield Department of Women’s and Reproductive Health, University of Oxford (REC ref. 09/H0604/58) according to WERF EPHect standards. Women between 18-49 years of age (n = 63) who had undergone diagnostic laparoscopy were classified according to cycle phase (proliferative/secretory/menstrual) and severity of endometriosis (ASRM stages I+II or stages III+IV). Exclusion criteria were hormonal treatment, malignancy, pregnancy, breastfeeding, and inability to understand the consent form.
Participants/materials, setting, methods
The participant groups were control proliferative, n = 7; control secretory, n = 9; control menstrual, n = 3; StI+II proliferative, n = 8; StI+II secretory, n = 10; St1+II menstrual, n = 7; StIII+IV proliferative, n = 5; StIII+IV secretory, n = 11; StIII+IV menstrual, n = 3. 1 mL PF was centrifuged to remove cells, debris, and microvesicles. sEV were isolated using size exclusion chromatography (SEC) and analysed by nanoparticle tracking analysis (NTA), immunoblotting, and mass spectrometry (LC-MS/MS).
Main results and the role of chance
We confirmed the presence of exosomes in PF from women at different stages of endometriosis and from disease-free patients at different menstrual cycle phases by NTA, immunoblotting and mass spectrometry. Enriched sEV were positive for ALIX, CD9, and syntenin. The mode size of PF particles from women with endometriosis was 115 ± 15.5 nm, whereas in non-endometriotic women it was 95 ± 17.3 nm (n.s.). sEV concentrations were higher in endometriosis compared to controls, and highest in stage III-IV endometriosis, followed by stage I-II endometriosis and controls, irrespective of menstrual cycle phase (P = 0.0210). sEV concentration in stage III-IV endometriosis decreased consistent with a transition from proliferative to secretory phase. Likewise, PF-derived sEV numbers within stage I-II endometriosis samples increased, as these samples transitioned from proliferative to secretory cycle phases. Proteomic analysis showed distinct distribution patterns of proteins within endometriosis PF-derived sEVs compared to controls. Consistent with earlier studies, we found CD44 as an sEV protein uniquely within the endometriosis population and contributing significantly to the separation of endometriosis and control samples by the highest variable importance projection (VIP) score in our data set.
Limitations, reasons for caution
The main limitation of this study is the small number of samples across the different groups, and the limited amount of PF per sample.
Wider implications of the findings
PF-derived sEV differ between endometriosis and control patients. Concentrations vary regardless of cycle phase and disease stage, and this difference appears to be reflected in the proteomics analysis. The presence of CD44 within sEV could help diagnose endometriosis.
Trial registration number
not applicable
Collapse
Affiliation(s)
- H Nazri
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health- University of Oxford, Oxford , United Kingdom
| | - R Heilig
- Target Discovery Institute, Nuffield Department of Medicine- University of Oxford, Oxford , United Kingdom
| | - R Fischer
- Target Discovery Institute, Nuffield Department of Medicine- University of Oxford, Oxford , United Kingdom
| | - B Kessler
- Target Discovery Institute, Nuffield Department of Medicine- University of Oxford, Oxford , United Kingdom
| | - K Subramaniam
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health- University of Oxford, Oxford , United Kingdom
- St John’s Institute of Dermatology, King's College London , London, United Kingdom
| | - C Becker
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health- University of Oxford, Oxford , United Kingdom
| | - T Tapmeier
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health- University of Oxford, Oxford , United Kingdom
- Monash University, Department of Obstetrics & Gynaecology , Clayton- Melbourne, Australia
- The Ritchie Centre, Hudson Institute of Medical Research , Clayton- Melbourne, Australia
| |
Collapse
|
9
|
Gibbons T, Reavey J, Georgiou E, Becker C. O-178 Timed intercourse for couples trying to conceive: an updated Cochrane systematic review and meta-analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does timing intercourse around the ‘fertile window’ using ovulation detection methods increase the chance of pregnancy in couples trying to conceive?
Summary answer
This update suggests that timed intercourse using urinary ovulation detection may increase the chances of pregnancy in couples trying to conceive.
What is known already
Development of health apps has surged, with many tracking menstrual cycles, generating ‘fertile window’ predictions for couples hoping to conceive as well as avoid pregnancy. Adjuncts have been marketed to improve the accuracy of ovulation detection, using LH/oestrogen urinary tests and fertility-based awareness method (FAMB) biosensors. These may all influence sexual behaviours, making timed intercourse more widely practiced. Thus, there is an increased need for clinicians and couples to understand the effectiveness of these methods and potential adverse effects such as stress.
Study design, size, duration
A Cochrane systematic review and meta-analysis was performed. The Cochrane Gynaecology and Fertility (CGF) Group trials register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO were searched in January 2022 to identify relevant randomised controlled trials (RCTs). In addition, relevant references lists were checked, and study authors were contacted to obtain unpublished data.
Participants/materials, setting, methods
Participants: Couples (fertile and subfertile) trying to conceive.
Intervention: Timed intercourse using ovulation detection methods such as digital apps, LH/oestrogen urine ovulation tests, and FABM.
Comparison: Intercourse not timed around the ‘fertile window’.
Two independent authors screened studies and extracted data. Risk ratios (RR) were calculated for dichotomous data and mean differences (MD) for continuous data, with 95% confidence intervals (CI). Heterogeneity was examined via the I² statistic.
Main results and the role of chance
In this update, 881 references were screened. Six studies were included, involving 2,374 women.
We are uncertain whether timed intercourse using FAMB resulted in a difference in live birth (RR 0.92, 95%CI 0.73 to 1.16, I²= 0%, 2 studies, 160 women: low-certainty evidence). No other studies reported live birth. We are uncertain whether timed intercourse using FAMB resulted in a difference in clinical or self-reported pregnancy (RR 0.96, 95% CI 0.8 to 1.15, I²=0, 2 studies, 160 women; low-certainty evidence). However, timed intercourse using urinary ovulation detection was associated with higher clinical or self-reported pregnancy (RR 1.28, 95% CI 1.10 to 1.50, I²=0, four studies, 2214 women; moderate-certainty evidence). This suggested that if the chance of a clinical or self-reported pregnancy following intercourse without ovulation prediction is assumed 18%, the chance following timed intercourse with urinary ovulation detection would be 20% to 28%. Subgroup analysis of all ovulation detection methods showed no difference between couples trying to conceive for under 12 months versus couples trying for over 12 months (subfertile). Finally, we are uncertain whether timed intercourse using urinary ovulation detection resulted in a difference in stress (MD 1.98, 95 CI% -0.87 to 4.83, 1 study, 77 women, low-certainty evidence).
Limitations, reasons for caution
Insufficient studies reported our specified outcomes including live birth (primary outcome), time to pregnancy, stress, and quality of life. Moreover, there were insufficient studies with large sample sizes assessing FABM, a key method used in timed intercourse and fertility apps.
Wider implications of the findings
This update provides evidence for the practice of timed intercourse using urinary ovulation detection. However, the majority of menstrual cycle apps use FABM for which there is currently insufficient evidence to support the use of when trying to conceive. This review highlights key areas where future research should be conducted.
Trial registration number
not applicable
Collapse
Affiliation(s)
- T Gibbons
- Oxford University, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| | - J Reavey
- Royal Berkshire Hospital, Obstetrics and Gynaecology , Reading, United Kingdom
| | - E Georgiou
- Princess Anne Hospital, Complete Fertility Centre , Southampton, United Kingdom
| | - C Becker
- Oxford University, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| |
Collapse
|
10
|
Swift B, Zondervan K, Becker C, Rahmioglu N. P-313 The Cyprus women’s health research (COHERE) initiative: estimating the prevalence, symptomatology, associated risk factors and economic burden of endometriosis in an Eastern Mediterranean population. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
In this previous undescribed population of women, what is the prevalence of endometriosis and associated symptomatology, and how are women affected?
Summary answer
Prevalence of endometriosis was 5.4% (95%CI; 4.9%-5.9%). Cases suffered from worse physical health, higher use of pain medication and decreased productivity at work.
What is known already
There is a lack of population level data on prevalence and distribution of women’s health conditions, such as endometriosis, from the Eastern Mediterranean region, despite their known negative effects on quality of life. In addition, there is a complete absence of any health statistics from Northern Cyprus, an emerging region in Europe. Most current endometriosis research comes from Western populations and is not generalisable to non-Western populations due to differences in culture, lifestyle, and care seeking patterns. Therefore, it is important to investigate endometriosis in a variety of settings.
Study design, size, duration
The COHERE Initiative is a cross-sectional, population-based study that recruited 7,646 women between the ages 18-55 residing in Northern Cyprus between January 31st 2018, and January 31st 2020. Recruitment took place face-to-face (90%) and online (10%). Participants completed an expanded version of the WERF Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) questionnaire, consisting of previously validated measurement instruments, such as the Short-Form-36-version-2 questionnaire (SF-36v2) and the Work Productivity and Impairment Questionnaire: General Health (WPAI:GH).
Participants/materials, setting, methods
Endometriosis cases were defined using a combination of self-reported and pelvic ultrasound data. Controls were women without endometriosis. Chi-square, Fisher’s exact test, Student’s t-test, linear regression, and multivariable logistic regression were used for data analysis. The significance level was set at p < 0.05.
Main results and the role of chance
Endometriosis prevalence was 5.4% (95%CI; 4.9%-5.9%;n=410). The mean age women with endometriosis reported to first experience related-symptoms was 25.9-years, despite average age of first menstrual-pain occurring at 16.2-years. Average age of first gynaecologist visit was 21.0-years and endometriosis diagnostic-delay was 1.5-years. Physical health-related-quality-of-life was lower in women with endometriosis compared to those without (48.4 vs 50.2, p = 0.001). Cases had a higher mean percentage of activity impairment (25.8% vs 22.5%, p = 0.03) and reduced effectiveness whilst working (23.4% vs 19.5%, p = 0.006) than controls. Hormone-use was higher in women with endometriosis compared to controls for heavy-bleeding (5.9% vs 1.4%, p < 0.001), irregular periods (14.4% vs 7.2%, p < 0.001) and pelvic-pain (9.3% vs 1.7%, p < 0.001), though overall hormone use was low at 24.1%. Iron and vitamin-D deficiency were the most reported co-morbidities, and these proportions were significantly different from women without endometriosis (38.8% vs 28.3%, 23.9% vs 17.0% respectively, p < 0.001). Migraine headaches were more frequent in women with endometriosis than in those without (19.8% vs 13.2%, p < 0.001). Women with endometriosis were more likely to have ever used drugs for pain relief (77.1% vs 60.5%, p < 0.001). Further analysis will include estimation of economic burden of endometriosis and investigation into Mediterranean-specific factors including sun-exposure and dietary-habits.
Limitations, reasons for caution
Given the cross-sectional nature of this study, causality cannot be inferred. The majority of endometriosis cases are self-reported which is not as reliable as hospital diagnosis/surgeries and laparoscopy is not available in Northern Cyprus. However, research has shown that women self-report endometriosis diagnoses with reasonable accuracy (>70%).
