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Papalampidi P, Keller F, Lapata M. Finding the Right Moment: Human-Assisted Trailer Creation via Task Composition. IEEE Trans Pattern Anal Mach Intell 2024; 46:292-304. [PMID: 37847637 DOI: 10.1109/tpami.2023.3323030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Movie trailers perform multiple functions: they introduce viewers to the story, convey the mood and artistic style of the film, and encourage audiences to see the movie. These diverse functions make trailer creation a challenging endeavor. In this work, we focus on finding trailer moments in a movie, i.e., shots that could be potentially included in a trailer. We decompose this task into two subtasks: narrative structure identification and sentiment prediction. We model movies as graphs, where nodes are shots and edges denote semantic relations between them. We learn these relations using joint contrastive training which distills rich textual information (e.g., characters, actions, situations) from screenplays. An unsupervised algorithm then traverses the graph and selects trailer moments from the movie that human judges prefer to ones selected by competitive supervised approaches. A main advantage of our algorithm is that it uses interpretable criteria, which allows us to deploy it in an interactive tool for trailer creation with a human in the loop. Our tool allows users to select trailer shots in under 30 minutes that are superior to fully automatic methods and comparable to (exclusive) manual selection by experts.
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Hoppe BS, Castellino S, Pei Q, Charpentier AM, Keller F, Vega RM, Roberts KB, Parikh RR, Punnett A, Parsons S, McCarten KM, Flampouri S, Kessel S, Wu Y, Cho SY, Kelly KM, Hodgson D. Radiotherapy Utilization and Outcomes on a Contemporary Trial for Pediatric High-Risk Hodgkin Lymphoma Study. Int J Radiat Oncol Biol Phys 2023; 117:S62-S63. [PMID: 37784541 DOI: 10.1016/j.ijrobp.2023.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Contemporary trials in pediatric Hodgkin lymphoma (cHL) evaluate strategies to reduce radiotherapy (RT) utilization while maintaining excellent progression-free survival (PFS). An alternative strategy is to irradiate selective sites at higher risk of relapse, and/or use proton therapy (PT) to minimize exposure to healthy tissue. We investigated the use of PT and photon therapy (XRT) and associated early outcomes among patients receiving involved site RT (ISRT) to high-risk sites on the Children's Oncology Group (COG) trial AHOD1331 (NCT021664643). MATERIALS/METHODS This multicenter randomized, open-label phase 3 study enrolled patients 2-21 years (yrs) with previously untreated cHL: stages IIB + bulk, IIIB, IVA, IVB. Patients were randomized to 5 cycles of either ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) or the brentuximab vedotin (BV) containing regimen BV-AVE-PC given every 21 days. ISRT to 21 Gy was given to bulky mediastinal adenopathy and slow responding lesions (SRL) defined by 5-point score 4 or 5 on PET-CT after 2 cycles. ISRT could be delivered as 3D conformal XRT (3D), intensity modulated XRT (IMRT), or proton therapy (PT). Utilization of RT was compared by mode and by study enrollment midpoint among irradiated patients. Severe acute toxicity assessment included any incident grade 3 or higher toxicity during the ISRT period, except for neuropathy. RESULTS Among 587 eligible patients who were enrolled across 153 institutions between March 2015 and August 2019 with a median follow up of 43.1 months, the 3-yr PFS was 82.5% (90% CI, 78.3%-85.9%) with ABVE-PC and 92.5% (90% CI 89.5%-94.6%) with BV-AVE-PC (p = 0.0002). There was no difference in ISRT receipt or modality by study arm (p = 0.33). Among those who received RT 69.7% received it due to bulky mediastinal adenopathy, 6.6% due to SRL, and 23.7% for both. Overall, 317 (54.0%) patients received protocol RT of which 28.7% received 3D, 44.8% received IMRT, and 26.5% received PT. PT utilization increased over the course of the study from 21.5% among the first 50% of irradiated patients to 31.5% in the second half of irradiated patients (p = 0.045). The 3-yr progression-free survival rates overall by RT were comparable: PT (88.0%, 90% CI 80.6% - 92.7%%); XRT (87.1%, 90% CI 82.9%-90.4%) (p = 0.85). No difference in PFS was observed between 3D versus IMRT (p = 0.65). No differences were observed in severe acute toxicities (8.33% vs. 8.15%, p = 0.96) between PT and XRT. CONCLUSION Selective use of RT results in excellent outcomes for pediatric patients with high-risk HL and combination chemotherapy inclusive of the novel agent BV. Over the course of the study, PT utilization increased as an RT modality. Early results suggest that PT does not compromise disease control and has similar acute toxicity as XRT. Long term follow-up (>10 years) is needed to evaluate for secondary malignancies and cardiac toxicity among the different RT modalities.
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Affiliation(s)
- B S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | - Q Pei
- University of Florida, Gainesville, FL
| | - A M Charpentier
- Centre hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - F Keller
- Children Hospital of Atlanta, Atlanta, GA
| | | | | | - R R Parikh
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - A Punnett
- University of Toronto, Toronto, ON, Canada
| | | | | | - S Flampouri
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - S Kessel
- Imaging and Radiation Oncology Core, Lincoln, RI
| | - Y Wu
- University of Florida, Gainesville, FL
| | - S Y Cho
- Department of Radiology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - K M Kelly
- Roswell Park Cancer Institute, Buffalo, NY
| | - D Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Hahn M, Keller F. Modeling task effects in human reading with neural network-based attention. Cognition 2023; 230:105289. [PMID: 36208565 DOI: 10.1016/j.cognition.2022.105289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
Research on human reading has long documented that reading behavior shows task-specific effects, but it has been challenging to build general models predicting what reading behavior humans will show in a given task. We introduce NEAT, a computational model of the allocation of attention in human reading, based on the hypothesis that human reading optimizes a tradeoff between economy of attention and success at a task. Our model is implemented using contemporary neural network modeling techniques, and makes explicit and testable predictions about how the allocation of attention varies across different tasks. We test this in an eyetracking study comparing two versions of a reading comprehension task, finding that our model successfully accounts for reading behavior across the tasks. Our work thus provides evidence that task effects can be modeled as optimal adaptation to task demands.
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Affiliation(s)
- Michael Hahn
- Department of Linguistics, Stanford University, Stanford, CA 94305, United States; Collaborative Research Center 1102, Saarland University, Saarbrücken, 66123, Germany.
| | - Frank Keller
- School of Informatics, University of Edinburgh, 10 Crichton Street, Edinburgh, EH8 9AB, United Kingdom.
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Lyvannak S, Sreynich K, Heng S, Thyl M, Chandna A, Chanpheaktra N, Pises N, Farrilend P, Jarzembowski J, Leventaki V, Davick J, Neunert C, Keller F, Kean LS, Camitta B, Tarlock K, Watkins B. Case Report: The First Case Report of Visceral Leishmaniasis in Cambodia. Am J Trop Med Hyg 2022; 107:336-338. [PMID: 35895585 PMCID: PMC9393436 DOI: 10.4269/ajtmh.22-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 08/03/2023] Open
Abstract
Leishmaniasis is considered a neglected tropical disease that is commonly found in Asia, Africa, South America, and Mediterranean countries. Visceral leishmaniasis (VL) is the most severe form of the disease and is almost universally fatal if left untreated. The symptoms of VL overlap with many infectious diseases, malignancies, and other blood disorders. The most common findings include fever, cytopenias, and splenomegaly. Given the nonspecific symptoms, the diagnosis requires detailed laboratory investigations, including bone marrow examination, that can be challenging in low- and middle-income countries. Diagnostic limitations likely lead to the underdiagnosis or delay in diagnosis of VL. We describe, to our knowledge, the first case report of VL in Cambodia in a child presenting with fever, anemia, and thrombocytopenia. The diagnosis required a liver biopsy and multiple bone marrow biopsies to visualize intracellular Leishmania spp. Our case illustrates the diagnostic challenges and the importance of timely diagnosis. This case also highlights the need for heightened awareness of the diagnostic findings of VL and improved reporting of tropical diseases.
