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Lançon A, Beaudouin A, Lambert L, Baurand A, Petit E, Schaefer E, Poirsier C, Piard J, Patay L, Garde A, Bournez M, Bertolone G, Kastner C, Tempé L, El Chehadeh S, Spodenkiewick M, Lissy L, Doco-Fenzy M, Cabrol C, Trouvé C, Brischoux EB, Cloteau M, Burtin A, Renaud M, Riviere A, Thomas Q, De Souza CS, Sawka C, Racine C, Robert M, Gautier E, Delanne J, Bertaut A, Thauvin-Robinet C, Faivre L, Nambot S. Patient satisfaction, experience and preferences in the implementation of genetics teleconsultations in the North-eastern region of France. Eur J Med Genet 2023; 66:104841. [PMID: 37714374 DOI: 10.1016/j.ejmg.2023.104841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/29/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION In France, few centres per region offer genetics consultations. Consequently, each centre covers a large area, often requiring patients to take a day off to travel long distances. In certain situations, genetic counselling in particular, a physical exam is not required. In these cases, teleconsultations between medical professional and patients, at the patient's location of choice, are an interesting offer. The COVID-19 pandemic has accelerated the implementation and the use of this type of consultation. With the aim of developing teleconsultation for certain types of referrals, a study of patient satisfaction, experience and preferences has been set up in our region. METHODS 2307 patients who had a teleconsultation by phone or videoconferencing with professionals from one of five genetic centres in North-eastern France between March and December 2020 were asked by e-mail or by post to answer an online survey. RESULTS 20% of the patients (n = 465) responded to the survey (80% women, 55% over 40 years old). In 64% of the cases (n = 299), the teleconsultation replaced a physical consultation due to the pandemic. In 56% of cases (n = 217), the consultations were conducted by videoconference. The teleconsultation involved the disclosure of results in 56% of cases (n = 260), a first consultation in 30% of cases (n = 138), and a follow-up consultation in 14% of cases (n = 67). The satisfaction rate was 96% (n = 447), with a rating of "excellent" in 72% of responses (n = 290) and "good" in 24% of responses (n = 157). Only 22% of the patients (n = 103), particularly patients who lived near the hospital or who were older than 70 years, would have preferred a physical consultation. Half of respondents (n = 232) declared that they avoided more than 1.5 h of transport, and 69% (n = 321) avoided taking a work day off. Patients were less often accompanied by a relative than if the consultation had taken place face-to-face (43%; n = 201 vs. 61%; n = 285). There was no change in responses during or after lock-down. CONCLUSION This collection of feedback and analysis of patients' preferences has validated the long-term implementation of medical genetics teleconsultations in certain circumstances and indications, for patients who prefer this approach.
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Affiliation(s)
- Allan Lançon
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France
| | - Amandine Beaudouin
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France
| | - Laetitia Lambert
- Service de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHRU, Nancy, France
| | - Amandine Baurand
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Estelle Petit
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Elise Schaefer
- Service de Génétique Médicale et Centre de référence Anomalies du Développement et Syndromes Malformatifs, Hôpitaux Universitaires de Strasbourg, Institut de Génétique Médicale d'Alsace, Strasbourg, France
| | - Céline Poirsier
- Unité de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHU, Reims, France
| | - Juliette Piard
- Centre de Génétique Humaine et Centre de compétence Anomalies du Développement et Syndromes Malformatifs, CHRU, Besançon, France
| | - Léa Patay
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France; Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Aurore Garde
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital d'Enfants, CHU, Dijon, France
| | - Marie Bournez
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Geoffrey Bertolone
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France; Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Claire Kastner
- Service de Génétique Médicale et Centre de référence Anomalies du Développement et Syndromes Malformatifs, Hôpitaux Universitaires de Strasbourg, Institut de Génétique Médicale d'Alsace, Strasbourg, France
| | - Laurine Tempé
- Service de Génétique Médicale et Centre de référence Anomalies du Développement et Syndromes Malformatifs, Hôpitaux Universitaires de Strasbourg, Institut de Génétique Médicale d'Alsace, Strasbourg, France
| | - Salima El Chehadeh
- Service de Génétique Médicale et Centre de référence Anomalies du Développement et Syndromes Malformatifs, Hôpitaux Universitaires de Strasbourg, Institut de Génétique Médicale d'Alsace, Strasbourg, France
| | - Marta Spodenkiewick
- Unité de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHU, Reims, France
| | - Lola Lissy
- Unité de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHU, Reims, France
| | - Martine Doco-Fenzy
- Unité de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHU, Reims, France
| | - Christelle Cabrol
- Centre de Génétique Humaine et Centre de compétence Anomalies du Développement et Syndromes Malformatifs, CHRU, Besançon, France
| | - Chloé Trouvé
- Centre de Génétique Humaine et Centre de compétence Anomalies du Développement et Syndromes Malformatifs, CHRU, Besançon, France
| | - Elise Boucher Brischoux
- Centre de Génétique Humaine et Centre de compétence Anomalies du Développement et Syndromes Malformatifs, CHRU, Besançon, France
| | - Mélanie Cloteau
- Service de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHRU, Nancy, France
| | - Alexia Burtin
- Service de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHRU, Nancy, France
| | - Mathilde Renaud
- Service de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHRU, Nancy, France
| | - Axelle Riviere
- Service de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, CHRU, Nancy, France
| | - Quentin Thomas
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | | | - Caroline Sawka
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France; Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Caroline Racine
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France; Centre de compétence maladies génétiques à expression psychiatrique, CHU, Dijon, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital d'Enfants, CHU, Dijon, France
| | - Marion Robert
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Elodie Gautier
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France
| | - Julian Delanne
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital d'Enfants, CHU, Dijon, France
| | - Aurélie Bertaut
- Unité de Méthodologie et Biostatistiques, Centre Georges-François Leclerc, UNICANCER, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital d'Enfants, CHU, Dijon, France
| | - Laurence Faivre
- Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France; Centre de compétence maladies génétiques à expression psychiatrique, CHU, Dijon, France; Centre de Référence Déficiences Intellectuelles de Causes Rares, Hôpital d'Enfants, CHU, Dijon, France
| | - Sophie Nambot
- Service d'Oncogénétique, Centre Georges-François Leclerc, UNICANCER, Dijon, France; Centre de Génétique Clinique et Centre de référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU, Dijon, France.
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Van Der Kelen A, Okutman Ö, Javey E, Serdarogullari M, Janssens C, Ghosh MS, Dequeker BJH, Perold F, Kastner C, Kieffer E, Segers I, Gheldof A, Hes FJ, Sermon K, Verpoest W, Viville S. A systematic review and evidence assessment of monogenic gene-disease relationships in human female infertility and differences in sex development. Hum Reprod Update 2023; 29:218-232. [PMID: 36571510 DOI: 10.1093/humupd/dmac044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/05/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As in other domains of medicine, high-throughput sequencing methods have led to the identification of an ever-increasing number of gene variants in the fields of both male and female infertility. The increasing number of recently identified genes allows an accurate diagnosis for previously idiopathic cases of female infertility and more appropriate patient care. However, robust evidence of the gene-disease relationships (GDR) allowing the proper translation to clinical application is still missing in many cases. OBJECTIVE AND RATIONALE An evidence-based curation of currently identified genes involved in female infertility and differences in sex development (DSD) would significantly improve both diagnostic performance and genetic research. We therefore performed a systematic review to summarize current knowledge and assess the available GDR. SEARCH METHODS PRISMA guidelines were applied to curate all available information from PubMed and Web of Science on genetics of human female infertility and DSD leading to infertility, from 1 January 1988 to 1 November 2021. The reviewed pathologies include non-syndromic as well as syndromic female infertility, and endocrine and reproductive system disorders. The evidence that an identified phenotype is caused by pathogenic variants in a specific gene was assessed according to a standardized scoring system. A final score (no evidence, limited, moderate, strong, or definitive) was assigned to every GDR. OUTCOMES A total of 45 271 publications were identified and screened for inclusion of which 1078 were selected for gene and variant extraction. We have identified 395 genes and validated 466 GDRs covering all reported monogenic causes of female infertility and DSD. Furthermore, we present a genetic diagnostic flowchart including 105 genes with at least moderate evidence for female infertility and suggest recommendations for future research. The study did not take into account associated genetic risk factor(s) or oligogenic/polygenic causes of female infertility. WIDER IMPLICATIONS We have comprehensively reviewed the existing research on the genetics of female infertility and DSD, which will enable the development of diagnostic panels using validated genes. Whole genome analysis is shifting from predominantly research to clinical application, increasing its diagnostic potential. These new diagnostic possibilities will not only decrease the number of idiopathic cases but will also render genetic counselling more effective for infertile patients and their families.
