1
|
Wiegand J, Petroff D, Karlas T. Metabolic dysfunction associated steatotic liver disease-Clinicians should not underestimate the role of steatosis. United European Gastroenterol J 2024; 12:277-278. [PMID: 38174620 PMCID: PMC11017754 DOI: 10.1002/ueg2.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Johannes Wiegand
- Division of HepatologyDepartment of Medicine IILeipzig University Medical CentreLeipzigGermany
| | - David Petroff
- Clinical Trial Centre LeipzigUniversity of LeipzigLeipzigGermany
| | - Thomas Karlas
- Division of GastroenterologyDepartment of Medicine IILeipzig University Medical CentreLeipzigGermany
| |
Collapse
|
2
|
Hilbert A, Rösch SA, Petroff D, Prettin C, Lührs M, Ehlis AC, Schmidt R. Near-infrared spectroscopy and electroencephalography neurofeedback for binge-eating disorder: an exploratory randomized trial. Psychol Med 2024; 54:675-686. [PMID: 37964437 DOI: 10.1017/s0033291723002350] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Binge-eating disorder (BED) co-occurs with neurobehavioral alterations in the processing of disorder-relevant content such as visual food stimuli. Whether neurofeedback (NF) directly targeting them is suited for treatment remains unclear. This study sought to determine feasibility and estimate effects of individualized, functional near-infrared spectroscopy-based real-time NF (rtfNIRS-NF) and high-beta electroencephalography-based NF (EEG-NF), assuming superiority over waitlist (WL). METHODS Single-center, assessor-blinded feasibility study with randomization to rtfNIRS-NF, EEG-NF, or WL and assessments at baseline (t0), postassessment (t1), and 6-month follow-up (t2). NF comprised 12 60-min food-specific rtfNIRS-NF or EEG-NF sessions over 8 weeks. Primary outcome was the binge-eating frequency at t1 assessed interview-based. Secondary outcomes included feasibility, eating disorder symptoms, mental and physical health, weight management-related behavior, executive functions, and brain activity at t1 and t2. RESULTS In 72 patients (intent-to-treat), the results showed feasibility of NF regarding recruitment, attrition, adherence, compliance, acceptance, and assessment completion. Binge eating improved at t1 by -8.0 episodes, without superiority of NF v. WL (-0.8 episodes, 95% CI -2.4 to 4.0), but with improved estimates in NF at t2 relative to t1. NF was better than WL for food craving, anxiety symptoms, and body mass index, but overall effects were mostly small. Brain activity changes were near zero. CONCLUSIONS The results show feasibility of food-specific rtfNIRS-NF and EEG-NF in BED, and no posttreatment differences v. WL, but possible continued improvement of binge eating. Confirmatory and mechanistic evidence is warranted in a double-blind randomized design with long-term follow-up, considering dose-response relationships and modes of delivery.
Collapse
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Sarah Alica Rösch
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Michael Lührs
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Brain Innovation B.V., Maastricht, The Netherlands
| | - Ann-Christin Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
3
|
Holzhey M, Petroff D, Wirkner K, Engel C, Baber R, Tönjes A, Zeynalova S, Yahiaoui-Doktor M, Berg T, Karlas T, Wiegand J. Relevance of GLP-1 receptor agonists or SGLT-2 inhibitors on the recruitment for clinical studies in patients with NAFLD. Eur J Gastroenterol Hepatol 2024; 36:107-112. [PMID: 37823453 DOI: 10.1097/meg.0000000000002656] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Guidelines increasingly recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) to prevent cardiovascular and cardiorenal endpoints. Both drugs also show beneficial effects in nonalcoholic fatty liver disease (NAFLD). Preexisting GLP-1 RA and SGLT2i therapies are frequently defined as exclusion criterion in clinical studies to avoid confounding effects. We therefore investigated how this might limit recruitment and design of NAFLD studies. METHODS GLP-1 RA and SGLT2i prescriptions were analyzed in NAFLD patients with diabetes mellitus recruited at a tertiary referral center and from the population-based LIFE-Adult-Study. Individuals were stratified according to noninvasive parameters of liver fibrosis based on vibration-controlled transient elastography (VCTE). RESULTS 97 individuals were recruited at tertiary care and 473 from the LIFE-Adult-Study. VCTE was available in 97/97 and 147/473 cases.GLP-1 RA or SGLT2i were used in 11.9% of the population-based cohort (LSM < 8 kPa), but in 32.0% with LSM ≥ 8 kPa. In the tertiary clinic, it was 30.9% overall, independent of LSM, and 36.8% in patients with medium and high risk for fibrotic NASH (FAST score > 0.35). At baseline, 3.1% of the patients in tertiary care were taking GLP-1 RA and 4.1% SGLT2i. Four years later, the numbers had increased to 15.5% and 21.6%. CONCLUSION GLP-1 RA and SGLT2i are frequently and increasingly prescribed. In candidates for liver biopsy for NASH studies (VCTE ≥ 8 kPa) the use of them exceeds 30%, which needs careful consideration when designing NASH trials.
Collapse
Affiliation(s)
- Michael Holzhey
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | | | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Ronny Baber
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig
| | - Anke Tönjes
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig, Germany
| | - Samira Zeynalova
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Maryam Yahiaoui-Doktor
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
| |
Collapse
|
4
|
Uhe T, Wasser K, Weber-Krüger M, Schäbitz WR, Köhrmann M, Brachmann J, Laufs U, Dichgans M, Gelbrich G, Petroff D, Prettin C, Michalski D, Kraft A, Etgen T, Schellinger PD, Soda H, Bethke F, Ertl M, Kallmünzer B, Grond M, Althaus K, Hamann GF, Mende M, Wagner M, Gröschel S, Uphaus T, Gröschel K, Wachter R. Intensive heart rhythm monitoring to decrease ischemic stroke and systemic embolism-the Find-AF 2 study-rationale and design. Am Heart J 2023; 265:66-76. [PMID: 37422010 DOI: 10.1016/j.ahj.2023.06.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most frequent causes of stroke. Several randomized trials have shown that prolonged monitoring increases the detection of AF, but the effect on reducing recurrent cardioembolism, ie, ischemic stroke and systemic embolism, remains unknown. We aim to evaluate whether a risk-adapted, intensified heart rhythm monitoring with consequent guideline conform treatment, which implies initiation of oral anticoagulation (OAC), leads to a reduction of recurrent cardioembolism. METHODS Find-AF 2 is a randomized, controlled, open-label parallel multicenter trial with blinded endpoint assessment. 5,200 patients ≥ 60 years of age with symptomatic ischemic stroke within the last 30 days and without known AF will be included at 52 study centers with a specialized stroke unit in Germany. Patients without AF in an additional 24-hour Holter ECG after the qualifying event will be randomized in a 1:1 fashion to either enhanced, prolonged and intensified ECG-monitoring (intervention arm) or standard of care monitoring (control arm). In the intervention arm, patients with a high risk of underlying AF will receive continuous rhythm monitoring using an implantable cardiac monitor (ICM) whereas those without high risk of underlying AF will receive repeated 7-day Holter ECGs. The duration of rhythm monitoring within the control arm is up to the discretion of the participating centers and is allowed for up to 7 days. Patients will be followed for at least 24 months. The primary efficacy endpoint is the time until recurrent ischemic stroke or systemic embolism occur. CONCLUSIONS The Find-AF 2 trial aims to demonstrate that enhanced, prolonged and intensified rhythm monitoring results in a more effective prevention of recurrent ischemic stroke and systemic embolism compared to usual care.
Collapse
Affiliation(s)
- Tobias Uhe
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Katrin Wasser
- Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
| | - Mark Weber-Krüger
- Department of Palliative Medicine, University of Göttingen Medical Center, Göttingen, Germany
| | | | - Martin Köhrmann
- Department of Neurology, University of Essen, Essen, Germany
| | | | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - David Petroff
- Clinical Trial Centre (ZKS) Leipzig, Leipzig University, Leipzig, Germany
| | - Christiane Prettin
- Clinical Trial Centre (ZKS) Leipzig, Leipzig University, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Andrea Kraft
- Department of Neurology, Hospital Martha-Maria, Halle, Germany
| | - Thorleif Etgen
- Department of Neurology, Klinikum Traunstein, Traunstein, Germany
| | - Peter D Schellinger
- Department of Neurology and Neurogeriatrics, University Hospital Minden, Minden, Germany
| | - Hassan Soda
- Department of Neurology, Rhön Hospital, Bad Neustadt, Germany
| | - Florian Bethke
- Department of Neurology, Ibbenbüren Hospital, Ibbenbüren, Germany
| | - Michael Ertl
- Clinic for Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Bernd Kallmünzer
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Grond
- Department of Neurology, Siegen Hospital, Siegen, Germany
| | | | - Gerhard F Hamann
- Clinic for Neurology and Neurorehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Meinhard Mende
- Clinical Trial Centre (ZKS) Leipzig, Leipzig University, Leipzig, Germany
| | - Marcus Wagner
- Clinical Trial Centre (ZKS) Leipzig, Leipzig University, Leipzig, Germany
| | - Sonja Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany; Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| |
Collapse
|
5
|
Girrbach F, Petroff D, Mols S, Brechtelsbauer K, Wrigge H, Simon P. Extubation with Reduced Inspiratory Oxygen Concentration or Postoperative Continuous Positive Pressure to Improve Oxygenation after Laparoscopic Bariatric Surgery: A Randomized Controlled Trial. Anesthesiology 2023; 139:546-548. [PMID: 37698435 DOI: 10.1097/aln.0000000000004654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
|
6
|
Misfeld M, Haunschild J, Petroff D, Borger MA, Etz CD. Rationale of the PAPAartis trial. Ann Cardiothorac Surg 2023; 12:463-467. [PMID: 37817856 PMCID: PMC10561337 DOI: 10.21037/acs-2023-scp-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/01/2023] [Indexed: 10/12/2023]
Abstract
Surgical and interventional repair of thoracoabdominal aortic aneurysms improve survival significantly compared to the natural history of the disease. However, both strategies are associated with a substantial risk of spinal cord ischemia, which has been reported to occur-even in contemporary series by expert centers-in up to 12% of patients, depending on the extent of the disease. Following improved neurological outcomes after staged approaches in extensive clinical and long-term large animal studies, and the description of the "collateral network", the concept of "Minimally Invasive Staged Segmental Artery Coil Embolization" (MIS2ACE) was introduced by Etz et al. This concept of priming the collateral network in order to improve spinal cord blood supply showed promising experimental and early clinical outcomes, and consequently led to the initiation of the randomized controlled multicenter PAPAartis trial (Paraplegia Prevention in Aortic Aneurysm Repair by Thoracoabdominal Staging). This Keynote Lecture describes the background and rationale for this trial and gives an update on the current status.
