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Rosenstock T, Schneider H, Neymeyer ML, Becker LL, Schulz B, Tietze A, Hernáiz Driever P, Kaindl AM, Vajkoczy P, Picht T, Thomale UW. Analysis of bihemispheric language function in pediatric neurosurgical patients using repetitive navigated transcranial magnetic stimulation. J Neurosurg Pediatr 2024:1-11. [PMID: 38669716 DOI: 10.3171/2024.2.peds23598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE Language dominance in the developing brain can vary widely across anatomical and pathological conditions as well as age groups. Repetitive navigated transcranial magnetic stimulation (rnTMS) has been applied to calculate the hemispheric dominance ratio (HDR) in adults. In this study, the authors aimed to assess the feasibility of using rnTMS to identify language lateralization in a pediatric neurosurgical cohort and to correlate the preoperative rnTMS findings with the postoperative language outcome. METHODS A consecutive prospectively collected cohort of 19 children with language-associated lesions underwent bihemispheric rnTMS mapping prior to surgery (100 stimulation sites on each hemisphere). In addition to feasibility and adverse effects, the HDR (ratio of the left hemisphere to right hemisphere error rate) was calculated. The anatomical surgical site and postoperative language outcome at 3 months after surgery were assessed according to clinical documentation. RESULTS Repetitive nTMS mapping was feasible in all 19 children (mean age 12.5 years, range 4-17 years; 16 left-sided lesions) without any relevant adverse events. Thirteen children (68%) showed left hemispheric dominance (HDR > 1.1), and 2 children (11%) showed right hemispheric dominance (HDR < 0.9). In 4 children (21%), the bihemispheric error rates were nearly the same (HDR ≥ 0.9 and ≤ 1.1). Sixteen children underwent surgery (14 tumor/lesion resections and 2 hemispherotomies) and 3 patients continued conservative therapy. After surgery, 4 patients (25%) showed an improvement in language function, 10 (63%) presented with stable language function, and 2 (12.5%) experienced deterioration in language function. Of the 6 patients with right hemispheric language involvement, 4 (80%) had glial tumors, 1 (20%) had focal cortical dysplasia, and 1 (20%) experienced hypoxic brain injury. Children with right hemispheric language involvement (HDR ≤ 1.1) did not show any language deterioration postoperatively. CONCLUSIONS Bihemispheric rnTMS language mapping as a noninvasive mapping technique to assess lateralization of language function in the pediatric neurosurgical population is safe and feasible. Why relevant right hemispheric language function (HDR ≤ 1.1) was associated with postoperative unaltered language function needs to be validated in future studies. Bihemispheric rnTMS language mapping strengthens risk-benefit considerations prior to pediatric tumor/epilepsy surgery in language-associated areas.
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Affiliation(s)
- Tizian Rosenstock
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
- 2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Academy, BIH Charité Digital Clinician Scientist Program, Berlin
| | - Heike Schneider
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
| | - Mitra Lara Neymeyer
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
| | - Lena-Luise Becker
- Departments of3Pediatric Neurology
- 4Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Berlin
- 5Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Cell Biology and Neurobiology, Berlin
| | - Bettina Schulz
- 4Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Berlin
| | - Anna Tietze
- 6Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Neuroradiology, Berlin; and
| | | | - Angela M Kaindl
- Departments of3Pediatric Neurology
- 4Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Berlin
- 5Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Cell Biology and Neurobiology, Berlin
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
| | - Thomas Picht
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
- 8Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt-Universität zu Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- 9Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
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Scherf-Clavel M, Baumann P, Hart XM, Schneider H, Schoretsanitis G, Steimer W, Zernig G, Zurek G. Behind the Curtain: Therapeutic Drug Monitoring of Psychotropic Drugs from a Laboratory Analytical Perspective. Ther Drug Monit 2024; 46:143-154. [PMID: 36941240 DOI: 10.1097/ftd.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE Therapeutic drug monitoring (TDM) is a well-established tool for guiding psychopharmacotherapy and improving patient care. Despite their established roles in the prescription of psychotropic drugs, the "behind the curtain" processes of TDM requests are invariably obscure to clinicians, and literature addressing this topic is scarce. METHODS In the present narrative review, we provide a comprehensive overview of the various steps, starting from requesting TDM to interpreting TDM findings, in routine clinical practice. Our goal was to improve clinicians' insights into the numerous factors that may explain the variations in TDM findings due to methodological issues. RESULTS We discussed challenges throughout the TDM process, starting from the analyte and its major variation forms, through sampling procedures and pre-analytical conditions, time of blood sampling, sample matrices, and collection tubes, to analytical methods, their advantages and shortcomings, and the applied quality procedures. Additionally, we critically reviewed the current and future advances in the TDM of psychotropic drugs. CONCLUSIONS The "behind the curtain" processes enabling TDM involve a multidisciplinary team, which faces numerous challenges in clinical routine. A better understanding of these processes will allow clinicians to join the efforts for achieving higher-quality TDM findings, which will in turn improve treatment effectiveness and safety outcomes of psychotropic agents.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
| | - Pierre Baumann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Xenia M Hart
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heike Schneider
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
- INSTAND e.V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Werner Steimer
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn
| | - Gerald Zernig
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Department of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
- Private Practice for Psychotherapy and Court-certified Expert Witness, Hall in Tirol, Austria; and
| | - Gabriela Zurek
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) Work Group on "Therapeutic Drug Monitoring" (Chair: Prof. Dr Med. Dipl.-Psych. Stefan Unterecker, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany)
- Medical Laboratory Bremen, Bremen, Germany
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Barron P, Mahomed H, Masilela TC, Vallabhjee K, Schneider H. District Health System performance in South Africa: Are current monitoring systems optimal? S Afr Med J 2023; 113:13. [PMID: 38525618 DOI: 10.7196/samj.2023.v113i12.1614] [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: 10/13/2023] [Indexed: 03/26/2024] Open
Abstract
In this article, we review the monitoring and evaluation system that is used to measure the performance of primary healthcare delivered through the district health system and district management teams. We then review some global frameworks, especially linked to the World Health Organization, and look at some of the differences between what is internationally recommended and what we do in South Africa. We end with some recommendations to improve the system.