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Affiliation(s)
- Sam Lyvannak
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Sing Heng
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Miliya Thyl
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Arjun Chandna
- Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Ngeth Pises
- Angkor Hospital for Children, Siem Reap, Cambodia
| | | | | | | | | | | | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Leslie S. Kean
- Boston Children’s Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Stevenson J, DeGroote NP, Keller F, Brock KE, Bergsagel DJ, Miller TP, Cornwell P, Fasano R, Chonat S, Castellino SM. Characteristics and outcomes of pediatric oncology patients at risk for guardians declining transfusion of blood components. Cancer Rep (Hoboken) 2022; 6:e1665. [PMID: 35792092 PMCID: PMC9875642 DOI: 10.1002/cnr2.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transfusion of blood products is a necessary part of successful delivery of myelosuppressive regimens in pediatric cancer. There is a paucity of literature characterizing outcomes or management of pediatric patients with cancer when transfusion is declined. AIMS The objective of this paper is to describe the clinical characteristics, care, and outcomes of patients with cancer at risk for declining transfusion. METHODS AND RESULTS A retrospective cohort of patients aged 0-21 years with cancer managed at Children's Healthcare of Atlanta between 2006 and 2020 and with ICD-9 codes indicating risk of "transfusion refusal" or Jehovah's witness (JW) religion was identified. Demographics, disease, and management were abstracted. Descriptive statistics were performed to examine associations with transfusion receipt. Among 35 eligible patients identified as at risk for declining transfusion, 89% had primary guardians who identified as JW, and 45.7% identified as Black, non-Hispanic. Only 40% of guardians actively declined transfusion. Transfusion recipients had significantly lower hemoglobin (g/dl) and platelet counts (1000/μl) at initial presentation (9.6 vs. 11.9, p < .002 and 116.0 vs. 406.5, p = .001, respectively) and at nadir (5.9 vs. 8.7, p < .001 and ≤ 10 vs. 154, p < .001, respectively) than non-recipients. Legal intervention was required in 36.4% of those who ultimately received a transfusion. CONCLUSION Among pediatric cancer patients whose medical record initially indicated a preference for no transfusion, 60% of guardians accepted blood products when prescribed for oncology care. Guidelines for systematic management and transfusion sparing approaches are needed to honor guardian's preferences when possible yet while maintaining equitable cancer outcomes in this population.
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Affiliation(s)
- Jason Stevenson
- Department of Pediatrics, Division of Graduate Medical EducationEmory UniversityAtlantaGeorgiaUSA
| | - Nicholas P. DeGroote
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Katharine E. Brock
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Palliative CareEmory UniversityAtlantaGeorgiaUSA
| | - D. John Bergsagel
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Patricia Cornwell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Ross Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Sharon M. Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA,Department of Pediatrics, Division of Pediatric Hematology/OncologyEmory UniversityAtlantaGeorgiaUSA
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Schützenberger S, Keller F, Grabner S, Kontic D, Schallmayer D, Komjati M, Fialka C. ACL reconstruction with femoral and tibial adjustable versus fixed-loop suspensory fixation: a retrospective cohort study. J Orthop Surg Res 2022; 17:244. [PMID: 35440030 PMCID: PMC9020032 DOI: 10.1186/s13018-022-03128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cortical suspensory fixation (CSF) devices gain more and more popularity as a reliable alternative to interference screws for graft fixation in anterior cruciate ligament (ACL) reconstruction. Adjustable-loop fixation may be associated with increased anterior laxity and inferior clinical outcome. The purpose of the study was to compare anterior laxity and clinical outcome after minimally invasive all-inside ACL reconstruction using an adjustable-loop (AL) to a standard technique with a fixed-loop (FL) CSF device. Methods Patients who underwent primary single-bundle ACL reconstruction with a quadrupled hamstring autograft at a single institution between 2012 and 2016 were reviewed. In the AL group minimally invasive popliteal tendon harvesting was performed with an all-inside approach (femoral and tibial sockets). In the FL group a traditional anteromedial approach was used for tendon harvesting and a femoral socket and full tibial tunnel were drilled. An objective clinical assessment was performed with Telos x-rays and the International Knee Documentation Committee (IKDC) Objective Score. Patient-reported outcomes (PRO) included the IKDC Subjective Score, the Lysholm Knee Score, the Knee Injury and Osteoarthritis Score (KOOS) and the Tegner Activity Scale. Results A total of 67 patients were enrolled in this retrospective study with a mean follow-up of 4 (± 1.5) years. The groups were homogenous at baseline regarding age, gender, and the time to surgery. At follow-up, no statistically significant differences were found regarding anterior laxity (AL: 2.3 ± 3 mm vs. FL: 2.3 ± 2.6 mm, p = 0.981). PRO scores were comparable between the AL and FL groups (IKDC score, 84.8 vs. 88.8, p = 0.185; Lysholm 87.3 vs. 89.9, p = 0.380; KOOS 90.7 vs. 91.4, p = 0.720; Tegner 5.5 vs. 6.2, p = 0.085). The rate of saphenous nerve lesions was significantly lower in the AL group with popliteal harvesting of the tendon (8.3% vs. 35.5%, p = 0.014). Conclusion The use of an adjustable-loop device on the femoral and tibial side led to similar stability and clinical results compared to a fixed-loop device.
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Affiliation(s)
- Sebastian Schützenberger
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
| | - F Keller
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - S Grabner
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Kontic
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - D Schallmayer
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - M Komjati
- Department of Orthopaedic Surgery, Sacred Heart of Jesus Hospital, Vienna, Austria
| | - C Fialka
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Kundratstrasse 37, 1120, Vienna, Austria.,Department for Traumatology, Sigmund Freud Medical University, Vienna, Austria
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Schützenberger S, Grabner S, Schallmayer D, Kontic D, Keller F, Fialka C. The risk of graft impingement still exists in modern ACL surgery and correlates with degenerative MRI signal changes. Knee Surg Sports Traumatol Arthrosc 2021; 29:2880-2888. [PMID: 33009942 DOI: 10.1007/s00167-020-06300-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/09/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Anatomic tunnel placement in ACL reconstruction is crucial to restore knee function. The aims of this study were to (i) evaluate the accuracy of tunnel placement for primary state-of-the-art ACL reconstruction, and (ii) examine the correlation between incorrect tunnel placement, graft appearance, and notch impingement. METHODS In this retrospective study, all patients underwent primary single-bundle ACL reconstruction with independent drilling of the femoral and tibial tunnels according to anatomical landmarks. The accuracy of tunnel placement and the rate of notch impingement were analysed with MRI. The study cohort was subdivided according to the morphology of the graft: intact, degeneration, and re-rupture. The objective outcome was evaluated with the IKDC objective score, and the subjective outcomes were evaluated with the IKDC subjective score, the Lysholm knee score, the KOOS, and the Tegner activity scale score. RESULTS Eighty-seven consecutive patients with a mean follow-up of 3.8 ± 1.4 years were evaluated. There was no significant difference among the groups concerning the baseline characteristics. The re-rupture rate was 9.2%. The position of the femoral tunnel was correct in 92% of the patients, and the position of the tibial tunnel was correct in 93% of the patients. In the intact group, impingement was not found in any of the cases, whereas the rate of impingement in the degeneration (65%) and re-rupture (80%) groups was significantly higher than that in the intact group (p < 0.001). The risk of impingement was more likely with femoral (71% vs. 13%, p < 0.001) or tibial (100% vs. 11%, p < 0.001) malpositioning. The objective IKDC score was A in 52 patients (60%), B in 26 patients (30%), and C in 9 patients (10%). The average subjective IKDC score, Lysholm score, and KOOS were comparable in the intact and degeneration groups but significantly lower in the patient group with newly diagnosed re-ruptures (p = 0.05). The Tegner activity scale score was comparable in all three groups. CONCLUSION Even though the accuracy of femoral tunnel placement in modern single-bundle ACL reconstruction is greater, the risk of malpositioning and graft impingement remains. In our patient cohort, there was a clear correlation between ACL graft impingement, degenerative changes in MRI, and incorrect tunnel positioning. The surgeon must focus on accurate tunnel placement specific to individual patient anatomy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- S Schützenberger
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria.
| | - S Grabner
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria
| | - D Schallmayer
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria
| | - D Kontic
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria
| | - F Keller
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria
| | - C Fialka
- Department of Orthopaedic Surgery and Traumatology, AUVA Traumacenter Meidling, Vienna, Austria.,Department for Traumatology, Sigmund Freud Medical University, Vienna, Austria
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Hoppe B, McCarten K, Kessel S, Alazraki A, Voss S, Pei Q, Mhlanga J, Laie H, Eutsler E, Hodgson D, Keller F, Kelly K, Cho S, Castellino S. The Value of Central Review of Deauville Scores for Response Adapted Treatment Protocols for Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shinn K, Wetzel M, DeGroote NP, Keller F, Briones M, Felker J, Castellino S, Miller TP. Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia. Pediatr Blood Cancer 2020; 67:e28570. [PMID: 32881268 PMCID: PMC7721999 DOI: 10.1002/pbc.28570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Polymerase chain reaction (PCR) respiratory viral panel (RVP) testing is often used in evaluation of pediatric cancer patients with febrile neutropenia (FN), but correlation with adverse outcomes has not been well characterized. PROCEDURE A retrospective cohort of all children ages 0-21 years with cancer admitted to Children's Healthcare of Atlanta for FN from January 2013 to June 2016 was identified. Patient demographic and clinical variables such as age, RVP results, length of stay (LOS), and deaths were abstracted. Relationship between RVP testing and positivity and LOS, highest temperature (Tmax), hypotension and intensive care unit (ICU) admission were compared using Wilcoxon rank sums, chi-square, or Fisher's exact tests adjusting for age, sex, bacteremia, and diagnosis. RESULTS The 404 patients identified had 787 total FN admissions. RVPs were sent in 38% of admissions and were positive in 59%. Patients with RVPs sent were younger (median 5.5 vs 8.0 years, P < .0001) with higher Tmax (39.2° vs 39.1°, P = .016). The most common virus identified was rhinovirus/Enterovirus (61%). There were no significant differences in highest temperature or lowest blood pressure based on RVP positivity. Patients admitted to the ICU were more likely to have RVPs sent (odds ratio [OR] = 3.19, P < .002); however, neither having RVP testing nor RVP positivity were significantly associated with increased LOS or death. Coinfection with bacteremia and a respiratory virus was identified in 9.1% of patients. CONCLUSIONS These data raise the question of the utility of sending potentially costly RVP testing as RVP positivity during febrile neutropenia does not impact LOS, degree of hypotension, or ICU admission.