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Affiliation(s)
- Annelore Van Der Kelen
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Özlem Okutman
- Laboratoire de Génétique Médicale LGM, Institut de Génétique Médicale d'Alsace IGMA, INSERM UMR 1112, Université de Strasbourg, Strasbourg, France.,Laboratoire de Diagnostic Génétique, Unité de Génétique de l'infertilité (UF3472), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Elodie Javey
- Laboratoires de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Münevver Serdarogullari
- Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Northern Cyprus via Mersin 10, Turkey
| | - Charlotte Janssens
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manjusha S Ghosh
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bart J H Dequeker
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Florence Perold
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Claire Kastner
- Institut de Génétique Médicale d'Alsace IGMA, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emmanuelle Kieffer
- Service de Génétique Médicale, Laboratoires de Diagnostic Génétique, Unité de Diagnostic Préimplantatoire (UF9327), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ingrid Segers
- Clinical Sciences, Research Group Reproduction and Genetics, Brussels IVF Centre for Reproductive Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Research Group Follicle Biology Laboratory (FOBI), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Alexander Gheldof
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Frederik J Hes
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Karen Sermon
- Research Group Reproduction and Genetics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Willem Verpoest
- Clinical Sciences, Research Group Reproduction and Genetics, Brussels IVF Centre for Reproductive Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stéphane Viville
- Laboratoire de Génétique Médicale LGM, Institut de Génétique Médicale d'Alsace IGMA, INSERM UMR 1112, Université de Strasbourg, Strasbourg, France.,Laboratoire de Diagnostic Génétique, Unité de Génétique de l'infertilité (UF3472), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Kastner C, Reibetanz J. [57/f-Asymptomatic cysts in the pancreas : Preparation for the medical specialist examination: part 8]. Chirurgie (Heidelb) 2022; 93:35-38. [PMID: 36066593 DOI: 10.1007/s00104-022-01716-6] [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: 08/11/2022] [Indexed: 06/15/2023]
Affiliation(s)
- C Kastner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, Haus A2, 97080, Würzburg, Deutschland
| | - J Reibetanz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, Haus A2, 97080, Würzburg, Deutschland.
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Orecchia L, Nardi A, Fletcher P, Ippoliti S, Grounds J, Dokubo I, Spicchiale CF, Miah S, Miano R, Barrett T, Kastner C. Development of roscap, a multivariate risk score for clinically significant cancer of the prostate focused on of patients with negative or equivocal MRI. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Oxley C, Thankappannair V, Saeb-Parsy K, Lamb B, Shah N, Kastner C, Geoghegan L, Fox H, Gnanapragasam V. 281 Impact of Using Risk Communication Tools in Counselling Patients with Newly Diagnosed Non-Metastatic Prostate Cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.183] [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]
Abstract
Abstract
Introduction
There have been substantial advances in risk communication tools that help patients understand prognosis associated with prostate cancer and the benefit/gain from treatment. Over the last three years, two tools; Cambridge Prognostic Groups (CPG), and Predict Prostate (https://prostate.predict.nhs.uk), along with decision-making consultations with clinical nurse specialists (CNS) have been integrated into the new diagnosis pathway in our unit.
Method
Treatment decisions for patients with new non-metastatic prostate cancer were audited after (2019–2020) and before (2016–2017) new risk communication tools were implemented. Data were compared between the two time periods and also benchmarked against national level data from the National Prostate Cancer Audit (NPCA) (Parry et al 2020; PMID: 32460859). The main outcome measured was comparison of rates of over and under-treatment of disease.
Results
168 and 95 patients were included in the 2019–2020 and 2016–2017 cohorts, respectively. Following implementation there was a reduction in over-treatment (use of radical surgery/radiotherapy) in patients with low risk/CPG1 (23% to 4%). These rates were also better than the national average from NPCA data (4% vs 11%). In parallel, there was an increase in use of radical treatment (reduced under-treatment) in high risk and very high-risk/CPG4-5 disease (84% vs 73%). Again, these rates were also superior to national level data from the NPCA (84% vs 76%).
Conclusions
Incorporating personalised risk-communication tools and dedicated CNS counselling in our unit has reduced over-treatment of early disease and under-treatment of advanced disease. Wider uptake could enhance risk-appropriate treatment of patients with a new prostate cancer diagnosis.
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Affiliation(s)
- C. Oxley
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - V. Thankappannair
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - K. Saeb-Parsy
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - B. Lamb
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - N. Shah
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - C. Kastner
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - L. Geoghegan
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - H. Fox
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - V. Gnanapragasam
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Fletcher P, De Santis M, Taylor N, Chinnery L, Barrett T, Kastner C. Vector prostate biopsy: A novel electro-magnetic biopsy technique for mpMRI/US fusion transperineal prostate biopsies under local anaesthesia. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01292-1] [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: 11/27/2022]
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Kastner C, Fletcher P, De Santis M, Chinnery L, Skalkidis I, Sakas G. Vecto® prostate biopsy: A novel electro-magnetic (EM) biopsy technique for mpMRI/US fusion prostate biopsies under local anaesthesia. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02731-2] [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: 11/27/2022] Open
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Kastner C, Taylor N, Barrett T, Chinnery L, Fletcher P. A new horizon-electromagnetic (EM) needle tip tracking to support mpMRI/US fusion transperineal prostate biopsies under local anaesthetia. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kastner C, Petritsch B, Kim M, Germer CT, Wiegering A. [Selection criteria for neoadjuvant chemoradiotherapy of rectal cancer : Neoadjuvant therapy even for locally advanced colon cancer?]. Chirurg 2020; 91:405-412. [PMID: 31915871 DOI: 10.1007/s00104-019-01088-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the last two decades a neoadjuvant treatment concept has been established for an increasing number of malignant tumors of the gastrointestinal tract; however, these concepts are still subject to a constant change concerning the indications and type of treatment. A prime example for this is rectal cancer. The rate of local recurrence in particular was significantly reduced by neoadjuvant therapy but until now it has not been possible to validly show an improvement in overall or disease-free survival. At the beginning of the millennium it was recommended to treat every rectal carcinoma in UICC stages II and III with neoadjuvant therapy, independent of the height localization. In the meantime this has increasingly been relativized and only locally advanced tumors of the middle and lower thirds of the rectum should be pretreated, whereas tumors of the upper third of the rectum should basically be treated in the same way as colon cancer. It is to be expected that there will be further differentiation concerning the indications in this context in the future mainly based on a preoperative magnetic resonance imaging (MRI) examination. At the same time, initial studies for colon cancer show that neoadjuvant chemotherapy can be beneficial and that an optimized computed tomography (CT) scan can be a worthwhile tool with respect to pretherapeutic stratification of patients.
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Affiliation(s)
- C Kastner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.,Institut für Biochemie und molekulare Biologie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - B Petritsch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Kim
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.,Comprehensive Cancer Center Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland. .,Institut für Biochemie und molekulare Biologie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland. .,Comprehensive Cancer Center Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland.