Collapse
Affiliation(s)
- Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Josephina Haunschild
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, Leipzig University, Leipzig, Germany
| | - Michael A. Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D. Etz
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
7
|
Wrigge H, Petroff D, Fernandez-Bustamante A. Pressure for High Positive End-expiratory Pressure in Obese Surgical Patients Is Growing. Anesthesiology 2023; 139:239-243. [PMID: 37552098 PMCID: PMC10662970 DOI: 10.1097/aln.0000000000004665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Hermann Wrigge
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Germany
- Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Ana Fernandez-Bustamante
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| |
Collapse
|
8
|
Petroff D, Wiegand J, Karlas T. Editorial: Let your muscles do the talking-what can muscle quality tell us about hepatic fibrosis? Aliment Pharmacol Ther 2023; 58:372-373. [PMID: 37452590 DOI: 10.1111/apt.17618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- David Petroff
- Clinical Trial Centre, Leipzig University, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
9
|
Wrigge H, Muders T, Petroff D. Electrical Impedance Tomography: The Electrocardiogram for the Lungs? Am J Respir Crit Care Med 2023; 208:3-5. [PMID: 37311244 PMCID: PMC10870851 DOI: 10.1164/rccm.202305-0810ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Hermann Wrigge
- Department of Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy Bergmannstrost Hospital Halle, Germany and Medical Faculty Martin-Luther University Halle-Wittenberg Halle, Germany
| | - Thomas Muders
- Department of Anesthesiology and Intensive Care Medicine University Hospital Bonn Bonn, Germany
| | - David Petroff
- Clinical Trial Centre University of Leipzig Leipzig, Germany
| |
Collapse
|
10
|
Petroff D, Wolffram I, Bätz O, Jedrysiak K, Kramer J, Berg T, Wiegand J. Confirmation of guideline-defined hepatitis C screening strategies within the 'Check-Up35+' examination in the primary care setting. Liver Int 2023; 43:785-793. [PMID: 36621849 DOI: 10.1111/liv.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/22/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Screening strategies for undiagnosed infections are fundamental for hepatitis C virus (HCV) elimination. We previously investigated HCV prevalence and screening strategies in an urban primary care setting. IV drug abuse, blood transfusion before 1992, immigration, or elevated ALT were identified as risk factors in a post hoc analysis and diagnosed 83% of unknown HCV-RNA-positive cases by screening only 26% of the population. We aimed to validate prospectively the proposed screening algorithm in two independent urban and rural cohorts and to analyse for potential differences. METHODS Anti-HCV and ALT were included in a routine check-up together with a questionnaire covering risk factors. HCV-RNA was analysed in anti-HCV-positive individuals. RESULTS In urban and rural areas, 4323 and 9321 individuals were recruited. The anti-HCV prevalence was 0.56% and 0.49%, and 0.1% of patients were HCV-RNA-positive in both regions. Fifty-two anti-HCV positive patients including eight HCV-RNA-positive cases were unaware of the infection (number needed to screen to detect one unknown anti-HCV-positive individual: 262). At least one of the three aforementioned risk factors or elevated serum ALT was present in 3000 patients (22%). Restricting HCV screening to only those with risk factors, 52% and 75% of all anti-HCV and HCV-RNA-positive undiagnosed patients were identified (number needed to screen: 111). CONCLUSIONS We confirm prospectively the efficiency of a risk-based HCV screening. The risk-based algorithm should be evaluated in other countries with similarly low HCV prevalence as in Germany to achieve WHO HCV elimination goals.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | | | - Olaf Bätz
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Katrin Jedrysiak
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Jan Kramer
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
11
|
Hilbert A, Juarascio A, Prettin C, Petroff D, Schlögl H, Hübner C. Smartphone-supported behavioural weight loss treatment in adults with severe obesity: study protocol for an exploratory randomised controlled trial (SmartBWL). BMJ Open 2023; 13:e064394. [PMID: 36854588 PMCID: PMC9980333 DOI: 10.1136/bmjopen-2022-064394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Behavioural weight loss (BWL) treatment is the standard evidence-based treatment for severe obesity (SO; body mass index ≥40.0 kg/m2 or ≥35.0 kg/m2 with obesity-related comorbidity), leading to moderate weight loss which often cannot be maintained in the long term. Because weight loss depends on patients' use of weight management skills, it is important to support them in daily life. In an ecological momentary intervention design, this clinical trial aims to adapt, refine and evaluate a personalised cognitive-behavioural smartphone application (app) in BWL treatment to foster patients' weight management skills use in everyday life. It is hypothesised that using the app is feasible and acceptable, improves weight loss and increases skills use and well-being. METHODS AND ANALYSIS In the pilot phase, the app will be adapted, piloted and optimised for BWL treatment following a participatory patient-oriented approach. In the subsequent single-centre, assessor-blind, exploratory randomised controlled trial, 90 adults with SO will be randomised to BWL treatment over 6 months with versus without adjunctive app. Primary outcome is the amount of weight loss (kg) at post-treatment (6 months), compared with pretreatment, derived from measured body weight. Secondary outcomes encompass feasibility, acceptance, weight management skills use, well-being and anthropometrics assessed at pretreatment, midtreatment (3 months), post-treatment (6 months) and 6-month follow-up (12 months). An intent-to-treat linear model with randomisation arm, pretreatment weight and stratification variables as covariates will serve to compare arms regarding weight at post-treatment. Secondary analyses will include linear mixed models, generalised linear models and regression and mediation analyses. For safety analysis (serious) adverse events will be analysed descriptively. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the University of Leipzig (DE-21-00013674) and notified to the Federal Institute for Drugs and Medical Devices. Study results will be disseminated through peer-reviewed publications. REGISTRATION This study was registered at the German Clinical Trials Register (DRKS00026018), www.drks.de. TRIAL REGISTRATION NUMBER DRKS00026018.
Collapse
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioural Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Saxony, Germany
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Saxony, Germany
| | - Haiko Schlögl
- Department of Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Claudia Hübner
- Integrated Research and Treatment Center AdiposityDiseases, Behavioural Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Saxony, Germany
| |
Collapse
|
12
|
Petroff D, Berg T, Wiegand J. Reply. Clin Gastroenterol Hepatol 2023; 21:240. [PMID: 35381386 DOI: 10.1016/j.cgh.2022.03.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023]
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
13
|
Romo-Avilés N, Zapata JF, Keuneke A, Petroff D, Etz CD, Epstein D. "There is nothing better than participating in this study": Living the PAPAartis cardiovascular randomised controlled trial. Contemp Clin Trials Commun 2022; 29:100987. [PMID: 36111175 PMCID: PMC9468490 DOI: 10.1016/j.conctc.2022.100987] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Qualitative research can bring new dimensions of understanding decision-making process in clinical trials. Participating in a randomized clinical trial requires patients to accept complex information and make decisions in a context of uncertainty. It becomes especially complicated in the case of serious diseases in which the treatment itself implies unknown risks. This study examines these issues in the context of the PAPAartis randomized clinical trial, which aims to prevent spinal cord injuries that can occur as an adverse event following complex surgical repair of thoracoabdominal aneurysm. In this study, we accessed a group of 16 patients participating in the trial and, through in-depth interviews, sought to understand the decision-making process when taking part in the trial and their experience of it. Our results showed that patients participated for different reasons: due to trust in doctors, the hope of having a better treatment or for altruistic and collaborative reasons with science. Many patients felt they did not fully understand the extraneous information provided about the study and the complex nature of the procedure. Avoidance of paraplegia played a fundamental role in the decision to participate in this trial. Family support and the socioeconomic conditions of the patients influenced the recovery process after surgery.
Collapse
Affiliation(s)
| | | | - Alena Keuneke
- Department of Social Anthropology, University of Granada, Spain
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Epstein
- Department of Applied Economics, University of Granada, Spain
| |
Collapse
|
14
|
Blank V, Petroff D, Boehlig A, Heinze A, Karlas T, Berg T, Wiegand J. Clinical implications of hepatic structure and function evaluation based on vibration-controlled transient elastography and liver maximum function capacity test in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol 2022; 34:686-692. [PMID: 35102112 DOI: 10.1097/meg.0000000000002347] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Transient elastography [vibration-controlled transient elastography (VCTE)] noninvasively guides risk stratification in patients with nonalcoholic fatty liver disease (NAFLD). Patients with nonalcoholic steatohepatitis (NASH) and fibrosis can be identified using the FAST-score. The liver maximum function test (LiMAx) could be helpful in more precise risk stratification. This pilot study evaluated VCTE, FAST-score, and LiMAx in NAFLD patients. METHODS NAFLD patients prospectively underwent VCTE and LiMAx. The cutoffs for high fibrosis risk were 9.3/9.6 kPa (M/XL-probe) and 331 dB/m for steatosis. A FAST-score greater than 0.67 was used to identify patients with NASH and LiMAx values below 315 μg/kg/h for impaired liver function. RESULTS In total, 57 NAFLD patients (BMI 32 ± 6 kg/m2; 60% diabetes) were included. High risk for fibrosis and steatosis was observed in 26/57 and 28/57 cases, respectively. Overall, 19/57 patients presented impaired liver function. However, 14/26 of patients with a high risk for fibrosis had impaired liver function compared to 5/31 of those without (P = 0.0026). Similarly, 12/18 patients at high risk for NASH had impaired liver function compared to 7/39 without (P < 0.001). The subgroup with diabetes had a liver stiffness a factor of 1.8 higher, FAST-score was 0.13 higher and LiMAx values were 66 μg/kg/h lower compared to nondiabetics. CONCLUSION There is a significant correlation between the functional liver capacity (LiMAx) and the structural liver assessment by VCTE. In cases with high liver stiffness or FAST-score, low LiMAx results may identify NAFLD patients at risk for disease progression and reduce the risk of false-positive categorization.
Collapse
Affiliation(s)
- Valentin Blank
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, Faculty of Medicine, University of Leipzig
| | - David Petroff
- Clinical Trial Centre Leipzig, University of Leipzig
| | - Albrecht Boehlig
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Aileen Heinze
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center
| | - Thomas Berg
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Department of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
15
|
Petroff D, Bätz O, Jedrysiak K, Kramer J, Berg T, Wiegand J. Age Dependence of Liver Enzymes: An Analysis of Over 1,300,000 Consecutive Blood Samples. Clin Gastroenterol Hepatol 2022; 20:641-650. [PMID: 33524594 DOI: 10.1016/j.cgh.2021.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Upper levels of normal for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltransferase (GGT) generally take sex into account, but not age. This simplification may lead to misclassification and burden the patient and health system unnecessarily. METHODS Consecutive blood samples were analyzed from a German laboratory. Subcohorts included samples from a prescribed routine check-up and a healthy cohort, defined as patients without increased GGT, triglyceride, cholesterol, glycated hemoglobin, or glucose levels, and without known hepatitis B. RESULTS A total of 1,369,180 blood samples were analyzed from 601,779 participants (50.8% female; mean age, 58.5 y; SD, 18.0 y). There is an extreme age dependence in ALT values for men: increased values were seen in 20.0% (95% CI, 19.5%-20.4%) of patients in the age group of 25 to 34 years, but only 6.7% (95% CI, 6.4%-7.0%) for the ages of 65 to 74 years. The 95th percentile reaches values greater than 80 U/L instead of 50 U/L at the age of 35, and decrease to less than 50 U/L by the age of 75. Similar qualitative results were found in the healthy and prescribed routine check-up subcohorts. The age dependence is much weaker for ALT in women. The proportion of women with an increased AST level increases from approximately 6% to 12% at approximately age 50. The 95th percentile for GGT increases up to the age of 60 in men, and throughout life in women. CONCLUSIONS Current guidelines and reference values for ALT imply that subsequent diagnostics are needed for a large proportion of young men. Our data strongly suggest that age adaptation should be considered.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Olaf Bätz
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Katrin Jedrysiak
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Jan Kramer
- LADR Laboratory Group Dr. Kramer & Colleagues, Geesthacht, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
| |
Collapse
|
16
|
Petroff D, Berg T, Wiegand J. Reply. Clin Gastroenterol Hepatol 2022; 20:716-717. [PMID: 33823292 DOI: 10.1016/j.cgh.2021.03.050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 02/07/2023]
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
17
|
Blank V, Petroff D, Wiegand J, Karlas T. M probe comes first: Impact of initial probe choice on diagnostic performance of vibration controlled transient elastography. Dig Liver Dis 2022; 54:358-364. [PMID: 34446354 DOI: 10.1016/j.dld.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Probe choice (M or XL) in transient elastography can be made by the user's own measure of skin-to-liver-capsule distance (SCD) or with an automated tool (AUTO). We studied how AUTO depends on initial probe choice. METHODS Three fictive clinics were considered: The "M-first clinic" uses AUTO from the M probe, the "XL-first clinic" uses AUTO from the XL probe and a "reference clinic" measures SCD independently. Agreement and discrepancies to the reference clinic were measured. RESULTS 200 patients with chronic liver disease were prospectively included (58% female, 56 years, BMI 28.1 kg/m²). Fleiss' kappa for agreement in probe selection was 0.11 (95% CI -0.09 to 0.31), but accuracy was above 0.8 for both. Probe failure occurred for 16 (M-first clinic), 4 (XL-first clinic) and 3 patients (reference clinic). Use of XL probe given M probe failure improved performance of the M-first approach. The odds ratio for discrepancy in the XL-first vs M-first clinic is 2.4 (95% CI 1.2 to 5.2, p = 0.012) for liver fibrosis and 4.8 (95% CI 1.8 to 16.1, p < 0.001) for steatosis. CONCLUSIONS Agreement in AUTO between M and XL probes is poor although each has acceptable accuracy. The M-first approach leads to fewer discrepancies and should be adopted as a standard.