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Affiliation(s)
| | - Martha Wetzel
- Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Nicholas P. DeGroote
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Michael Briones
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - James Felker
- Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Sharon Castellino
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Tamara P. Miller
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA;,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Parekh A, Keller F, McCarten K, Kessel S, Pei Q, Castellino S, Constine L, Schwartz C, Hodgson D, Kelly K, Hoppe B. Impact of Early PET Response and Use of Radiotherapy on Patterns of Relapse in Early-Stage, Low-Risk Pediatric Hodgkin Lymphoma: Secondary Analysis of COG AHOD 0431. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scherer J, Keller F, Pape HC, Osterhoff G. Would patients undergo postoperative follow-up by using a smartphone application? BMC Surg 2020; 20:229. [PMID: 33028309 PMCID: PMC7542718 DOI: 10.1186/s12893-020-00889-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background eHealth applications have been proposed as an alternative to monitor patients in frequent intervals or over long distances. The aim of this study was to assess whether patients would accept an application on their smartphone to be monitored by their physicians. Methods During September 2017 and December 2017 a survey amongst smartphone users was conducted via paper and web-based questionnaires. Results More than half of the 962 participants (54%) were older than 55 years of age. The majority of the participants (68.7%) would accept a follow-up by a smartphone application obtaining personal healthcare data. 72.6% of all patients older than 55 years of age would use the application. The most prevalent reason against installing the application was data protection. Patients being currently treated in an orthopaedic practice and pedestrians were more eager to accept a follow-up by a mobile app than participants from social media. Conclusion The majority of participants would accept a mobile application, collecting personal health-related data for postoperative follow-up, and saw a direct benefit for the patient in such an application.
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Affiliation(s)
- Julian Scherer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Frank Keller
- Orthozentrum Rosenheim, Äußere Münchener Straße 94, 83026, Rosenheim, Germany
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Georg Osterhoff
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Kuhlwilm L, Schönfeldt-Lecuona C, Gahr M, Connemann BJ, Keller F, Sartorius A. The neuroleptic malignant syndrome-a systematic case series analysis focusing on therapy regimes and outcome. Acta Psychiatr Scand 2020; 142:233-241. [PMID: 32659853 DOI: 10.1111/acps.13215] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Neuroleptic malignant syndrome (NMS) is a rare, potentially life-threatening antipsychotic-associated disorder that requires an efficient and timely therapy. The aim of the study was to compare the effectiveness of different NMS therapies and to analyze its outcome depending on NMS severity. METHOD Systematic search for NMS cases in biomedical databases. The focus of the analysis was on therapy with dantrolene, bromocriptine, and electroconvulsive therapy (ECT) when each was compared with symptomatic therapy. Primary outcomes were the survival rate and the duration of treatment. RESULT 405 case reports were included. Overall, no statistically significant differences regarding mortality rate or duration of treatment were found between dantrolene, bromocriptine, or ECT compared to supportive care. A subgroup analysis regarding NMS severity showed that the mortality under specific NMS pharmacotherapy (dantrolene, bromocriptine) and under ECT was significantly lower than under purely symptomatic therapy in severe NMS (P = 0.018). The difference was not significant in mild and moderate cases. DISCUSSION An overall superiority of the specific NMS therapy (dantrolene, bromocriptine, and ECT) was not found in this study. When regarding severity classification, specific therapies were superior but only in severe cases, and ECT showed the lowest mortality rate. In previous case series, an effect on survival or the duration of the disease could only be observed in part for specific therapies, but the evidence available is inconsistent. The results of this study support our hypothesis that NMS treatment with dantrolene, bromocriptine, and ECT is advantageous over purely symptomatic therapy in severe NMS cases.
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Affiliation(s)
- L Kuhlwilm
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - C Schönfeldt-Lecuona
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - M Gahr
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - B J Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - F Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - A Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Kächele M, Keller F. [Pharmacokinetics and pharmacodynamics in extracorporeal renal replacement therapy]. Med Klin Intensivmed Notfmed 2020; 116:295-300. [PMID: 32047978 DOI: 10.1007/s00063-020-00654-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Abstract
Intermittent hemodialysis, continuous hemofiltration and prolonged daily dialysis are used for renal replacement therapy in the intensive care units. Independent of the replacement modality, antibiotic therapy must start with a high loading dose. Dose adjustment to the kidneys must follow 48 h later to prevent toxic accumulation. Dose recommendations on product labels are often underdosed. On continuous hemofiltration, meanwhile many intensivists administer a normal standard dose because the high filtration rate corresponds to a half-normal glomerular filtration rate. After intermittent hemodialysis, a dose similar to the loading dose will be needed. On day off dialysis, the maintenance dose must be adjusted to the failing kidney function. Immediately after prolonged daily dialysis, a loading dose should be given; with twice daily dosing the maintenance dose needs to be adjusted to kidney function. Therapeutic drug monitoring is recommended for gentamicin, vancomycin, piperacillin, meropenem and voriconazole. Due to pharmacodynamic reasons, the target concentration corresponds to the concentration producing the half-maximum effect. Accordingly, the target concentration is the normal peak for concentration-dependent action with bolus dosing. The target is the average steady-state concentration for antibiotics with time-dependent action and continuous infusion.
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Affiliation(s)
- M Kächele
- Zentrum für Innere Medizin, Innere 1, Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - F Keller
- Zentrum für Innere Medizin, Innere 1, Nephrologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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14
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Miller LH, Keller F, Mertens A, Klein M, Allen K, Castellino S, Woods WG. Impact of fluid overload and infection on respiratory adverse event development during induction therapy for childhood acute myeloid leukemia. Pediatr Blood Cancer 2019; 66:e27975. [PMID: 31502412 PMCID: PMC6803045 DOI: 10.1002/pbc.27975] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment-related morbidity and mortality occur frequently in childhood acute myeloid leukemia (AML) induction. Yet the contributions of respiratory adverse events (AEs) within this population are poorly understood. Furthermore, the roles of fluid overload (FO) and infection in AML pulmonary complications have been inadequately examined. OBJECTIVES To describe the incidence, categories, and grades of respiratory AEs and to assess the associations of FO and infection on respiratory AE development in childhood AML induction. METHODS We retrospectively examined the induction courses of a cohort of de novo pediatric AML patients for any NCI CTCAE grade 2 to 5 respiratory AE, FO, and systemic/pulmonary infection occurrence. Demographic, disease, and treatment-related data were abstracted. Descriptive, univariate, survival, and multivariable analyses were conducted. RESULTS Among 105 eligible subjects from 2009 to 2016, 49.5% (n = 52) experienced 63 discrete respiratory AEs. FO occurred in 28.6% of subjects (n = 30), with half occurring within 24 hours of hospitalization. Positive FO status < 10 days (aHR 5.5, 95% CI 2.3-12.8), ≥ 10 days (aHR 13, 95% CI 4.1-41.8), and positive infection status ≥ 10 days into treatment (aHR 14.9, 5.4-41.6) were each independently associated with AE development. CONCLUSIONS We describe a higher incidence of respiratory AEs during childhood AML induction than previously illustrated. FO occurs frequently and early in this course. Late infections and FO at any time frame were strongly associated with AE development. Interventions focused on the prevention and management of FO and infectious respiratory complications could be instrumental in reducing preventable treatment-related morbidity and mortality.
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Affiliation(s)
- Lane H Miller
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Frank Keller
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann Mertens
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristen Allen
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Sharon Castellino
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA,Drs Castellino and Woods provided equal contribution as senior authors
| | - William G Woods
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA,Drs Castellino and Woods provided equal contribution as senior authors
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15
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Mauz-koerholz C, Kelly K, Keller F, Ramchandren R, Nahar A, Giulino-Roth L. Phase II, open-label study of pembrolizumab in children and young adults with newly diagnosed classical Hodgkin lymphoma (cHL) with slow early response (SER) to frontline chemotherapy: KEYNOTE-667. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz427.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Gella S, Keller F, Lapata M. Disambiguating Visual Verbs. IEEE Trans Pattern Anal Mach Intell 2019; 41:311-322. [PMID: 29990137 DOI: 10.1109/tpami.2017.2786699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article, we introduce a new task, visual sense disambiguation for verbs: given an image and a verb, assign the correct sense of the verb, i.e., the one that describes the action depicted in the image. Just as textual word sense disambiguation is useful for a wide range of NLP tasks, visual sense disambiguation can be useful for multimodal tasks such as image retrieval, image description, and text illustration. We introduce a new dataset, which we call VerSe (short for Verb Sense) that augments existing multimodal datasets (COCO and TUHOI) with verb and sense labels. We explore supervised and unsupervised models for the sense disambiguation task using textual, visual, and multimodal embeddings. We also consider a scenario in which we must detect the verb depicted in an image prior to predicting its sense (i.e., there is no verbal information associated with the image). We find that textual embeddings perform well when gold-standard annotations (object labels and image descriptions) are available, while multimodal embeddings perform well on unannotated images. VerSe is publicly available at https://github.com/spandanagella/verse.