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Diers J, Wagner J, Baum P, Lichthardt S, Kastner C, Matthes N, Matthes H, Germer CT, Löb S, Wiegering A. Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany. BJS Open 2020; 4:310-319. [PMID: 32207577 PMCID: PMC7093786 DOI: 10.1002/bjs5.50254] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.
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Affiliation(s)
- J Diers
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany.,Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - J Wagner
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - P Baum
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - S Lichthardt
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - C Kastner
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - N Matthes
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany.,Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
| | - H Matthes
- Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - C-T Germer
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University of Würzburg Medical Centre, Würzburg, Germany
| | - S Löb
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - A Wiegering
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University of Würzburg Medical Centre, Würzburg, Germany.,Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
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11
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Otto C, Schmidt S, Kastner C, Denk S, Kettler J, Müller N, Germer CT, Wolf E, Gallant P, Wiegering A. Targeting bromodomain-containing protein 4 (BRD4) inhibits MYC expression in colorectal cancer cells. Neoplasia 2019; 21:1110-1120. [PMID: 31734632 PMCID: PMC6888720 DOI: 10.1016/j.neo.2019.10.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/23/2023] Open
Abstract
The transcriptional regulator BRD4 has been shown to be important for the expression of several oncogenes including MYC. Inhibiting of BRD4 has broad antiproliferative activity in different cancer cell types. The small molecule JQ1 blocks the interaction of BRD4 with acetylated histones leading to transcriptional modulation. Depleting BRD4 via engineered bifunctional small molecules named PROTACs (proteolysis targeting chimeras) represents the next-generation approach to JQ1-mediated BRD4 inhibition. PROTACs trigger BRD4 for proteasomale degradation by recruiting E3 ligases. The aim of this study was therefore to validate the importance of BRD4 as a relevant target in colorectal cancer (CRC) cells and to compare the efficacy of BRD4 inhibition with BRD4 degradation on downregulating MYC expression. JQ1 induced a downregulation of both MYC mRNA and MYC protein associated with an antiproliferative phenotype in CRC cells. dBET1 and MZ1 induced degradation of BRD4 followed by a reduction in MYC expression and CRC cell proliferation. In SW480 cells, where dBET1 failed, we found significantly lower levels of the E3 ligase cereblon, which is essential for dBET1-induced BRD4 degradation. To gain mechanistic insight into the unresponsiveness to dBET1, we generated dBET1-resistant LS174t cells and found a strong downregulation of cereblon protein. These findings suggest that inhibition of BRD4 by JQ1 and degradation of BRD4 by dBET1 and MZ1 are powerful tools for reducing MYC expression and CRC cell proliferation. In addition, downregulation of cereblon may be an important mechanism for developing dBET1 resistance, which can be evaded by incubating dBET1-resistant cells with JQ1 or MZ1.
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Affiliation(s)
- C Otto
- Experimental Visceral Surgery, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital Würzburg, Germany
| | - S Schmidt
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany
| | - C Kastner
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany; Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital Würzburg, Germany
| | - S Denk
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany
| | - J Kettler
- Experimental Visceral Surgery, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital Würzburg, Germany
| | - N Müller
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital Würzburg, Germany; University of Würzburg, Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - E Wolf
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany
| | - P Gallant
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany
| | - A Wiegering
- University of Würzburg, Department of Biochemistry and Molecular Biology, Biocenter, Würzburg, Germany; Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery (Department of Surgery I), University Hospital Würzburg, Germany; University of Würzburg, Comprehensive Cancer Center Mainfranken, Würzburg, Germany.
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12
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Köhler F, Rosenfeldt M, Matthes N, Kastner C, Germer CT, Wiegering A. [Incidental finding of mucinous neoplasia of the appendix : Treatment strategies]. Chirurg 2019; 90:194-201. [PMID: 30456645 DOI: 10.1007/s00104-018-0768-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/08/2023]
Abstract
Tumors of the appendix are not a uniform group but differ significantly in terms of their origin/histology and metastatic behavior. Furthermore, tumors of the appendix are often diagnosed as incidental findings after appendectomy for acute appendicitis. A subgroup of these neoplasms are low-grade appendiceal mucinous neoplasms (LAMN). These are mucus-forming tumors of the appendiceal lumen, which can lead to rupture of the appendix and seeding into the abdominal cavity. Therefore LAMN are considered precursors of pseudomyxoma peritonei (PMP). It is essential to clearly differentiate the subgroups of LAMN as well as the resection status. According to this it is determined whether (radical) appendectomy is a sufficient therapy or further treatment, such as ileocecal resection with hyperthermic intraperitoneal chemotherapy (HIPEC) or cytoreductive surgery (CRS) is necessary. There is no standardized concept regarding the follow-up after resection of LAMN. Generally, it is recommended to perform a computed tomography (CT) scan of the abdomen and determination of tumor markers 6 months postoperatively and then once a year. A recommendation regarding the duration of follow-up is difficult as there are case reports in which PMP has occurred more than 15 years after removal of LAMN.
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Affiliation(s)
- F Köhler
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland
| | - M Rosenfeldt
- Pathologisches Institut, Universität Würzburg, Würzburg, Deutschland
| | - N Matthes
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland
| | - C Kastner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland.,Comprehensive Cancer Centre Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - A Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Deutschland. .,Comprehensive Cancer Centre Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland. .,Lehrstuhl für Biochemie und Molekularbiologie, Universität Würzburg, Würzburg, Deutschland.
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13
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Diers J, Wagner J, Baum P, Lichthardt S, Kastner C, Matthes N, Löb S, Matthes H, Germer CT, Wiegering A. Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany. BJS Open 2019; 3:672-677. [PMID: 31592096 PMCID: PMC6773649 DOI: 10.1002/bjs5.50173] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/11/2019] [Indexed: 01/17/2023] Open
Abstract
Background Colonic cancer is the most common cancer of the gastrointestinal tract. The aim of this study was to determine mortality rates following colonic cancer resection and the effect of hospital caseload on in‐hospital mortality in Germany. Methods Patients admitted with a diagnosis of colonic cancer undergoing colonic resection from 2012 to 2015 were identified from a nationwide registry using procedure codes. The outcome measure was in‐hospital mortality. Hospitals were ranked according to their caseload for colonic cancer resection, and patients were categorized into five subgroups on the basis of hospital volume. Results Some 129 196 colonic cancer resections were reviewed. The overall in‐house mortality rate was 5·8 per cent, ranging from 6·9 per cent (1775 of 25 657 patients) in very low‐volume hospitals to 4·8 per cent (1239 of 25 825) in very high‐volume centres (P < 0·001). In multivariable logistic regression analysis the risk‐adjusted odds ratio for in‐house mortality was 0·75 (95 per cent c.i. 0·66 to 0·84) in very high‐volume hospitals performing a mean of 85·0 interventions per year, compared with that in very low‐volume hospitals performing a mean of only 12·7 interventions annually, after adjustment for sex, age, co‐morbidity, emergency procedures, prolonged mechanical ventilation and transfusion. Conclusion In Germany, patients undergoing colonic cancer resections in high‐volume hospitals had with improved outcomes compared with patients treated in low‐volume hospitals.