Wider implications of the findings
This is the first study that has estimated prevalence of endometriosis in the region and provided insight into the current-status of healthcare. It has highlighted gaps in the public’s general knowledge of common gynaecological conditions. The results form the basis for targeted follow-up-studies and promotes evidence-based reproductive-medicine in the Eastern-Mediterranean-region.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- B Swift
- University of Oxford, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| | - K Zondervan
- University of Oxford, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| | - C Becker
- University of Oxford, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| | - N Rahmioglu
- University of Oxford, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| |
Collapse
|
11
|
Becker C, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, Van Hanegem N, Vulliemoz N, Vermeulen N. O-283 Evidence based management of endometriosis – what has changed since 2013? Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
In 2005, under the auspices of ESHRE, a group of international experts evaluated the existing best evidence and published the first European guideline on the management of endometriosis. This highly successful project was the first guideline by ESHRE and was adopted by many counties as their national standard. A second, fully-updated edition was presented in 2013.
For the new ESHRE Endometriosis Guideline, published in February 2022, all available evidence for twelve chosen topics was gathered by a senior research specialist. Subgroups comprised of patient representatives and experts in healthcare, reproductive science and epidemiology evaluated the data according to GRADE criteria. Each subgroup wrote a chapter and formulated their recommendations which were then presented by a representative to the core group. There, a provisional document was generated and made available for stakeholder review. The resulting comments were taken into account and where relevant incorporated into the final guideline document for which approval was sought and gained from the ESHRE Executive Committee.
35 PICO (Patients, Interventions, Comparison, Outcome) and seven narrative questions were addressed resulting in 78 Research Recommendations were formulated. Where sufficient scientific evidence was lacking and the Guideline Development Group (GDG) was of the opinion that an important topic needed to be highlighted Good Clinical Practice Points where created based on experts’ experience.
During the process of reviewing the literature it became apparent that large knowledge gaps of the best clinical approach to endometriosis exist. As a result, 30 research recommendations were also produced.
One of the main differences to the 2013 version of the ESHRE guidelines is that laparoscopy is no longer the gold standard for endometriosis per se as there exist sufficient data to support the use of transvaginal ultrasound performed by an experienced operator or MRI can equally identify or rule out ovarian and most of deep endometriosis. However, it is recognised by the GDG that the required imaging standards are not ubiquitously available and for peritoneal disease both sensitivity and specificity using either imaging modalities are still poor. As opposed to the 2013 recommendation, the GDG does not anymore recommend an ultralong protocol for the women with rASRM stage III/IV endometriosis to improve IVF success rates. Furthermore, gonadotropin releasing hormone antagonists seem to be effective in the treatment of endometriosis-associate pain and, where available, could be considered as second-line treatment.
Other changes were specific chapters on endometriosis in adolescents and in menopausal women as the GDG strongly felt that these groups are concerningly underrepresented in clinical care and research. Finally, a chapter focussing on the association of endometriosis with certain forms of cancer namely subgroups of ovarian cancer, breast and thyroid cancer was added to give both patients and clinicians a better insight into the current evidence of this complex topic.
The GDG hope that the new ESHRE Endometriosis Guideline will improve the clinical management of a highly prevalent and heterogenous disease and that the freely-available patient-friendly version of the guideline empowers symptomatic and asymptomatic women to seek the best available advice, support and treatment.
Collapse
Affiliation(s)
- C Becker
- University of Oxford, Nuffield Department of Women's and Reproductive Health , Oxford, United Kingdom
| | - A Bokor
- Semmelweis University, Department of Obstetrics and Gynecology , Budapest, Hungary
| | - O Heikinheimo
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics & Gynecology , Helsinki, Finland
| | - A Horne
- University of Edinburgh, EXPPECT Centre for Endometriosis and Pelvic Pain- MRC Centre for Reproductive Health , Edinburgh, United Kingdom
| | - F Jansen
- EndoHome, Endometriosis Association Belgium , Eksel, Belgium
| | - L Kiesel
- University Hospital Muenster, Department of Gynecology and Obstetrics , Muenster, Germany
| | - K King
- Individual Endometriosis Advocate , Private, Dublin, Ireland
| | - M Kvaskoff
- Paris-Saclay University- UVSQ- Univ. Paris-Sud- Inserm- Gustave Roussy, “Exposome and Heredity” team- CESP , Paris, France
| | - A Nap
- Radboudumc, Department of Gynaecology and Obstetrics , Nijmegen, The Netherlands
| | - K Petersen
- University College London Hospitals, Pain Management Centre , London, United Kingdom
| | - E Saridogan
- Universirty College London Hospitals, Elizabeth Garrett Anderson Institute for Women’s Health , London, United Kingdom
| | - C Tomassetti
- University Hospitals Leuven, Dept. Obstetrics and Gynaecology- Leuven University Fertility Center , Leuven, Belgium
| | - N Van Hanegem
- University Medical Center Utrecht, Department of Obstetrics and Gynecology , Utrecht, The Netherlands
| | - N Vulliemoz
- Lausanne University Hospital, Fertility Medicine and Gynaecological Endocrinology- Department Woman Mother Child , Lausanne, Switzerland
| | - N Vermeulen
- European Society of Human Reproduction and Embryology, Central Office , Strombeek-Bever, Belgium
| |
Collapse
|
12
|
Venturella R, As-Sanie S, Kotarski J, Mehedintu C, Imm S, Qurratul A, Becker C. 70 Effects of relugolix combination therapy on endometriosis-associated pain and analgesic use in spirit studies: overall study and european populations. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.131] [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]
|
13
|
van Dam van Isselt EF, Schols JMGA, Gordon AL, Achterberg WP, van Haastregt J, Becker C, Grund S, Bauer JM. Post-acute COVID-19 geriatric rehabilitation : A European perspective. Z Gerontol Geriatr 2022; 55:655-659. [PMID: 36434130 PMCID: PMC9702857 DOI: 10.1007/s00391-022-02128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) poses a threat to the health and independence of older people in particular. In this article we elaborate on the content and importance of post-acute COVID-19 geriatric rehabilitation from a European perspective. We explain the geriatric rehabilitation paradox and how this can and should be solved. We also present what post-acute COVID-19 geriatric rehabilitation should entail. This might not only help us to develop better geriatric rehabilitation services, but it should also inform pandemic preparedness in the future.
Collapse
Affiliation(s)
- E. F. van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J. M. G. A. Schols
- Department of Health Services Research, Focusing on Value-based Care and Ageing, Caphri—Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - A. L. Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK ,NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| | - W. P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J. van Haastregt
- Department of Health Services Research, Focusing on Value-based Care and Ageing, Caphri—Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C. Becker
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - S. Grund
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany ,Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - J. M. Bauer
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany ,Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| |
Collapse
|
14
|
Becker C, Haferkamp A. [The 2021 DGU research fellowships]. Urologe A 2021; 60:1461-1465. [PMID: 34648047 DOI: 10.1007/s00120-021-01699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Becker
- Ressort Forschungsförderung, Düsseldorf/Berlin, Forschungskoordination, Deutsche Gesellschaft für Urologie, Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| | - A Haferkamp
- Ressort Forschungsförderung, Düsseldorf/Berlin, Forschungskoordination, Deutsche Gesellschaft für Urologie, Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.,Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland
| |
Collapse
|
15
|
Meyer M, Ruehs H, Solms A, Frei M, Becker C, Trujillo M, Garmann D. A concentration-QTc analysis of vericiguat. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Vericiguat is a soluble guanylate cyclase stimulator developed for the treatment of symptomatic chronic heart failure (HF) in patients with ejection fraction less than 45% who had a previous decompensation event. A dedicated, randomised, Phase Ib, QT study of vericiguat (NCT03504982) in 74 adult patients with stable coronary artery disease demonstrated no clinically significant prolongation of the time-matched, placebo-adjusted change from baseline in the Fridericia-corrected QT interval (QTcF) after vericiguat 10 mg once daily at steady state.
Purpose
We conducted a concentration–QTc (C-QTc) modelling analysis, on data from the QT study, to investigate the potential effect of vericiguat on QTcF and define the vericiguat plasma concentration window within which a relevant prolongation in QTcF can be excluded.
Methods
In the QT study, the effect of vericiguat once daily (2.5 mg titrated to 5 mg and then to 10 mg [treatments A, B, C] over 42±9 days) on the QT interval was investigated. The positive control was a single dose of moxifloxacin 400 mg (treatment D) on Day 8 or Day 50 (7 days before the first vericiguat dose or 7 days after the last vericiguat dose), depending on the treatment sequence (Figure 1).
Baseline electrocardiogram assessments were performed 24 h before the start of treatment (“baseline”) and at follow-up (“back-up baseline”; Figure 1). Time-matched, baseline- and placebo-adjusted QTcF (ΔΔQTc) mean values and 90% confidence intervals (CIs) were calculated. Two analytical approaches were used to calculate ΔΔQTc. The first one (“single baseline ΔΔQTc” approach) was data-driven, where ΔΔQTc was adjusted with placebo- and either “baseline” or “back-up baseline”. The second one (“modelled baseline ΔΔQTc”) accounted for individual baseline and placebo effects, such as diurnal time course, used linear mixed effects and integrated all individual baseline and placebo data. Calculated ΔΔQTc values were then related to observed vericiguat concentrations in the C-QTc modelling step, performed with linear mixed effects implemented in R (R, the R Foundation for Statistical Computing, version 3.2.5).
Results
The C-QTc modelling of ΔΔQTc calculated with the “single baseline ΔΔQTc” approach indicated a positive, but non-significant, slope (Figure 2A). The “modelled baseline ΔΔQTc” approach indicated a positive and statistically significant slope (Figure 2B). In both cases, the upper limits of the 90% CI were below the threshold of clinical relevance of 10 ms within the investigated exposure range (up to 745 μg/l).
Conclusion
Based on the presented analysis, a clinically meaningful QT prolongation was robustly excluded within the plasma concentration range associated with the recommended target dose of vericiguat 10 mg. The C-QTc analysis supports the conclusion of the primary study statistical analysis that administration of vericiguat between 2.5 and 10 mg is not associated with a clinically meaningful QTc prolongation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Funding was provided by Bayer AG, Berlin, Germany and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA Figure 1Figure 2
Collapse
Affiliation(s)
- M Meyer
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - H Ruehs
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - A Solms
- Bayer AG, Pharmacometrics, Berlin, Germany
| | - M Frei
- Bayer AG, Pharmacometrics, Berlin, Germany
| | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Trujillo
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - D Garmann
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| |
Collapse
|
16
|
Meyer M, Schneckener S, Loosen R, Coboeken K, Willmann S, Burghaus R, Lippert J, Mueck W, Becker C. Leveraging translational approaches for accelerated clinical development of vericiguat. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Vericiguat is a soluble guanylate cyclase (sGC) stimulator, like riociguat and nelociguat, and entered clinical development in 2012. Before entering Phase 2, pharmacokinetics (PK) and pharmacodynamics (PD) of vericiguat had been studied in healthy volunteers only, whereas riociguat and nelociguat had also been studied in patients with pulmonary hypertension (PH) and left ventricular dysfunction (LVD) or biventricular chronic heart failure (HF). We hypothesised that integrating all PK/PD data from these compounds into population PK/PD (popPK/PD) and physiology-based PK (PBPK) models could be used to predict optimal and safe dose ranges of vericiguat for Phase 2b studies in patients with worsening chronic HF. This novel bridging approach was applied in one of several translational stages to accelerate the development of vericiguat (Figure 1).