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17
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Schmalz G, Dietl M, Vasko R, Müller GA, Rothermund L, Keller F, Ziebolz D, Rasche FM. Dialysis vintage time has the strongest correlation to psychosocial pattern of oral health-related quality of life - a multicentre cross-sectional study. Med Oral Patol Oral Cir Bucal 2018; 23:e698-e706. [PMID: 30341269 PMCID: PMC6261004 DOI: 10.4317/medoral.22624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Aim of this cross-sectional, multicentre study was to investigate associations of dialysis vintage time in haemodialysis (CKD5D) patients with oral health-related quality of life (OHRQoL) and dental and periodontal treatment need. Material and Methods CKD5D patients were divided into subgroups according to dialysis vintage time in different dialysis centres in Germany. OHRQoL was assessed with oral health impact profile (OHIP-G14). Dental treatment need was classified as presence of carious lesions. Periodontal treatment need was defined as periodontal screening index score (PSI) 3-4. Results In total, 190 participants were divided into the subgroups according to the time on CKD5D: 0 - 2 (n = 29), 3 - 5 (n = 35), 6 - 8 (n = 34), 9 - 12 (n = 29), 13 - 20 (n = 34) and >20 years (n = 29). The overall treatment need in the total cohort was 92% (dental 56%, periodontal 88%) with a total OHIP-G14 sum score of 4.17 [2; 0-5] without a significant correlation. Time on CKD5D was inversely correlated with the OHIP G14 score (p<0.01, R = -0.201). The pattern psychosocial impact was significantly associated with the dialysis duration (p<0.01) and showed a negative correlation to the OHIP-G14 (R = -0.283, Spearman´s rho test p<0.01). For oral function also a negative correlation with OHIP-G14 was detected (Spearman´s rho: -0.183). Conclusions Patients with a prolonged dialysis vintage time show an improved OHRQoL, which might be mainly caused by the positive development of psychosocial pattern of OHRQoL. The oral health situation of HD patients seems unsatisfying, independently of dialysis vintage time and OHRQoL. Accordingly, an improvement in oral health situation of CKD5D patients is mandatory necessary. Thereby, consideration of psychosocial aspects especially at the beginning of CKD5D therapy and a sensitization regarding oral health issues with increasing vintage time might be recommendable. Key words:Dental care, oral health, oral related quality of life, haemodialysis, chronic kidney disease.
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Affiliation(s)
- G Schmalz
- University Medical Center Leipzig, Dept. of Cariology, Endodontology and Periodontology, Liebigstr 12 D, 04103 Leipzig, Germany,
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18
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Miller L, Kobayashi S, Pauly M, Lew G, Saxe D, Keller F, Qayed M, Castellino S. Evaluating approaches to enhance survival in children with hypodiploid acute lymphoblastic leukaemia (ALL). Br J Haematol 2018; 185:613-616. [PMID: 30255927 DOI: 10.1111/bjh.15590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lane Miller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Shogo Kobayashi
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Fukushima Medical University, Fukushima, Japan
| | - Melinda Pauly
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Glen Lew
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Debra Saxe
- Emory University School of Medicine, Atlanta, GA, USA
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
| | - Sharon Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Emory University School of Medicine, Atlanta, GA, USA
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Abstract
SummaryUnderlying disorders of the coagulation system such as inhibitor deficiencies or decreased fibrinolysis are common in patients suffering from venous thrombosis. They may lead to the necessity of a lifelong prophylaxis. Prompt diagnosis is obviously to the patients benefit. We investigated 22 patients suffering from venous thromboses for the inhibitors antithrombin III (ATIII), protein C, and protein S during the first 8 to 12 days after admission to hospital and in addition after withdrawal from anticoagulant treatment after several months. At the day of admission ATIII and protein C levels were comparable to those several months later, but after 2 days they shifted downward or upward, respectively. Protein S did not shift during the period of hospitalisation, but was initially slightly lower than several months later. For inhibitors the day of admission to hospital is most suitable to take the samples. About 50% of the patients still had elevated activation markers (prothrombin fragments F1+2, thrombin-antithrombin complex TAT, and D-dimers) after several months.
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Affiliation(s)
- W Reiter
- The Central Laboratory, Dept. of Medicine, University Hospital, Wurzburg, Germany
| | - H Ehrensberger
- The Central Laboratory, Dept. of Medicine, University Hospital, Wurzburg, Germany
| | - B Steinbrückner
- The Central Laboratory, Dept. of Medicine, University Hospital, Wurzburg, Germany
| | - F Keller
- The Central Laboratory, Dept. of Medicine, University Hospital, Wurzburg, Germany
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20
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Bader R, Mannucci PMM, Tripodi A, Hirsh J, Keller F, Solleder EM, Hawkins P, Peng M, Pelzer H, Teijidor LM, Ramirez IF, Kolde HJ. Multicentric Evaluation of a New PT Reagent Based on Recombinant Human Tissue Factor and Synthetic Phospholipids. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642433] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA new PT reagent based on recombinant human tissue factor and synthetic phospholipids (phosphatidyl choline and phosphatidyl serine) with defined fatty acid side chains was calibrated against BCT/253 and CRM 149R. A small but consistent bias in the International Sensitivity Index (ISI) value was obtained using either the human or rabbit brain reference material. ISI values were around 1.0 or slightly lower depending on the respective instrument. Mixing studies with factor deficient plasmas showed a high factor sensitivity especially for factor VII as compared to commercial rabbit brain or human placenta thromboplastin. In an international field trial the reagent was tested using fully or semi automated Electra™ coagulometers in 4 different laboratories. Results with normal samples were in excellent agreement among the different laboratories. Mean values were 10.9, 10.9, 11.0, 11,7 s with a range of 9.5 to 12.5 s. Results of males and females were not different. In patients with liver disease very similar PT activities were found as compared to sensitive rabbit brain or human placental thromboplastins. In normals and patients with oral anticoagulation INR values correlated very well against BCT (r = 0.98, regression line y =-0.07 + 0.9 x). The distribution of samples was linear over the whole range. In the comparison against sensitive rabbit brain thromboplastin or human placental thromboplastin similar correlations were found. In a few cases higher INR values were observed for the recombinant reagent especially in patients with intensive treatment. Factor assays in those patients showed at least the strong reduction of one vitamin Independent coagulation factor. Over all the linearity was better against the rabbit brain reagent than against the human placental reagent which is slightly less factor VII sensitive as shown in mixing studies with normal and factor VII deficient plasma. Precision studies in the 4 laboratories showed excellent reproducibility of lyophilised controls or local patient plasma pools for all reagents with a better performance of the recombinant reagent. C. V. values from day to day ranged from 1.3% to 5% for normal and abnormal controls.These results show that the recombinant PT reagent, especially in conjunction with a precise automated instrument, may improve the results of PT testing and thus may lead to better patient care.
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Affiliation(s)
- R Bader
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - P M M Mannucci
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - A Tripodi
- The IRCCS Maggiore Hospital and University, Policlinico Centro Hemophilia, Milano, Italy
| | - J Hirsh
- The Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada
| | - F Keller
- The Medizinische Universitätsklinik, Zentrallabor, Würzburg, Germany
| | - E M Solleder
- The Medizinische Universitätsklinik, Zentrallabor, Würzburg, Germany
| | - P Hawkins
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - M Peng
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - H Pelzer
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - L M Teijidor
- The Baxter Diagnostics, R & D, Miami, Florida, USA
| | - I F Ramirez
- The Baxter Deutschland GmbH, Haemostase Europa, Unterschleißheim/München, Germany
| | - H-J Kolde
- The Baxter Deutschland GmbH, Haemostase Europa, Unterschleißheim/München, Germany
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21
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Dati F, Barthels M, Conard J, Flückiger J, Girolami A, Hänseler E, Huber J, Keller F, Kolde HJ, Müller-Berghaus G, Samama M, Thiel W. Multicenter Evaluation of a Chromogenic Substrate Method for Photometric Determination of Prothrombin Time. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA multicenter study of a chromogenic substrate method for photometric determination of prothrombin time was conducted in order to evaluate its clinical application. Seven laboratories pailicipaled in the study using a total of 742 plasma samples from 417 patients on oral anticoagulant therapy, 261 healthy subjects and 64 patients with different diseases especially of the liver as well as 30 patients with hereditary deficiency of coagulation factors II, V, VII, X. The chromogenic PT method was compared to a standardized coagulometric PT assay which uses the same sensitive human placenta thromboplastin calibrated against international reference preparations. A high correlation of the prothrombin ratio values of the chromogenic and the coagulometric assay was obtained in 402 plasma samples (r = 0.940; y = 1.02x − 0.1). The study showed that the chromogenic PT reagent is sensitive to deficiency of the coagulation factors of the extrinsic pathway but not affected by heparin up to 1 IU/ml because of the heparin antagonist added. The precision (coefficient of variation) of the photometric method ranged between 0.6 and 3% (intraassay CV) and between 1.4 and 5.8 (interassay CV). The International Sensitivity Index (ISI) obtained for the used lot was 1.09. The therapeutical range in percentage activity for patients in a stable phase of an anticoagulant therapy was found to be from 15 to 27 percent of normal. The results of the clinical evaluation proved the good comparability of the new chromogenic PT test with coagulometric methods, its high factor sensitivity, good reproducibility and easy performance.