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Affiliation(s)
- J Diers
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany.,Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany
| | - J Wagner
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany
| | - P Baum
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany
| | - S Lichthardt
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany
| | - C Kastner
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany
| | - N Matthes
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany.,Havelhöhe Community Hospital Berlin Germany
| | - S Löb
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany
| | - H Matthes
- Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany
| | - C-T Germer
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany.,Department of Biochemistry and Molecular Biology University of Würzburg Würzburg Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery University Hospital, University of Würzburg Würzburg Germany.,Department of Biochemistry and Molecular Biology University of Würzburg Würzburg Germany.,Havelhöhe Community Hospital Berlin Germany
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14
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Jurowich C, Lichthardt S, Matthes N, Kastner C, Haubitz I, Prock A, Filser J, Germer CT, Wiegering A. Effects of anastomotic technique on early postoperative outcome in open right-sided hemicolectomy. BJS Open 2018; 3:203-209. [PMID: 30957068 PMCID: PMC6433329 DOI: 10.1002/bjs5.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
Background Despite recent improvements in colonic cancer surgery, the rate of anastomotic leakage after right hemicolectomy is still around 6–7 per cent. This study examined whether anastomotic technique (handsewn or stapled) after open right hemicolectomy for right‐sided colonic cancer influences postoperative complications. Methods Patient data from the German Society for General and Visceral Surgery (StuDoQ) registry from 2010 to 2017 were analysed. Univariable and multivariable analyses were performed. The primary endpoint was anastomotic leakage; secondary endpoints were postoperative ileus, complications and length of postoperative hospital stay (LOS). Results A total of 4062 patients who had undergone open right hemicolectomy for colonic cancer were analysed. All patients had an ileocolic anastomosis, 2742 handsewn and 1320 stapled. Baseline characteristics were similar. No significant differences were identified in anastomotic leakage, postoperative ileus, reoperation rate, surgical‐site infection, LOS or death. The stapled group had a significantly shorter duration of surgery and fewer Clavien–Dindo grade I–II complications. In multivariable logistic regression analysis, ASA grade and BMI were found to be significantly associated with postoperative complications such as anastomotic leakage, postoperative ileus and reoperation rate. Conclusion Handsewn and stapled ileocolic anastomoses for open right‐sided colonic cancer resections are equally safe. Stapler use was associated with reduced duration of surgery and significantly fewer minor complications.
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Affiliation(s)
- C Jurowich
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany.,Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - S Lichthardt
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - N Matthes
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - C Kastner
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - I Haubitz
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - A Prock
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany
| | - J Filser
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany
| | - C-T Germer
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany.,Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany.,Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany.,Department of Biochemistry and Molecular Biology University of Würzburg Würzburg Germany
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15
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Hansen NL, Koo BC, Warren AY, Kastner C, Barrett T. Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection. Eur J Radiol 2017; 95:307-313. [PMID: 28987685 DOI: 10.1016/j.ejrad.2017.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 06/30/2017] [Revised: 08/13/2017] [Accepted: 08/16/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate sub-differentiation of PI-RADS-3 prostate lesions using pre-defined T2- and diffusion-weighted (DWI) MRI criteria, to aid the biopsy decision process. METHODS 143 patients with PIRADS-3 index lesions on MRI underwent targeted transperineal-MR/US fusion biopsy. Radiologists with 2 and 7-years experience performed blinded retrospective second-reads using set criteria and assigned biopsy recommendations. Inter-reader agreement, Gleason score (GS), positive (PPV) predictive values (±95% confidence intervals) were calculated and compared by Fisher's exact test with Bonferroni-Hom correction. RESULTS 43% (61/143) patients had GS 6-10 and 21% (30/143) GS≥3+4 cancer. For peripheral zone lesions, significant differences in any cancer detection were found for shape (0.26±0.13 geographical vs. 0.69±0.23 rounded; p=0.0055) and ADC (mild 0.21±0.12 vs marked 0.81±0.19; p=0.0001). For transition zone, significantly increased cancer detection was shown for location (anterior 0.63±0.15 vs. mid/posterior 0.31±0.14; p=0.0048), border (pseudo-capsule 0.32±0.14 vs. ill-defined 0.61±0.15; p=0.0092), and ADC (mild 0.35±0.12 vs marked restriction 0.68±0.17; p=0.0057). Biopsy recommendations had 62% inter-reader agreement (89/143). Experienced reader PPVs were significantly higher for any cancer with "biopsy-recommended" 0.61±0.11 vs. "no biopsy" 0.21±0.10 (p=0.0001), and for GS 7-10 cancers: 0.32±0.10 vs. 0.08±0.07, respectively (p=0.0003). CONCLUSION Identification of certain objective imaging criteria as well as a subjective biopsy recommendation from an experienced radiologist can help to increase the predictive value of equivocal prostate lesions and inform the decision making process of whether or not to biopsy.
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Affiliation(s)
- N L Hansen
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, DE, Germany
| | - B C Koo
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - A Y Warren
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - C Kastner
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - T Barrett
- CamPARI Clinic, Addenbrooke's Hospital & University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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16
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Hansen N, Koo B, Warren A, Kastner C, Barrett T. Subdifferenzierung von intermediären Läsionen (PI-RADS 3) in der multiparametrischen Prostata-MRT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N Hansen
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - B Koo
- Addenbrooke's University Hospital, Department of Radiology, Cambridge, UK
| | - A Warren
- Addenbrooke's University Hospital, Department of Pathology, Cambridge, UK
| | - C Kastner
- Addenbrooke's University Hospital, Department of Urology, Cambridge, UK
| | - T Barrett
- Addenbrooke's University Hospital, Department of Radiology, Cambridge, UK
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17
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Gnanapragasam VJ, Burling K, George A, Stearn S, Warren A, Barrett T, Koo B, Gallagher FA, Doble A, Kastner C, Parker RA. The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population. Sci Rep 2016; 6:35364. [PMID: 27748407 PMCID: PMC5066204 DOI: 10.1038/srep35364] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022] Open
Abstract
Both multi-parametric MRI (mpMRI) and the Prostate Health Index (PHI) have shown promise in predicting a positive biopsy in men with suspected prostate cancer. Here we investigated the value of combining both tests in men requiring a repeat biopsy. PHI scores were measured in men undergoing re-biopsy with an mpMRI image-guided transperineal approach (n = 279, 94 with negative mpMRIs). The PHI was assessed for ability to add value to mpMRI in predicting all or only significant cancers (Gleason ≥7). In this study adding PHI to mpMRI improved overall and significant cancer prediction (AUC 0.71 and 0.75) compared to mpMRI + PSA alone (AUC 0.64 and 0.69 respectively). At a threshold of ≥35, PHI + mpMRI demonstrated a NPV of 0.97 for excluding significant tumours. In mpMRI negative men, the PHI again improved prediction of significant cancers; AUC 0.76 vs 0.63 (mpMRI + PSA). Using a PHI≥35, only 1/21 significant cancers was missed and 31/73 (42%) men potentially spared a re-biopsy (NPV of 0.97, sensitivity 0.95). Decision curve analysis demonstrated clinically relevant utility of the PHI across threshold probabilities of 5-30%. In summary, the PHI adds predictive performance to image-guided detection of clinically significant cancers and has particular value in determining re-biopsy need in men with a negative mpMRI.