Purpose
We used prior knowledge from other sGC stimulators in a combined PK/PD and PBPK modelling approach to directly initiate Phase 2b studies of vericiguat in patients after Phase 1 studies in healthy volunteers.
Methods
PK, heart rate (HR) and systemic vascular resistance (SVR) data for vericiguat, nelociguat and riociguat were used to calculate PK/PD slopes of linear models, corrected with fraction unbound percentages (2.2%, 3.6% and 3.9%, respectively), to compare potency relative to riociguat based on unbound concentrations. PK estimates for nelociguat and riociguat were derived using population PK modelling (NONMEM) from patient studies with sparse PK sampling. PBPK models informed by preclinical physicochemical and PK data as well as clinical data for vericiguat were used to predict vericiguat PK in patients with HF (PK-Sim). Exposure–response data for riociguat in patients indicated the optimal range of PD responses for vericiguat (blood pressure for safety and cardiac index for efficacy).
Results
Vericiguat and nelociguat had lower potency than riociguat when comparing PK/PD slopes for HR and SVR (slope ratios of 0.23–0.32 for vericiguat and 0.33–0.47 for nelociguat). Plasma concentrations of vericiguat would need to be ∼3.6 times that of riociguat for equivalent responses. In patients with PH and LVD the optimal plasma concentration range for riociguat was ∼10–100 μg/l in exposure–response and safety studies, which translates to a target exposure range of ∼90–900 μg/l for vericiguat in patients with HF. PBPK modelling showed that vericiguat 2.5 mg and 10 mg would cover the target exposure range and that 1.25 mg would be a “non-effective” dose level with respect to haemodynamics.
Conclusions
Our novel translational approach combining popPK/PD analyses of other sGC stimulators with PBPK modelling enabled vericiguat to move directly from Phase 1 to Phase 2b, reducing development time by ∼2 years. PK and safety results from Phase 2b (SOCRATES-REDUCED) and Phase 3 (VICTORIA) trials confirmed that use of this translational approach to predict dose ranges of vericiguat was successful.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Funding for this research was provided by Bayer AG, Berlin, Germany Figure 1
Collapse
Affiliation(s)
- M Meyer
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | | | - R Loosen
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - K Coboeken
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - S Willmann
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - R Burghaus
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - J Lippert
- Bayer AG, Pharmacometrics, Wuppertal, Germany
| | - W Mueck
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| |
Collapse
|
17
|
Boettcher MF, Duengen HD, Corcea V, Donath F, Fuhr R, Gal P, Mikus G, Trenk D, Werner N, Pires P, Maschke C, Aliprantis A, Besche N, Becker C. Vericiguat: a QTc interval study in patients with coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vericiguat is a soluble guanylate cyclase stimulator developed for the treatment of symptomatic chronic heart failure (HF) in adult patients with ejection fraction less than 45% who had a previous decompensation event. Guidelines on QT studies recommend evaluation of investigational drugs at supratherapeutic exposures in healthy volunteers. We anticipated that supratherapeutic doses of vericiguat would decrease blood pressure. We conducted an adjusted QT study using the therapeutic range of vericiguat in patients with coronary artery disease (CAD), who were expected to be more haemodynamically stable with fewer confounders (e.g., on the electrocardiogram) than a HF population.
Purpose
To assess the effect of vericiguat 10 mg once-daily on placebo-adjusted change from baseline of the Fridericia-corrected QT interval (QTcF) in patients with stable CAD.
Methods
This was a randomised, Phase Ib, placebo-controlled, double blind, double-dummy, multicentre study (NCT03504982). Test drug was vericiguat once-daily (up-titrated from 2.5 mg to 5 mg and then to 10 mg [treatments A, B, C] at 14-day intervals). The positive control was moxifloxacin 400 mg (single dose on Day 8 or Day 50 with placebo on other days [treatment D]; Figure). Patients were randomised to one of two sequences.
We evaluated QTcF interval prolongation potential of vericiguat at increasing doses up to 10 mg, steady state. We investigated the pharmacokinetics, safety and tolerability of vericiguat. A clinically meaningful effect was defined as a QTcF change from baseline >10 ms relative to placebo. Assay sensitivity for moxifloxacin was confirmed by the lower limit of the 90% confidence interval (CI) of the time-matched, baseline-adjusted mean difference to placebo exceeding 5 ms at >1 time point.
Results
A total of 74 patients (66 males and 8 females) with CAD, mean (standard deviation) age 63.4 (8.0) years, were included. Mean difference between vericiguat and placebo in QTcF change from baseline (≤7 h post-dose) was <6 ms; no upper limit of the 90% CIs crossed the threshold of 10 ms. Lower limits of the two-sided 90% CI of the differences between moxifloxacin and placebo in QTcF change from baseline were >5 ms at 3 of 4 time points (Table).
Peak plasma concentration (Cmax) of vericiguat following administration of vericiguat 10 mg was 322 μg/l and median time of maximum concentration (Tmax) was 4.5 h post-dose, in line with concentrations observed following administration of vericiguat 10 mg to patients with HF [1]. For moxifloxacin 400 mg, Cmax was 1960 μg/l and median Tmax was 3 h post-dose, in line with previously reported values [2]. Vericiguat up to 10 mg was generally safe and well tolerated.
Conclusion
This study supports the assessment that administration of vericiguat 10 mg is not associated with clinically meaningful QTc prolongation. These data contribute to the overall safety profile of vericiguat for the treatment of patients with HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Funding was provided by Bayer AG, Berlin, Germany, and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA QTc study design
Collapse
Affiliation(s)
| | - H.-D Duengen
- Charite Universitatsmedizin Berlin, Department of Internal Medicine, Cardiology, Berlin, Germany
| | - V Corcea
- PMSI Clinical Republican Hospital “T. Mosneaga”, Department of Cardiac Surgery, Chisinau, Moldova (Republic of)
| | - F Donath
- SocraTec R&D GmbH, Erfurt, Germany
| | - R Fuhr
- PAREXEL, DRK Hospital Berlin, Berlin, Germany
| | - P Gal
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - G Mikus
- University Hospital of Heidelberg, Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - N Werner
- University Hospital Bonn, Heart Center, Department of Medicine II, Bonn, Germany
| | - P.V Pires
- Bayer AG, Research & Development, Wuppertal, Germany
| | - C Maschke
- Bayer AG, Study Management, Wuppertal, Germany
| | - A.O Aliprantis
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - N Besche
- Chrestos Concept GmbH & Co. KG, Essen, Germany
| | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| |
Collapse
|
18
|
Stewart B, Dean JG, Koek A, Chua J, Wabl R, Martin K, Davoodian N, Becker C, Himedan M, Kim A, Albin R, Chou KL, Kotagal V. Psychedelic-assisted therapy for functional neurological disorders: A theoretical framework and review of prior reports. Pharmacol Res Perspect 2021; 8:e00688. [PMID: 33280274 PMCID: PMC7719191 DOI: 10.1002/prp2.688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Functional neurological disorders (FNDs), which are sometimes also referred to as psychogenic neurological disorders or conversion disorder, are common disabling neuropsychiatric disorders with limited treatment options. FNDs can present with sensory and/or motor symptoms, and, though they may mimic other neurological conditions, they are thought to occur via mechanisms other than those related to identifiable structural neuropathology and, in many cases, appear to be triggered and sustained by recognizable psychological factors. There is intriguing preliminary evidence to support the use of psychedelic‐assisted therapy in a growing number of psychiatric illnesses, including FNDs. We review the theoretical arguments for and against exploring psychedelic‐assisted therapy as a treatment for FNDs. We also provide an in‐depth discussion of prior published cases detailing the use of psychedelics for psychosomatic conditions, analyzing therapeutic outcomes from a contemporary neuroscientific vantage as informed by several recent neuroimaging studies on psychedelics and FNDs.
Collapse
Affiliation(s)
- Benjamin Stewart
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jon G Dean
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Adriana Koek
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jason Chua
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Wabl
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kayla Martin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Mai Himedan
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Kim
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Roger Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
19
|
As-Sanie S, Giudice L, Abrao MS, Wilk K, Mehedintu C, Becker C, Arjona Ferreira JC, Wagman RB, Wang F, Warsi QA, Neil J. O-132 Sustained efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT 52-week data. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
To assess the long-term (52-week) efficacy and safety of relugolix combination therapy (Relugolix-CT) in the treatment of endometriosis-associated pain.
Summary answer
Relugolix-CT demonstrated a sustained improvement of endometriosis-associated pain and maintenance of bone mineral density (BMD) over the extension treatment period. It was well tolerated.
What is known already
Endometriosis is a chronic condition characterized by symptoms of menstrual and non-menstrual pain, and dyspareunia, which have a substantial impact on women’s lives. SPIRIT 1 and 2 were Phase 3, randomized, double-blind, placebo-controlled studies of once-daily Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) in premenopausal women (age 18–50 years) with surgically diagnosed endometriosis and moderate-to-severe dysmenorrhea and non-menstrual pelvic pain (NMPP) at baseline. These trials demonstrated a significant improvement of dysmenorrhea, NMPP and dyspareunia in women treated with Relugolix-CT, with a minimal decline in BMD vs placebo over 24 weeks.
Study design, size, duration
Women who completed the 24-week pivotal studies (SPIRIT 1 and 2 trials) were eligible to enroll in an open-label, single-arm, long-term safety and efficacy extension study for an additional 80 weeks. All women received once-daily oral Relugolix-CT. Analyses were done based on original randomization in pivotal studies: Relugolix-CT, delayed Relugolix-CT (relugolix 40 mg alone for 12 weeks, then Relugolix-CT for 12 weeks), or placebo. Here, 52-week efficacy and safety outcomes are presented.
Participants/materials, setting, methods
The primary endpoints were the proportion of dysmenorrhea and NMPP responders at Week 52, based on daily Numerical Rating Scale (NRS) scores (0=no pain, 10=worst pain imaginable). A responder was a woman who achieved a predefined, clinically meaningful reduction from baseline in NRS score with no increase in analgesic use. Secondary efficacy endpoints included change in Endometriosis Health Profile-30 (EHP-30) pain domain scores, and analgesic/opioid use. Safety endpoints included adverse events (AEs) and BMD evaluation.
Main results and the role of chance
Of 1261 randomized patients, 1044 completed the primary studies; 802 enrolled in the long-term extension and 681 completed 52 weeks of treatment. Baseline demographics and clinical characteristics of the extension population were consistent with those of the original randomized population.