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Affiliation(s)
- P Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - H Mahomed
- Western Cape Government Health and Wellness and Division of Health, Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - T C Masilela
- Department of Planning, Monitoring and Evaluation, Pretoria, South Africa.
| | - K Vallabhjee
- Clinton Health Access Initiative, Pretoria, South Africa.
| | - H Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa.
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Schneider H, Masilela T, Mndebele J, Vallabhjee K, Petersen I, Gilson L, Engelbrecht B. Special series on the District Health System. S Afr Med J 2023; 113:14. [PMID: 38525616 DOI: 10.7196/samj.2023.v113i11.1653] [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] [Received: 10/26/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
| | - T Masilela
- Outcomes Facilitator, Department of Planning, Monitoring and Evaluation, South Africa.
| | - J Mndebele
- Chief Director, District Health Services, KwaZulu-Natal Department of Health, South Africa.
| | - K Vallabhjee
- Advisor, Clinton Health Access Initiative, South Africa.
| | - I Petersen
- Director and Research Professor, Centre for Rural Health, School of Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - L Gilson
- Professor, Division of Health Policy and Systems, School of Public Health, University of Cape Town, South Africa.
| | - B Engelbrecht
- Adjunct Associate Professor, School of Public Health, University of Cape Town, and Extraordinary Associate Professor, Faculty of Health Sciences, North West University, Potchefstroom, South Africa.
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Schneider H, Mukinda F, Cupido J, Wessels J, Kupa P, Leboho P, Nkoana N, Bosch N, Pillay Y. Improving health outcomes and quality at the subdistrict level: Evaluation of the '3 feet model' in Waterberg District, Limpopo Province, South Africa. S Afr Med J 2023; 113:15-21. [PMID: 38525622 DOI: 10.7196/samj.2023.v113i11.1558] [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: 09/22/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND There is a gap in understanding of potential roles and actions at the subdistrict level to improve quality of care and health outcomes in South Africa (SA). OBJECTIVES To report on the evaluation of a subdistrict health system-strengthening initiative that aimed to reduce maternal, newborn and child mortality, referred to as the '3 feet model' in Waterberg District, Limpopo Province, SA. The model is centred on systems of real-time morbidity/mortality surveillance and co-ordinated responses. It was implemented in three of five Waterberg subdistricts over an 18-month period in 2021 and 2022. METHODS A prospective, process-tracing evaluation was conducted jointly between researchers, intervention partners and subdistrict decision-makers. Data sources combined ~100 hours of researcher participant observation, interviews with 14 health system actors, structured reflections by three subdistrict managers and information from the routine District Health Information System. Sources were triangulated and analysed based on a priori hypotheses on mechanisms of action. RESULTS Following uptake of the model, the perinatal mortality rate (PMR) improved by 28.8%, 11.5% and 28% in the three subdistricts, respectively, while the PMR worsened in two of four neighbouring subdistricts. Plausible factors in implementation successes were the presence of stable and committed hybrid (clinical-managerial) subdistrict leaders and their ability to overcome entrenched silos between a variety of system actors; new collaborative relationships between primary healthcare facilities, hospitals and emergency medical services; the generation and packaging of information in ways that directed responses ('actionable intelligence'); and support from senior district managers. CONCLUSION While not advocating for a cut-and-paste approach to improving quality and outcomes, positive experiences in Waterberg District suggest that the principles and mechanisms of action of the 3 feet model have wider relevance for policy and practice, especially as emphasis shifts towards the subdistrict as a core unit of population health and wellbeing in SA.
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Affiliation(s)
- H Schneider
- School of Public Health and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa.
| | - F Mukinda
- School of Public Health and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa.
| | - J Cupido
- Clinton Health Access Initiative, Pretoria, South Africa.
| | - J Wessels
- Clinton Health Access Initiative, Pretoria, South Africa.
| | - P Kupa
- Waterberg Health District, Limpopo Department of Health, Polokwane, South Africa.
| | - P Leboho
- Waterberg Health District, Limpopo Department of Health, Polokwane, South Africa.
| | - N Nkoana
- Waterberg Health District, Limpopo Department of Health, Polokwane, South Africa.
| | - N Bosch
- Waterberg Health District, Limpopo Department of Health, Polokwane, South Africa.
| | - Y Pillay
- Clinton Health Access Initiative, Pretoria, South Africa, and Department of Public Health and Health Systems, Stellenbosch University, Cape Town, South Africa.