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Affiliation(s)
- V. J. Gnanapragasam
- Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK
- CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
- Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - K. Burling
- Core Biochemical Assay Laboratory, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - A. George
- Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK
| | - S. Stearn
- Academic Urology Group, University of Cambridge, Box 279 (S4) Cambridge Biomedical Campus Cambridge CB2 0QQ, UK
| | - A. Warren
- Department of Pathology, Cambridge University Hospitals Trust,Cambridge CB2 0QQ UK
| | - T. Barrett
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK
- Department of Radiology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - B. Koo
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK
| | - F. A. Gallagher
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ UK
- Department of Radiology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - A. Doble
- CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
- Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - C. Kastner
- CamPARI Clinic, Box 41, Clinic 4A, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
- Department of Urology, Cambridge University Hospitals Trust, Cambridge CB2 0QQ UK
| | - R. A. Parker
- Edinburgh Clinical Trials Unit University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh EH89AG UK
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18
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Scheltema MJ, Tay KJ, Postema AW, de Bruin DM, Feller J, Futterer JJ, George AK, Gupta RT, Kahmann F, Kastner C, Laguna MP, Natarajan S, Rais-Bahrami S, Rastinehad AR, de Reijke TM, Salomon G, Stone N, van Velthoven R, Villani R, Villers A, Walz J, Polascik TJ, de la Rosette JJMCH. Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol 2016; 35:695-701. [PMID: 27637908 PMCID: PMC5397427 DOI: 10.1007/s00345-016-1932-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 08/01/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT). Methods An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results. Results mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers. Conclusions The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1932-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
| | - K J Tay
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Feller
- Desert Medical Imaging, Indian Wells, CA, USA
| | - J J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel and Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cambridge University Hospitals Trust, Cambridge, UK
| | - M P Laguna
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Natarajan
- Department of Urology, Surgery and Bioengineering, University of California, Los Angeles, CA, USA
| | - S Rais-Bahrami
- Department of Urology and Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - A R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T M de Reijke
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R van Velthoven
- Department of Urology, Institut Jules Bordet, Brussels, Belgium
| | - R Villani
- Department of Radiology, North Shore University Hospital, Northwell Health, NY, USA
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - T J Polascik
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Hansen N, Barrett T, Koo B, Gallagher F, Gnanapragasam V, Doble A, Bratt O, Kastner C. Die Auswirkung der Dichte von Prostata-spezifischem Antigen auf den positiven prädiktiven Wert der intermediären multiparameterischen Prostata-MRT (PIRADS 3). ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hansen N, Barrett T, Koo B, Gallagher F, Gnanapragasam V, Doble A, Bratt O, Kastner C. Die Auswirkung der Dichte von Prostata-spezifischem Antigen auf den negativen prädiktiven Wert der multiparameterischen Prostata-MRT. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Postema AW, De Reijke TM, Ukimura O, Van den Bos W, Azzouzi AR, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman JA, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill IS, Gupta RT, Henkel TO, Hohenfellner M, Jones JS, Kahmann F, Kastner C, Köhrmann KU, Kovacs G, Miano R, van Moorselaar RJ, Mottet N, Osorio L, Pieters BR, Polascik TJ, Rastinehad AR, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay KJ, Varkarakis IM, Villers A, Walz J, De la Rosette JJ. Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project. World J Urol 2016; 34:1373-82. [PMID: 26892160 PMCID: PMC5026990 DOI: 10.1007/s00345-016-1782-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
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Affiliation(s)
- A W Postema
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
| | - T M De Reijke
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - O Ukimura
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - W Van den Bos
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - A R Azzouzi
- Department of Urology, Angers University Hospital, Angers, France
| | - E Barret
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - D Baumunk
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - A Blana
- Department of Urology, Fuerth Hospital, Fuerth, Germany
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Brausi
- Department of Urology, Ospedale Civile Ramazzini, Carpi, Italy
| | - J A Coleman
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - J Dominguez-Escrig
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - R Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - S Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - I S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R T Gupta
- Departments of Radiology, Duke University Medical Center, Durham, NC, USA
| | - T O Henkel
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - J S Jones
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel & Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cancer Directorate, Cambridge University Hospitals Trust, Cambridge, UK
| | - K U Köhrmann
- Department of Urology, Theresien Krankenhaus Mannheim, Mannheim, Germany
| | - G Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - R J van Moorselaar
- Department of Urology, Free University Medical Centre, Amsterdam, The Netherlands
| | - N Mottet
- Department of Urology, University Hospital St Etienne, Saint-Étienne, France
| | - L Osorio
- Department of Urology, Porto Hospital Centre, Porto, Portugal
| | - B R Pieters
- Departments of Radiation Oncology, AMC University Hospital, Amsterdam, The Netherlands
| | - T J Polascik
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A R Rastinehad
- Department of Urology, Hofstra North Shore-Lij, Hofstra University, Hempstead, NY, USA
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - R Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France
| | - M Schostak
- Department of Urology, Magdeburg University Medical Center, Magdeburg, Germany
| | - L Sentker
- Urologische Gemeinschaftspraxis, Sinsheim, Germany
| | - K J Tay
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - J J De la Rosette
- Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands
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Kieffer E, Nicod JC, Gardes N, Kastner C, Becker N, Celebi C, Pirrello O, Rongières C, Koscinski I, Gosset P, Moutou C. Improving preimplantation genetic diagnosis for Fragile X syndrome: two new powerful single-round multiplex indirect and direct tests. Eur J Hum Genet 2015; 24:221-7. [PMID: 25966634 DOI: 10.1038/ejhg.2015.96] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/02/2015] [Accepted: 04/15/2015] [Indexed: 11/09/2022] Open
Abstract
Fragile X syndrome (FraX) is caused by the expansion of an unstable CGG repeat located in the Fragile X mental retardation 1 gene (FMR1) gene. Preimplantation genetic diagnosis (PGD) can be proposed to couples at risk of transmitting the disease, that is, when the female carries a premutation or a full mutation. We describe two new single-cell, single-round multiplex PCR for indirect and direct diagnosis of FraX on biopsied embryos. These tests include five unpublished, highly heterozygous simple sequence repeats, and the co-amplification of non-expanded CGG repeats for the direct test. Heterozygosity of the new markers ranged from 69 to 81%. The mean rate of non-informative marker included in the tests was low (26% and 23% for the new indirect and direct tests, respectively). This strategy allows offering a PGD for FraX to 96% of couples requesting it in our centre. A conclusive genotype was obtained in all cells with a rate of cells presenting an allele dropout ranging from 17% for the indirect test to 26% for the direct test. The new indirect test was applied for eight PGD cycles: 32 embryos were analysed, 9 were transferred and 3 healthy babies were born. By multiplexing these highly informative markers, robustness of the diagnosis is improved and the loss of potentially healthy embryos (because they are non-diagnosed or misdiagnosed) is limited. This may increase the chances of success of couples requesting a PGD for FraX, in particular, when premature ovarian insufficiency in premutated women leads to a reduced number of embryos available for analysis.
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Affiliation(s)
- Emmanuelle Kieffer
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Jean-Christophe Nicod
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Nathalie Gardes
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Claire Kastner
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Nicolas Becker
- Laboratoire de Biologie de la Reproduction, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Catherine Celebi
- Laboratoire de Biologie de la Reproduction, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Olivier Pirrello
- Assistance Médicale à la Procréation, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Catherine Rongières
- Assistance Médicale à la Procréation, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Isabelle Koscinski
- Laboratoire de Biologie de la Reproduction, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France.,Université de Strasbourg, Strasbourg, France
| | - Philippe Gosset
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France
| | - Céline Moutou
- Laboratoire de Diagnostic Préimplantatoire, Hôpitaux Universitaires de Strasbourg, site du CMCO, Strasbourg, France.,Université de Strasbourg, Strasbourg, France
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Kastner C, Löbler M, Guthoff R, Schmitz KP. In Vitro Rabbit Drug Cytotoxicity Model for Fibrosis Prevention in Glaucoma Surgery. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-O/bmt-2013-4376/bmt-2013-4376.xml. [PMID: 24043089 DOI: 10.1515/bmt-2013-4376] [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: 11/15/2022]
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24
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Kastner C, Löbler M, Reske T, Sternberg K, Guthoff R, Schmitz KP. Determination of human anterior lens capsule permeability for fluorescent model substances and after-cataract preventive drugs. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Dittrich B, Koch B, Kooten TV, Kastner C, Guthoff R, Sternberg K, Möller M. Drug delivery system for sustained delivery of caffeic acid phenethyl ester within lens capsule after cataract surgery. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vyas L, Kastner C, Beard R. UP-1.53: The introduction of a prostate holmium laser service to a district general hospital (DGH). Urology 2010. [DOI: 10.1016/j.urology.2010.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Mayinger B, Neumann F, Kastner C, Haider T, Schwab D. Hexaminolevulinate-induced fluorescence colonoscopy versus white light endoscopy for diagnosis of neoplastic lesions in the colon. Endoscopy 2010; 42:28-33. [PMID: 20066590 DOI: 10.1055/s-0029-1243804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS To compare the rate of detection of colorectal neoplastic lesions using the selective photosensitizer precursor hexaminolevulinate (HAL) combined with a new fluorescence video endoscope system against that of standard white light endoscopy, and secondarily, to evaluate the safety profile of HAL-induced fluorescence colonoscopy. PATIENTS AND METHODS This prospective phase II clinical pilot study from two hospital study centers included 25 patients with known or highly suspected colorectal neoplasia. They underwent sensitization with locally applied 500 ml HAL enemas at a concentration of 1.6 mmol/L. At 60 minutes after enteral HAL administration, fluorescence imaging was done using a special light source capable of delivering either white light or blue excitation light. Red fluorescence induced by illumination with blue light was detected via a prototype fluorescence video colonoscope. Biopsies were taken from suspicious areas found with white or blue light. RESULTS Using histology as the gold standard, 55 / 93 of neoplastic lesions were detected with white light endoscopy, 53 / 93 with both white and blue light, 38 / 93 with blue light and second-pass white light, and 27/93 with blue light only. Of all neoplastic lesions, 91 / 93 revealed red fluorescence under fluorescence imaging ( P < 0.0001). Fluorescence mode showed 38.7 % (36 / 93) more neoplasms than did white light endoscopy. An isolated slight elevation of bilirubin, by a factor of 1.5, was noted after the administration of HAL. CONCLUSIONS Administration of HAL as enema induces selective lesion fluorescence and increases lesion detection rate in patients with colorectal neoplasia, especially of flat, nonvisible adenomas.