Sustained improvement of endometriosis-associated pain was demonstrated with Relugolix-CT through 52 weeks, the proportion of responders for dysmenorrhea was 84.8% and 73.3% for NMPP.
NRS least squares (LS) mean scores for dysmenorrhea and NMPP decreased from 7.4 (severe) and 6.0 (moderate) at SPIRIT study baseline to 1.3 (mild) and 2.2 (mild) at Week 52, equating to 82.8% and 62.9% reduction in dysmenorrhea and NMPP, respectively. Mean NRS for dyspareunia decreased from 5.9 (moderate) to 2.4 (mild), demonstrating 60.1% reduction with Relugolix-CT.
Daily functioning measured by the EHP-30 pain domain score was improved (–38.1 point) and the majority of women (85.6%) were opioid-free at Week 52. There was no disproportionate increase in the incidence of AEs in the Relugolix-CT group with no new safety signals identified through the 52 weeks. BMD was preserved over the extension period with overall LS mean change from baseline to Week 52 of –0.83% (95% CI: –1.34, –0.32) for lumbar spine in the Relugolix-CT group.
Limitations, reasons for caution
The study was conducted as an open-label study without a control group over the 28 weeks of the extension period.
Wider implications of the findings
Relugolix-CT demonstrated a sustained improvement of dysmenorrhea, NMPP, and dyspareunia, and reduced pain-related functional limitations and the need for opioids over 52 weeks in women with moderate-to-severe endometriosis-associated pain. Relugolix-CT was generally well tolerated and associated with minimal BMD loss after treatment initiation followed by BMD maintenance over 52 weeks.
Trial registration number
NCT03654274
Collapse
Affiliation(s)
- S As-Sanie
- University of Michigan, Obstetrics and Gynecology, Ann Arbor- Michigan, U.S.A
| | - L Giudice
- University of California San Francisco, School of Medicine, San Francisco, U.S.A
| | - M S Abrao
- Sao Paulo University, Obstetrics and Gynaecology, Sao Paulo, Brazil
| | - K Wilk
- Boni Fratres Hospital, Obstetrics and Gynecology Department, Katowice, Poland
| | - C Mehedintu
- Carol Davila University of Medicine and Pharmacy, Obstetrics and Gynaecology, Bucharest, Romania
| | - C Becker
- John Radcliffe Hospital, Nuffield Department of Women’s and Reproductive Health, Headington Oxford, United Kingdom
| | | | - R B Wagman
- Myovant Sciences- Inc., Clinical Development, Brisbane- California, U.S.A
| | - F Wang
- Myovant Sciences- Inc., Clinical Development, Brisbane- California, U.S.A
| | - Q A Warsi
- Myovant Sciences- Inc., Clinical Development, Brisbane- California, U.S.A
| | - J Neil
- Robinson Research Institute- Auckland Gynaecology Group and Repromed Auckland, Gynaecology, Auckland, New Zealand
| |
Collapse
|
20
|
Becker C, Kotarski J, Mehedintu C, Reznichenko G, Imm SJ, Warsi QA, Rakov VG, As-Sanie S. O-131 The effect of time since surgical diagnosis of endometriosis on treatment outcomes with relugolix combination therapy in women with endometriosis-associated pain: SPIRIT program. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To assess the efficacy of Relugolix-CT vs placebo in women who were surgically diagnosed with endometriosis <5 and > = 5 years ago.
Summary answer
Treatment outcomes did not differ for dysmenorrhea and daily functioning between subgroups of patients with <5 years or ≥ 5 years since surgical diagnosis.
What is known already
Time since clinical manifestation and diagnosis of endometriosis may influence the treatment success of patients with endometriosis-associated pain. SPIRIT 1 and 2 were randomized, double-blind, placebo-controlled Phase 3 studies of Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) in premenopausal women (age 18–50 years) with surgically diagnosed endometriosis and a history of moderate-to-severe dysmenorrhea and non-menstrual pelvic pain (NMPP). These studies previously demonstrated that Relugolix-CT significantly reduced dysmenorrhea and NMPP, and improved daily functioning measured by the Endometriosis Health Profile-30 (EHP-30) pain domain score vs placebo over 24 weeks.
Study design, size, duration
Premenopausal women with surgically diagnosed endometriosis and moderate-to-severe dysmenorrhea and NMPP at baseline were randomized 1:1:1 to 24 weeks of treatment with once daily oral Relugolix-CT, delayed Relugolix-CT (relugolix 40 mg monotherapy for 12 weeks followed by Relugolix-CT for 12 weeks), or placebo. The proportion of dysmenorrhea and NMPP responders at Week 24/End-of-Treatment (EoT), based on daily Numerical Rating Scale (NRS), and analgesic use status were co-primary endpoints.
Participants/materials, setting, methods
Pooled SPIRIT 1 and 2 data of patients who received 24 weeks of treatment with once daily Relugolix-CT (N = 418) or placebo (N = 416) are presented. Outcomes for the delayed Relugolix-CT group were only for the safety assessment and therefore not reported here. Analyses of NRS scores for dysmenorrhea, NMPP, and EHP-30 pain domain score were carried out in the subgroups of patients with time since diagnosis of < 5 years (N = 579) and ≥5 years (N = 255).
Main results and the role of chance
Baseline demographics and clinical characteristics were comparable between the time since diagnosis subgroups except for a numerically higher mean age in the ≥5-years subgroup. Mean time since diagnosis (standard deviation) was 2.1 (1.5) years with both Relugolix-CT and placebo for <5-years subgroup, and 8.0 (2.8) and 7.8 (2.3) years, respectively, for ≥5-years subgroup.
In Relugolix-CT-treated patients, mean NRS score for dysmenorrhea decreased from 7.5 (severe) to 1.8 (mild) in the <5-years subgroup and from 6.9 (moderate) to 1.8 (mild) in the ≥5-years subgroup with a significant difference to placebo (p < 0.0001, both subgroups), and demonstrating 74.8% and 72.7% reduction in pain from baseline to Week 24/EoT, respectively. Mean NRS score for NMPP decreased from 6.0 (moderate) to 3.0 (mild) with a significant difference compared with placebo (p < 0.0001), equating to 48.8% pain reduction in the <5-years subgroup, and from 5.6 (moderate) to 2.7 (mild) equating to 51.5% pain reduction (p = 0.089) in the ≥5-years subgroup. Improvement of daily functioning as measured by EHP-30 pain domain score was significantly greater with Relugolix-CT vs placebo in both subgroups, with decrease in EHP-30 pain score from 59.1 to 24.0 in the <5-years subgroup, and from 57.4 to 21.1 in the ≥5-years subgroup (p < 0.0001, both subgroups).
Limitations, reasons for caution
A lower number of patients were included into the subgroup with ≥5-years since surgically diagnosed endometriosis. Five-year dichotomy was close to the mean time since surgical diagnosis in the studies and to certain extent is arbitrary. Furthermore, time since surgical diagnosis is not the same as time since symptom onset.
Wider implications of the findings
In women with endometriosis-associated pain, Relugolix-CT vs placebo significantly reduced dysmenorrhea and improved daily functioning in both groups: with surgical diagnosis of < 5 years or ≥ 5 years. Substantial decrease in NMPP was also observed and was significantly different to placebo in the <5-years subgroup.
Trial registration number
NCT03204318 and NCT03204331
Collapse
Affiliation(s)
- C Becker
- John Radcliffe Hospital, Nuffield Department of Women’s and Reproductive Health, Headington- Oxford, United Kingdom
| | - J Kotarski
- Medical University of Lublin, Department of Gynecological Oncology and Gynecology, Lublin, Poland
| | - C Mehedintu
- Carol Davila University of Medicine and Pharmacy, Obstetrics and Gynaecology, Bucharest, Romania
| | - G Reznichenko
- Clinical Maternity Hospital # 4 Zaporizhzhya, Department of Obstetrics and Gynecology, Zaporizhzhya, Ukraine
| | - S J Imm
- Myovant Sciences- Inc., Myovant, Brisbane, U.S.A
| | - Q A Warsi
- Myovant Sciences- Inc., Myovant, Brisbane, U.S.A
| | - V G Rakov
- Myovant Sciences- Inc., Myovant, Brisbane, U.S.A
| | - S As-Sanie
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, U.S.A
| |
Collapse
|
21
|
Mansour N, Backes C, Becker C, Hofauer B, Knopf A. [Clear resection margins to avoid escalation of adjuvant therapy in oropharyngeal squamous cell carcinoma]. HNO 2021; 69:256-262. [PMID: 32975607 PMCID: PMC7997822 DOI: 10.1007/s00106-020-00932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Resection margins in patients with oropharyngeal squamous cell carcinoma (OPSCC) are a predictive marker for overall survival (OS) and recurrence-free interval (RFI). Adjuvant therapy is influenced by TNM status, extracapsular extension (ECE), and resection margin status (R) of the primary tumor. The R status can be directly influenced by the head and neck surgeon. The aim of the current study was to evaluate the impact of R status on treatment decisions, RFI, and OS. MATERIALS AND METHODS All patients with OPSCC who underwent surgery (with/without adjuvant therapy) between 2001 and 2011 were enrolled. Clinical data, survival parameters, histologic data such as ECE, resection margin status, and tumor size were retrospectively collected and analyzed. RESULTS A total of 208 patients were enrolled. Survival parameters showed that patients with microscopically clear (R0) resection margins had an RFI/OS of 89/87 months. These values decreased in patients with R1 (65/65 months), R2 (38/33 months), and Rx (unclear) resections (59/45 months; p = 0.036/p = 0.001). In patients with ECE and R1 resection, but also in those with R0 resections achieved by follow-up resection and those with Rx resections, adjuvant therapy was escalated. CONCLUSION Unclear resection status reduces OS and RFI in patients with OPSCC. Therefore, in surgical therapy, clear resection status in the first pass should be strived for to avoid escalation of adjuvant therapy due to an unclear R status.
Collapse
Affiliation(s)
- N Mansour
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - C Backes
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - C Becker
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - B Hofauer
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - A Knopf
- Klinik für Hals, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| |
Collapse
|
22
|
Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr 2021; 54:152-160. [PMID: 33595696 PMCID: PMC7887547 DOI: 10.1007/s00391-021-01864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.
Collapse
Affiliation(s)
- R Wirth
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland.