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Affiliation(s)
- F Dati
- The Research Laboratories of Behringwerke AG, Marburg, Germany
| | - M Barthels
- The Dept. of Hematology and Oncology, University Medical School, Hannover, Germany
| | - J Conard
- The Laboratoire Central d’Hematologie, Hôtel-Dieu Hospital, Paris, France
| | - J Flückiger
- The Central Laboratory of Clinical Chemistry, University Hospital Zürich, Switzerland
| | - A Girolami
- The Istituto di Semeiotica Medica, University of Padua, Padua, Italy
| | - E Hänseler
- The Central Laboratory of Clinical Chemistry, University Hospital Zürich, Switzerland
| | - J Huber
- The Central Laboratory of the Medical University Clinic, Würzburg, Germany
| | - F Keller
- The Central Laboratory of the Medical University Clinic, Würzburg, Germany
| | - H -J Kolde
- The Research Laboratories of Behringwerke AG, Marburg, Germany
| | - G Müller-Berghaus
- The Clinical Research Unit for Blood Coagulation and Thrombosis, Max-Planck-Gesellschaft, Giessen, Germany
| | - M Samama
- The Laboratoire Central d’Hematologie, Hôtel-Dieu Hospital, Paris, France
| | - W Thiel
- The Clinical Research Unit for Blood Coagulation and Thrombosis, Max-Planck-Gesellschaft, Giessen, Germany
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Affiliation(s)
- F. Keller
- Free University of Berlin Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45
| | - G. Schultze
- Free University of Berlin Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45
| | - G. Offermann
- Free University of Berlin Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45
| | - M. Molzahn
- Free University of Berlin Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45
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23
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Affiliation(s)
- F. Keller
- Free University Klinikum Steglitz Medical Department Hindenburgdamm 30 1000 Berlin 45, West Germany
| | - G. Offermann
- Free University Klinikum Steglitz Medical Department Hindenburgdamm 30 1000 Berlin 45, West Germany
| | - J. Scholle
- Free University Klinikum Steglitz Medical Department Hindenburgdamm 30 1000 Berlin 45, West Germany
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24
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Wilms H, Keller F, Offermann G. Membrane Plasma Exchange by Single-Needle Hemofiltration Device. A Technical Note. Int J Artif Organs 2018. [DOI: 10.1177/039139888400700417] [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: 10/17/2022]
Affiliation(s)
- H. Wilms
- Free University Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45 West Germany
| | - F. Keller
- Free University Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45 West Germany
| | - G. Offermann
- Free University Klinikum Steglitz Medical Department Nephrology Hindenburgdamm 30 1000 Berlin 45 West Germany
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25
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Abstract
Heparinization during hemodialysis may cause severe bleeding complications in patients with high bleeding risk. Heparin-free hemodialyses (n=208) were performed in 46 unselected patients with high bleeding risk after kidney transplantation (n=25), after major surgery (n=10), and with bleeding disorders (n=11). Dialyser and blood lines were primed without heparin. In addition to the established measures (high blood flow, intermittent rinsing), system clotting was prevented by prophylactically changing the dialyser and blood lines in 107 of 208 dialyses (52 percent). Total system clotting with blood loss ranging from 100 to 250 ml occurred in six cases (3 percent). Mean hemodialysis time (± SD) was 4.1 hours (± 0.4), rising volume of the extracorporeal system 1.4 liters/hour (± 0.6), blood flow 244 ml/min (± 38), clotting time 12 min (+ 4), and weight loss 2.5 kg (± 1.5). Mean hemodialysis creatinine clearance was 110 ml/min (± 34) and BUN clearance 138 ml/min (± 48). Heparin-free hemodialysis with prophylactic change of system is thus a safe and practical method of treatment for patients at high bleeding risk, but it is less effective, more expensive and the patient requires closer care.
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Affiliation(s)
- L. Preuschof
- Free University, Klinikum Steglitz Abteilung für Allgemeine Innere Medizin und Nephrologie Berlin, FR Germany
| | - F. Keller
- Free University, Klinikum Steglitz Abteilung für Allgemeine Innere Medizin und Nephrologie Berlin, FR Germany
| | - J. Seemann
- Free University, Klinikum Steglitz Abteilung für Allgemeine Innere Medizin und Nephrologie Berlin, FR Germany
| | - G. Offermann
- Free University, Klinikum Steglitz Abteilung für Allgemeine Innere Medizin und Nephrologie Berlin, FR Germany
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Abstract
Abstract:A pharmacokinetic database was constructed that is as free of errors as possible. Pharmacokinetic parameters were derived from the literature using a text-processing system and a database system. A random data sample from each system was compared with the original literature. The estimated error frequencies using statistical methods differed significantly between the two systems. The estimated error frequency in the text-processing system was 7.2%, that in the database system 2.7%. Compared with the original values in the literature, the estimated probability of error for identical pharmacokinetic parameters recorded in both systems is 2.4% and is not significantly different from the error frequency in the database. Parallel data entry with a text-processing system and a database system is, therefore, not significantly better than structured data entry for reducing the error frequency.
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Mueller SP, Helo C, Keller F, Taddeucci J, Castro JM. First experimental observations on melting and chemical modification of volcanic ash during lightning interaction. Sci Rep 2018; 8:1389. [PMID: 29362499 PMCID: PMC5780474 DOI: 10.1038/s41598-018-19608-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/05/2018] [Indexed: 11/09/2022] Open
Abstract
Electrification in volcanic ash plumes often leads to syn-eruptive lightning discharges. High temperatures in and around lightning plasma channels have the potential to chemically alter, re-melt, and possibly volatilize ash fragments in the eruption cloud. In this study, we experimentally simulate temperature conditions of volcanic lightning in the laboratory, and systematically investigate the effects of rapid melting on the morphology and chemical composition of ash. Samples of different size and composition are ejected towards an artificially generated electrical arc. Post-experiment ash morphologies include fully melted spheres, partially melted particles, agglomerates, and vesiculated particles. High-speed imaging reveals various processes occurring during the short lightning-ash interactions, such as particle melting and rounding, foaming, and explosive particle fragmentation. Chemical analyses of the flash-melted particles reveal considerable bulk loss of Cl, S, P and Na through thermal vaporization. Element distribution patterns suggest convection as a key process of element transport from the interior of the melt droplet to rim where volatiles are lost. Modeling the degree of sodium loss delivers maximum melt temperatures between 3290 and 3490 K. Our results imply that natural lighting strikes may be an important agent of syn-eruptive morphological and chemical processing of volcanic ash.
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Affiliation(s)
- S P Mueller
- Intitute of Geosciences, University of Mainz, J.-J.-Becherweg 21, D-55122, Mainz, Germany.
| | - C Helo
- Intitute of Geosciences, University of Mainz, J.-J.-Becherweg 21, D-55122, Mainz, Germany
| | - F Keller
- Intitute of Geosciences, University of Mainz, J.-J.-Becherweg 21, D-55122, Mainz, Germany
| | - J Taddeucci
- Istituto Nazionale di Geofisica e Vulcanologia, Via di Vigna Murata 605, 00143, Rome, Italy
| | - J M Castro
- Intitute of Geosciences, University of Mainz, J.-J.-Becherweg 21, D-55122, Mainz, Germany
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Abstract
Purpose To compare long-term efficacy and biocompatibility of the 5 most commonly applied LDL-apheresis techniques using a specifically modified calculation method of the area under the curve (AUC) for laboratory parameters. Design Retrospective long-term analysis of 20 patients with homozygous or severe heterozygous familial hypercholesterolemia. Procedures The following 5 extra-corporeal LDL-apheresis methods were compared: IMAL (Immuno Adsorption of Lipoproteins), DSA (Dextran Sulphate Adsorption), HELP (Heparin Induced Extra-corporeal LDL Precipitation), DALI (Direct Adsorption of Lipoproteins), MDF (Membrane Differential Filtration). Main outcome measures AUC derived plasma concentrations (CAUC) of lipoproteins between two apheresis procedures and their long-term course. Comparison of biocompatibility and efficacy concerning the LDL-C target of < 2.6 mmol/L of 5 apheresis techniques. Progression of atherosclerosis in patients with severe hypercholesterolemia. Main findings The means of AUC derived average plasma concentrations (CAUC) of all treatment intervals were for LDL-C and the LDL/HDL ratio as follows: IMAL (5.59 mmol/L; ratio 4.1), DSA (3.03 mmol/L; ratio 2.0), HELP (4.06 mmol/L; ratio 2.2), DALI (3.83 mmol/L; ratio 3.3), MDF (3.26 mmol/L; ratio 3.2). Coronary heart disease and cardiac events (myocardial infarction, PTCA/ stent implantation, CABG) progressed in only 2 patients whereas atherosclerosis manifestations (sclerosis abdominal aorta, carotid artery stenosis, peripheral vascular disease) worsened in 13 patients. Mean ergometric capacity improved from 112 to 118 Watt. Conclusions All 5 apheresis methods (IMAL, DSA, HELP, DALI, MDF) proved to be safe and suitable for long-term treatment in patients with severe hypercholesterolemia. The introduction of the CAUC revealed that the target of LDL-C < 2.6 mmol/L was not achieved with regard to the time averaged concentration (CAUC).