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Kuchler T, Günthner R, Ribeiro A, Hausinger R, Streese L, Wöhnl A, Kesseler V, Negele J, Assali T, Carbajo-Lozoya J, Lech M, Schneider H, Adorjan K, Stubbe HC, Hanssen H, Kotilar K, Haller B, Heemann U, Schmaderer C. Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation. Angiogenesis 2023; 26:547-563. [PMID: 37507580 PMCID: PMC10542303 DOI: 10.1007/s10456-023-09885-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Post-COVID-19 syndrome (PCS) is a lingering disease with ongoing symptoms such as fatigue and cognitive impairment resulting in a high impact on the daily life of patients. Understanding the pathophysiology of PCS is a public health priority, as it still poses a diagnostic and treatment challenge for physicians. METHODS In this prospective observational cohort study, we analyzed the retinal microcirculation using Retinal Vessel Analysis (RVA) in a cohort of patients with PCS and compared it to an age- and gender-matched healthy cohort (n = 41, matched out of n = 204). MEASUREMENTS AND MAIN RESULTS PCS patients exhibit persistent endothelial dysfunction (ED), as indicated by significantly lower venular flicker-induced dilation (vFID; 3.42% ± 1.77% vs. 4.64% ± 2.59%; p = 0.02), narrower central retinal artery equivalent (CRAE; 178.1 [167.5-190.2] vs. 189.1 [179.4-197.2], p = 0.01) and lower arteriolar-venular ratio (AVR; (0.84 [0.8-0.9] vs. 0.88 [0.8-0.9], p = 0.007). When combining AVR and vFID, predicted scores reached good ability to discriminate groups (area under the curve: 0.75). Higher PCS severity scores correlated with lower AVR (R = - 0.37 p = 0.017). The association of microvascular changes with PCS severity were amplified in PCS patients exhibiting higher levels of inflammatory parameters. CONCLUSION Our results demonstrate that prolonged endothelial dysfunction is a hallmark of PCS, and impairments of the microcirculation seem to explain ongoing symptoms in patients. As potential therapies for PCS emerge, RVA parameters may become relevant as clinical biomarkers for diagnosis and therapy management. TRIAL REGISTRATION This study was previously registered at ClinicalTrials ("All Eyes on PCS-Analysis of the Retinal Microvasculature in Patients with Post-COVID-19 Syndrome". NCT05635552. https://clinicaltrials.gov/ct2/show/NCT05635552 ). Persistent endothelial dysfunction in post-COVID-19 syndrome. Acute SARS-CoV-2 infection indirectly or directly causes endotheliitis in patients. N = 41 PCS patients were recruited and retinal vessel analysis was performed to assess microvascular endothelial function. Images of SVA and DVA are illustrative for RVA data analysis. For each PCS patient and healthy cohort, venular vessel diameter of the three measurement cycles was calculated and plotted on a diameter-time curve. Patients exhibited reduced flicker-induced dilation in veins (vFID) measured by dynamic vessel analysis (DVA) and lower central retinal arteriolar equivalent (CRAE) and arteriolar-venular ratio (AVR) and a tendency towards higher central retinal venular equivalent (CRVE) when compared to SARS-CoV-2 infection naïve participants. Created with BioRender.com.
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Affiliation(s)
- Timon Kuchler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribeiro
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Renate Hausinger
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Streese
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Anna Wöhnl
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Veronika Kesseler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johanna Negele
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tarek Assali
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Javier Carbajo-Lozoya
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Heike Schneider
- School of Medicine, Klinikum Rechts Der Isar, Department of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Christian Stubbe
- Medizinische Klinik Und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, University of Basel, Basel, Switzerland
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- School of Medicine, Institute for AI and Informatics in Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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Kuchler T, Günthner R, Ribeiro A, Hausinger R, Streese L, Wöhnl A, Kesseler V, Negele J, Assali T, Carbajo-Lozoya J, Lech M, Schneider H, Adorjan K, Stubbe HC, Hanssen H, Kotilar K, Haller B, Heemann U, Schmaderer C. Correction: Persistent endothelial dysfunction in post-COVID-19 syndrome and its associations with symptom severity and chronic inflammation. Angiogenesis 2023; 26:565. [PMID: 37612533 PMCID: PMC10542566 DOI: 10.1007/s10456-023-09892-7] [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: 08/25/2023]
Affiliation(s)
- Timon Kuchler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roman Günthner
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Ribeiro
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Renate Hausinger
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas Streese
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Anna Wöhnl
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Veronika Kesseler
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johanna Negele
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tarek Assali
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Javier Carbajo-Lozoya
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maciej Lech
- Medizinische Klinik Und Poliklinik IV, LMU University Hospital Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - Heike Schneider
- School of Medicine, Klinikum Rechts Der Isar, Department of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Hans Christian Stubbe
- Medizinische Klinik Und Poliklinik II, LMU University Hospital Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, University of Basel, Basel, Switzerland
| | - Konstantin Kotilar
- Aachen University of Applied Sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- School of Medicine, Institute for AI and Informatics in Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum Rechts Der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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Prochnow M, Strobel P, Bliedtner M, Struck J, Bittner L, Szidat S, Salazar G, Schneider H, Acharya S, Zech M, Zech R. Summer paleohydrology during the Late Glacial and Early Holocene based on δ 2H and δ 18O from Bichlersee, Bavaria. Sci Rep 2023; 13:18487. [PMID: 37898674 PMCID: PMC10613243 DOI: 10.1038/s41598-023-45754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
Isotope-based records provide valuable information on past climate changes. However, it is not always trivial to disentangle past changes in the isotopic composition of precipitation from possible changes in evaporative enrichment, and seasonality may need to be considered. Here, we analyzed δ2H on n-alkanes and δ18O on hemicellulose sugars in sediments from Bichlersee, Bavaria, covering the Late Glacial and Early Holocene. Our δ2Hn-C31 record documents past changes in the isotopic composition of summer precipitation and roughly shows the isotope pattern known from Greenland. Both records show lower values during the Younger Dryas, but at Bichlersee the signal is less pronounced, corroborating earlier suggestions that the Younger Dryas was mainly a winter phenomenon and less extreme during summer. δ18Ofucose records the isotopic composition of the lake water during summer and is sensitive to evaporative enrichment. Coupling δ2Hn-C31 and δ18Ofucose allows calculating lake water deuterium-excess and thus disentangling changes in the isotopic composition of precipitation and evaporative enrichment. Our deuterium-excess record reveals that the warm Bølling-Allerød and Early Holocene were characterized by more evaporative enrichment compared to the colder Younger Dryas. Site-specific hydrological conditions, seasonality, and coupling δ2H and δ18O are thus important when interpreting isotope records.