Collapse
Affiliation(s)
- Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstrasse 20, 04103 Leipzig, Germany; Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany; Clinical Trial Centre Leipzig, University of Leipzig, Härtelstrasse 16/18, 04107 Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstrasse 20, 04103 Leipzig, Germany.
| |
Collapse
|
18
|
Bräunlich J, Köppe-Bauernfeind N, Petroff D, Franke A, Wirtz H. Nasal high-flow compared to non-invasive ventilation in treatment of acute acidotic hypercapnic exacerbation of chronic obstructive pulmonary disease-protocol for a randomized controlled noninferiority trial (ELVIS). Trials 2022; 23:28. [PMID: 35012620 PMCID: PMC8744018 DOI: 10.1186/s13063-021-05978-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a major negative impact on health status, rates of hospitalization, readmission, disease progression and mortality. Non-invasive ventilation (NIV) is the standard therapy for hypercapnic acidotic respiratory failure in AECOPD. Despite its beneficial effects, NIV is often poorly tolerated (11–34 % failure rate). An increasing number of studies have documented a beneficial effect of nasal high-flow (NHF) in acute hypercapnia. We designed a prospective, randomized, multi-centre, open label, non-inferiority trial to compare treatment failure in nasal NHF vs NIV in patients with acidotic hypercapnic AECOPD. Methods The study will be conducted in about 35 sites in Germany. Patients with hypercapnic AECOPD with respiratory acidosis (pH < 7.35) will be randomized 1:1 to NIV or NHF. The primary outcome is the combined endpoint of intubation, treatment failure or death at 72 h. The switch from one to the other device marks a device failure but acts as a rescue treatment in absence of intubation criteria. A sample size of 720 was calculated to have 80% power for showing that NHF is non-inferior to NIV with a margin of 8 percentage points. Linear regression will be used for the confirmatory analysis. Discussion If NHF is shown to be non-inferior to NIV in acidotic hypercapnic AECOPD, it could become an important alternative treatment. Trial registration ClinicalTrials.gov, NCT04881409, Registered on May 11, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05978-z.
Collapse
Affiliation(s)
- Jens Bräunlich
- University of Leipzig, Leipzig, Germany. .,Hospital Emden, Bolardusstrasse 20, 26721, Emden, Germany.
| | | | | | | | | |
Collapse
|
19
|
Busse D, Simon P, Schmitt L, Petroff D, Dorn C, Dietrich A, Zeitlinger M, Huisinga W, Michelet R, Wrigge H, Kloft C. Comparative Plasma and Interstitial Tissue Fluid Pharmacokinetics of Meropenem Demonstrate the Need for Increasing Dose and Infusion Duration in Obese and Non-obese Patients. Clin Pharmacokinet 2021; 61:655-672. [PMID: 34894344 PMCID: PMC9095536 DOI: 10.1007/s40262-021-01070-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES A quantitative evaluation of the PK of meropenem, a broad-spectrum β-lactam antibiotic, in plasma and interstitial space fluid (ISF) of subcutaneous adipose tissue of obese patients is lacking as of date. The objective of this study was the characterisation of meropenem population pharmacokinetics in plasma and ISF in obese and non-obese patients for identification of adequate dosing regimens via Monte-Carlo simulations. METHODS We obtained plasma and microdialysate concentrations after administration of meropenem 1000 mg to 15 obese and 15 non-obese surgery patients from a prospective clinical trial. After characterizing plasma- and microdialysis-derived ISF pharmacokinetics via population pharmacokinetic analysis, we simulated thrice-daily (TID) meropenem short-term (0.5 h), prolonged (3.0 h), and continuous infusions. Adequacy of therapy was assessed by the probability of pharmacokinetic/pharmacodynamic (PK/PD) target attainment (PTA) analysis based on time unbound concentrations exceeded minimum inhibitory concentrations (MIC) on treatment day 1 (%fT > MIC) and the sum of PTA weighted by relative frequency of MIC values for infections by pathogens commonly treated with meropenem. To avoid interstitial tissue fluid concentrations below MIC for the entire dosing interval during continuous infusions, a more conservative PK/PD index was selected (%fT > 4 × MIC). RESULTS Adjusted body weight (ABW) and calculated creatinine clearance (CLCRCG_ABW) of all patients (body mass index [BMI] = 20.5-81.5 kg/m2) explained a considerable proportion of the between-patient pharmacokinetic variability (15.1-31.0% relative reduction). The ISF:plasma ratio of %fT > MIC was relatively similar for MIC ≤ 2 mg/L but decreased for MIC = 8 mg/L over ABW = 60-120 kg (0.50-0.20). Steady-state concentrations were 2.68 times (95% confidence interval [CI] = 2.11-3.37) higher in plasma than in ISF, supporting PK/PD targets related to four times the MIC during continuous infusions to avoid suspected ISF concentrations constantly below the MIC. A 3000 mg/24 h continuous infusion was sufficient at MIC = 2 mg/L for patients with CLCRCG_ABW ≤ 100 mL/min and ABW < 90 kg, whereas 2000 mg TID prolonged infusions were adequate for those with CLCRCG_ABW ≤ 100 mL/min and ABW > 90 kg. For MIC = 2 mg/L and %fT> MIC = 95, PTA was adequate in patients over the entire investigated range of body mass and renal function using a 6000 mg continuous infusion. A prolonged infusion of meropenem 2000 mg TID was sufficient for MIC ≤ 8 mg/L and all investigated ABW and CLCRCG_ABW when employing the PK/PD target %fT > MIC = 40. Short-term infusions of 1000 mg TID were sufficient for CLCRCG_ABW ≤ 130 mL/min and distributions of MIC values for Escherichia coli, Citrobacter freundii, and Klebsiella pneumoniae but not for Pseudomonas aeruginosa. CONCLUSIONS This analysis indicated a need for higher doses (≥ 2000 mg) and prolonged infusions (≥ 3 h) for obese and non-obese patients at MIC ≥ 2 mg/L. Higher PTA was achieved with prolonged infusions in obese patients and with continuous infusions in non-obese patients. TRIAL REGISTRATION EudraCT: 2012-004383-22.
Collapse
Affiliation(s)
- David Busse
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Kelchstr. 31, 12169, Berlin, Germany
- Graduate Research Training Program PharMetrX, Berlin, Germany
| | - Philipp Simon
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Lisa Schmitt
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Kelchstr. 31, 12169, Berlin, Germany
- Graduate Research Training Program PharMetrX, Berlin, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Arne Dietrich
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Huisinga
- Institute of Mathematics, University of Potsdam, Potsdam, Germany
| | - Robin Michelet
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Kelchstr. 31, 12169, Berlin, Germany
| | - Hermann Wrigge
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Kelchstr. 31, 12169, Berlin, Germany.
| |
Collapse
|
20
|
Bercker S, Petroff D, Polze N, Karagianidis C, Bein T, Laudi S, Stehr SN, Voelker MT. ECMO use in Germany: An analysis of 29,929 ECMO runs. PLoS One 2021; 16:e0260324. [PMID: 34874960 PMCID: PMC8651096 DOI: 10.1371/journal.pone.0260324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Extracorporeal Membrane Oxygenation (ECMO) use is increasing despite limited evidence. The aim of this study was to demonstrate heterogeneity of ECMO use and its association with hospital size and annual frequency in Germany. Methods This is a database analysis of all ECMO cases in Germany from 2010 to 2016 using the German Diagnosis Related Groups (DRG) coding system for ECMO. Results During the study period, 510 hospitals performed 29,929 ECMO runs (12,572 vvECMO, 11,504 vaECMO, 1993 pECLA) with an increase over time. Mortality ranged between 58% and 66% for vaECMO cases and 66% and 53% for vvECMO cases. 304 (61%) hospitals performed only one ECMO per year. 78%% of all ECMO runs were performed in centres with more than 20 cases per year and more than half of all ECMO runs were performed in hospitals with >1.000 beds. Mortality for vv and vaECMO was highest in very small hospitals (< 200 beds; 70%; 74%) and very large hospitals (>1000 beds; 60%; 62%). Conclusions Use of ECMO is still increasing and a substantial proportion of hospitals performs very few ECMO runs. Small hospitals had a significantly higher mortality, but dependence on hospital size and ECMO mortality was irregular.
Collapse
Affiliation(s)
- Sven Bercker
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
- * E-mail:
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Nina Polze
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Christian Karagianidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Thomas Bein
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Sebastian N. Stehr
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Maria Theresa Voelker
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, Leipzig, Germany
| |
Collapse
|
21
|
Petroff D, Bätz O, Jedrysiak K, Lüllau A, Kramer J, Möller H, Heyne R, Jäger B, Berg T, Wiegand J. From Screening to Therapy: Anti-HCV Screening and Linkage to Care in a Network of General Practitioners and a Private Gastroenterology Practice. Pathogens 2021; 10:pathogens10121570. [PMID: 34959525 PMCID: PMC8706228 DOI: 10.3390/pathogens10121570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, 04107 Leipzig, Germany;
| | - Olaf Bätz
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (A.L.); (J.K.)
| | - Katrin Jedrysiak
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (A.L.); (J.K.)
| | - Anja Lüllau
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (A.L.); (J.K.)
| | - Jan Kramer
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (A.L.); (J.K.)
| | - Hjördis Möller
- Leberzentrum am Checkpoint, 10961 Berlin, Germany; (H.M.); (R.H.); (B.J.)
| | - Renate Heyne
- Leberzentrum am Checkpoint, 10961 Berlin, Germany; (H.M.); (R.H.); (B.J.)
| | - Burkhard Jäger
- Leberzentrum am Checkpoint, 10961 Berlin, Germany; (H.M.); (R.H.); (B.J.)