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Affiliation(s)
- A Krebs
- Division of Nephrology, Medical Faculty, University of Ulm, Germany
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Abstract
BACKGROUND Social media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet. METHODS During 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed. RESULTS Most commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week. CONCLUSIONS Pictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.
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Affiliation(s)
- R C Brown
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - T Fischer
- Freelancing data journalist,Berlin,Germany
| | | | - F Keller
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - R Young
- MRC Social and Public Health Sciences Unit,University of Glasgow,Glasgow,Scotland
| | - P L Plener
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
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Hinney K, Gleixner J, Keller F, Schambeck CM. Venous Thromboembolism and Associated High Plasma Factor VIII Levels:Linked to Cytomegalovirus Infection? Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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31
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Geisen U, Schwender S, Keller F, Grossmann R. Continuous Infusion of Recombinant Factor VIIa (NovoSeven®) in the Treatment of a Patient with Type III von Willebrand’s Disease and Alloantibodies against von Willebrand Factor. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613878] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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32
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Coco MI, Dale R, Keller F. Performance in a Collaborative Search Task: The Role of Feedback and Alignment. Top Cogn Sci 2017; 10:55-79. [DOI: 10.1111/tops.12300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 07/10/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Moreno I. Coco
- School of Philosophy, Psychology and Language Sciences; University of Edinburgh
| | - Rick Dale
- Cognitive and Information Sciences; University of California; Merced
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33
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Peter RS, Keller F, Föger B, Nagel G. Discrimination of metabolically healthy and unhealthy individuals using the triglyceride glucose index – distributional considerations. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605988] [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: 10/18/2022]
Affiliation(s)
- RS Peter
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm
| | - F Keller
- Klinik für Kinder – und Jugendpsychiatrie, Universitätsklinikum Ulm, Ulm
| | - B Föger
- Arbeitskreis für Vorsorge- und Sozialmedizin, Bregenz
| | - G Nagel
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm
- Arbeitskreis für Vorsorge- und Sozialmedizin, Bregenz
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34
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Brown RC, Witt A, Fegert JM, Keller F, Rassenhofer M, Plener PL. Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychol Med 2017; 47:1893-1905. [PMID: 28397633 DOI: 10.1017/s0033291717000496] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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: 11/06/2022]
Abstract
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
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Affiliation(s)
- R C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - A Witt
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - J M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - F Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - M Rassenhofer
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
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35
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Wolfersdorf M, Vogel R, Vogl R, Grebner M, Keller F, Purucker M, Wurst FM. [Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]. Nervenarzt 2017; 87:474-82. [PMID: 27090898 DOI: 10.1007/s00115-016-0111-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.
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Affiliation(s)
- M Wolfersdorf
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Bayreuth, Akademisches Lehrkrankenhaus der Universität Erlangen-Nürnberg, Nordring 2, 95445, Bayreuth, Deutschland.
| | - R Vogel
- Klinik für Forensische Psychiatrie und Psychotherapie, Abteilung Psychiatrie II der Universität Ulm, Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - R Vogl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Christophsbad Göppingen, Göppingen, Deutschland
| | - M Grebner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Christophsbad Göppingen, Göppingen, Deutschland
| | - F Keller
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universität Ulm, Ulm, Deutschland
| | - M Purucker
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Bayreuth, Akademisches Lehrkrankenhaus der Universität Erlangen-Nürnberg, Nordring 2, 95445, Bayreuth, Deutschland
| | - F M Wurst
- Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
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36
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Abrahamczyk S, Kessler M, Hanley D, Karger DN, Müller MPJ, Knauer AC, Keller F, Schwerdtfeger M, Humphreys AM. Pollinator adaptation and the evolution of floral nectar sugar composition. J Evol Biol 2016; 30:112-127. [PMID: 27747987 DOI: 10.1111/jeb.12991] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 12/30/2022]
Abstract
A long-standing debate concerns whether nectar sugar composition evolves as an adaptation to pollinator dietary requirements or whether it is 'phylogenetically constrained'. Here, we use a modelling approach to evaluate the hypothesis that nectar sucrose proportion (NSP) is an adaptation to pollinators. We analyse ~ 2100 species of asterids, spanning several plant families and pollinator groups (PGs), and show that the hypothesis of adaptation cannot be rejected: NSP evolves towards two optimal values, high NSP for specialist-pollinated and low NSP for generalist-pollinated plants. However, the inferred adaptive process is weak, suggesting that adaptation to PG only provides a partial explanation for how nectar evolves. Additional factors are therefore needed to fully explain nectar evolution, and we suggest that future studies might incorporate floral shape and size and the abiotic environment into the analytical framework. Further, we show that NSP and PG evolution are correlated - in a manner dictated by pollinator behaviour. This contrasts with the view that a plant necessarily has to adapt its nectar composition to ensure pollination but rather suggests that pollinators adapt their foraging behaviour or dietary requirements to the nectar sugar composition presented by the plants. Finally, we document unexpectedly sucrose-poor nectar in some specialized nectarivorous bird-pollinated plants from the Old World, which might represent an overlooked form of pollinator deception. Thus, our broad study provides several new insights into how nectar evolves and we conclude by discussing why maintaining the conceptual dichotomy between adaptation and constraint might be unhelpful for advancing this field.
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Affiliation(s)
- S Abrahamczyk
- Nees Institute for Plant Biodiversity, University of Bonn, Bonn, Germany
| | - M Kessler
- Institute of Systematic and Evolutionary Botany, University of Zurich, Zurich, Switzerland
| | - D Hanley
- Department of Biology, Long Island University - Post, Brookville, NY, USA
| | - D N Karger
- Institute of Systematic and Evolutionary Botany, University of Zurich, Zurich, Switzerland
| | - M P J Müller
- Institute of Systematic and Evolutionary Botany, University of Zurich, Zurich, Switzerland
| | - A C Knauer
- Institute of Systematic and Evolutionary Botany, University of Zurich, Zurich, Switzerland
| | - F Keller
- Institute of Plant Science, University of Zurich, Zurich, Switzerland
| | - M Schwerdtfeger
- Albrecht-v.-Haller Institute of Plant Science, University of Goettingen, Goettingen, Germany
| | - A M Humphreys
- Department of Life Sciences, Imperial College London, Berkshire, UK.,Department of Ecology, Environment and Plant Sciences, University of Stockholm, Stockholm, Sweden
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37
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Rasche FM, Keller F, Rasche WG, Schiekofer S, Boldt A, Sack U, Fahnert J. Why, when and how should immunosuppressive therapy considered in patients with immunoglobulin A nephropathy? Clin Exp Immunol 2016; 186:115-133. [PMID: 27283488 PMCID: PMC5054563 DOI: 10.1111/cei.12823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 12/13/2022] Open
Abstract
IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Lifelong mesangial deposition of IgA1 complexes subsist inflammation and nephron loss, but the complex pathogenesis in detail remains unclear. In regard to the heterogeneous course, classical immunosuppressive and specific therapeutic regimens adapted to the loss of renal function will here be discussed in addition to the essential common renal supportive therapy. Renal supportive therapy alleviates secondary, surrogate effects or sequelae on renal function and proteinuria of high intraglomerular pressure and subsequent nephrosclerosis by inhibition of the renin angiotensin system (RAASB). In patients with physiological (ΔGFR < 1·5 ml/min/year) or mild (ΔGFR 1·5-5 ml/min/year) decrease of renal function and proteinuric forms (> 1 g/day after RAASB), corticosteroids have shown a reduction of proteinuria and might protect further loss of renal function. In patients with progressive loss of renal function (ΔGFR > 3 ml/min within 3 months) or a rapidly progressive course with or without crescents in renal biopsy, cyclophosphamide with high-dose corticosteroids as induction therapy and azathioprine maintenance has proved effective in one randomized controlled study of a homogeneous cohort in loss of renal function (ΔGFR). Mycophenolic acid provided further maintenance in non-randomized trials. Differentiated, precise, larger, randomized, placebo-controlled studies focused on the loss of renal function in the heterogeneous forms of IgAN are still lacking. Prospectively, fewer toxic agents will be necessary in the treatment of IgAN.