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Affiliation(s)
- Maximilian Prochnow
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany.
| | - Paul Strobel
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Marcel Bliedtner
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Julian Struck
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Lucas Bittner
- Heisenberg Chair of Physical Geography with Focus on Paleoenvironmental Research, Institute of Geography, Technische Universität Dresden, Dresden, Germany
| | - Sönke Szidat
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences and Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Gary Salazar
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences and Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Heike Schneider
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Sudip Acharya
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Michael Zech
- Heisenberg Chair of Physical Geography with Focus on Paleoenvironmental Research, Institute of Geography, Technische Universität Dresden, Dresden, Germany
| | - Roland Zech
- Chair of Physical Geography, Institute of Geography, Friedrich-Schiller-Universität Jena, Jena, Germany
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9
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Wartewig T, Daniels J, Schulz M, Hameister E, Joshi A, Park J, Morrish E, Venkatasubramani AV, Cernilogar FM, van Heijster FHA, Hundshammer C, Schneider H, Konstantinidis F, Gabler JV, Klement C, Kurniawan H, Law C, Lee Y, Choi S, Guitart J, Forne I, Giustinani J, Müschen M, Jain S, Weinstock DM, Rad R, Ortonne N, Schilling F, Schotta G, Imhof A, Brenner D, Choi J, Ruland J. PD-1 instructs a tumor-suppressive metabolic program that restricts glycolysis and restrains AP-1 activity in T cell lymphoma. Nat Cancer 2023; 4:1508-1525. [PMID: 37723306 PMCID: PMC10597841 DOI: 10.1038/s43018-023-00635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/15/2023] [Indexed: 09/20/2023]
Abstract
The PDCD1-encoded immune checkpoint receptor PD-1 is a key tumor suppressor in T cells that is recurrently inactivated in T cell non-Hodgkin lymphomas (T-NHLs). The highest frequencies of PDCD1 deletions are detected in advanced disease, predicting inferior prognosis. However, the tumor-suppressive mechanisms of PD-1 signaling remain unknown. Here, using tractable mouse models for T-NHL and primary patient samples, we demonstrate that PD-1 signaling suppresses T cell malignancy by restricting glycolytic energy and acetyl coenzyme A (CoA) production. In addition, PD-1 inactivation enforces ATP citrate lyase (ACLY) activity, which generates extramitochondrial acetyl-CoA for histone acetylation to enable hyperactivity of activating protein 1 (AP-1) transcription factors. Conversely, pharmacological ACLY inhibition impedes aberrant AP-1 signaling in PD-1-deficient T-NHLs and is toxic to these cancers. Our data uncover genotype-specific vulnerabilities in PDCD1-mutated T-NHL and identify PD-1 as regulator of AP-1 activity.
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Affiliation(s)
- Tim Wartewig
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- Center of Molecular and Cellular Oncology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Jay Daniels
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Miriam Schulz
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Erik Hameister
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Abhinav Joshi
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Joonhee Park
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Emma Morrish
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Anuroop V Venkatasubramani
- Protein Analysis Unit, Biomedical Center, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Filippo M Cernilogar
- Department of Molecular Biology, Biomedical Center, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Frits H A van Heijster
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Hundshammer
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Heike Schneider
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Filippos Konstantinidis
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Judith V Gabler
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Klement
- Institute of Molecular Oncology and Functional Genomics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Henry Kurniawan
- Experimental and Molecular Immunology, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Immunology and Genetics, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belvaux, Luxembourg
| | - Calvin Law
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Yujin Lee
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sara Choi
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Ignasi Forne
- Protein Analysis Unit, Biomedical Center, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Jérôme Giustinani
- Institut Mondor de Recherche Biomédicale, Inserm U955, Paris-Est Créteil University, Créteil, France
| | - Markus Müschen
- Center of Molecular and Cellular Oncology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Salvia Jain
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - David M Weinstock
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Merck Research Laboratories, Boston, MA, USA
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nicolas Ortonne
- Institut Mondor de Recherche Biomédicale, Inserm U955, Paris-Est Créteil University, Créteil, France
- Pathology Department, AP-HP Inserm U955, Henri Mondor Hospital, Créteil, France
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gunnar Schotta
- Department of Molecular Biology, Biomedical Center, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Axel Imhof
- Protein Analysis Unit, Biomedical Center, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Dirk Brenner
- Experimental and Molecular Immunology, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Immunology and Genetics, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belvaux, Luxembourg
- Odense Research Center for Anaphylaxis, Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jaehyuk Choi
- Department of Biochemistry and Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
- Center for Genetic Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Center for Human Immunobiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
- Center for Synthetic Biology, Northwestern University, Evanston, IL, USA.
| | - Jürgen Ruland
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany.
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany.
- German Cancer Consortium (DKTK), Heidelberg, Germany.
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
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10
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Nackenhorst MC, Kapalla M, Weidle S, Kirchhoff F, Zschäpitz D, Sieber S, Reeps C, Eckstein HH, Schneider H, Thaler M, Moog P, Busch A, Sachs N. The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort. J Clin Med 2023; 12:4029. [PMID: 37373722 DOI: 10.3390/jcm12124029] [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: 04/28/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Abdominal aortic aneurysms (AAA) are the most frequent aortic dilation, with considerable morbidity and mortality. Inflammatory (infl) and IgG4-positive AAAs represent specific subtypes of unclear incidence and clinical significance. Here, histologic and serologic analyses with retrospective clinical data acquisition are investigated via detailed histology, including morphologic (HE, EvG: inflammatory subtype, angiogenesis, and fibrosis) and immunhistochemic analyses (IgG and IgG4). In addition, complement factors C3/C4 and immunoglobulins IgG, IgG2, IgG4 and IgE were measured in serum samples and clinical data uses patients' metrics, as well as through semi-automated morphometric analysis (diameter, volume, angulation and vessel tortuosity). A total of 101 eligible patients showed five (5%) IgG4 positive (all scored 1) and seven (7%) inflammatory AAAs. An increased degree of inflammation was seen in IgG4 positive and inflAAA, respectively. However, serologic analysis revealed no increased levels of IgG or IgG4. The operative procedure time was not different for those cases and the short-term clinical outcomes were equal for the entire AAA cohort. Overall, the incidence of inflammatory and IgG4-positive AAA samples seems very low based on histologic and serum analyses. Both entities must be considered distinct disease phenotypes. Short-term operative outcomes were not different for both sub-cohorts.