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany;
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany;
- Correspondence: ; Tel.: +49-341-97-12330; Fax: +49-341-97-12339
| |
Collapse
|
22
|
Petroff D, Bätz O, Jedrysiak K, Kramer J, Berg T, Wiegand J. The Practicability of the Xpert HCV Viral Load Fingerstick Point-of-Care Assay in Primary Care Settings. Viruses 2021; 13:2327. [PMID: 34835133 PMCID: PMC8623012 DOI: 10.3390/v13112327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Linkage to care presents one obstacle toward eliminating HCV, and the current two-step pathway (anti-HCV, followed by HCV-RNA testing) results in the loss of patients. HCV screening was tested in the primary care setting with the fingerstick Xpert HCV viral load point-of-care assay to analyze the practicability of immediate diagnosis. Anti-HCV (Cobas) and HCV-RNA (Cobas Amplicor version 2.0, only performed if anti-HCV was positive) were analyzed centrally as the gold standard. The Xpert assay was performed by 10 primary care private practices. In total, 622 patients were recruited. Five individuals (0.8%) were anti-HCV positive, and one was HCV-RNA positive. The Xpert test was valid in 546/622 (87.8%) patients. It was negative in 544 and positive in 2 cases, both of whom were anti-HCV negative. The HCV-RNA PCR and the Xpert test were both negative in 4/5 anti-HCV-positive cases, and the individual with HCV-RNA 4.5 × 106 IU/mL was not detected by the Xpert test. Primary care physicians rated the Xpert test practicability as bad, satisfactory, or good in 6%, 13%, and 81%, respectively, though 14/29 (48%) bad test ratings were assigned by a single practice. Despite adequate acceptance, interpretability and diagnostic performance in primary care settings should be further evaluated before its use in HCV screening can be recommended.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, 04107 Leipzig, Germany;
| | - Olaf Bätz
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (J.K.)
| | - Katrin Jedrysiak
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (J.K.)
| | - Jan Kramer
- LADR Laboratory Group Dr. Kramer & Colleagues, 21502 Geesthacht, Germany; (O.B.); (K.J.); (J.K.)
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany;
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany;
| |
Collapse
|
23
|
Busse D, Borghardt JM, Petroff D, Pevzner A, Dorn C, El-Najjar N, Huisinga W, Wrigge H, Simon P, Kloft C. Evaluating prediction methods for glomerular filtration to optimise drug doses in obese and nonobese patients. Br J Clin Pharmacol 2021; 88:2973-2981. [PMID: 34688225 DOI: 10.1111/bcp.15115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/20/2021] [Revised: 08/19/2021] [Accepted: 10/03/2021] [Indexed: 01/02/2023] Open
Abstract
AIMS The most suitable method for predicting the glomerular filtration rate (GFR) in obesity is currently debated. Therefore, multiple GFR/creatinine clearance prediction methods were applied to (morbidly) obese and nonobese patients ranging from moderate renal impairment to glomerular hyperfiltration and their predictions were rated based on observed fosfomycin pharmacokinetics, as this model drug is exclusively eliminated via glomerular filtration. METHODS The GFR/creatinine clearance predictions via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD; indexed and de-indexed by body surface area) and creatinine clearance via the Cockcroft-Gault formula (CLCRCG ) using different body size descriptors were compared to the fosfomycin clearance (CLFOF ) from 30 surgical patients (body mass index = 20.1-52.0 kg m-2 ), receiving 8000 mg as intravenous infusion. RESULTS The concordance between CLFOF and creatinine clearance predictions was highest for CLCRCG employing either ideal body weight or adjusted body weight (if body mass >1.3 ideal body weight; CLCRCG_ABW-Schwartz , concordance-correlation coefficient [95% confidence interval] = 0.474 [0.156; 0.703], CCC) and GFR predictions via the de-indexed MDRD equation (concordance-correlation coefficient = 0.452 [0.137; 0.685]). The proportion of predicted GFR values within ±30% of the observed CLFOF (P30 = 72.3-76.7%) was only marginally lower than the reported P30 in the original CKD-EPI and MDRD publications (P30 = 84.1-90.0%). CONCLUSION This analysis represents a successful proof-of-concept for evaluating GFR/creatinine clearance prediction methods: Across all body mass index classes CLCRCG_ABW-Schwartz or the de-indexed MDRD were most suitable for predicting creatinine clearance/GFR also in (morbidly) obese, CKD stage <3B individuals in therapeutic use. Their application is proposed in optimising doses for vital therapies in obese patients requiring monitoring of renal function (e.g. methotrexate dosing).
Collapse
Affiliation(s)
- David Busse
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany.,Graduate Research Training program PharMetrX, Berlin/Potsdam, Germany
| | - Jens Markus Borghardt
- Drug Discovery Sciences, Research DMPK, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Alice Pevzner
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany
| | - Christoph Dorn
- University of Regensburg, Institute of Pharmacy, Regensburg, Germany
| | - Nahed El-Najjar
- Institute of Clinical Microbiology and Hygiene, Faculty of Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Wilhelm Huisinga
- University of Potsdam, Institute of Mathematics, Potsdam, Germany
| | - Hermann Wrigge
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany.,Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany
| | - Philipp Simon
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Charlotte Kloft
- Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Freie Universitaet Berlin, Berlin, Germany
| |
Collapse
|
24
|
Hilbert A, Neuhaus P, Köhler N, Petroff D, Hay P, Hübner C. Group cognitive remediation therapy prior to behavioral weight loss treatment for adults with severe obesity: A randomized clinical trial (CRT study). J Consult Clin Psychol 2021; 89:695-706. [PMID: 34472896 DOI: 10.1037/ccp0000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Individuals with obesity show executive dysfunctions that have been implicated in weight management failure. Initial evidence suggests that cognitive remediation therapy (CRT) conducted after behavioral weight loss (BWL) treatment improves weight loss and executive function, but efficacy for CRT conducted before BWL treatment is unknown. This study investigated whether group CRT in adults with Class II or III obesity (body mass index, BMI≥35 kg/m2) improves weight loss, executive function, weight management behavior, and mental and physical health in real-world group BWL treatment. Method: In this prospective single-center, assessor-blind trial (DRKS00009333), 270 adults with Class II and III obesity (age 44.5 ± 12.8 years, BMI 45.6 ± 6.9 kg/m2, and 68.9% women) were randomized to CRT with 8 group sessions over 2 months versus no treatment control, followed by routine BWL treatment of up to 12 months for both groups. The primary outcome was percent weight change at 6 months. Secondary outcomes included executive functions, weight management behaviors, and mental and physical health. Results: In intent-to-treat analyses, overall weight loss after 6 months was 1.2%, 95% CI [-2.0% to -0.4%], p = .002. The difference between arms was 0.4%, 95% CI [-1.1% to 1.8%], p = .629, Cohen's d = 0.09, after 6 months and 0.3%, 95% CI [-1.5% to 2.2%], p = .721, Cohen's d = 0.01, after 12 months. Improvements in most secondary outcomes including executive functions were seen at most time points, however, without differences between arms. Conclusions: Group CRT versus no treatment prior to real-world BWL treatment in adults with Class II and III obesity does not improve weight loss. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center
| | - Petra Neuhaus
- Clinical Trial Centre (ZKS) Leipzig, University of Leipzig
| | - Norbert Köhler
- Clinical Trial Centre (ZKS) Leipzig, University of Leipzig
| | - David Petroff
- Clinical Trial Centre (ZKS) Leipzig, University of Leipzig
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University
| | - Claudia Hübner
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center
| |
Collapse
|
25
|
Busse D, Simon P, Petroff D, Dorn C, Schmitt L, Bindellini D, Kratzer A, Dietrich A, Zeitlinger M, Huisinga W, Michelet R, Wrigge H, Kloft C. Similar Piperacillin/Tazobactam Target Attainment in Obese versus Nonobese Patients despite Differences in Interstitial Tissue Fluid Pharmacokinetics. Pharmaceutics 2021; 13:1380. [PMID: 34575456 PMCID: PMC8464843 DOI: 10.3390/pharmaceutics13091380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/09/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Precision dosing of piperacillin/tazobactam in obese patients is compromised by sparse information on target-site exposure. We aimed to evaluate the appropriateness of current and alternative piperacillin/tazobactam dosages in obese and nonobese patients. Based on a prospective, controlled clinical trial in 30 surgery patients (15 obese/15 nonobese; 0.5-h infusion of 4 g/0.5 g piperacillin/tazobactam), piperacillin pharmacokinetics were characterized in plasma and at target-site (interstitial fluid of subcutaneous adipose tissue) via population analysis. Thereafter, multiple 3-4-times daily piperacillin/tazobactam short-term/prolonged (recommended by EUCAST) and continuous infusions were evaluated by simulation. Adequacy of therapy was assessed by probability of pharmacokinetic/pharmacodynamic target-attainment (PTA ≥ 90%) based on time unbound piperacillin concentrations exceed the minimum inhibitory concentration (MIC) during 24 h (%fT>MIC). Lower piperacillin target-site maximum concentrations in obese versus nonobese patients were explained by the impact of lean (approximately two thirds) and fat body mass (approximately one third) on volume of distribution. Simulated steady-state concentrations were 1.43-times, 95%CI = (1.27; 1.61), higher in plasma versus target-site, supporting targets of %fT>2×MIC instead of %fT>4×MIC during continuous infusion to avoid target-site concentrations constantly below MIC. In all obesity and renally impairment/hyperfiltration stages, at MIC = 16 mg/L, adequate PTA required prolonged (thrice-daily 4 g/0.5 g over 3.0 h at %fT>MIC = 50) or continuous infusions (24 g/3 g over 24 h following loading dose at %fT>MIC = 98) of piperacillin/tazobactam.
Collapse
Affiliation(s)
- David Busse
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (L.S.); (D.B.); (R.M.)
- Graduate Research Training Program PharMetrX, 12169 Berlin, Germany
| | - Philipp Simon
- Department of Anesthesiology, Intensive Care, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (P.S.); (A.D.)
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (H.W.)
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (H.W.)
- Clinical Trial Centre Leipzig, University of Leipzig, 04109 Leipzig, Germany
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, 93053 Regensburg, Germany;
| | - Lisa Schmitt
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (L.S.); (D.B.); (R.M.)
- Graduate Research Training Program PharMetrX, 12169 Berlin, Germany
| | - Davide Bindellini
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (L.S.); (D.B.); (R.M.)
- Graduate Research Training Program PharMetrX, 12169 Berlin, Germany
| | - Alexander Kratzer
- Hospital Pharmacy, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Arne Dietrich
- Department of Anesthesiology, Intensive Care, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (P.S.); (A.D.)
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, University Medical University of Vienna, 1090 Vienna, Austria;
| | - Wilhelm Huisinga
- Institute of Mathematics, University of Potsdam, 14469 Potsdam, Germany;
| | - Robin Michelet
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (L.S.); (D.B.); (R.M.)
| | - Hermann Wrigge
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (H.W.)