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Affiliation(s)
- B Mayinger
- Department of Medicine II, Hospital Munich-Pasing, Teaching Hospital of the University of Munich (LMU), D-81241 Munich, Germany.
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Mayinger B, Neumann F, Kastner C, Degitz K, Hahn EG, Schwab D. Early detection of premalignant conditions in the colon by fluorescence endoscopy using local sensitization with hexaminolevulinate. Endoscopy 2008; 40:106-9. [PMID: 18197583 DOI: 10.1055/s-2007-967019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 01/29/2023]
Abstract
BACKGROUND AND STUDY AIMS We aimed to determine the feasibility of obtaining selective fluorescence of precancerous/cancerous lesions in the colon with a new fluorescence video endoscope system in combination with the selective photosensitizer precursor hexaminolevulinate (HAL), and to carry out a dose-finding study with evaluation of the optimal dose and application time. PATIENTS AND METHODS 12 patients with colorectal lesions underwent sensitization with locally applied HAL enemas in two concentrations (0.8 mmol and 1.6 mmol). The examination was conducted either 30 or 60 minutes after rectal administration of the sensitizer, using a special light source capable of delivering either white or blue excitation light. Red fluorescence induced by illumination with blue light was detected via a prototype fluorescence video colonoscope. Biopsies were taken from suspicious areas found with white or blue light. Corresponding endoscopic, fluorescence, and microscopic findings were compared. RESULTS Using histological findings as the gold standard, 52/53 of the premalignant/malignant lesions showed red fluorescence under the photodynamic diagnosis (PDD) examination; 38/53 were detected with white-light endoscopy. The PDD mode showed 28 % more polyps than did white-light endoscopic imaging. The greatest fluorescence intensity in precancerous lesions was found with retention for 60 minutes of 500 ml of 1.6 mmol HAL. CONCLUSIONS Administration of HAL enema induces selective lesion fluorescence and increases the lesion detection rate in patients with colorectal adenoma and early carcinoma.
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Affiliation(s)
- B Mayinger
- Department of Medicine II, Hospital Munich-Pasing, Teaching Hospital of University of Munich (LMU), Munich, Germany.
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Kastner C, Armitage J, Kimble A, Rawal J, Carter PG, Venn S. The Charlson comorbidity score: a superior comorbidity assessment tool for the prostate cancer multidisciplinary meeting. Prostate Cancer Prostatic Dis 2006; 9:270-4. [PMID: 16770340 DOI: 10.1038/sj.pcan.4500889] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Multidisciplinary team (MDT) meetings use precise prognostic factors to select treatment options for patients with prostate cancer. Comorbidity is judged subjectively. Recent publications favour the Charlson comorbidity score (CS) for the use in the management of prostate cancer. We assess the feasibility of using the CS by our MDT in planning the treatment of patients with prostate cancer. PATIENTS AND METHODS Patients from the histopathology database aged less than 75 years and with a diagnosis of localized prostate cancer between 1993 and 1995 were included in a notes audit. A second group consisted of patients recommended for curative treatment for localized prostate cancer by the local MDT in 2004. Data on comorbidity, prostatic malignancy and survival up to 10 years was collected. The prognostic accuracy of the CS was assessed for those patients offered radical treatment between 1993 and 1995. RESULTS Of 1043 patients initially assessed, 37 patients with localized prostate cancer were identified. Using Cox regression, we found the CS to be a statistically significant predictor of survival, following radical treatment for localized prostate cancer (P=0.005). Current practice in 2004 (56 patients) shows a mean (range) Charlson probability of 10-year survival for radical prostatectomy of 0.823 (0.592-0.923) and for radical radiotherapy of 0.653 (0.07-0.936). CONCLUSIONS Our results support the findings of recent research. We also found the CS easy to calculate and therefore feasible to use in our MDT setting. We propose the introduction of the Charlson score by prostate cancer MDTs to assess age and comorbidity.
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Affiliation(s)
- C Kastner
- Department of Urology, St Richard's Hospital, Chichester, UK.
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Miller P, Kastner C, Fletcher H, Nelson C, Jennings M. Cooled thermotherapy (TUMT) for chronic abacterial prostatitis (CP/CPPS): 2 years after treatment. Urology 2005. [DOI: 10.1016/j.urology.2005.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Franke D, Kastner C, Ziegler A. Generalized estimating equations for association structures: familial correlations of lipid profiles. Stat Med 2004. [DOI: 10.1002/sim.1652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kastner C, Jakse G. Measurement of immunoglobulins in seminal fluid with modified nephelometry--an alternative diagnostic tool for chronic prostatitis. Prostate Cancer Prostatic Dis 2003; 6:86-9. [PMID: 12664071 DOI: 10.1038/sj.pcan.4500629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2002] [Revised: 06/13/2002] [Accepted: 08/07/2002] [Indexed: 11/08/2022]
Abstract
The objectives of the study were to investigate the feasibility of the modified nephelometry technique to measure immunoglobulin G and A in seminal fluid and to evaluate their use in diagnosis and follow-up of chronic prostatitis.IgG and A in seminal fluid of healthy individuals (HI) and chronic prostatitis patients (CP) were measured with modified nephelometry. The literature values were confirmed. IgG reflects the long-term healing process of chronic prostatitis. IgA was significantly increased in patients with exacerbation of the disease. Nephelometry proves to be a reliable and inexpensive test to obtain IgG and IgA in seminal fluid. IgG and IgA are useful as objective parameters to confirm subjective symptom scores in a chronic prostatitis research setting.
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Affiliation(s)
- C Kastner
- East Surrey Hospital, Redhill, Surrey, UK.
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Kastner C, Tagg A. Improving the effectiveness of the emergency management of renal colic in a district general hospital: a completed audit cycle. Emerg Med J 2003; 20:449-50. [PMID: 12954686 PMCID: PMC1726168 DOI: 10.1136/emj.20.5.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the current practice of emergency management of renal colic in a district hospital, review literature, implement new guidelines, and assess them. METHODS Data were collected about the use of analgesia, waiting time for intravenous urography (IVU), and admission status of patients presenting to the hospital with symptoms of renal colic over the period of three months. A literature search into the use of analgesia, imaging, and treatment was performed. Members of the involved departments were consulted and new guidelines developed and implemented. This was followed by further data collection over three months. RESULTS Seven of 14 patients were admitted. Five to wait for their IVU. Their average waiting time was 12.3 (SD 2.2) hours. Mainly intramuscular opioid analgesia was used. Literature recommended the use of diclofenac. Although computed tomography was favoured it was decided to continue to use IVU because of circumstances within the hospital. The literature recommended a cut off between conservative and surgical treatment at a calculus size of >4 mm. Existing policies of the relevant departments were obeyed and a training system for the junior doctors was introduced. Emergency department staff were encouraged to perform 3-film IVUs. After this, of 5 of 19 patients were admitted, only one of those to wait for an IVU. The average waiting time for an IVU was 4.1 (SD 0.96) hours. Rectal diclofenac was noted to be the drug of choice. CONCLUSION Coordination of efforts, interdepartmental communication, and a practical application of available literature has resulted in a significant improvement of effectiveness without affecting medical standards, workload, or resources. Accident and emergency senior house officers felt highly satisfied at being able to complete management from presentation to diagnosis and treatment. Interdisciplinary communication has to be continued to maintain smooth operation of the guidelines.