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Affiliation(s)
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Simon Weidle
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - Felix Kirchhoff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - David Zschäpitz
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, 80333 Munich, Germany
| | - Sabine Sieber
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
| | - Heike Schneider
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - Markus Thaler
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - Philipp Moog
- Department of Nephrology, School of Medicine, Technical University Munich, 80333 Munich, Germany
| | - Albert Busch
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, 01307 Dresden, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
| | - Nadja Sachs
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 10785 Berlin, Germany
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11
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Ivren M, Grittner U, Khakhar R, Belotti F, Schneider H, Pöser P, D'Agata F, Spena G, Vajkoczy P, Picht T, Rosenstock T. Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery. Neuroimage Clin 2023; 38:103436. [PMID: 37236052 PMCID: PMC10232884 DOI: 10.1016/j.nicl.2023.103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Two statistical models have been established to evaluate characteristics associated with postoperative motor outcome in patients with glioma associated to the motor cortex (M1) or the corticospinal tract (CST). One model is based on a clinicoradiological prognostic sum score (PrS) while the other one relies on navigated transcranial magnetic stimulation (nTMS) and diffusion-tensor-imaging (DTI) tractography. The objective was to compare the models regarding their prognostic value for postoperative motor outcome and extent of resection (EOR) with the aim of developing a combined, improved model. METHODS We retrospectively analyzed a consecutive prospective cohort of patients who underwent resection for motor associated glioma between 2008 and 2020, and received a preoperative nTMS motor mapping with nTMS-based diffusion tensor imaging tractography. The primary outcomes were the EOR and the motor outcome (on the day of discharge and 3 months postoperatively according to the British Medical Research Council (BMRC) grading). For the nTMS model, the infiltration of M1, tumor-tract distance (TTD), resting motor threshold (RMT) and fractional anisotropy (FA) were assesed. For the PrS score (ranging from 1 to 8, lower scores indicating a higher risk), we assessed tumor margins, volume, presence of cysts, contrast agent enhancement, MRI index (grading white matter infiltration), preoperative seizures or sensorimotor deficits. RESULTS Two hundred and three patients with a median age of 50 years (range: 20-81 years) were analyzed of whom 145 patients (71.4%) received a GTR. The rate of transient new motor deficits was 24.1% and of permanent new motor deficits 18.8%. The nTMS model demonstrated a good discrimination ability for the short-term motor outcome at day 7 of discharge (AUC = 0.79, 95 %CI: 0.72-0.86) and the long-term motor outcome after 3 months (AUC = 0.79, 95 %CI: 0.71-0.87). The PrS score was not capable to predict the postoperative motor outcome in this cohort but was moderately associated with the EOR (AUC = 0.64; CI 0.55-0.72). An improved, combined model was calculated to predict the EOR more accurately (AUC = 0.74, 95 %CI: 0.65-0.83). CONCLUSION The nTMS model was superior to the clinicoradiological PrS model for potentially predicting the motor outcome. A combined, improved model was calculated to estimate the EOR. Thus, patient counseling and surgical planning in patients with motor-associated tumors should be performed using functional nTMS data combined with tractography.
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Affiliation(s)
- Meltem Ivren
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Rutvik Khakhar
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Francesco Belotti
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Neurosurgery Unit, Spedali Civili di Brescia Hospital, 25123 Brescia, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Pöser
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Federico D'Agata
- Department of Neuroscience, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Spedali Civili di Brescia Hospital, 25123 Brescia, Italy
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Unter den Linden 6, 10099 Berlin, Germany
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany.
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12
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Schneider H, Kredo T, Odendaal WA, Abdullah F. Healthcare Delivery. S Afr Med J 2023; 113:61-64. [PMID: 36757075 DOI: 10.7196/samj.2023.v113i2.16798] [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: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
We report here on the process and findings of a research prioritisation exercise for universal health coverage (UHC) in South Africa, conducted during the course of 2019. As plans to roll out National Health Insurance (NHI) gather momentum and we transition into a pandemic recovery phase, we believe that it is now time to revisit these priorities, while recognising that experiences with the COVID-19 pandemic have revealed new system challenges and strengths and introduced new priorities. The UHC research priority-setting methodology followed a stepwise process of collation of evidence, expert brainstorming and the development of a survey completed by 68 members of the Public Health Association of South Africa. Themes related to leadership and governance were ranked most highly, and with other priorities generated, provide an initial road map of knowledge needs that could guide individual institutions and commissioning by funding bodies. We further reflect on the importance of researcher-decision-maker dialogue and strengthening the contribution of health policy and systems research to policy and practice, especially as new reforms are implemented.
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Affiliation(s)
- H Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa; Health Services to Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - T Kredo
- South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa.