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, 06112 Halle, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (L.S.); (D.B.); (R.M.)
| |
Collapse
|
26
|
Dorn C, Petroff D, Stoelzel M, Kees MG, Kratzer A, Dietrich A, Kloft C, Zeitlinger M, Kees F, Wrigge H, Simon P. Perioperative administration of cefazolin and metronidazole in obese and non-obese patients: a pharmacokinetic study in plasma and interstitial fluid. J Antimicrob Chemother 2021; 76:2114-2120. [PMID: 33969405 DOI: 10.1093/jac/dkab143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/11/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess plasma and tissue pharmacokinetics of cefazolin and metronidazole in obese patients undergoing bariatric surgery and non-obese patients undergoing intra-abdominal surgery. PATIENTS AND METHODS Fifteen obese and 15 non-obese patients received an IV short infusion of 2 g cefazolin and 0.5 g metronidazole for perioperative prophylaxis. Plasma and microdialysate from subcutaneous tissue were sampled until 8 h after dosing. Drug concentrations were determined by HPLC-UV. Pharmacokinetic parameters were calculated non-compartmentally. RESULTS In obese patients (BMI 39.5-69.3 kg/m2) compared with non-obese patients (BMI 18.7-29.8 kg/m2), mean Cmax of total cefazolin in plasma was lower (115 versus 174 mg/L) and Vss was higher (19.4 versus 14.2 L). The mean differences in t½ (2.7 versus 2.4 h), CL (5.14 versus 4.63 L/h) and AUC∞ (402 versus 450 mg·h/L) were not significant. The influence of obesity on the pharmacokinetics of metronidazole was similar (Cmax 8.99 versus 14.7 mg/L, Vss 73.9 versus 51.8 L, t½ 11.9 versus 9.1 h, CL 4.62 versus 4.13 L/h, AUC∞ 116 versus 127 mg·h/L). Regarding interstitial fluid (ISF), mean concentrations of cefazolin remained >4 mg/L until 6 h in both groups, and those of metronidazole up to 8 h in the non-obese group. In obese patients, the mean ISF concentrations of metronidazole were between 3 and 3.5 mg/L throughout the measuring interval. CONCLUSIONS During the time of surgery, cefazolin concentrations in plasma and ISF of subcutaneous tissue were lower in obese patients, but not clinically relevant. Regarding metronidazole, the respective differences were higher, and may influence dosing of metronidazole for perioperative prophylaxis in obese patients.
Collapse
Affiliation(s)
- Christoph Dorn
- Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany.,Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Melanie Stoelzel
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Leipzig, Germany
| | - Martin G Kees
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Kratzer
- Hospital Pharmacy, University Hospital Regensburg, Regensburg, Germany
| | - Arne Dietrich
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Department of Surgery, University of Leipzig, Leipzig, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Frieder Kees
- Department of Pharmacology, University of Regensburg, Regensburg, Germany
| | - Hermann Wrigge
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany
| | - Philipp Simon
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, Leipzig, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Leipzig, Germany
| |
Collapse
|
27
|
Strauß M, Petroff D, Huang J, Ulke C, Paucke M, Bogatsch H, Böhme P, Hoffmann K, Reif A, Kittel-Schneider S, Heuser I, Ahlers E, Gallinat J, Schöttle D, Fallgatter A, Ethofer T, Unterecker S, Hegerl U. The "VIP-ADHD trial": Does brain arousal have prognostic value for predicting response to psychostimulants in adult ADHD patients? Eur Neuropsychopharmacol 2021; 43:116-128. [PMID: 33388218 DOI: 10.1016/j.euroneuro.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
EEG studies have shown that adult ADHD patients have less stable brain arousal regulation than age and gender matched controls. Psychostimulants have brain arousal stabilising properties evident in EEG patterns. The aim of this study was to investigate whether the stability of brain arousal regulation has prognostic value in predicting response to methylphenidate therapy in adult ADHD patients. In an open-label, single-arm, multi-centre, confirmatory trial, 121 adult ADHD patients were recruited and 112 qualified for the full analysis set. All participants received an initial dose of 20 mg extended release methylphenidate at baseline. After a titration phase of up to 4 weeks, patients remained on a weight-based target dose of extended release methylphenidate for 4 weeks. Using the Vigilance Algorithm Leipzig (VIGALL 2.1), we assessed brain arousal regulation before the treatment with methylphenidate, based on a 15-min EEG at quiet rest recorded at baseline. Using automatic stage-classification of 1 s segments, we computed the mean EEG-vigilance (indexing arousal level) and an arousal stability score (indexing arousal regulation). The primary endpoint was the association between successful therapy, defined by a 30% reduction in CAARS, and stable/unstable brain arousal. 52 patients (46%) showed an unstable brain arousal regulation of which 23% had therapy success. In the stable group, 35% had therapy success, implying an absolute difference of 12 percentage points (95% CI -5 to 29, p = 0.17) in the direction opposite to the hypothesized one. There were no new findings regarding the tolerability and safety of extended release methylphenidate therapy.
Collapse
Affiliation(s)
- Maria Strauß
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany.
| | - David Petroff
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Germany
| | - Jue Huang
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Holger Bogatsch
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Germany
| | - Pierre Böhme
- Department of Psychiatry and Psychotherapy, University Hospital of Bochum, Germany
| | - Knut Hoffmann
- Department of Psychiatry and Psychotherapy, University Hospital of Bochum, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Germany
| | - Isabella Heuser
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany
| | - Eike Ahlers
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany
| | - Juergen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany
| | - Thomas Ethofer
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Hospital of Tübingen, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt
| |
Collapse
|
28
|
Petroff D, Blank V, Newsome PN, Shalimar, Voican CS, Thiele M, de Lédinghen V, Baumeler S, Chan WK, Perlemuter G, Cardoso AC, Aggarwal S, Sasso M, Eddowes PJ, Allison M, Tsochatzis E, Anstee QM, Sheridan D, Cobbold JF, Naveau S, Lupsor-Platon M, Mueller S, Krag A, Irles-Depe M, Semela D, Wong GLH, Wong VWS, Villela-Nogueira CA, Garg H, Chazouillères O, Wiegand J, Karlas T. Assessment of hepatic steatosis by controlled attenuation parameter using the M and XL probes: an individual patient data meta-analysis. Lancet Gastroenterol Hepatol 2021; 6:185-198. [PMID: 33460567 DOI: 10.1016/s2468-1253(20)30357-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnostic tools for liver disease can now include estimation of the grade of hepatic steatosis (S0 to S3). Controlled attenuation parameter (CAP) is a non-invasive method for assessing hepatic steatosis that has become available for patients who are obese (FibroScan XL probe), but a consensus has not yet been reached regarding cutoffs and its diagnostic performance. We aimed to assess diagnostic properties and identify relevant covariates with use of an individual patient data meta-analysis. METHODS We did an individual patient data meta-analysis, in which we searched PubMed and Web of Science for studies published from database inception until April 30, 2019. Studies reporting original biopsy-controlled data of CAP for non-invasive grading of steatosis were eligible. Probe recommendation was based on automated selection, manual assessment of skin-to-liver-capsule distance, and a body-mass index (BMI) criterion. Receiver operating characteristic methods and mixed models were used to assess diagnostic properties and covariates. Patients with non-alcoholic fatty liver disease (NAFLD) were analysed separately because they are the predominant patient group when using the XL probe. This study is registered with PROSPERO, CRD42018099284. FINDINGS 16 studies reported histology-controlled CAP including the XL probe, and individual data from 13 papers and 2346 patients were included. Patients with a mean age of 46·5 years (SD 14·5) were recruited from 20 centres in nine countries. 2283 patients had data for BMI; 673 (29%) were normal weight (BMI <25 kg/m2), 530 (23%) were overweight (BMI ≥25 to <30 kg/m2), and 1080 (47%) were obese (BMI ≥30 kg/m2). 1277 (54%) patients had NAFLD, 474 (20%) had viral hepatitis, 285 (12%) had alcohol-associated liver disease, and 310 (13%) had other liver disease aetiologies. The XL probe was recommended in 1050 patients, 930 (89%) of whom had NAFLD; among the patients with NAFLD, the areas under the curve were 0·819 (95% CI 0·769-0·869) for S0 versus S1 to S3 and 0·754 (0·720-0·787) for S0 to S1 versus S2 to S3. CAP values were independently affected by aetiology, diabetes, BMI, aspartate aminotransferase, and sex. Optimal cutoffs differed substantially across aetiologies. Risk of bias according to QUADAS-2 was low. INTERPRETATION CAP cutoffs varied according to cause, and can effectively recognise significant steatosis in patients with viral hepatitis. CAP cannot grade steatosis in patients with NAFLD adequately, but its value in a NAFLD screening setting needs to be studied, ideally with methods beyond the traditional histological reference standard. FUNDING The German Federal Ministry of Education and Research and Echosens.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany; Faculty of Medicine, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany
| | - Valentin Blank
- Faculty of Medicine, Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany; Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK; Centre for Liver Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Cosmin Sebastian Voican
- Faculté de Médecine Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service d'Hépato-Gastroentérologie et Nutrition, Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France; INSERM U996, DHU Hepatinov, Labex LERMIT, Clamart, France
| | - Maja Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Victor de Lédinghen
- Centre d'Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France; INSERM U1053, Bordeaux University, Bordeaux, France
| | - Stephan Baumeler
- Department of Gastroenterology and Hepatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gabriel Perlemuter
- Faculté de Médecine Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service d'Hépato-Gastroentérologie et Nutrition, Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France; INSERM U996, DHU Hepatinov, Labex LERMIT, Clamart, France
| | - Ana-Carolina Cardoso
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Magali Sasso
- Research and Development Department, Echosens, Paris, France
| | - Peter J Eddowes
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK; Centre for Liver Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; University of Nottingham, Nottingham, UK
| | - Michael Allison
- Liver Unit, Addenbrooke's Hospital, Cambridge Biomedical Research Centre, Cambridge, UK
| | - Emmanuel Tsochatzis
- University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle National Institute for Health Research Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Sheridan
- Institute of Translational and Stratified Medicine, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Jeremy F Cobbold
- Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Sylvie Naveau
- Faculté de Médecine Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France; Service d'Hépato-Gastroentérologie et Nutrition, Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France; INSERM U996, DHU Hepatinov, Labex LERMIT, Clamart, France
| | - Monica Lupsor-Platon
- Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Sebastian Mueller
- Department of Medicine and Liver Diseases, Salem Medical Center, University of Heidelberg, Heidelberg, Germany
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Marie Irles-Depe
- Centre d'Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France; INSERM U1053, Bordeaux University, Bordeaux, France
| | - David Semela
- Department of Gastroenterology and Hepatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Grace Lai-Hung Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Vincent Wai-Sun Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Cristiane A Villela-Nogueira
- Hepatology Unit, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Harshit Garg
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Olivier Chazouillères
- Hepatology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Centre de Recherche Saint-Antoine, Sorbonne University, Paris, France
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
| |
Collapse
|
29
|
Petroff D, Bätz O, Jedrysiak K, Kramer J, Berg T, Wiegand J. Fibrosis-4 (FIB-4) score at the primary care level: an analysis of over 160 000 blood samples. Gut 2021; 70:219-221. [PMID: 32245907 DOI: 10.1136/gutjnl-2020-320995] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 01/04/2023]
Affiliation(s)
- David Petroff
- Clinical Trial Centre, Leipzig University, Leipzig, Sachsen, Germany
| | - Olaf Bätz
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany
| | - Katrin Jedrysiak
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany
| | - Jan Kramer
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany
| | - Thomas Berg
- Clinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University, Leipzig, Sachsen, Germany.,Department of Gastroenterology, Leipzig University, Leipzig, Sachsen, Germany
| | - Johannes Wiegand
- Department of Gastroenterology, Leipzig University, Leipzig, Sachsen, Germany
| |
Collapse
|
30
|
Simon P, Petroff D, Busse D, Heyne J, Girrbach F, Dietrich A, Kratzer A, Zeitlinger M, Kloft C, Kees F, Wrigge H, Dorn C. Meropenem Plasma and Interstitial Soft Tissue Concentrations in Obese and Nonobese Patients-A Controlled Clinical Trial. Antibiotics (Basel) 2020; 9:antibiotics9120931. [PMID: 33371322 PMCID: PMC7767385 DOI: 10.3390/antibiotics9120931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This controlled clinical study aimed to investigate the impact of obesity on plasma and tissue pharmacokinetics of meropenem. METHODS Obese (body mass index (BMI) ≥ 35 kg/m2) and age-/sex-matched nonobese (18.5 kg/m2 ≥ BMI ≤ 30 kg/m2) surgical patients received a short-term infusion of 1000-mg meropenem. Concentrations were determined via high performance liquid chromatography-ultraviolet (HPLC-UV) in the plasma and microdialysate from the interstitial fluid (ISF) of subcutaneous tissue up to eight h after dosing. An analysis was performed in the plasma and ISF by noncompartmental methods. RESULTS The maximum plasma concentrations in 15 obese (BMI 49 ± 11 kg/m2) and 15 nonobese (BMI 24 ± 2 kg/m2) patients were 54.0 vs. 63.9 mg/L (95% CI for difference: -18.3 to -3.5). The volume of distribution was 22.4 vs. 17.6 L, (2.6-9.1), but the clearance was comparable (12.5 vs. 11.1 L/h, -1.4 to 3.1), leading to a longer half-life (1.52 vs. 1.31 h, 0.05-0.37) and fairly similar area under the curve (AUC)8h (78.7 vs. 89.2 mg*h/L, -21.4 to 8.6). In the ISF, the maximum concentrations differed significantly (12.6 vs. 18.6 L, -16.8 to -0.8) but not the AUC8h (28.5 vs. 42.0 mg*h/L, -33.9 to 5.4). Time above the MIC (T > MIC) in the plasma and ISF did not differ significantly for MICs of 0.25-8 mg/L. CONCLUSIONS In morbidly obese patients, meropenem has lower maximum concentrations and higher volumes of distribution. However, due to the slightly longer half-life, obesity has no influence on the T > MIC, so dose adjustments for obesity seem unnecessary.