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Affiliation(s)
- C Kastner
- Department of Urology, East Surrey Hospital, Redhill,
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Abstract
Elevated plasma levels of apolipoproteins A1 (apoA1) and B (apoB) are important protective factors and risk factors, respectively, for atherosclerosis and coronary heart disease. It is well known that both apoA1 and apoB reveal strong familial aggregation. Our goal was to investigate whether exogenous variables influence these associations. We used marginal regression models for the mean and association structure (generalized estimating equations 2; GEE2) to analyse data from 1435 family members within 469 families of different sizes included in the Donolo-Tel Aviv Three-Generation Offspring Study. The usual robust variance matrix was approximated by extensions of jack-knife estimators of variance to GEE2 models. Estimation of standard errors in models with quite complex correlation structures was possible using this approach. All analyses were easily carried out using a menu-driven stand-alone software tool for marginal regression modelling. We demonstrate that a variety of hypotheses can be tested using Wald statistics by modelling regression matrices for the association structure. We show that correlation for apoB between parent-offspring pairs increased with decreasing age difference and that pairs with individuals of the same gender had more similar apoA1 levels than individuals of different gender. Associations between different relative pairs did not all agree with those expected from differences in kinship coefficients. The analysis using GEE2 models revealed structures that would not have been detected by other models and should therefore be used in addition to traditional approaches of analysing family data. GEE2 should be considered a standard method for the investigation of familial aggregation.
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Affiliation(s)
- A Ziegler
- Medical Centre for Methodology and Health Research, Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Germany.
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Hoffmeister HM, Kastner C, Szabo S, Beyer ME, Helber U, Kazmaier S, Baumbach A, Wendel HP, Heller W. Fibrin specificity and procoagulant effect related to the kallikrein-contact phase system and to plasmin generation with double-bolus reteplase and front-loaded alteplase thrombolysis in acute myocardial infarction. Am J Cardiol 2000; 86:263-8. [PMID: 10922430 DOI: 10.1016/s0002-9149(00)00911-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was undertaken to compare the effects of reteplase and alteplase regimens on hemostasis and fibrinolysis in acute myocardial infarction (AMI). Thrombolytic treatment in patients with AMI is hampered by paradoxical procoagulant effects that favor early reocclusion. In vivo data comparing this effect and the fibrin specificity of double-bolus reteplase and front-loaded alteplase regimens are not available. In a prospective, randomized study, 50 patients with AMI were either treated with double bolus (10 + 10 U) reteplase or with front-loaded alteplase (up to 100 mg) within 6 hours of symptom onset. Thirty apparently healthy persons served as controls. Molecular markers of coagulation and fibrinolysis were serially examined for up to 5 days. Paradoxical thrombin activation at 3 hours after initiation of therapy was comparable between reteplase and alteplase. Reteplase (65 +/- 5 U/L) and alteplase (72 +/- 8 U/L) caused significantly elevated kallikrein activity at 3 hours after adminstration (p <0.01 vs controls 30 +/- 1 U/L). Fibrin specificity was less for reteplase (p <0.05) with a decrease in fibrinogen at 3 hours to 122 +/- 27 mg/dl versus 224 +/- 28 mg/dl for alteplase (p <0.01 and p <0.05 vs controls). D-Dimer levels at 3 hours were higher (p <0.05) after reteplase (5,459 +/- 611 ng/ml) versus alteplase (3,445 +/- 679 ng/ml) (both p <0.01 vs controls 243 +/- 17 ng/ml). Plasmin generation (plasmin-antiplasmin complexes) was significantly (p <0.01) increased at 3 hours with both regimens to 27,079 +/- 3,964 microg/L (reteplase) and 19,522 +/- 2,381 microg/L (alteplase). The data from 3 hours after start of thrombolytic therapy proved less marked fibrin specificity of the reteplase regimen (in vivo) compared with front-loaded alteplase. Both regimens have a moderate procoagulant effect without differences in activation of the kallikrein system.
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Affiliation(s)
- H M Hoffmeister
- Medizinische Universitätsklinik, Abteilung Innere Medizin III, Eberhard-Karls Universität Tübingen, Tübingen, Germany
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Abstract
The Generalized Estimating Equations (GEE) is an approach to analyze correlated data. It is applied here to data from an epidemiological study of oesophageal cancer in a high incidence area in China to investigate familial aggregation. Regression diagnostics for mean structures and association structures are used to identify families that influence estimates of these structures. It is shown that most of the families influencing the mean structure have a low age of disease onset in common. Most families identified by regression diagnostics for the association structure influence the parent correlation. It is concluded that regression diagnostic techniques can be used to identify clusters influencing mean and association structures of the models.
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Affiliation(s)
- A Ziegler
- Medical Center for Methodology and Health Research, Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Germany.
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Ziegler A, Hebebrand J, Kastner C, Müller-Myhsok B. Significant evidence for linkage of a simulated trait to D1G024--a conclusion reached using multiallelic transmission/disequilibrium tests. Genet Epidemiol 1999; 17 Suppl 1:S785-9. [PMID: 10597531 DOI: 10.1002/gepi.13701707129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We applied three versions of the transmission/disequilibrium test (TDT) for detecting linkage in nuclear families using the a priori information of possibly present association. For our analyses we employed all marker data for a simulated trait. Results for replicate 11 showed significant linkage to D1G024 using the multiallelic Tmhet statistic and the extended TDT. The TDT for the most frequent parental allele which had been applied successfully in previous studies failed to detect linkage. This result may have happened because the data did not arise from a realistic simulation of the evolution of a real population, where mutations might be expected to occur against a specific haplotype. Simulation studies are required to elucidate the applicability of the TDT for the most frequent parental allele in realistic situations. Furthermore, guidelines have to be developed for how to pool categories in large, sparse contingency tables to obtain larger cell frequencies and lower degrees of freedom.
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Affiliation(s)
- A Ziegler
- Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Germany
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Hoffmeister HM, Szabo S, Kastner C, Beyer ME, Helber U, Kazmaier S, Wendel HP, Heller W, Seipel L. Thrombolytic therapy in acute myocardial infarction: comparison of procoagulant effects of streptokinase and alteplase regimens with focus on the kallikrein system and plasmin. Circulation 1998; 98:2527-33. [PMID: 9843458 DOI: 10.1161/01.cir.98.23.2527] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thrombolytic therapy in patients with acute myocardial infarction (AMI) is hampered by procoagulant effects. In vitro studies have indicated that plasmin stimulation activates the kallikrein-contact-phase system, resulting in thrombin activation. This prospective comparative study was designed to examine the procoagulant effects of streptokinase or alteplase in AMI. METHODS AND RESULTS Sixty-one patients with AMI received 1.5 million U of streptokinase or front-loaded alteplase (up to 100 mg) and systemic heparin. Twenty-four patients with AMI and no thrombolytic therapy and 30 control subjects were examined for comparison. Molecular markers of thrombin, plasmin activation, and coagulation activities were determined before therapy and serially for up to 10 days. Moderate thrombin (initial thrombin-antithrombin [TAT] complex 18+/-5 versus 4+/-0.3 microg/L, P<0.05) and kallikrein (up to 45+/-4 versus 30+/-1 U/L at 3 hours, P<0.01) activation occurs in patients with AMI. D-Dimers are increased (P<0.01), and plasmin is stimulated (P<0.01). Streptokinase and alteplase increase TAT to 50+/-17 and 51+/-18 microg/L at 3 hours and to 50+/-17 and 33+/-14 microg/L at 6 hours, respectively (P<0.01). Kallikrein activity is elevated (P<0. 01) to 76+/-5 and 71+/-7 U/L at 3 hours and 64+/-6 and 47+/-5 U/L by streptokinase and alteplase, respectively, at 6 hours. Reductions in fibrinogen and increases in D-dimers and plasmin-antiplasmin complexes are more marked (P<0.05 and 0.01) after streptokinase versus alteplase. Correlations were found among TAT, kallikrein activity, and plasmin activation (P<0.01). CONCLUSIONS The data indicate a more marked procoagulant action of the streptokinase regimen compared with front-loaded alteplase, thus supporting the hypothesis of a plasmin-mediated kallikrein activation with consecutive procoagulant action in vivo.