| | - W A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - F Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Cape Town, South Africa; Division of Infectious Diseases, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
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13
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Engelhardt M, Schneider H, Reuther J, Vajkoczy P, Picht T, Rosenstock T. Repetitive navigated transcranial magnetic stimulation (rnTMS) to facilitate recovery of motor deficits after supratentorial tumor resection. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.344] [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: 02/17/2023] Open
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14
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Reisch K, Böttcher F, Tuncer MS, Schneider H, Vajkoczy P, Picht T, Fekonja LS. Tractography-based navigated TMS language mapping protocol. Front Oncol 2022; 12:1008442. [PMID: 36568245 PMCID: PMC9780436 DOI: 10.3389/fonc.2022.1008442] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction This study explores the feasibility of implementing a tractography-based navigated transcranial magnetic stimulation (nTMS) language mapping protocol targeting cortical terminations of the arcuate fasciculus (AF). We compared the results and distribution of errors from the new protocol to an established perisylvian nTMS protocol that stimulated without any specific targeting over the entire perisylvian cortex. Methods Sixty right-handed patients with language-eloquent brain tumors were examined in this study with one half of the cohort receiving the tractographybased protocol and the other half receiving the perisylvian protocol. Probabilistic tractography using MRtrix3 was performed for patients in the tractography-based group to identify the AF's cortical endpoints. nTMS mappings were performed and resulting language errors were classified into five psycholinguistic groups. Results Tractography and nTMS were successfully performed in all patients. The tractogram-based group showed a significantly higher median overall ER than the perisylvian group (3.8% vs. 2.9% p <.05). The median ER without hesitation errors in the tractogram-based group was also significantly higher than the perisylvian group (2.0% vs. 1.4%, p <.05). The ERs by error type showed no significant differences between protocols except in the no response ER, with a higher median ER in the tractogram-based group (0.4% vs. 0%, p <.05). Analysis of ERs based on the Corina cortical parcellation system showed especially high nTMS ERs over the posterior middle temporal gyrus (pMTG) in the perisylvian protocol and high ERs over the middle and ventral postcentral gyrus (vPoG), the opercular inferior frontal gyrus (opIFG) and the ventral precentral gyrus (vPrG) in the tractography-based protocol. Discussion By considering the white matter anatomy and performing nTMS on the cortical endpoints of the AF, the efficacy of nTMS in disrupting patients' object naming abilities was increased. The newly introduced method showed proof of concept and resulted in AF-specific ERs and noninvasive cortical language maps, which could be applied to additional fiber bundles related to the language network in future nTMS studies.
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Affiliation(s)
- Klara Reisch
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Franziska Böttcher
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Mehmet S. Tuncer
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Heike Schneider
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Peter Vajkoczy
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
| | - Thomas Picht
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany
| | - Lucius S. Fekonja
- Image Guidance Lab, Department of Neurosurgery, Charité – University Hospital, Berlin, Germany
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt University, Berlin, Germany
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15
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Leo B, Schneider H, Hammersen J. Reproductive decision-making by women with X-linked hypohidrotic ectodermal dysplasia. J Eur Acad Dermatol Venereol 2022; 36:1863-1870. [PMID: 35611639 DOI: 10.1111/jdv.18267] [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: 11/29/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In X-linked hypohidrotic ectodermal dysplasia (XLHED), ectodysplasin A1 (EDA1) deficiency results in malformation of hair, teeth, and sweat glands. Lack of sweating which can cause life-threatening hyperthermia is amenable to intrauterine therapy with recombinant EDA1. OBJECTIVES This study aimed at evaluating reproductive decision-making by women with XLHED and at clarifying the potential impact of a prenatal treatment option. METHODS In a retrospective cross-sectional analysis, a 75-item questionnaire filled in by 50 women with XLHED (age 19-49 years) was assessed. RESULTS 16 women (32%) prevented pregnancies because of the risk to pass on XLHED, 15 considered assisted reproduction for the same reason. Twelve women had a history of miscarriage, stillbirth or abortion, three women reported on previous abortion of affected fetuses. When imagining to be pregnant, all except one showed interest in prenatal diagnosis of XLHED and in the possibility of treatment before birth. In 13 out of 50 women (26%), XLHED if detected prenatally would have impact on the continuation of pregnancy. Among 35 mothers of at least one affected child, XLHED had rarely been diagnosed during the first pregnancy (17%) but regularly during subsequent pregnancies (77%). Becoming aware of the condition before birth had caused a moral conflict for 50% of these women. Subjects with an affected child less frequently considered assisted reproduction to prevent XLHED (p<0.05). In more than 66% of the women who reported an effect of XLHED on family planning, a prenatal treatment option for this disease would influence their decision-making. CONCLUSIONS Many pregnant XLHED carriers who seek prenatal diagnosis experience moral conflicts. A prenatal treatment option would have strong impact on reproductive decisions, underlining the importance of adequate professional counselling.
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Affiliation(s)
- B Leo