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Affiliation(s)
- F M Rasche
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - F Keller
- Department of Internal Medicine I, Division of Nephrology, University Hospital of Ulm, Ulm, Germany.
| | - W G Rasche
- Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
| | - S Schiekofer
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - A Boldt
- Institute of Clinical Immunology, Medical Faculty, Leipzig, Germany
| | - U Sack
- Institute of Clinical Immunology, Medical Faculty, Leipzig, Germany
| | - J Fahnert
- Department of Diagnostic and Interventional Radiology, University Leipzig, Leipzig, Germany
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38
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Micera A, O. Balzamino B, Biamonte F, Esposito G, Marino R, Fanelli F, Keller F. Current Progress of Reelin in Development, Inflammation and Tissue Remodeling: From Nervous to Visual Systems. Curr Mol Med 2016. [DOI: 10.2174/1566524016666160805115044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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39
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Micera A, Balzamino BO, Biamonte F, Esposito G, Marino R, Fanelli F, Keller F. Current progress of Reelin in development, inflammation and tissue remodeling: from nervous to visual systems. Curr Mol Med 2016:77575. [PMID: 27494703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 06/06/2023]
Abstract
Reelin is a matrix glycoprotein that plays a pivotal role for the positioning of neurons throughout brain development. In the early developing cortex Reelin regulates radial migration of cortical neurons while later in development, Reelin promotes maturation of dendrites and dendritic spines. Low Reelin levels characterize healthy adult brain while increased Reelin levels have been associated with cellular events underlying response to injury. Reelin has been detected in structural and immune cells outside brain (liver, gut/colon tracts, kidney, testis, ovary, lung, retina and cornea). In the Visual system, Reelin was first described in the retina and thereafter in the cornea. Increased Reelin levels were observed during retinogenesis, low levels were found in adulthood and a significant increase was detected upon injury. Insult-driven Reelin changes occur after upregulation of adhesion molecules, cytokines, neurotrophins, growth factors, neuropeptides and other mediators as well as their receptors. These soluble factors contribute to the development of nervous and visual system and promote survival/recovery of neurons/accessory cells populating the injured visual system. Likewise, Reelin might modulate these factors by driving different multiple effects on homeostasis/plasticity, inflammation, healing and remodeling at different physiopathological levels. Very low-density lipoprotein receptor, apolipoprotein E receptor 2, integrins and the adaptor molecule Disabled 1 trigger Reelin. Recent advances highlight some Reelin activities during inflammation and tissue remodeling and point out to a crucial Reelin activity in the visual system. A better understanding of Reelin function in retinal development might open to new attractive perspective for counteracting retina degeneration.
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Affiliation(s)
- A Micera
- Research Laboratories in Ophthalmology, IRCCS-G.B. Bietti Foundation, via Alvaro del Portillo 21, 00128 Rome, Italy.
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Matsui Y, Horikawa M, Jahangiri Y, Kaufman J, Kolbeck K, Barton R, Keller F, Farsad K. Degree of baseline Lipiodol accumulation after transarterial chemoembolization for hepatocellular carcinoma: identification of a threshold value predicting tumor response. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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41
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Bernardi R, Cakici R, Elliott D, Erdem A, Erdem E, Ikizler-Cinbis N, Keller F, Muscat A, Plank B. Automatic Description Generation from Images: A Survey of Models, Datasets, and Evaluation Measures. J ARTIF INTELL RES 2016. [DOI: 10.1613/jair.4900] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Automatic description generation from natural images is a challenging problem that has recently received a large amount of interest from the computer vision and natural language processing communities. In this survey, we classify the existing approaches based on how they conceptualize this problem, viz., models that cast description as either generation problem or as a retrieval problem over a visual or multimodal representational space. We provide a detailed review of existing models, highlighting their advantages and disadvantages. Moreover, we give an overview of the benchmark image datasets and the evaluation measures that have been developed to assess the quality of machine-generated image descriptions. Finally we extrapolate future directions in the area of automatic image description generation.
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Naderer A, Keller F, Plener P, Unseld M, Lesch OM, Walter H, Erfurth A, Kapusta ND. The brief TEMPS-M temperament questionnaire: A psychometric evaluation in an Austrian sample. J Affect Disord 2015; 188:43-6. [PMID: 26342887 DOI: 10.1016/j.jad.2015.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 04/02/2015] [Revised: 07/20/2015] [Accepted: 08/04/2015] [Indexed: 01/14/2023]
Affiliation(s)
- A Naderer
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - F Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - P Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - M Unseld
- Medical University of Vienna, Department of Internal Medicine I, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - O M Lesch
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H Walter
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Erfurth
- Social Medical Center Baumgartner Höhe, Otto-Wagner Hospital, 6th Psychiatric Ward, Baumgartner Höhe 1, 1140 Vienna, Austria
| | - N D Kapusta
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Rasche FM, Keller F, Rasche WG, Schiekofer S, Kahn T, Fahnert J. Sequential therapy with cyclophosphamide and mycophenolic acid in patients with progressive immunoglobulin A nephropathy: a long-term follow-up. Clin Exp Immunol 2015; 183:307-16. [PMID: 26439797 DOI: 10.1111/cei.12719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
In progressive immunoglobulin (Ig)A nephropathy (IgAN), cyclophosphamide pulse therapy (CyP), high-dose intravenous immunoglobulins (IVIg) and mycophenolic acid (MPA) have been used to stop progressive loss of renal function, but disease progression may occur after the end of the initial treatment. Here, we report the long-term follow-up of patients with progressive IgAN with MPA as maintenance therapy after CyP (CyP-MPA). In a median observation time of 6·2 years, we analysed the slopes of the loss of renal function of 47 patients with biopsy-proven IgAN and treated with CyP. Thirty-one patients with further progression were treated with MPA maintenance for a median time of 5·2 years. Follow-up was compared with symptomatic therapy and IVIg as historically matched control groups. Median loss of renal function was reduced significantly from 0·9 ml/min to 0·1 ml/min per month with CyP (P < 0·05), and with MPA in patients with a relapse from -0·4 ml/min to -0·1 ml/min per month (P < 0·05) until the end of the study. Proteinuria decreased significantly from 1·6 g/l to 1·0 g/l after CyP, and during MPA treatment to 0·6 g/l (P = 0·001 Friedman test). Median renal survival time was in patients with CyP 10·5 years (range = 3·2-17·8), with CyP-MPA 10·7 years (range = 8·3-13·1), with IVIg 4·7 years (range = 2·6-6·6), and in untreated patients 1·2 years (range = 0·8-1·6; log-rank test P < 0·01). In patients with progressive IgAN, our long-term follow-up observation indicates that sequential CyP-MPA therapy maintains renal survival significantly.
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Affiliation(s)
- F M Rasche
- Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Nephrology, Section of Nephrology, University Leipzig, Leipzig, Germany
| | - F Keller
- Department of Internal Medicine I, Division of Nephrology, University Hospital of Ulm, Ulm, Germany
| | - W G Rasche
- Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
| | - S Schiekofer
- Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - T Kahn
- Department of Diagnostic and Interventional Radiology, University Leipzig, Leipzig, Germany
| | - J Fahnert
- Department of Diagnostic and Interventional Radiology, University Leipzig, Leipzig, Germany
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Hue L, Makhloufi S, Sall N'Diaye P, Blanchet-Bardon C, Sulimovic L, Pomykala F, Colomb M, Baccard M, Lassau F, Reuter G, Keller F, Fite C, Triller R, Crémieux AC. Real-time mobile teledermoscopy for skin cancer screening targeting an agricultural population: an experiment on 289 patients in France. J Eur Acad Dermatol Venereol 2015; 30:20-4. [PMID: 26568080 DOI: 10.1111/jdv.13404] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/24/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of skin cancer has reached epidemic proportions in the white population and is significantly elevated in agricultural populations, who are exposed to ultraviolet radiation during their professional activities. In 2014, the Agricultural Social Insurance Mutual Benefit Fund (MSA) offered its customers who work in agriculture and live in rural areas with reduced access to dermatologists the ability to participate in a 1-day teledermoscopic (TDS) screening event. OBJECTIVE This study's aim was to assess the feasibility of real-time mobile TDS triage of a large number of agricultural workers by trained medical officers and occupational physicians. METHODS Fifteen TDS screening centres were located in different areas of France. Individuals older than 18 years who worked in agriculture and lived in rural area near a TDS screening centre were invited to participate in a 1-day screening event and were examined by an MSA physician. In cases of suspicious skin lesions, clinical and dermoscopic images were obtained and transferred immediately to four dermatologists who were simultaneously present at the tele-platform for diagnosis and decision-making. Low-quality images were retaken. RESULTS Two-hundred eighty-nine patients underwent skin cancer screening. Among 199 patients (69%), 390 suspicious lesions were identified and generated 412 pictures. All lesions were analysed by dermatologists. For 105 patients (53%), no follow-up was required. Seventeen patients were referred to local dermatologists for rapid examination, including 12 cases of suspected malignant melanocytic lesions. Among the 12 patients with suspected melanoma, face-to-face visits were conducted within 10 days for 11 of them, and 1 case of melanoma was confirmed by histopathology. CONCLUSIONS Our study suggests that teledermoscopy performed in the context of occupational medicine and targeted to agricultural populations is feasible and could be useful for improving skin cancer screening in at-risk populations while avoiding face-to-face examinations by a dermatologist in 53% of cases.