Collapse
Affiliation(s)
- Philipp Simon
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (J.H.); (F.G.); (H.W.)
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (A.D.)
- Correspondence: ; Tel.: +49-341-97-17700
| | - David Petroff
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (A.D.)
- Clinical Trial Centre Leipzig, University of Leipzig, 04107 Leipzig, Germany
| | - David Busse
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (C.K.)
- Graduate Research Training Program PharMetrX, 12169 Berlin, Germany
| | - Jana Heyne
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (J.H.); (F.G.); (H.W.)
| | - Felix Girrbach
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (J.H.); (F.G.); (H.W.)
| | - Arne Dietrich
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (A.D.)
- Department of Surgery, University of Leipzig Medical Centre, 04103 Leipzig, Germany
| | - Alexander Kratzer
- Institute of Pharmacy, University of Regensburg, 93053 Regensburg, Germany; (A.K.); (C.D.)
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, 12169 Berlin, Germany; (D.B.); (C.K.)
| | - Frieder Kees
- Department of Pharmacology, University of Regensburg, 93053 Regensburg, Germany;
| | - Hermann Wrigge
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, 04103 Leipzig, Germany; (J.H.); (F.G.); (H.W.)
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany; (D.P.); (A.D.)
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, 06112 Halle, Germany
| | - Christoph Dorn
- Institute of Pharmacy, University of Regensburg, 93053 Regensburg, Germany; (A.K.); (C.D.)
| |
Collapse
|
31
|
Hilbert A, Petroff D, Neuhaus P, Schmidt R. Cognitive-Behavioral Therapy for Adolescents with an Age-Adapted Diagnosis of Binge-Eating Disorder: A Randomized Clinical Trial. Psychother Psychosom 2020; 89:51-53. [PMID: 31533113 DOI: 10.1159/000503116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany, .,Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany,
| | - David Petroff
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Petra Neuhaus
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
32
|
Blank V, Petroff D, Beer S, Böhlig A, Heni M, Berg T, Bausback Y, Dietrich A, Tönjes A, Hollenbach M, Blüher M, Keim V, Wiegand J, Karlas T. Current NAFLD guidelines for risk stratification in diabetic patients have poor diagnostic discrimination. Sci Rep 2020; 10:18345. [PMID: 33110165 PMCID: PMC7591877 DOI: 10.1038/s41598-020-75227-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with type 2 diabetes (T2D) are at risk for non-alcoholic fatty liver disease (NAFLD) and associated complications. This study evaluated the performance of international (EASL-EASD-EASO) and national (DGVS) guidelines for NAFLD risk stratification. Patients with T2D prospectively underwent ultrasound, liver stiffness measurement (LSM) and serum-based fibrosis markers. Guideline-based risk classification and referral rates for different screening approaches were compared and the diagnostic properties of simplified algorithms, genetic markers and a new NASH surrogate (FAST score) were evaluated. NAFLD risk was present in 184 of 204 screened patients (age 64.2 ± 10.7 years; BMI 32.6 ± 7.6 kg/m2). EASL-EASD-EASO recommended specialist referral for 60-77% depending on the fibrosis score used, only 6% were classified as low risk. The DGVS algorithm required LSM for 76%; 25% were referred for specialised care. The sensitivities of the diagnostic pathways were 47-96%. A simplified referral strategy revealed a sensitivity/specificity of 46/88% for fibrosis risk. Application of the FAST score reduced the referral rate to 35%. This study (a) underlines the high prevalence of fibrosis risk in T2D, (b) demonstrates very high referral rates for in-depth hepatological work-up, and (c) indicates that simpler referral algorithms may produce comparably good results and could facilitate NAFLD screening.
Collapse
Affiliation(s)
- Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Härtelstraße 16/18, 04107, Leipzig, Germany
| | - Sebastian Beer
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Albrecht Böhlig
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Maria Heni
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Yvonne Bausback
- Division of Angiology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Arne Dietrich
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Division of Visceral, Transplantation, Thorax and Vascular Surgery, Section of Bariatric Surgery, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anke Tönjes
- Division of Endocrinology and Nephrology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Marcus Hollenbach
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Center (IFB) AdiposityDiseases, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103, Leipzig, Germany
- Division of Endocrinology and Nephrology, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Volker Keim
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
| |
Collapse
|
33
|
Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int J Eat Disord 2020; 53:1353-1376. [PMID: 32583527 DOI: 10.1002/eat.23297] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes. METHOD Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling. RESULTS Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely. DISCUSSION This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.
Collapse
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Reinhard Pietrowsky
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Silja Vocks
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
34
|
Girrbach F, Petroff D, Schulz S, Hempel G, Lange M, Klotz C, Scherz S, Giannella-Neto A, Beda A, Jardim-Neto A, Stolzenburg JU, Reske AW, Wrigge H, Simon P. Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial. Br J Anaesth 2020; 125:373-382. [DOI: 10.1016/j.bja.2020.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 02/07/2023] Open
|
35
|
Quinkler M, Petroff D, Knappe UJ, Schopohl J, Tönjes A, Schmid SM. Medical Therapy of Acromegaly in Germany 2019 - Data from the German Acromegaly Registry. Exp Clin Endocrinol Diabetes 2020; 129:216-223. [PMID: 32604431 DOI: 10.1055/a-1191-2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONTEXT Acromegaly is a rare disease caused by excessive growth hormone (GH) secretion from pituitary adenomas in most cases. If neurosurgical therapy is contraindicated or not sufficient, medical therapy is the second line therapy. OBJECTIVE To describe current medical therapy in acromegaly. DESIGN & METHODS Retrospective data analysis from 2732 patients treated in 69 centers of the German Acromegaly Registry. 749 patients were seen within the recent 18 months, of which 420 were on medical therapy (56.1%). RESULTS 73% of medically treated acromegalic patients had normal/low IGF-1 levels. 57% of patients with non-normalized IGF-1 levels had an IGF-1 value between 1- and 1.25-fold above the upper limit of normal. Most patients (55%) received somatostatin analogs as monotherapy, 12% GH receptor monotherapy, and 9% dopamine agonist therapy. Doses of each medical therapy varied widely, with 120 mg lanreotide LAR every 4 weeks, 30 mg octreotide LAR every 4 weeks, 140 mg pegvisomant per week and 1mg cabergoline per week being the most frequent used regimens. A combination of different medical regimens was used in almost 25% of the patients. CONCLUSION The majority of German acromegalic patients receiving medical therapy are controlled according to normal IGF-1 levels.
Collapse
Affiliation(s)
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Ulrich J Knappe
- Department of Neurosurgery, Johannes Wesling Hospital, Minden, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Anke Tönjes
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Sebastian M Schmid
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| |
Collapse
|
36
|
Gerhardt F, Petroff D, Blank V, Böhlig A, van Bömmel F, Wittekind C, Berg T, Karlas T, Wiegand J. Biopsy rate and nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD). Scand J Gastroenterol 2020; 55:706-711. [PMID: 32476514 DOI: 10.1080/00365521.2020.1766554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Licensed therapies for nonalcoholic fatty liver disease (NAFLD) do not yet exist, but clinical trials are testing treatment options. Inclusion criteria often require liver biopsy showing fibrosis (F2/3) or cirrhosis (F4) and nonalcoholic steatohepatitis (NASH). However, histological criteria pose a serious obstacle for recruitment.Aims: Characterize the relevance of liver biopsies in the selection of patients with NAFLD.Methods: Patients between 2013 and 2018 with the ICD-10 code K76.0 were analyzed. Fibrosis was defined by the NASH clinical research network (CRN) fibrosis staging system, NASH by a NAFLD activity score (NAS) ≥4. Predictive factors were determined by logistic regression.Results: Liver biopsy was performed in 87/638 (13.6%) patients (49% female, age 52.5 ± 14.0, BMI 30.4 ± 5.9 kg/m2). Fibrosis stage F0/F1/F2/F3/F4 was observed in N = 7/47/7/17/9, an NAS ≥4 in N = 27. Fibrosis stage F2/F3 and F4 along with NAS ≥4 was found in 1.7% and 0.5% of cases. Liver stiffness measurement, LSM (OR 2.3 per doubling of value; CI 1.3-4.4, p = .005) and FIB-4 (OR 2.3 per doubling of value; CI 1.2-4.4, p = .012) were significant predictors for fibrosis ≥ F2. Predictive factors for NASH were not identified.Conclusion: The biopsy rate in NAFLD patients is low and fibrosis ≥ F2 along with NAS ≥4 only present in a few cases. Transient elastography and FIB-4 are useful to select patients at risk for fibrosis for liver biopsy.
Collapse
Affiliation(s)
- Florian Gerhardt
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Valentin Blank
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany.,Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Albrecht Böhlig
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Florian van Bömmel
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | | | - Thomas Berg
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Karlas
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Clinic and Polyclinic of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
37
|
Haunschild J, Schellinger IN, Barnard SJ, von Aspern K, Davierwala P, Misfeld M, Petroff D, Borger MA, Etz CD. Bicuspid aortic valve patients show specific epigenetic tissue signature increasing extracellular matrix destruction. Interact Cardiovasc Thorac Surg 2020; 29:937-943. [PMID: 31501876 DOI: 10.1093/icvts/ivz210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/03/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Patients with a bicuspid aortic valve (BAV) have an increased risk for developing thoracic aortic aneurysm, which is characterized by the destruction of the elastic media of the aortic wall. Several important enzymes have been characterized to play key roles in extracellular matrix homeostasis, namely matrix metalloproteinases (MMPs). In this study, we investigated MMP-2 levels and their epigenetic regulation via the miR-29 family. METHODS Aortic tissue samples from 58 patients were collected during cardiac surgery, of which 30 presented with a BAV and 28 with a tricuspid aortic valve. Polymerase chain reaction, western blot analysis and immunohistochemistry were performed to analyse MMP-2. In addition, enzyme-linked immunosorbent assay measurements were carried out to investigate both MMP-2 and tissue inhibitor of metalloproteinase-2 levels. To examine the epigenetic regulation of aortic extracellular matrix homeostasis, we furthermore studied the expression levels of miR-29 via qRT-PCR. RESULTS Patients with a BAV were significantly younger at the time of surgery, presented significantly less frequently with arterial hypertension and displayed more often with an additional valvular disease. On a molecular level, we found that MMP-2 is increased on gene and protein level in BAV patients. Tissue inhibitor of metalloproteinase-2 levels do not differ between the groups. Interestingly, we also found that only miR-29A is significantly downregulated in BAVs. CONCLUSIONS Our findings highlight the importance of MMP-2 in the context of extracellular matrix destruction in BAV patients. We present new evidence that miR-29A is a crucial epigenetic regulator of these pathomechanistic processes and might hold promise for future translational research.