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - H Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - J Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Backhoff D, Müller MJ, Betz T, Arnold A, Schneider H, Paul T, Krause U. Contact Force Guided Radiofrequency Current Application at Developing Myocardium: Summary and Conclusions. J Cardiovasc Electrophysiol 2022; 33:1757-1766. [PMID: 35578015 DOI: 10.1111/jce.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter contact is one key determinant for lesion size in radiofrequency catheter ablation (RFA). Monitoring of contact force (CF) during RFA has been shown to improve efficacy of RFA in experimental settings as well as in adult patients. Coronary artery narrowing after RFA has been described in experimental settings as well as in children and adults and may be dependent from catheter contact. Value of CF monitoring concerning these issues has not been systematically yet. OBJECTIVE Value of high versus low CF during RFA in piglets was studied to assess lesion size and potential coronary artery involvement mimicking RFA in small children. ANIMALS AND METHODS RFA with continuous CF monitoring was performed in 24 piglets (median weight 18.5 kg) using a 7F TactiCath Quartz RF ablation catheter (Abbott, Illinois, USA). A total of 7 lesions were induced in each animal applying low (10-20 g) or high (40-60 g) CF. RF energy was delivered with a target temperature of 65 °C at 30 W for 30 seconds. Coronary angiography was performed prior and immediately after RF application. Animals were assigned to repeat coronary angiography followed by heart removal after 48 h (n=12) or 6 months (n=12). Lesions with surrounding myocardium were excised, fixated and stained. Lesion volumes were measured by microscopic planimetry. RESULTS A total of 148 RF lesions were identified in the explanted hearts. Only in the subset of lesions at the AV annulus 6 month after ablation, lesion size and number of lesions exhibiting transmural extension were higher in the high CF group compared to low CF. In all other locations CF had no impact on lesion size and mural extension after 48 h as well as after 6 months. Additional parameters as Lesion Size Index and Force Time Integral were also not related to lesion size. Coronary artery damage was present in 2 animals after 48 h and in 1 after 6 months and was not related to CF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Teresa Betz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Andreas Arnold
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
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Schneider H. Influences on therapeutic drug monitoring of psychotropic drugs
– analyst's perspective. PHARMACOPSYCHIATRY 2022. [DOI: 10.1055/s-0042-1747658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kulić Ž, Ritter T, Röck B, Elsäßer J, Schneider H, Germer S. A Detailed View on the Proanthocyanidins in Ginkgo Extract EGb 761. Planta Med 2022; 88:398-404. [PMID: 33862645 PMCID: PMC9020886 DOI: 10.1055/a-1379-4553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
The Ginkgo extract EGb 761® manufactured with leaves of Ginkgo biloba has been continuously produced over decades at a large scale and is used as a clinically proven remedy for, among other things, the improvement of age-associated cognitive impairment and quality of life in patients with mild dementia. It belongs to the class of extracts addressed as quantified extracts according to the European Pharmacopeia. Accordingly, several compounds (e.g., flavone glycosides and terpene trilactones) are acknowledged to contribute to its clinical efficacy. Covering only about 30% of the mass balance, these characterized compounds are accompanied by a larger fraction of additional compounds, which might also contribute to the clinical efficacy and safety of the extract. As part of our systematic research to fully characterize the constituents of Ginkgo extract EGb 761, we focus on the structural class of proanthocyanidins in the present study. Structural insights into the proanthocyanidins present in EGb 761 and a quantitative method for their determination using HPLC are shown. The proanthocyanidins were found to be of oligomeric to polymeric structure, which yield delphinidin and cyanidin as main building blocks after acidic hydrolysis. A validated HPLC method for quantification of the anthocyanidins was developed in which delphinidin and cyanidin were detected after hydrolysis of the proanthocyanidins. The content of proanthocyanidins in Ginkgo extract EGb 761 was found to be approximately 7%.
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Affiliation(s)
- Žarko Kulić
- Department of Preclinical Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Thomas Ritter
- Department of Analytical Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Birgit Röck
- Department of Preclinical Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Jens Elsäßer
- Department of Preclinical Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Heike Schneider
- Department of Preclinical Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Stefan Germer
- Department of Analytical Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
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Schneider H, Hess C, Kessler A, Steimer W. Quantification of Antibiotics in Patient Samples: State of the Art in Standardization and Proficiency Testing. Ther Drug Monit 2022; 44:230-240. [PMID: 34923543 DOI: 10.1097/ftd.0000000000000953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND For many antibiotics, the convenient one-fits-all dosing regimen had to be abandoned. Owing to highly variable pharmacokinetics, therapeutic drug monitoring has become an indispensable prerequisite. It is based on a suitable measuring method, sample materials, and standardization. Appropriate quality control including external quality assessment (EQA) is essential. For many antibiotics, EQAs have been established for many decades, whereas others have only lately been introduced. This article gives an insight into the state of the art regarding the therapeutic drug monitoring of antibiotics regarding standardization, EQAs, and reference measurement procedures (RMPs). METHODS An overview of the currently available international EQA schemes for antibiotics and a literature overview of available RMPs are given. EQAs including gentamicin and vancomycin have been offered by German providers for more than 25 years. The period 2000-2020 was selected for a detailed analysis. The experiences with a new EQA including linezolid, meropenem, and piperacillin are described. RESULTS EQAs for gentamicin and vancomycin are provided in many countries. Those for linezolid, meropenem, and piperacillin do not seem to be very common. Most of the antibiotics monitored for decades are measured by commercially available assays. EQAs for linezolid, meropenem, and piperacillin introduced in 2018 were rapidly accepted in Germany. Methods reported in this study were HPLC based either with UV or mass spectrometric detection. The number of participants succeeding was comparable between UV and mass spectrometry. Candidate RMPs for gentamicin, vancomycin, and linezolid based on isotope dilution mass spectrometry were published. CONCLUSIONS EQAs are offered regularly for many antibiotics worldwide. The results of EQAs in Germany generally compare well, but there is potential for improvement. Both immunoassays and HPLC-based methods work properly in EQAs evaluated in Germany. From a quality control perspective, fast and inexpensive methods may be selected without endangering the patient's health based on clinical needs.