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Affiliation(s)
- H M Hoffmeister
- Medizinische Universitätsklinik, Abt Innere Medizin III, Tübingen, Germany
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Dumont FJ, Altmeyer A, Kastner C, Fischer PA, Lemon KP, Chung J, Blenis J, Staruch MJ. Relationship between multiple biologic effects of rapamycin and the inhibition of pp70S6 protein kinase activity. Analysis in mutant clones of a T cell lymphoma. J Immunol 1994; 152:992-1003. [PMID: 8301150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Rapamycin (RAP) inhibits several biologic responses in the YAC-1 T cell lymphoma, including the serum-driven proliferation and cyclin A mRNA expression, the induction of Ly-6E Ag expression by IFN, and the induction of IFN-gamma production by IL-1. RAP also suppresses the enzymatic activity of the 70 kDa S6 protein kinase (pp70s6k). To define the mechanistic relationship between these multiple effects of RAP, we have generated stable somatic mutants with altered sensitivities to this drug. A first series of mutants, represented by the R19, 4R16, and 10R13 clones, showed markedly reduced sensitivity to the inhibitory effect of RAP on all biologic responses tested and on pp70s6k activity. Two other mutant types, R103 and R125, were both highly sensitive to RAP-mediated suppression of proliferation, of IL-1-induced IFN-gamma production, and of pp70s6k activity but differed in their Ly-6E response. This response was not affected by RAP in the R125 clone and was enhanced in the R103 clone. Therefore, the inhibitory effects of RAP on proliferation and IL-1-mediated IFN-gamma induction both appear associated with the inhibition of pp70s6k activity, whereas the modulation of Ly-6E induction is independent from the latter. Moreover, the cellular binding of [3H]dihydro-FK-506 was found to be blocked by RAP in all mutant types to the same extent as in wild-type YAC-1 cells, suggesting that the altered sensitivity to the effects of RAP in these mutants is not due to an inability of the drug to enter the cells or to interact with FKBP. Further biochemical characterization of the mutant cells described here is expected to help clarify the mechanisms of RAP action.
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Affiliation(s)
- F J Dumont
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
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Dumont FJ, Altmeyer A, Kastner C, Fischer PA, Lemon KP, Chung J, Blenis J, Staruch MJ. Relationship between multiple biologic effects of rapamycin and the inhibition of pp70S6 protein kinase activity. Analysis in mutant clones of a T cell lymphoma. The Journal of Immunology 1994. [DOI: 10.4049/jimmunol.152.3.992] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Rapamycin (RAP) inhibits several biologic responses in the YAC-1 T cell lymphoma, including the serum-driven proliferation and cyclin A mRNA expression, the induction of Ly-6E Ag expression by IFN, and the induction of IFN-gamma production by IL-1. RAP also suppresses the enzymatic activity of the 70 kDa S6 protein kinase (pp70s6k). To define the mechanistic relationship between these multiple effects of RAP, we have generated stable somatic mutants with altered sensitivities to this drug. A first series of mutants, represented by the R19, 4R16, and 10R13 clones, showed markedly reduced sensitivity to the inhibitory effect of RAP on all biologic responses tested and on pp70s6k activity. Two other mutant types, R103 and R125, were both highly sensitive to RAP-mediated suppression of proliferation, of IL-1-induced IFN-gamma production, and of pp70s6k activity but differed in their Ly-6E response. This response was not affected by RAP in the R125 clone and was enhanced in the R103 clone. Therefore, the inhibitory effects of RAP on proliferation and IL-1-mediated IFN-gamma induction both appear associated with the inhibition of pp70s6k activity, whereas the modulation of Ly-6E induction is independent from the latter. Moreover, the cellular binding of [3H]dihydro-FK-506 was found to be blocked by RAP in all mutant types to the same extent as in wild-type YAC-1 cells, suggesting that the altered sensitivity to the effects of RAP in these mutants is not due to an inability of the drug to enter the cells or to interact with FKBP. Further biochemical characterization of the mutant cells described here is expected to help clarify the mechanisms of RAP action.
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Affiliation(s)
- F J Dumont
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - A Altmeyer
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - C Kastner
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - P A Fischer
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - K P Lemon
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - J Chung
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - J Blenis
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
| | - M J Staruch
- Department of Immunology, Merck Research Laboratories, Rahway, NJ 07065
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Dumont FJ, Kastner C, Iacovone F, Fischer PA. Quantitative and temporal analysis of the cellular interaction of FK-506 and rapamycin in T-lymphocytes. J Pharmacol Exp Ther 1994; 268:32-41. [PMID: 7507994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The structurally related immunosuppressive macrolides FK-506 and rapamycin (RAP) exert distinct biological effects: inhibition of interleukin-2 production and inhibition of interleukin-2-induced proliferation, respectively, through binding to intracellular receptors, termed FKBPs. Although the interaction of these drugs with purified FKBPs in vitro has been well characterized, little is known about their interaction with FKBPs in living cells. Here, we used [3H]-dihydro-FK-506 as a probe to examine the binding of these macrolides in both normal mouse splenic T-cells and the human Jurkat T-cell lymphoma. These cells were found to accumulate the radioligand, predominantly in the cytosol, to a saturable level corresponding to an estimated concentration of 6 to 7 microM. Half-maximal suppression of T-cell activation was shown to require radioligand occupancy of only 3 to 5% of the pool of available intracellular binding sites (FKBPs). Moreover, the binding and immunosuppressive effect of the radioligand could not be removed by extensive washing and remained stable for at least 6 hr upon incubation of the cells at 37 degrees C. However, a molar excess of either FK-506 or RAP was found to rapidly displace [3H]-dihydro-FK-506 from its cellular binding sites. Consistently, FK-506 and RAP were able to antagonize mutually their immunosuppressive activities even when added several hr after each other to T-cell cultures. We took advantage of the reciprocal antagonism of FK-506 and RAP to define their apparent affinities for the functionally relevant cellular receptors by Schild analysis. This indicated that the drugs compete for a single cellular receptor with similar KdS and, therefore, may mediate their immunosuppressive action upon interaction with similar or highly related FKBPs.
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Affiliation(s)
- F J Dumont
- Department of Immunology Research, Merck Research Laboratories, Rahway, New Jersey
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Kastner C, Svare CW, Scandrett FR, Kerber PE, Taylor TD, Semler HE. Effects of chemical denture cleaners on the flexibility of cast clasps. J Prosthet Dent 1983; 50:473-9. [PMID: 6579286 DOI: 10.1016/0022-3913(83)90565-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kastner C. [Juvenile hyperuricemia, gout and cerebral palsy (Lesch-Nyhan syndrome)]. Z Kinderheilkd 1969; 107:1-14. [PMID: 5356484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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