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Becker
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - M Djukic
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Drebenstedt
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, St.-Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - H J Heppner
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Helios Klinikum Schwelm, Lehrstuhl für Geriatrie, Universität Witten-Herdecke, Schwelm, Deutschland
| | - A H Jacobs
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie mit Neurologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland
- CIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- EIMI, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - M Meisel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau, Dessau, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - R Nau
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - J Pantel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - J M Bauer
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum und Netzwerk Altersmedizin, Agaplesion Bethanien Krankenhaus Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| |
Collapse
|
23
|
Pölcher M, Braun M, Tischitz M, Hamann M, Szeterlak N, Kriegmair A, Brambs C, Becker C, Stoetzer O. Concordance of the molecular subtype classification between core needle biopsy and surgical specimen in primary breast cancer. Arch Gynecol Obstet 2021; 304:783-790. [PMID: 33585986 DOI: 10.1007/s00404-021-05996-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Molecular profiling of breast cancer (BC) classifies several intrinsic subtypes based on different patterns of gene expression. Multigene assays estimate the risk of recurrence and help to select high-risk patients for adjuvant chemotherapy. However, these tests are associated with significant costs. Immunohistochemistry (IHC) offers a surrogate classification for molecular subtypes by determining estrogen (ER) and progesterone receptors (PR), human epidermal growth factor (Her2neu), as well as the proliferation marker Ki67. Core needle biopsy (CNB) is well established in BC diagnosis and allows a pre-operative assessment of biomarkers. The aim of this study was to analyze the concordance of these markers between CNB and surgical specimens to assess whether re-testing of the surgical specimen is mandatory. MATERIALS AND METHODS Within a 3-year period, patients with primary BC and paired samples of CNB and surgical specimens were analyzed retrospectively. Concordance rates of ER, PR, Her2neu, Ki67, and the surrogate classification for molecular subtypes were calculated using the Landis and Koch agreement grades. RESULTS Out of 2254 patients with primary breast cancer, 1307 paired specimens without pre-operative treatment were available for analysis Concordance rates for ER, PR, Her2neu, and Ki67 status showed substantial-to-almost perfect agreement grades (κ = 0.91, 0.75, 0.89, and 0.61, respectively). Though substantial concordance was also found for the subtype classification (κ = 0.70), the molecular subtype changed in 18.5% of patients based on the testing of the surgical specimen, mainly from luminal A-like to luminal B-like. CONCLUSIONS Though the concordance rates for single markers were convincing, a significant proportion of the molecular subtypes differed between CNB and the surgical specimen. Re-testing of PR and Ki67 is mandatory to ensure optimal treatment decisions. Further research is necessary to define safe, efficient, and cost-effective predictive models in adjuvant breast cancer therapy.
Collapse
Affiliation(s)
- M Pölcher
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany.
| | - M Braun
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - M Tischitz
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - M Hamann
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - N Szeterlak
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - A Kriegmair
- Department of Gynecology, Rotkreuzklinikum München, Taxisstraße 3, 80637, Munich, Germany
| | - C Brambs
- School of Medicine, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - C Becker
- Department of Pathology, Rotkreuzklinikum München, Winthirstraße 11, 80639, Munich, Germany
| | - O Stoetzer
- MVZ (Ambulatort Health Care Center) for Hematology and Oncology, Winthirstraße 11, 80639, Munich, Germany
| |
Collapse
|
24
|
Hofauer B, Mansour N, Becker C, Ketterer MC, Knopf A. [Functional outcomes after surgical treatment of oropharyngeal carcinomas]. HNO 2021; 69:95-100. [PMID: 32430667 DOI: 10.1007/s00106-020-00887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The primary goal of surgical resection of oropharyngeal carcinoma (OPSCC) is an R0 resection. The extension of the primary tumor is decisive for selection of access route, which should be as circumscribed as possible but as radical as necessary. To date, there are no prospective comparative studies that compared functional outcome in terms of surgical access route. MATERIALS AND METHODS A selective literature search was carried out for the period from 01/01/2000 to 12/31/2019 to assess the functional result after different surgical approaches in the treatment of OPSCC. The search strategy aimed to identify publications that investigated the functional result of transoral approaches, robot-assisted transoral resections (TORS), and surgical resection using pharyngotomies or transmandibular approaches. RESULTS Various measures were identified which enable subjective and objective assessment of swallowing and speaking restrictions. For all surgical access routes, studies were identified that examined the functional aspects of the respective access, but there are no direct comparisons between the individual approaches. CONCLUSION There are various surgical approaches available for resection of OPSCC, each of which has been examined in various studies with regard to its oncological and functional results.
Collapse
Affiliation(s)
- B Hofauer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - N Mansour
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A Knopf
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| |
Collapse
|
25
|
Becker C, Hofauer BG, Mansour N, Ketterer MC, Schulz T, Knopf A. [The 8th edition of the TNM staging system-a curse or a blessing for oropharyngeal carcinoma?]. HNO 2021; 69:89-94. [PMID: 32385531 DOI: 10.1007/s00106-020-00875-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
At the beginning of 2017, the 8th edition of the TNM classification was presented. For oropharyngeal carcinoma, this was accompanied by a paradigm shift, as a separation of the classification depending on the association with human papillomavirus (HPV) status has been established. By considering the literature, this paper provides an overview of the characteristics of HPV-associated carcinomas, the new features of the TNM classification, and the existing points of discussion. The revision has improved the prognostic significance of the TNM classification; however, there are still tumor- and patient-dependent influencing factors that must be considered for future versions.
Collapse
Affiliation(s)
- C Becker
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - B G Hofauer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Mansour
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Schulz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| |
Collapse
|
26
|
Frechen S, Ince I, Dallmann A, Gerisch M, Jungmann N, Becker C, Lobmeyer M, Trujillo M, Xu S, Burghaus R, Meyer M. Physiologically-based pharmacokinetic (PBPK) exploration of extrinsic factors influencing vericiguat pharmacokinetics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Vericiguat is a once daily, novel oral stimulator of soluble guanylate cyclase (sGC) that showed clinical benefit in the Phase III VICTORIA study in heart failure patients with reduced ejection fraction (HFrEF, NCT02861534). Nonclinical and clinical studies demonstrated that the primary route of elimination of vericiguat was glucuronidation to an inactive metabolite M-1 (N-glucuronide). This glucuronidation was catalyzed by uridine 5'-diphospho-glucuronosyltransferases (UGT)1A9 as well as UGT1A1, thus vericiguat may have a potential for victim drug-drug interaction (DDI) when co-administered with potent UGT inhibitors.
Purpose
In a clinical DDI study with mefenamic acid as an UGT1A9 inhibitor no clinically relevant increase in vericiguat exposure in healthy subjects was observed (EudraCT 2014–000764–17). This analysis aims to prospectively investigate as extrinsic factors the DDI potential with atazanavir as a selective UGT1A1 inhibitor via full dynamic physiologically-based pharmacokinetic (PBPK) modelling.
Methods
A PBPK model for vericiguat and M-1 in healthy adults was built with PK-Sim (PBPK platform as part of the Open Systems Pharmacology Suite) by integrating physicochemical, in vitro metabolism and transporter data as well as PK data from clinical pharmacology studies in order to assess the victim DDI potential of vericiguat when co-administered with UGT inhibitors. First, PBPK models for mefenamic acid and atazanavir were separately developed and verified using published literature data. The PBPK model for vericiguat was then verified with regard to its fraction of metabolism by UGTs by comparing simulated and observed data of the clinical mefenamic acid DDI study. Finally, the UGT1A1 DDI potential of vericiguat was prospectively predicted by simulating an in silico study between the UGT1A1 inhibitor atazanavir and vericiguat.
Results
In line with the results of the clinical DDI study with mefenamic acid, an increase in total vericiguat exposure by 14% (area under the concentration time curve ratio (AUCR) of 1.14 (geoCV 5.3%; 90% population interval: 1.06 to 1.25) and peak exposure increase by 6% (CmaxR of 1.06; geoCV 5.9%; 90% population interval: 1.01 to 1.20) was simulated using the PBPK model. A prospective prediction of a virtual DDI trial between the UGT1A1 inhibitor atazanavir yielded an AUCR of 1.12 (geoCV 2.9%; 90% population interval: 1.07 to 1.17) and a CmaxR of 1.04 (geoCV 1.1%; 90% population interval: 1.03 to 1.06). The proposed population intervals for AUCR and CmaxR for both DDI studies lie within the default no-effect boundary of 0.80 to 1.25 according to the to January 2020 FDA DDI guideline.
Conclusion(s)
Results of UGT1A9-DDI simulations were consistent with those of the clinical study-The prospective UGT1A1-DDI simulation results suggest a low potential for vericiguat to be subject to DDI when co-administered with UGT1A1 inhibitors.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Funding for this research was provided by Bayer and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
Collapse
Affiliation(s)
- S Frechen
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - I Ince
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | - A Dallmann
- Bayer AG, Clinical Pharmacometrics, Lerverkusen, Germany
| | | | | | - C Becker
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Lobmeyer
- Bayer AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Trujillo
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - S Xu
- Merck Sharp & Dohme Corp., Inc., Kenilworth, United States of America
| | - R Burghaus
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
| | - M Meyer
- Bayer AG, Clinical Pharmacometrics, Wuppertal, Germany
| |
Collapse
|
27
|
Boettcher M, Aliprantis A, Lobmeyer M, Meyer M, Mueck W, Trujillo M, Becker C. Vericiguat clinical pharmacology programme: biopharmaceutical properties and potential intrinsic and extrinsic factor effects. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The Phase III VICTORIA study (NCT02861534), which evaluated vericiguat vs placebo in patients with worsening chronic heart failure (WCHF) with ejection fraction <45%, demonstrated a significant reduction in the primary composite endpoint of cardiovascular death and HF hospitalisation.
Purpose
A comprehensive clinical pharmacological programme of 28 Phase I trials in >650 participants was performed to inform use of vericiguat.
Methods
Biopharmaceutical properties, pharmacokinetics (PK) and the potential for intrinsic factors to influence vericiguat dose administration were investigated. The PK and pharmacodynamic (PD) interaction potential of vericiguat with other drugs was assessed.
Results
Vericiguat had a mean half-life of approximately 24 h and high bioavailability when taken with food, leading to the recommendation of once daily dosing with food. Due to the multi-pathway metabolism and excretion profile of vericiguat, there was a low risk of PK drug–drug interactions (DDI; Table). No clinically relevant PD DDI were identified between vericiguat and aspirin, warfarin, sacubitril/valsartan or nitrates. There was a relatively minor influence of intrinsic factors on vericiguat PK.
Conclusion
This clinical pharmacology programme supports use of vericiguat in patients with WCHF who are characterised by multiple comorbidities and polypharmacy.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Funding for this research was provided by Bayer AG, Berlin, Germany and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
Collapse
Affiliation(s)
- M Boettcher
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - A.O Aliprantis
- Merck and Co., Inc., Kenilworth, New Jersey, United States of America
| | - M Lobmeyer
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - M Meyer
- Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - W Mueck
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| | - M Trujillo
- Merck and Co., Inc., Kenilworth, New Jersey, United States of America
| | - C Becker
- Clinical Pharmacology, Bayer AG, Wuppertal, Germany
| |
Collapse
|
28
|
Rohse P, Butlewski J, Klein F, Wagner T, Friesen C, Schwarz A, Wiesendanger R, Sengstock K, Becker C. A cavity optomechanical locking scheme based on the optical spring effect. Rev Sci Instrum 2020; 91:103102. [PMID: 33138582 DOI: 10.1063/5.0010255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
We present a novel locking scheme for active length-stabilization and frequency detuning of a cavity optomechanical device based on the optical spring effect. The error signal is generated by utilizing the position measurement of a thermally driven intra-cavity nanomechanical device and employing its detuning-dependent frequency shift caused by the dispersive coupling to the cavity field. The scheme neither requires external modulation of the laser or the cavity nor does it demand for additional error signal readout, rendering its technical implementation rather simple for a large variety of existing optomechanical devices. Specifically, for large-linewidth microcavities or in situations where other locking schemes appear unfavorable conceptually or are hard to realize technically, the optical spring lock represents a potential alternative for stabilizing the cavity length. We explain the functional principle of the lock and characterize its performance in terms of bandwidth and gain profile.