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Affiliation(s)
- L Hue
- Caisse centrale, Mutualité Sociale Agricole, Direction of Social Politics, Bagnolet Cedex, France
| | - S Makhloufi
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - P Sall N'Diaye
- Caisse centrale, Mutualité Sociale Agricole, Direction of Social Politics, Bagnolet Cedex, France
| | | | - L Sulimovic
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - F Pomykala
- Caisse centrale, Mutualité Sociale Agricole, Direction of Social Politics, Bagnolet Cedex, France
| | - M Colomb
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - M Baccard
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - F Lassau
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - G Reuter
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - F Keller
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - C Fite
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - R Triller
- Syndicat national des dermato-vénérologues de France, Paris, France
| | - A C Crémieux
- Caisse centrale, Mutualité Sociale Agricole, Direction of Social Politics, Bagnolet Cedex, France
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Nickel RS, Daves M, Keller F. Treatment of an adolescent with chronic myeloid leukemia and the T315I mutation with ponatinib. Pediatr Blood Cancer 2015; 62:2050-1. [PMID: 25939962 DOI: 10.1002/pbc.25551] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 02/04/2015] [Accepted: 03/20/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Robert Sheppard Nickel
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.,Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
| | - Marla Daves
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Frank Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Coco MI, Keller F, Malcolm GL. Anticipation in Real-World Scenes: The Role of Visual Context and Visual Memory. Cogn Sci 2015; 40:1995-2024. [DOI: 10.1111/cogs.12313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/06/2015] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
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Keller F. Pharmacokinetics, Pharmacodynamics, and antimicrobials in Cancer patients with Kidney Dysfunction. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dubovsky EV, Curtis JJ, Luke RG, Jones P, Edwards M, Keller F, Whelchel JD, Diethelm AR. Captopril as a predictor of curable hypertension in renal transplant recipients. Contrib Nephrol 2015; 56:117-23. [PMID: 3301194 DOI: 10.1159/000413791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Taffoni F, Focaroli V, Keller F, Iverson JM. A technological approach to studying motor planning ability in children at high risk for ASD. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:3638-41. [PMID: 25570779 DOI: 10.1109/embc.2014.6944411] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work we propose a new method to study the development of motor planning abilities in children and, in particular, in children at high risk for ASD. Although several modified motor signs have been found in children with ASD, no specific markers enabling the early assessment of risk have been found yet. In this work, we discuss the problem posed by objective and quantitative behavioral analysis in non-structured environment. After an initial description of the main constraints imposed by the ecological approach, a technological and methodological solution to these issues is presented. Preliminary results on 12 children are reported and briefly discussed.
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Roberts KG, Li Y, Payne-Turner D, Harvey RC, Yang YL, Pei D, McCastlain K, Ding L, Lu C, Song G, Ma J, Becksfort J, Rusch M, Chen SC, Easton J, Cheng J, Boggs K, Santiago-Morales N, Iacobucci I, Fulton RS, Wen J, Valentine M, Cheng C, Paugh SW, Devidas M, Chen IM, Reshmi S, Smith A, Hedlund E, Gupta P, Nagahawatte P, Wu G, Chen X, Yergeau D, Vadodaria B, Mulder H, Winick NJ, Larsen EC, Carroll WL, Heerema NA, Carroll AJ, Grayson G, Tasian SK, Moore AS, Keller F, Frei-Jones M, Whitlock JA, Raetz EA, White DL, Hughes TP, Guidry Auvil JM, Smith MA, Marcucci G, Bloomfield CD, Mrózek K, Kohlschmidt J, Stock W, Kornblau SM, Konopleva M, Paietta E, Pui CH, Jeha S, Relling MV, Evans WE, Gerhard DS, Gastier-Foster JM, Mardis E, Wilson RK, Loh ML, Downing JR, Hunger SP, Willman CL, Zhang J, Mullighan CG. Targetable kinase-activating lesions in Ph-like acute lymphoblastic leukemia. N Engl J Med 2014; 371:1005-15. [PMID: 25207766 PMCID: PMC4191900 DOI: 10.1056/nejmoa1403088] [Citation(s) in RCA: 965] [Impact Index Per Article: 96.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) is characterized by a gene-expression profile similar to that of BCR-ABL1-positive ALL, alterations of lymphoid transcription factor genes, and a poor outcome. The frequency and spectrum of genetic alterations in Ph-like ALL and its responsiveness to tyrosine kinase inhibition are undefined, especially in adolescents and adults. METHODS We performed genomic profiling of 1725 patients with precursor B-cell ALL and detailed genomic analysis of 154 patients with Ph-like ALL. We examined the functional effects of fusion proteins and the efficacy of tyrosine kinase inhibitors in mouse pre-B cells and xenografts of human Ph-like ALL. RESULTS Ph-like ALL increased in frequency from 10% among children with standard-risk ALL to 27% among young adults with ALL and was associated with a poor outcome. Kinase-activating alterations were identified in 91% of patients with Ph-like ALL; rearrangements involving ABL1, ABL2, CRLF2, CSF1R, EPOR, JAK2, NTRK3, PDGFRB, PTK2B, TSLP, or TYK2 and sequence mutations involving FLT3, IL7R, or SH2B3 were most common. Expression of ABL1, ABL2, CSF1R, JAK2, and PDGFRB fusions resulted in cytokine-independent proliferation and activation of phosphorylated STAT5. Cell lines and human leukemic cells expressing ABL1, ABL2, CSF1R, and PDGFRB fusions were sensitive in vitro to dasatinib, EPOR and JAK2 rearrangements were sensitive to ruxolitinib, and the ETV6-NTRK3 fusion was sensitive to crizotinib. CONCLUSIONS Ph-like ALL was found to be characterized by a range of genomic alterations that activate a limited number of signaling pathways, all of which may be amenable to inhibition with approved tyrosine kinase inhibitors. Trials identifying Ph-like ALL are needed to assess whether adding tyrosine kinase inhibitors to current therapy will improve the survival of patients with this type of leukemia. (Funded by the American Lebanese Syrian Associated Charities and others.).
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Affiliation(s)
- Kathryn G Roberts
- From the Departments of Pathology (K.G.R., D.P.-T., Y.-L.Y., K. McCastlain, G.S., J.M., S.-C.C., J.C., N.S.-M., I.I., J.W., J.R.D., C.G.M.), Computational Biology and Bioinformatics (Y.L., J.B., M.R., E.H., P.G., P.N., G.W., X.C., J.Z.), Biostatistics (D.P., C.C.), Pharmaceutical Sciences (S.W.P., M.V.R., W.E.E.), and Oncology (C.-H.P., S.J.), the Pediatric Cancer Genome Project (Y.L., L.D., C.L., M.R., J.E., J.C., K.B., R.S.F., E.H., P.G., P.N., G.W., X.C., D.Y., B.V., H.M., M.V.R., W.E.E., E.M., R.K.W., J.R.D., J.Z., C.G.M.), and Cytogenetics Shared Resource (M.V.), St. Jude Children's Research Hospital, Memphis, TN; the University of New Mexico Cancer Center and School of Medicine, Albuquerque (R.C.H., I-M.C., C.L.W.); the Genome Institute at Washington University (L.D., C.L., R.S.F., E.M., R.K.W.), the Department of Genetics, Washington University School of Medicine (L.D., C.L., R.S.F., E.M., R.K.W.), and Siteman Cancer Center, Washington University (E.M., R.K.W.) - all in St. Louis; Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville (M.D.); the Research Institute at Nationwide Children's Hospital (S.R., A.S., J.M.G.-F.), the Department of Pathology, College of Medicine, Ohio State University (N.A.H.), and Ohio State University Comprehensive Cancer Center (G.M., C.D.B., K. Mrózek, J.K.) - all in Columbus, OH; the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (N.J.W.), Scott and White Hospitals and Clinics and Texas A&M Health Science Center, Temple (G.G.), the University of Texas Health Science Center San Antonio, San Antonio (M.F.-J.), and the Departments of Leukemia and Stem Cell Transplantation, Division of Cancer Medicine, University of Texas M.D. Anderson Cancer Center, Houston (S.M.K., M.K.) - all in Texas; Maine Children's Cancer Program, Scarborough (E.C.L.); New York University Cancer Institute, New York (W.L.C.), and the Department of Medicine (Oncology), Albert Einstein
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