Collapse
Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | - Isabel N Schellinger
- Department of Endocrinology and Nephrology, University Medical Center Leipzig, Leipzig, Germany
| | - Sarah J Barnard
- Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | | | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Petroff
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| |
Collapse
|
38
|
Knappe UJ, Petroff D, Quinkler M, Schmid SM, Schöfl C, Schopohl J, Stieg MR, Tönjes A. Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. Eur J Endocrinol 2020; 182:275-284. [PMID: 31917680 DOI: 10.1530/eje-19-0784] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND If biochemical control of acromegaly is not achieved by operation and medication, radiotherapy may be indicated. OBJECTIVE To describe fractionated radiotherapy (FRT) and stereotactic radiosurgery (SRS) regarding excess of IGF-1 and pituitary function. DESIGN AND METHODS A retrospective analysis of 352 patients (4126 patient-years) from the German Acromegaly Registry was performed. Follow-up was 1.0-45.1 years after radiotherapy. Therapeutic success was defined by low or normal IGF-1 according to center-specific reference ranges without (= remission) or on (= controlled disease) suppressive medication. RESULTS Time between radiotherapy and last follow-up was 13.0 ± 8.2 years for FRT (n = 233) and 8.9 ± 5.0 years for SRS (n = 119, P < 0.001). Median (IQR) basal growth hormone before radiotherapy was 6.3 (2.9-16.2) ng/mL for FRT and 3.5 (1.8-6.9) ng/mL for SRS (P < 0.001). Mean time in uncontrolled state was 3.0 years after FRT and 2.1 years after SRS (95% CI for the difference is 0.1 to 1.6 years, P = 0.021). The 10-year calculated remission rate was 48% for FRT and 52% for SRS (95% CI for the difference is -18 to 26% age points, P = 0.74) and the respective controlled disease rate was 23 and 26%. The odds ratio for adrenocorticotropic or thyreotropic insufficiency was 0.54 (95% CI: 0.30-1.00, P = 0.049) in SRS compared to FRT patients. CONCLUSION Both after FRT and SRS about 75% of patients with acromegaly are in remission or controlled after 10 years. A slightly faster achievement of target values was observed after SRS. The rate of pituitary insufficiency in FRT patients is significantly higher.
Collapse
Affiliation(s)
- U J Knappe
- Department of Neurosurgery, Johannes Wesling Hospital, Minden, Germany
| | - D Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - M Quinkler
- Endocrinology in Charlottenburg, Stuttgarter Platz, Berlin, Germany
| | - S M Schmid
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - C Schöfl
- Centers of Endocrinology and Metabolism, Bamberg and Erlangen, Bamberg, Germany
| | - J Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, Munich, Germany
| | - M R Stieg
- Max-Planck-Institute of Psychiatry, Munich, Germany
| | - A Tönjes
- University of Leipzig Medical Center, Medical Department III - Endocrinology, Nephrology, Rheumatology, Leipzig, Germany
| |
Collapse
|
39
|
Haunschild J, Friebe S, Petroff D, Borger M, Mayr S, Etz C. Ex Vivo Biomechanics Cast Doubts on Current Diameter-Based Guidelines for Bicuspid Aortic Valve-Associated Proximal Aortic Disease. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705404] [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: 10/24/2022]
|
40
|
Skeith L, Le Gal G, de Vries JIP, Middeldorp S, Goddijn M, Kaaja R, Gris JC, Martinelli I, Schleußner E, Petroff D, Langlois N, Rodger MA. The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study. BMC Pregnancy Childbirth 2019; 19:455. [PMID: 31783795 PMCID: PMC6884748 DOI: 10.1186/s12884-019-2615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). Methods The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. Results There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35–1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17–0.84; p = 0.01). Conclusions The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
Collapse
Affiliation(s)
- Leslie Skeith
- Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, C210 Foothills Medical Centre, 1403 29th Street, NW, Calgary, Alberta, T2N 2T9, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Grégoire Le Gal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, the Netherlands
| | - Saskia Middeldorp
- Academic Medical Center, Department of Vascular Medicine, Amsterdam, the Netherlands
| | - Mariëtte Goddijn
- Academic Medical Center, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Risto Kaaja
- Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jean-Christophe Gris
- Department of Hematology, Nimes University Hospital and University of Montpellier, Montpellier, France
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Ekkehard Schleußner
- Department of Obstetrics and Gynecology, Jena University Hospital Friedrich Schiller University, Jena, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Nicole Langlois
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc A Rodger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | | |
Collapse
|
41
|
Herta T, Petroff D, Engelmann C, Herber A, Aehling N, Scheuermann U, Bartels M, Seehofer D, Berg T, Wiegand J. Hepatitis B Vaccination in Patients with Liver Cirrhosis Evaluated for Liver Transplantation - A Simple Intervention Ensures High Adherence. Ann Transplant 2019; 24:527-531. [PMID: 31515466 PMCID: PMC6755938 DOI: 10.12659/aot.917198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is an unmet need to improve the HBV vaccination status in patients with chronic liver diseases. Primary care physicians and outpatient hepatologists often fail to vaccinate as recommended. Thus, new strategies to improve the HBV vaccination rate are required. MATERIAL AND METHODS This study was performed in a cohort of patients with chronic liver diseases evaluated for liver transplantation. Vaccination status was taken from the patients' vaccination cards. HBsAg-, anti-HBc-, and anti-HBs-negative individuals were vaccinated against HBV at hospital discharge, and subsequent outpatient completion of the standard vaccination protocol was recommended in detail in the discharge letter. At months 2 and 8, titer controls were performed, and completion of vaccination was evaluated. RESULTS We prospectively recruited 37 patients. At baseline, the vaccination rate against HBV was 24% (N=9/37), and 3/9 HBV vaccinated patients presented with an anti-HBs-titer >10 IU/L. Thus, N=34 were vaccinated with Engerix® or Twinrix®. We evaluated 26/34 patients at month 2 and 10/26 again at month 8. The second vaccine dose was obtained by 21/26 (80%) of the patients seen at month 2, and 9/10 (90%) seen at month 8 obtained the third vaccine dose by primary care physicians or ambulant hepatologists. Only 2 patients presented with an anti-HBs-titer >10 IU/L at month 8. CONCLUSIONS Initiation of HBV vaccination during hospitalization and detailed recommendations on subsequent vaccinations in the discharge letter improve previously inadequate vaccination rates in the outpatient setting. Similar measures should be implemented at earlier time points of chronic liver diseases to achieve higher immune response rates.
Collapse
Affiliation(s)
- Toni Herta
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center, University of Leipzig, Leipzig, Germany
| | | | - Adam Herber
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Niklas Aehling
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Vascular, Thoracic, and Transplant Surgery, University of Leipzig, Leipzig, Germany
| | - Michael Bartels
- Department of General, Visceral, Thoracic, and Vascular Surgery, Helios Park Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Vascular, Thoracic, and Transplant Surgery, University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
42
|
Wirtz H, Petroff D, Bräunlich J. Response to the letter to the editor "Nasal high-flow versus non-invasive ventilation in patients with chronic hypercapnic COPD" [Response to letter]. Int J Chron Obstruct Pulmon Dis 2019; 14:2119-2120. [PMID: 31571847 PMCID: PMC6748159 DOI: 10.2147/copd.s228830] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Hubert Wirtz
- Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Jens Bräunlich
- Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany
| |
Collapse
|
43
|
Bräunlich J, Dellweg D, Bastian A, Budweiser S, Randerath W, Triché D, Bachmann M, Kähler C, Bayarassou AH, Mäder I, Geiseler J, Köhler N, Petroff D, Wirtz H. Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:1411-1421. [PMID: 31308647 PMCID: PMC6615713 DOI: 10.2147/copd.s206111] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness. Methods In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2 changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints. Results A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body mass index 23.1±4.8 kg/m2, 90% GOLD D, pCO2 56.5±5.4 mmHg were randomized. PCO2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8-7.5, P=0.002) using NHF and 7.1% (95% CI 4.1-10.1, P<0.001) from baseline using NIV (indistinguishable to intention-to-treat analysis). The difference of pCO2 changes between the two devices was -1.4 mmHg (95% CI -3.1-0.4, P=0.12). Both devices had positive impact on blood gases and respiratory scores (St. George's Respiratory Questionnaire, Severe Respiratory Insufficiency Questionnaire). Conclusions NHF may constitute an alternative to NIV in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV with respect to pCO2 reduction and improvement in QoL.