Collapse
Affiliation(s)
- P Rohse
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - J Butlewski
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - F Klein
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - T Wagner
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - C Friesen
- INF (Institut für Nanostruktur- und Festkörperphysik), Universität Hamburg, Jungiusstraße 9, 20355 Hamburg, Germany
| | - A Schwarz
- INF (Institut für Nanostruktur- und Festkörperphysik), Universität Hamburg, Jungiusstraße 9, 20355 Hamburg, Germany
| | - R Wiesendanger
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - K Sengstock
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - C Becker
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| |
Collapse
|
29
|
Offergeld C, Ketterer M, Neudert M, Hassepaß F, Weerda N, Richter B, Traser L, Becker C, Deeg N, Knopf A, Wesarg T, Rauch AK, Jakob T, Ferver F, Lang F, Vielsmeier V, Hackenberg S, Diensthuber M, Praetorius M, Hofauer B, Mansour N, Kuhn S, Hildenbrand T. ["Online from tomorrow on please": comparison of digital framework conditions of curricular teaching at national university ENT clinics in times of COVID-19 : Digital teaching at national university ENT clinics]. HNO 2020; 69:213-220. [PMID: 32929523 PMCID: PMC7490113 DOI: 10.1007/s00106-020-00939-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Hintergrund Die Corona-Krise beeinflusst nicht nur das professionelle Handeln, sondern auch die Lehre an den Universitäten. Schlagworte wie „E-Learning“ und „Digitalisierung“ suggerieren die Möglichkeit innovativer, ad hoc verfügbarer Lösungsansätze für die Lehre in der aktuellen COVID-19-Situation. Die aktuelle Umstellung auf digitale Lehre ist aber nicht primär durch eine didaktische Sinnhaftigkeit oder institutionelle Strategie, sondern durch äußere Notwendigkeit geprägt. Ziel der Arbeit Ziel der Arbeit war die Erfassung der Lehrsituation an nationalen Universitäts-HNO-Kliniken und akademischen Lehrkrankenhäusern zu Beginn des virtuellen Corona-Sommersemesters 2020. Material und Methode Ein eigens erstellter Fragebogen zur jeweiligen lokalen Situation, den örtlichen Rahmenbedingungen sowie zu bundesweiten Szenarien wurde an alle 39 nationalen Universitäts-HNO-Kliniken und 20 akademischen Lehrkrankenhäuser mit HNO-Hauptabteilung versandt. Ergebnisse Die ausgefüllten Fragebögen von 31 Universitätskliniken (UK) und 10 akademische Lehrkrankenhäuser (ALK) gingen in die Auswertung ein. Es zeigten sich offensichtliche Diskrepanzen zwischen verfügbaren Ressourcen und tatsächlich verfügbaren digitalisierten Lehrinhalten. Weitere Kritikpunkte offenbarten sich in Bezug auf die Kommunikation mit der Medizinischen Fakultät, die digitale Infrastruktur und insbesondere in der oftmals mangelnden Kollaboration mit den zentralen Supportstrukturen, wie Medien‑, Didaktik- und Rechenzentren. Schlussfolgerung Es gibt durchaus positive Beispiele für eine gelungene Überführung der Präsenzlehre in das ausschließlich virtuelle Sommersemester 2020 innerhalb der Universitäts-HNO-Kliniken. Mehrheitlich aber überwiegen kritische Einschätzungen der Lehrbeauftragten bzw. Ärztlichen Direktoren gegenüber der aktuellen Lehrsituation. Eine zeitkritische strategische Weiterentwicklung ist dringend erforderlich.
Collapse
Affiliation(s)
- C Offergeld
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - M Ketterer
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M Neudert
- Univ.-HNO-Klinik, Med. Fakultät, Technische Universität Dresden, Dresden, Deutschland
| | - F Hassepaß
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Weerda
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - B Richter
- Institut für Musikermedizin, Med. Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
| | - L Traser
- Institut für Musikermedizin, Med. Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
| | - C Becker
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Deeg
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A Knopf
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Wesarg
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A-K Rauch
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Jakob
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - F Ferver
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - F Lang
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - V Vielsmeier
- Univ.-HNO-Klinik, Med. Fakultät, Universität Regensburg, Regensburg, Deutschland
| | - S Hackenberg
- Univ.-HNO-Klinik, Med. Fakultät, Julius-Maximilians-Universität, Würzburg, Deutschland
| | - M Diensthuber
- Univ.-HNO-Klinik, Med. Fakultät, , Goethe Universität, Frankfurt/M, Deutschland
| | - M Praetorius
- Univ.-HNO-Klinik, Med. Fakultät, Ruprecht-Karls-Universität, Heidelberg, Deutschland
| | - B Hofauer
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Mansour
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| | - S Kuhn
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin, Johannes Gutenberg-Universität, Mainz, Deutschland
| | - T Hildenbrand
- Univ.-HNO-Klinik, Med. Fakultät, Albert-Ludwigs-Universität, Killianstraße 5, 79106, Freiburg, Deutschland
| |
Collapse
|
30
|
Becker C, Burger M. [DGU research grants 2020]. Urologe A 2020; 59:733-736. [PMID: 32435864 DOI: 10.1007/s00120-020-01230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- C Becker
- Ressort Forschungsförderung, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Deutschland.
| | - M Burger
- Ressort Forschungsförderung, Deutsche Gesellschaft für Urologie, Düsseldorf/Berlin, Deutschland.,Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Regensburg, Deutschland
| |
Collapse
|
31
|
Schulz C, König HH, Rapp K, Becker C, Rothenbacher D, Büchele G. Analysis of mortality after hip fracture on patient, hospital, and regional level in Germany. Osteoporos Int 2020; 31:897-904. [PMID: 31822928 DOI: 10.1007/s00198-019-05250-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
UNLABELLED Knowledge about risk factors of mortality after hip fracture might encourage prevention and further improvements in care. This study identified patient risk factors as well as hospital and regional characteristics associated with a decreased risk. Variation of mortality was largest on patient level and modest on hospital and regional level. INTRODUCTION Among numerous studies analyzing mortality as worst consequence after hip fracture, the majority focused on patient level and fewer on hospital and regional level. Comprehensive knowledge about contributing factors on all levels might help to reveal relevant inequalities, which would encourage prevention and further improvements in care. This study aimed at investigating variation of mortality after hip fracture on patient, hospital, and regional level in Germany. METHODS We performed a retrospective cohort study on hip fracture patients aged 65 and older using statutory health insurance claims data from Jan 2009 through Dec. 2012 and additional information from the Federal Statistical Office Germany. Regions were classified based on two-digit postal code. We applied a multilevel Cox proportional hazard model with random intercepts on hospital and regional level to investigate the risk factors for mortality within 6 and 12 months after hip fracture. RESULTS The dataset contained information on 123,119 hip fracture patients in 1014 hospitals in 95 German regions. Within 6/12 months, 20.9%/27.6% of the patients died. On patient level, male sex, increasing age, increased pre-fracture care level, and increasing comorbidity were associated with an increased hazard of mortality. Hospitals with increasing hip fracture volume or with orthogeriatric co-management and regions with increased population density were associated with a decreased hazard. Variation was largest on patient level and rather modest on hospital and regional level. CONCLUSIONS The identification of patient-related risk factors enables prognosticating mortality after hip fracture. After adjusting for those, variation seemed to be attributable rather to hospitals than to regions.
Collapse
Affiliation(s)
- C Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| |
Collapse
|
32
|
Büchele G, Rapp K, Bauer J, Jaensch A, Becker C, Benzinger P. Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon. Aging Clin Exp Res 2020; 32:441-447. [PMID: 31102254 DOI: 10.1007/s40520-019-01215-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon. AIMS The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status. METHODS The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider. RESULTS Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively). CONCLUSIONS OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.
Collapse
|
33
|
Alballaa A, Aschendorff A, Arndt S, Hildenbrand T, Becker C, Hassepass F, Laszig R, Beck R, Speck I, Wesarg T, Ketterer MC. [Incomplete partition type III revisited-long-term results following cochlear implant. German version]. HNO 2019; 67:760-768. [PMID: 31485697 DOI: 10.1007/s00106-019-00733-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incomplete partition type III (IP III) is defined by a missing lamina cribrosa between the cochlea and the internal auditory canal (IAC). Cochlear implantation (CI) may result in an insertion of the electrode array into the IAC. The aim of this study is to evaluate CI surgery protocols, long-term audiological outcome, mapping and electrophysiological data after CI in IP III patients. MATERIALS AND METHODS Nine IP III patients were implanted with perimodiolar electrode arrays between 1999 and 2014; eight of them were included in this study. We evaluated mapping data, stapedius reflexes, electrode impedances and ECAP thresholds. We matched them with 3 CI patients each with normal cochlear morphology regarding sex, age, side, implant type and surgical date. Speech discrimination was evaluated with the Oldenburger sentence test for adults, Göttingen audiometric speech test for children and the Freiburger monosyllabic word test. RESULTS 3 years after CI IP III patients showed a significant increase in pulse width, calculated electric load and electrode impedances in basal electrodes. Intraoperative electrically-evoked stapedius reflexes could be measured in all patients. Speech recognition scores were lower than average scores for matched patients, but without statistical significance. CONCLUSIONS The significant increase of pulse width, electric load and electrode impedances of basal electrodes over time seem to be characteristic for IP III patients probably occurring due to fibrosis and neurodegeneration of the cochlear nerve. The long term audiological results are stable. Intraoperative imaging and stapedius reflexes are highly recommended to control the right position of the electrode array.
Collapse
Affiliation(s)
- A Alballaa
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
- Department of Otolaryngology, King Abdulaziz University Hospital, King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Aschendorff
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - S Arndt
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Hildenbrand
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - C Becker
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - F Hassepass
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - R Laszig
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - R Beck
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - I Speck
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Wesarg
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| |
Collapse
|
34
|
Becker C, Pierard S, Pasquet A, Poncelet A, De Beco G, Momeni M. The value of three-dimensional echocardiography in the evaluation of cor triatrium sinister. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
35
|
Spies-Upton S, Gade S, Gonzalez J, Choi E, Becker C, Creekpaum M, Lucas E, Escher C, Gomez R. A-23 Mental Illness and Emotional Functioning as Moderated by Executive Functioning: Incarcerated Population. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
The purpose of this study is to investigate whether executive functioning will moderate the relationship of a history of mental illness on aggression in a male forensic population.