Collapse
Affiliation(s)
- Jens Bräunlich
- Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany
| | - Dominic Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH , Schmallenberg Grafschaft, Germany
| | - Andreas Bastian
- Pneumologie/Intensivmedizin/Infektiologie, Marienkrankenhaus Kassel , Kassel, Germany
| | - Stephan Budweiser
- Medizinische Klinik III, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Winfried Randerath
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany
| | - Dora Triché
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany
| | - Martin Bachmann
- Intensivmedizin und Beatmungsmedizin, Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Christian Kähler
- Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Abdel Hakim Bayarassou
- Klinik für Pneumologie, Kardiologie, Schlaf- und Beatmungsmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg, Bonn, Germany
| | - Irmhild Mäder
- Zentralklinik Bad Berka GmbH, Klinik für Pneumologie, Bad Berka, Germany
| | - Jens Geiseler
- Medizinische Klinik IV, Klinikum Vest - Paracelsus-Klinik Marl, Marl, Germany
| | - Norbert Köhler
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany
| |
Collapse
|
44
|
Dorn C, Petroff D, Neumann N, Kratzer A, El-Najjar N, Dietrich A, Kloft C, Zeitlinger M, Kees MG, Kees F, Wrigge H, Simon P. Plasma and tissue pharmacokinetics of fosfomycin in morbidly obese and non-obese surgical patients: a controlled clinical trial. J Antimicrob Chemother 2019; 74:2473. [PMID: 31173638 DOI: 10.1093/jac/dkz249] [Citation(s) in RCA: 1] [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] Open
|
45
|
Simon P, Petroff D, Dorn C, Ehmann L, Kloft C, Prettin C, Dietrich A, Zeitlinger M, Kees F, Wrigge H. Measurement of soft tissue drug concentrations in morbidly obese and non-obese patients - A prospective, parallel group, open-labeled, controlled, phase IV, single center clinical trial. Contemp Clin Trials Commun 2019; 15:100375. [PMID: 31193565 PMCID: PMC6535681 DOI: 10.1016/j.conctc.2019.100375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Pharmacokinetic (PK) and pharmacodynamic (PD) data on perioperative antibiotic prophylaxis or antibiotic therapy are rare in patients suffering from morbid obesity. Furthermore, dosing regimens should be based on PK/PD models that ensure effective antibiotic exposure not in plasma, but primarily at the site of infection, mostly in the interstitial fluid (ISF). The aim of this trial is to investigate whether current dosing regimens of various antibiotics lead to effective concentrations in the ISF of morbidly obese patients. Methods We designed a prospective, parallel group, open-labeled, controlled single center trial to investigate the plasma and tissue pharmacokinetics of the antibiotics linezolid, meropenem, tigecycline, piperacillin/tazobactam, fosfomcyine, cefazolin, metronidazole and as secondary aim the analgesics metamizole and acetaminophen. Inclusion criteria comprise body mass index ≥35 kg/m2 for obese or between 18.5 and 30 kg/m2 for non-obese patients scheduled for elective abdominal surgery. For PK analysis, blood and microdialysate samples of subcutaneous tissue were collected 0–8 h after study drug administration. The primary endpoint is to investigate a possible dependency of the area-under-the-curve (AUC0-8) in the interstitial fluid on body weight and obesity with population based pharmacokinetic analysis. Discussion Inadequate dosing regimes of antibiotics may be a relevant factor for morbidity and mortality of patients, as well as for the development of bacterial antibiotic resistance. The measurement of plasma and tissue concentrations will provide information necessary for PK/PD-modelling. These data about antibiotic PK/PDcharacteristics in soft tissue and their dependence on weight should help to develop weight-dependent models for calculation of patient's individual doses of different antibiotics. Trial registration EU clinical trials register (EudraCT-No. 2012-004383-22) and German Clinical trials Register (DRKS00004776);
Collapse
Affiliation(s)
- P Simon
- University of Leipzig, Department of Anaesthesiology and Intensive Care Medicine, Leipzig, Germany.,University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany
| | - D Petroff
- University of Leipzig, Clinical Trial Centre Leipzig, Germany
| | - C Dorn
- University of Regensburg, Institute of Pharmacy, Regensburg, Germany
| | - L Ehmann
- Freie Universitaet Berlin, Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Berlin, Germany
| | - C Kloft
- Freie Universitaet Berlin, Institute of Pharmacy, Department of Clinical Pharmacy and Biochemistry, Berlin, Germany
| | - C Prettin
- University of Leipzig, Clinical Trial Centre Leipzig, Germany
| | - A Dietrich
- University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany.,University of Leipzig, Department of Visceral, Transplantation, Vascular and Thoracic Surgery, Leipzig, Germany
| | - M Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - F Kees
- University of Regensburg, Department of Pharmacology, Regensburg, Germany
| | - H Wrigge
- University of Leipzig, Department of Anaesthesiology and Intensive Care Medicine, Leipzig, Germany.,University of Leipzig, Integrated Research and Treatment Center (IFB) Adiposity Diseases, Leipzig, Germany.,Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Germany
| |
Collapse
|
46
|
Nestler C, Simon P, Petroff D, Hammermüller S, Kamrath D, Wolf S, Dietrich A, Camilo LM, Beda A, Carvalho AR, Giannella-Neto A, Reske AW, Wrigge H. Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography. Br J Anaesth 2019; 119:1194-1205. [PMID: 29045567 DOI: 10.1093/bja/aex192] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects. Methods Patients with a BMI ≥35 kg m -2 undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg -1 predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEP IND ) or (ii) no RM and PEEP of 5 cm H 2 O (PEEP 5 ). Gas exchange, regional ventilation distribution, and EELV (multiple breath nitrogen washout method) were determined before, during, and after anaesthesia. The primary end point was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction ( P aO 2 / F iO 2 ). Results For PEEP IND ( n =25) and PEEP 5 ( n =25) arms together, P aO 2 / F iO 2 and EELV decreased by 15 kPa [95% confidence interval (CI) 11-20 kPa, P <0.001] and 1.2 litres (95% CI 0.9-1.6 litres, P <0.001), respectively, after intubation. Mean ( sd ) PEEP IND was 18.5 (5.6) cm H 2 O. In the PEEP IND arm, P aO 2 / F iO 2 before extubation was 23 kPa higher (95% CI 16-29 kPa; P <0.001), EELV was 1.8 litres larger (95% CI 1.5-2.2 litres; P <0.001), driving pressure was 6.7 cm H 2 O lower (95% CI 5.4-7.9 cm H 2 O; P <0.001), and regional ventilation was more equally distributed than for PEEP 5 . After extubation, however, these differences between the arms vanished. Conclusions In obese patients, an RM and higher PEEP IND restored EELV, regional ventilation distribution, and oxygenation during anaesthesia, but these differences did not persist after extubation. Therefore, lung protection strategies should include the postoperative period. Clinical trial registration German clinical trials register DRKS00004199, www.who.int/ictrp/network/drks2/en/ .
Collapse
Affiliation(s)
- C Nestler
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - P Simon
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases
| | - D Petroff
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases.,Clinical Trial Centre
| | - S Hammermüller
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - D Kamrath
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - S Wolf
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - A Dietrich
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases.,Department of Surgery, University of Leipzig, Leipzig, Germany
| | - L M Camilo
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luis Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Beda
- Department of Electronic Engineering and Postgraduate Program of Electrical Engineering, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - A R Carvalho
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luis Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Giannella-Neto
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.,Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luis Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A W Reske
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases
| | - H Wrigge
- Department of Anaesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.,Integrated Research and Treatment Centre (IFB) AdiposityDiseases
| |
Collapse
|
47
|
Karlas T, Weiße T, Petroff D, Beer S, Döhring C, Gnatzy F, Niederwieser D, Behre G, Mössner J, Fischer J, Tröltzsch M, Wiegand J, Keim V, Franke GN. Author Correction: Predicting hepatic complications of allogeneic hematopoietic stem cell transplantation using liver stiffness measurement. Bone Marrow Transplant 2019; 54:1920. [PMID: 30890767 DOI: 10.1038/s41409-019-0512-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the original article, the affiliations were presented incorrectly. David Petroff is in fact the only author at affiliation 2. All other authors listed as being at affiliation 2 (Tina Weiße, Sebastian Beer, Franziska Gnatzy, Joachim Mössner, Michael Tröltzsch, Johannes Wiegand and Volker Keim) are in fact just at affiliation 1. These have now been corrected in the original article.
Collapse
Affiliation(s)
- Thomas Karlas
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany.
| | - Tina Weiße
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Sebastian Beer
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Christine Döhring
- Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Franziska Gnatzy
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Dietger Niederwieser
- Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Gerhard Behre
- Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Joachim Mössner
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Janett Fischer
- Division of Gastroenterology, Section of Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Tröltzsch
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Volker Keim
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | | |
Collapse
|
48
|
Petroff D, Czerny M, Kölbel T, Melissano G, Lonn L, Haunschild J, von Aspern K, Neuhaus P, Pelz J, Epstein DM, Romo-Avilés N, Piotrowski K, Etz CD. Paraplegia prevention in aortic aneurysm repair by thoracoabdominal staging with 'minimally invasive staged segmental artery coil embolisation' (MIS²ACE): trial protocol for a randomised controlled multicentre trial. BMJ Open 2019; 9:e025488. [PMID: 30837256 PMCID: PMC6429943 DOI: 10.1136/bmjopen-2018-025488] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) including permanent paraplegia constitutes a common complication after repair of thoracoabdominal aortic aneurysms. The staged-repair concept promises to provide protection by inducing arteriogenesis so that the collateral network can provide a robust blood supply to the spinal cord after intervention. Minimally invasive staged segmental artery coil embolisation (MIS2ACE) has been proved recently to be a feasible enhanced approach to staged repair. METHODS AND ANALYSIS This randomised controlled trial uses a multicentre, multinational, parallel group design, where 500 patients will be randomised in a 1:1 ratio to standard aneurysm repair or to MIS2ACE in 1-3 sessions followed by repair. Before randomisation, physicians document whether open or endovascular repair is planned. The primary endpoint is successful aneurysm repair without substantial SCI 30 days after aneurysm repair. Secondary endpoints include any form of SCI, mortality (up to 1 year), length of stay in the intensive care unit, costs and quality-adjusted life years. A generalised linear mixed model will be used with the logit link function and randomisation arm, mode of repair (open or endovascular repair), the Crawford type and the European System for Cardiac Operative Risk Evaluation (euroSCORE) II as fixed effects and the centre as a random effect. Safety endpoints include kidney failure, respiratory failure and embolic events (also from debris). A qualitative study will explore patient perceptions. ETHICS AND DISSEMINATION This trial has been approved by the lead Ethics Committee from the University of Leipzig (435/17-ek) and will be reviewed by each of the Ethics Committees at the trial sites. A dedicated project is coordinating communication and dissemination of the trial. TRIAL REGISTRATION NUMBER NCT03434314.
Collapse
Affiliation(s)
- David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Universitats-Herzzentrum Freiburg Bad Krozingen GmbH, Bad Krozingen, Germany
- Department of Cardiovascular Surgery, Albert-Ludwigs-Universitat Freiburg Medizinische Fakultat, Freiburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany
| | - Germano Melissano
- Division of Vascular Surgery, Universita Vita Salute San Raffaele, Milano, Italy
| | - Lars Lonn
- Department of (Interventional) Radiology, Rigshospitalet, Kobenhavn, Denmark
| | - Josephina Haunschild
- Department of Cardiac Surgery, University Heart Center Leipzig, Leipzig, Germany
| | | | - Petra Neuhaus
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Universitatsklinikum Leipzig, Leipzig, Germany
| | - David Mark Epstein
- Economía Aplicada, Universidad de Granada – Campus de Cartuja, Granada, Spain
| | - Nuria Romo-Avilés
- Department of Social Anthropology, University of Granada, Granada, Spain
| | | | - Christian D Etz
- Department of Cardiac Surgery, University Heart Center Leipzig, Leipzig, Germany
| |
Collapse
|
49
|
Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol 2019; 87:91-105. [PMID: 30570304 DOI: 10.1037/ccp0000358] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a comprehensive meta-analysis on the efficacy of psychological and medical treatments for binge-eating disorder (BED), including those targeting weight loss. METHOD Through a systematic search before March 2018, 81 published and unpublished randomized-controlled trials (RCTs), totaling 7,515 individuals with BED (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition [DSM-IV] and Fifth Edition [DSM-5]), were retrieved and analyzed using random-effect modeling. RESULTS In RCTs with inactive control groups, psychotherapy, mostly consisting of cognitive-behavioral therapy, showed large-size effects for the reduction of binge-eating episodes and abstinence from binge eating, followed by structured self-help treatment with medium-to-large effects when compared with wait-list. Pharmacotherapy and pharmacological weight loss treatment mostly outperformed pill placebo conditions with small effects on binge-eating outcome. These results were confirmed for the most common treatments of cognitive-behavioral therapy, self-help treatment based on cognitive-behavioral therapy, and lisdexamfetamine. In RCTs with active control groups, there was limited evidence for the superiority of one treatment category or treatment. In a few studies, psychotherapy outperformed behavioral weight loss treatment in short- and long-term binge-eating outcome and led to lower longer-term abstinence than self-help treatment, while combined treatment revealed no additive effect on binge-eating outcome over time. Overall study quality was heterogeneous and the quality of evidence for binge-eating outcome was generally very low. CONCLUSIONS This comprehensive meta-analysis demonstrated the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy for patients with BED. More high quality research on treatments for BED is warranted, with a focus on long-term maintenance of therapeutic gains, comparative efficacy, mechanisms through which treatments work, and complex models of care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig
| | - David Petroff
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Clinic Bochum, Ruhr-University Bochum
| | - Reinhard Pietrowsky
- Institute of Experimental Psychology, Department of Clinical Psychology, University of Düsseldorf
| | | | - Silja Vocks
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology, University of Leipzig
| |
Collapse
|
50
|
Affiliation(s)
- Thomas Karlas
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gastroenterologie
| | - Johannes Wiegand
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Gastroenterologie
| | | |
Collapse
|