Method
Using an archival database from a larger study, 232 male inmates (ages 21 and 49 years old) from three medium/maximum Maryland Correctional facilities were recruited using a pseudo-random selection process during intake. Participants were administered three EF tasks (Cambridge Decision Making Task, Logan Stop-Signal Task, and Stroop Interference Task), history of mental illness was obtained using the Symptom Checklist-90, and aggression was assessed with the Novaco Reaction to Provocation Questionnaire.
Results
Hierarchical multiple regressions were conducted. For overall aggression reactivity, inhibition moderated depression (IR2 = .025, F(3, 224) = 9.977, p < .001, β = -.246, p = .015) and psychoticism (IR2 = .019, F(3, 224) = 8.216, p < .001, β = -.136, p = .031). For reactive aggression subtype, inhibition moderated depression (IR2 = .025, F(3, 224) = 2.679, p = .048, β = .071, p = .017). For proactive aggression subtype, cognitive flexibility moderated anxiety (IR2 = .018, F(3, 224) = 4.731, p = .003, β = -.014, p = .039); and depression (IR2 = .022, F(3, 224) = 3.888, p = .010, β = -.017, p = .025).
Conclusions
Overall, there was mixed findings for inhibition. On Cambridge Decision Making task, inhibition moderated the predictive relationship of depression on reactive aggression and psychoticism and overall aggression but not for other measures of inhibition. For another inhibition task (Stroop), inhibition did not significantly moderate any mental illness on severity of aggression. Cognitive flexibility moderated the predictive relationships of anxiety and depression on proactive aggression. Findings suggest targeting cognitive flexibility for inmates diagnosed with anxiety depression, and psychosis when treating aggression in a male forensic population.
Collapse
|
36
|
Herrmann A, Haefeli WE, Lindemann U, Rapp K, Roigk P, Becker C. [Epidemiology and prevention of heat-related adverse health effects on elderly people]. Z Gerontol Geriatr 2019; 52:487-502. [PMID: 31346679 DOI: 10.1007/s00391-019-01594-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022]
Abstract
Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States have developed recommendations for heat action plans, in which the medical profession should also participate in the prevention of heat-related damage to health. Physicians and their team should first become acquainted with the topic. In addition, they should inform patients at risk and their relatives of the risks and preventive measures. In the summer a critical check of drugs is also needed because medications impair cooling mechanisms in heat waves, the pharmacokinetics can change and unwanted side effects of drugs occur more frequently. Lastly, due to their central position in the healthcare system, physicians should participate in the coordination of a good nursing care and intensification of social contacts during heat waves.
Collapse
Affiliation(s)
- A Herrmann
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
| | - W E Haefeli
- Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Medizinische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - U Lindemann
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
| | - K Rapp
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
| | - P Roigk
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
| | - C Becker
- Abteilung für Geriatrie und Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Deutschland
| |
Collapse
|
37
|
Benzinger P, Riem S, Bauer J, Jaensch A, Becker C, Büchele G, Rapp K. Risk of institutionalization following fragility fractures in older people. Osteoporos Int 2019; 30:1363-1370. [PMID: 30877349 DOI: 10.1007/s00198-019-04922-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.
Collapse
Affiliation(s)
- P Benzinger
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany.
- Faculty of Social and Health Studies, University of Applied Sciences Kempten, Bahnhofstraße 61, 87435, Kempten, Germany.
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany.
| | - S Riem
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Klinik für Unfallchirurgie, Kreiskrankenhaus Lörrach, Spitalstraße 25, 79539, Lörrach, Germany
| | - J Bauer
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
| | - A Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
| | - G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| |
Collapse
|
38
|
Becker C. [DGU Research Grants 2019]. Urologe A 2019; 58:938-942. [PMID: 31240372 DOI: 10.1007/s00120-019-0986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Becker
- Forschungskoordination, Deutsche Gesellschaft für Urologie e. V., Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| |
Collapse
|
39
|
Taubert H, Becker C, Füssel S, Seitz G, Kristiansen G, Wach S, Wullich B. [The 16th DPKK annual conference "Urology meets Pathology"]. Urologe A 2019; 58:686-689. [PMID: 31069452 DOI: 10.1007/s00120-019-0941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- H Taubert
- Urologische und Kinderurologische Klinik, Universtitäsklinikum Erlangen, Erlangen, Deutschland
| | - C Becker
- Forschungskoordination, Geschäftsstelle Düsseldorf, Deutsche Gesellschaft für Urologie e. V., Uerdinger Str. 64, 40474, Düsseldorf, Deutschland.
| | - S Füssel
- Klinik und Poliklinik für Urologie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - G Seitz
- Institut für Pathologie, Klinikum Bamberg, Bamberg, Deutschland
| | - G Kristiansen
- Institut für Pathologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - S Wach
- Urologische und Kinderurologische Klinik, Universtitäsklinikum Erlangen, Erlangen, Deutschland
| | - B Wullich
- Urologische und Kinderurologische Klinik, Universtitäsklinikum Erlangen, Erlangen, Deutschland
| |
Collapse
|
40
|
Kiss T, Wittenstein J, Becker C, Birr K, Cinnella G, Cohen E, El Tahan MR, Falcão LF, Gregoretti C, Granell M, Hachenberg T, Hollmann MW, Jankovic R, Karzai W, Krassler J, Loop T, Licker MJ, Marczin N, Mills GH, Murrell MT, Neskovic V, Nisnevitch-Savarese Z, Pelosi P, Rossaint R, Schultz MJ, Neto AS, Severgnini P, Szegedi L, Vegh T, Voyagis G, Zhong J, de Abreu MG, Senturk M. Correction to: Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial. Trials 2019; 20:259. [PMID: 31068212 PMCID: PMC6505178 DOI: 10.1186/s13063-019-3371-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- T Kiss
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - J Wittenstein
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Becker
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - K Birr
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - G Cinnella
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
| | - E Cohen
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
| | - M R El Tahan
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - L F Falcão
- Federal University of São Paulo, Sao Paulo, Brazil
| | - C Gregoretti
- UOC Anestesia e Rianimazione A.O.Universitaria "P. Giaccone", Dipartimento Di.Chir.On.S, Università degli Studi di Palermo, Palermo, Italy
| | - M Granell
- Hospital General Universitario de Valencia, Valencia, Spain
| | - T Hachenberg
- University Hospital Magdeburg, Magdeburg, Germany
| | - M W Hollmann
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R Jankovic
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
| | - W Karzai
- Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - T Loop
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M J Licker
- University Hospital Geneva, Geneva, Switzerland
| | - N Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK.,Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - G H Mills
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
| | - M T Murrell
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
| | - V Neskovic
- Military Medical Academy, Belgrade, Serbia
| | | | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS San Martino Policlinico Hospital, Genoa, Italy
| | - R Rossaint
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - A Serpa Neto
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - P Severgnini
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell'Insubria, Varese, Italy
| | - L Szegedi
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - T Vegh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.,Outcomes Research Consortium, Cleveland, USA
| | - G Voyagis
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, "Sotiria" Chest Diseases Hospital, Athens, Greece.,Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
| | - J Zhong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Senturk
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | | |
Collapse
|
41
|
Lazzarino LL, Kazemi MM, Haunhorst C, Becker C, Hartwell S, Jakob MA, Przystawik A, Usenko S, Kip D, Hartl I, Laarmann T. Shaping femtosecond laser pulses at short wavelength with grazing-incidence optics. Opt Express 2019; 27:13479-13491. [PMID: 31052869 DOI: 10.1364/oe.27.013479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
We present the design of an extreme ultraviolet (XUV) pulse shaper relying on reflective optics. The instrument will allow tailoring of the time-frequency spectrum of femtosecond pulses generated by seeded free-electron lasers (FEL) and high-harmonic generation (HHG) sources down to a central wavelength of ~15 nm. The device is based on the geometry of a 4f grating compressor that is a standard concept in ultrafast laser science and technology. We apply it to shorter wavelengths using grazing-incidence optics operated under ultra-high vacuum conditions. The design blaze angle and the line density of the gratings allow the manipulation of all different harmonics typical for seeded FEL and HHG photon sources without the need of realignment of the instrument and even simultaneously in multi-color experiments. A proof-of-principle pulse shaping experiment using 266 nm laser light has been performed, demonstrating relative phase-control of femtosecond UV pulses.
Collapse
|
42
|
Kiss T, Wittenstein J, Becker C, Birr K, Cinnella G, Cohen E, El Tahan MR, Falcão LF, Gregoretti C, Granell M, Hachenberg T, Hollmann MW, Jankovic R, Karzai W, Krassler J, Loop T, Licker MJ, Marczin N, Mills GH, Murrell MT, Neskovic V, Nisnevitch-Savarese Z, Pelosi P, Rossaint R, Schultz MJ, Serpa Neto A, Severgnini P, Szegedi L, Vegh T, Voyagis G, Zhong J, Gama de Abreu M, Senturk M. Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial. Trials 2019; 20:213. [PMID: 30975217 PMCID: PMC6460685 DOI: 10.1186/s13063-019-3208-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. METHODS PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two different intraoperative mechanical ventilation strategies. Investigators screen patients aged 18 years or older, scheduled for open thoracic or video-assisted thoracoscopic surgery under general anesthesia requiring OLV, with a maximal body mass index of 35 kg/m2, and a planned duration of surgery of more than 60 min. Further, the expected duration of OLV shall be longer than two-lung ventilation, and lung separation is planned with a double lumen tube. Patients will be randomly assigned to PEEP of 10 cmH2O with lung RM, or PEEP of 5 cmH2O without RM. During two-lung ventilation tidal volume is set at 7 mL/kg predicted body weight and, during OLV, it will be decreased to 5 mL/kg. The occurrence of PPC will be recorded as a collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION PROTHOR is the first randomized controlled trial in patients undergoing thoracic surgery with OLV that is adequately powered to compare the effects of intraoperative high PEEP with RM versus low PEEP without RM on PPC. The results of the PROTHOR trial will support anesthesiologists in their decision to set intraoperative PEEP during protective ventilation for OLV in thoracic surgery. TRIAL REGISTRATION The trial was registered in clinicaltrials.gov ( NCT02963025 ) on 15 November 2016.
Collapse
Affiliation(s)
- T. Kiss
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J. Wittenstein
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C. Becker
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - K. Birr
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - G. Cinnella
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
| | - E. Cohen
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
| | - M. R. El Tahan
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - L. F. Falcão
- Federal University of São Paulo, Sao Paulo, Brazil
| | - C. Gregoretti
- UOC Anestesia e Rianimazione A.O.Universitaria “P. Giaccone”, Dipartimento Di.Chir.On.S., Università degli Studi di Palermo, Palermo, Italy
| | - M. Granell
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - M. W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R. Jankovic
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
| | - W. Karzai
- Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - T. Loop
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - N. Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
- Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - G. H. Mills
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
| | - M. T. Murrell
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
| | | | | | - P. Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS San Martino Policlinico Hospital, Genoa, Italy
| | - R. Rossaint
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - M. J. Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - A. Serpa Neto
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - P. Severgnini
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell’Insubria, Varese, Italy
| | - L. Szegedi
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - T. Vegh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
- Outcomes Research Consortium, Cleveland, USA
| | - G. Voyagis
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, “Sotiria” Chest Diseases Hospital, Athens, Greece
- Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
| | - J. Zhong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M. Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. Senturk
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - the Research Workgroup PROtective VEntilation Network (PROVEnet) of the European Society of Anaesthesiology (ESA)
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Federal University of São Paulo, Sao Paulo, Brazil
- UOC Anestesia e Rianimazione A.O.Universitaria “P. Giaccone”, Dipartimento Di.Chir.On.S., Università degli Studi di Palermo, Palermo, Italy
- Hospital General Universitario de Valencia, Valencia, Spain
- University Hospital Magdeburg, Magdeburg, Germany
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
- Zentralklinik Bad Berka, Bad Berka, Germany
- Thoracic Center Coswig, Coswig, Germany
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University Hospital Geneva, Geneva, Switzerland
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
- Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
- Military Medical Academy, Belgrade, Serbia
- Penn State Hershey Anesthesiology & Perioperative Medicine, Hershey, USA
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS San Martino Policlinico Hospital, Genoa, Italy
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell’Insubria, Varese, Italy
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
- Outcomes Research Consortium, Cleveland, USA
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, “Sotiria” Chest Diseases Hospital, Athens, Greece
- Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| |
Collapse
|
43
|
Becker C, Barbulescu K, Wirtz S, Meyer zum Büschenfelde KH, Pettersson S, Neurath MF. Constitutive and inducible in vivo protein-DNA interactions at the tumor necrosis factor-alpha promoter in primary human T lymphocytes. Gene Expr 2018; 8:115-27. [PMID: 10551799 PMCID: PMC6157389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Tumor necrosis factor-alpha (TNF-alpha) is a key cytokine of lymphocytes with major regulatory functions in immunomodulation, chronic inflammation, and septic shock. However, only limited information on TNF promoter regulation in vivo in primary lymphocytes is available. To determine and compare protein-DNA interactions at the native TNF locus in primary lymphocytes, we analyzed the human TNF-alpha promoter by ligation-mediated polymerase chain reaction (LM-PCR) techniques. Accordingly, primary CD4+ T lymphocytes from peripheral blood were cultured in the presence of various stimuli and analyzed by LM-PCR. Inducible in vivo protein-DNA interactions at the TNF promoter were detected between -120 and -70 bp of the human TNF promoter relative to the transcriptional start site. This area includes binding sites for transcription factors such as ETS-1, NFAT, ATF-2/c-jun, SP-1/Egr-1, and NF-kappaB. In contrast, no protein-DNA interactions were observed at various binding sites with reported regulatory function in tumor cell lines such as the k2 element, the NFAT site at -160, the AP1 site at -50, and the SP1 site at -65. Additional mutagenesis and transfection studies demonstrated that NF-kappaB and CREB/AP-1 are important regulators of inducible TNF promoter activity in primary human T lymphocytes. These results provide novel insights into the complex regulation of TNF gene transcription in primary T lymphocytes in vivo by constitutive and inducible protein-DNA interactions that appear to be at least partially different compared to previously characterized tumor cell lines.
Collapse
Affiliation(s)
- C Becker
- Laboratory of Immunology, I. Medical Clinic, University of Mainz, Germany
| | | | | | | | | | | |
Collapse
|
44
|
Becker C, Choi E, Gonzalez Catalan M, Shin S, Arora S, Huddleson M, Gomez R. A - 25Executive Attention Predicts Agitation in Older Adults with Cognitive Impairment and Dementia. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
45
|
Kumar MR, Clover T, Olaitan AD, Becker C, Solouki T, Farmer PJ. The reaction between GSNO and H 2 S: On the generation of NO, HNO and N 2 O. Nitric Oxide 2018; 77:96-105. [DOI: 10.1016/j.niox.2018.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
|
46
|
Persson M, Becker C, Elding Larsson H, Lernmark Å, Forsander G, Ivarsson SA, Ludvigsson J, Samuelsson U, Marcus C, Carlsson A. The Better Diabetes Diagnosis (BDD) study - A review of a nationwide prospective cohort study in Sweden. Diabetes Res Clin Pract 2018; 140:236-244. [PMID: 29626585 DOI: 10.1016/j.diabres.2018.03.057] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/08/2017] [Accepted: 03/29/2018] [Indexed: 12/26/2022]
Abstract
The incidence of type 1 diabetes (T1D) in Sweden is one of the highest in the world. However, the possibility of other types of diabetes must also be considered. In addition, individuals with T1D constitute a heterogeneous group. A precise classification of diabetes is a prerequisite for optimal outcome. For precise classification, knowledge on the distribution of genetic factors, biochemical markers and clinical features in individuals with new onset of diabetes is needed. The Better Diabetes Diagnosis (BDD), is a nationwide study in Sweden with the primary aim to facilitate a more precise classification and diagnosis of diabetes in order to enable the most adequate treatment for each patient. Secondary aims include identification of risk factors for diabetes-related co-morbidities. Since 2005, data on almost all children and adolescents with newly diagnosed diabetes in Sweden are prospectively collected and including heredity of diabetes, clinical symptoms, levels of C peptide, genetic analyses and detection of autoantibodies. Since 2011, analyses of HLA profile, autoantibodies and C peptide levels are part of clinical routine in Sweden for all pediatric patients with suspected diagnosis of diabetes. In this review, we present the methods and main results of the BDD study so far and discuss future aspects.
Collapse
Affiliation(s)
- M Persson
- Department of Medicine, Clinical Epidemiology, Karolinska University Hospital, Stockholm, Sweden.
| | - C Becker
- Department of Clinical Chemistry, Skåne University Hospital, Malmö, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - G Forsander
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and the Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S A Ivarsson
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - J Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - U Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - C Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Pediatrics, Stockholm, Sweden
| | - A Carlsson
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| |
Collapse
|
47
|
Eisenhauer D, Sai H, Matsui T, Köppel G, Rech B, Becker C. Honeycomb micro-textures for light trapping in multi-crystalline silicon thin-film solar cells. Opt Express 2018; 26:A498-A507. [PMID: 29801256 DOI: 10.1364/oe.26.00a498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
The liquid phase crystallization (LPC) of silicon is an emerging technology for fabricating 10 - 20 µm thin multi-crystalline silicon layers on glass. LPC silicon solar cells exhibit similar electronic performance to multi-crystalline wafer-based devices. Due to the reduced absorber thickness, however, effective measures for light trapping have to be taken. We present tailor-made micro-structures for light trapping at the LPC silicon back-side, whereby a nano-imprinted resist layer serves as a three-dimensional etching mask in subsequent reactive ion etching. Contrary to state-of-the-art random pyramid textures produced by wet-chemical etching, this method allows to produce tailor-made textures independent of grain orientation. Differently shaped micro-textures were replicated in LPC silicon. Absorptance and external quantum efficiency of periodic honeycomb patterns and random pyramids were found to be equivalent. Thus, the method enables the potential to further optimize light trapping in LPC silicon solar cells.
Collapse
|
48
|
Horstmanshof D, George S, Mendenhall M, Chelikani N, El Banayosy M, Gibbs C, Jacob T, Patrick A, Duke M, Becker C, Walter T, Nelson K. Inter-facility Collaboration to Decrease Acute Care Length of Stay Post LVAD Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
49
|
Greer SM, Bern M, Becker C, Brodbelt JS. Extending Proteome Coverage by Combining MS/MS Methods and a Modified Bioinformatics Platform Adapted for Database Searching of Positive and Negative Polarity 193 nm Ultraviolet Photodissociation Mass Spectra. J Proteome Res 2018; 17:1340-1347. [DOI: 10.1021/acs.jproteome.7b00673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sylvester M. Greer
- Department of Chemistry, University of Texas at Austin, Austin, Texas 78712, United States
| | - Marshall Bern
- Protein
Metrics,
Inc., San Carlos, California 94070, United States
| | | | - Jennifer S. Brodbelt
- Department of Chemistry, University of Texas at Austin, Austin, Texas 78712, United States
| |
Collapse
|
50
|
Bern M, Caval T, Kil YJ, Tang W, Becker C, Carlson E, Kletter D, Sen KI, Galy N, Hagemans D, Franc V, Heck AJR. Parsimonious Charge Deconvolution for Native Mass Spectrometry. J Proteome Res 2018; 17:1216-1226. [PMID: 29376659 PMCID: PMC5838638 DOI: 10.1021/acs.jproteome.7b00839] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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] [Indexed: 12/20/2022]
Abstract
![]()
Charge
deconvolution infers the mass from mass over charge (m/z) measurements in electrospray ionization
mass spectra. When applied over a wide input m/z or broad target mass range, charge-deconvolution algorithms
can produce artifacts, such as false masses at one-half or one-third
of the correct mass. Indeed, a maximum entropy term in the objective
function of MaxEnt, the most commonly used charge deconvolution algorithm,
favors a deconvolved spectrum with many peaks over one with fewer
peaks. Here we describe a new “parsimonious” charge
deconvolution algorithm that produces fewer artifacts. The algorithm
is especially well-suited to high-resolution native mass spectrometry
of intact glycoproteins and protein complexes. Deconvolution of native
mass spectra poses special challenges due to salt and small molecule
adducts, multimers, wide mass ranges, and fewer and lower charge states.
We demonstrate the performance of the new deconvolution algorithm
on a range of samples. On the heavily glycosylated plasma properdin
glycoprotein, the new algorithm could deconvolve monomer and dimer
simultaneously and, when focused on the m/z range of the monomer, gave accurate and interpretable
masses for glycoforms that had previously been analyzed manually using m/z peaks rather than deconvolved masses.
On therapeutic antibodies, the new algorithm facilitated the analysis
of extensions, truncations, and Fab glycosylation. The algorithm facilitates
the use of native mass spectrometry for the qualitative and quantitative
analysis of protein and protein assemblies.
Collapse
Affiliation(s)
- Marshall Bern
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | - Tomislav Caval
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Science4Life, Utrecht University and Netherlands Proteomics Centre , Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Yong J Kil
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | - Wilfred Tang
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | | | - Eric Carlson
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | - Doron Kletter
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | - K Ilker Sen
- Protein Metrics, Inc. , San Carlos, California 94070, United States
| | - Nicolas Galy
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Science4Life, Utrecht University and Netherlands Proteomics Centre , Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Dominique Hagemans
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Science4Life, Utrecht University and Netherlands Proteomics Centre , Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Vojtech Franc
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Science4Life, Utrecht University and Netherlands Proteomics Centre , Padualaan 8, 3584 CH Utrecht, The Netherlands
| | - Albert J R Heck
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Science4Life, Utrecht University and Netherlands Proteomics Centre , Padualaan 8, 3584 CH Utrecht, The Netherlands
| |
Collapse
|