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Affiliation(s)
- Heike Schneider
- Institute of Clinical Chemistry and Pathobiochemistry, University Hospital Klinikum Rechts der Isar of Technical University of Munich (TUM), Munich
- INSTAND e. V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn; and
| | - Cornelius Hess
- Reference Institute for Bioanalytics (RfB), Bonn, Germany
| | - Anja Kessler
- Reference Institute for Bioanalytics (RfB), Bonn, Germany
| | - Werner Steimer
- Institute of Clinical Chemistry and Pathobiochemistry, University Hospital Klinikum Rechts der Isar of Technical University of Munich (TUM), Munich
- INSTAND e. V. Society for Promoting Quality Assurance in Medical Laboratories, Duesseldorf
- German Society for Clinical Chemistry and Laboratory Medicine e. V. (DGKL), Section Therapeutic Drug Monitoring and Clinical Toxicology, Berlin/Bonn; and
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Engelhardt M, Schneider H, Reuther J, Vajkoczy P, Picht T, Rosenstock T. Repetitive navigated transcranial magnetic stimulation (rnTMS) to facilitate recovery of motor deficits after supratentorial tumor resection – Interim analysis. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Al B, Freimooser S, Holzscheck N, Traidl S, Zeitvogel J, Schneider H, Dorda M, Dittrich-Breiholz O, Werfel T, Seidel J. 036 Identifying immune targets for atopic dermatitis relapse prevention. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosenstock T, Häni L, Grittner U, Schlinkmann N, Ivren M, Schneider H, Raabe A, Vajkoczy P, Seidel K, Picht T. Bicentric validation of the navigated transcranial magnetic stimulation motor risk stratification model. J Neurosurg 2021; 136:1194-1206. [PMID: 34534966 DOI: 10.3171/2021.3.jns2138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to validate the navigated transcranial magnetic stimulation (nTMS)-based risk stratification model. The postoperative motor outcome in glioma surgery may be preoperatively predicted based on data derived by nTMS. The tumor-to-tract distance (TTD) and the interhemispheric resting motor threshold (RMT) ratio (as a surrogate parameter for cortical excitability) emerged as major factors related to a new postoperative deficit. METHODS In this bicentric study, a consecutive prospectively collected cohort underwent nTMS mapping with diffusion tensor imaging (DTI) fiber tracking of the corticospinal tract prior to surgery of motor eloquent gliomas. The authors analyzed whether the following items were associated with the patient's outcome: patient characteristics, TTD, RMT value, and diffusivity parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]). The authors assessed the validity of the published risk stratification model and derived a new model. RESULTS A new postoperative motor deficit occurred in 36 of 165 patients (22%), of whom 20 patients still had a deficit after 3 months (13%; n3 months = 152). nTMS-verified infiltration of the motor cortex as well as a TTD ≤ 8 mm were confirmed as risk factors. No new postoperative motor deficit occurred in patients with TTD > 8 mm. In contrast to the previous risk stratification, the RMT ratio was not substantially correlated with the motor outcome, but high RMT values of both the tumorous and healthy hemisphere were associated with worse motor outcome. The FA value was negatively associated with worsening of motor outcome. Accuracy analysis of the final model showed a high negative predictive value (NPV), so the preoperative application may accurately predict the preservation of motor function in particular (day of discharge: sensitivity 47.2%, specificity 90.7%, positive predictive value [PPV] 58.6%, NPV 86.0%; 3 months: sensitivity 85.0%, specificity 78.8%, PPV 37.8%, NPV 97.2%). CONCLUSIONS This bicentric validation analysis further improved the model by adding the FA value of the corticospinal tract, demonstrating the relevance of nTMS/nTMS-based DTI fiber tracking for clinical decision making.
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Affiliation(s)
- Tizian Rosenstock
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Germany
| | - Levin Häni
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ulrike Grittner
- 4Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and
| | - Nicolas Schlinkmann
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Meltem Ivren
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Heike Schneider
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Andreas Raabe
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Kathleen Seidel
- 3Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Picht
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,5Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin, Germany
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Wehr M, Lecointre L, Schneider H, Schwartz L, Faller E, Boisramé T, Baldauf JJ, Akladios C. [Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. ACTA ACUST UNITED AC 2021; 50:33-39. [PMID: 34509670 DOI: 10.1016/j.gofs.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.
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Affiliation(s)
- M Wehr
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - L Lecointre
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, université de Strasbourg, 67081 Strasbourg, France; Institut hospitalo-universitaire (IHU) Institute for Minimally Invasive Hybrid Image-Guided Surgery, université de Strasbourg, 67081 Strasbourg, France.
| | - H Schneider
- Centre hospitalier de Saverne, Saverne et Haguenau, France.
| | - L Schwartz
- Centre hospitalier de Haguenau, Saverne et Haguenau, France.
| | - E Faller
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - T Boisramé
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - J-J Baldauf
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - C Akladios
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
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Acker G, Giampiccolo D, Rubarth K, Mertens R, Zdunczyk A, Hardt J, Jussen D, Schneider H, Rosenstock T, Mueller V, Picht T, Vajkoczy P. Motor excitability in bilateral moyamoya vasculopathy and the impact of revascularization. Neurosurg Focus 2021; 51:E7. [PMID: 34469868 DOI: 10.3171/2021.6.focus21280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Motor cortical dysfunction has been shown to be reversible in patients with unilateral atherosclerotic disease after cerebral revascularization. Moyamoya vasculopathy (MMV) is a rare bilateral stenoocclusive cerebrovascular disease. The aim of this study was to analyze the corticospinal excitability and the role of bypass surgery in restoring cortical motor function in patients by using navigated transcranial magnetic stimulation (nTMS). METHODS Patients with bilateral MMV who met the criteria for cerebral revascularization were prospectively included. Corticospinal excitability, cortical representation area, and intracortical inhibition and facilitation were assessed by nTMS for a small hand muscle (first dorsal interosseous) before and after revascularization. The clinically and/or hemodynamically more severely affected hemisphere was operated first as the leading hemisphere. Intra- and interhemispheric differences were analyzed before and after direct or combined revascularization. RESULTS A total of 30 patients with bilateral MMV were examined by nTMS prior to and after revascularization surgery. The corticospinal excitability was higher in the leading hemisphere compared with the non-leading hemisphere prior to revascularization. This hyperexcitability was normalized after revascularization as demonstrated in the resting motor threshold ratio of the hemispheres (preoperative median 0.97 [IQR 0.89-1.08], postoperative median 1.02 [IQR 0.94-1.22]; relative effect = 0.61, p = 0.03). In paired-pulse paradigms, a tendency for a weaker inhibition of the leading hemisphere was observed compared with the non-leading hemisphere. Importantly, the paired paradigm also demonstrated approximation of excitability patterns between the two hemispheres after surgery. CONCLUSIONS The study results suggested that, in the case of a bilateral chronic ischemia, a compensation mechanism between both hemispheres seemed to exist that normalized after revascularization surgery. A potential role of nTMS in predicting the efficacy of revascularization must be further assessed.
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Affiliation(s)
- Gueliz Acker
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin.,2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin
| | - Davide Giampiccolo
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Kerstin Rubarth
- 2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin.,3Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin
| | - Robert Mertens
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Anna Zdunczyk
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Juliane Hardt
- 3Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin.,4University of Applied Sciences Hannover, Hochschule Hannover-University of Applied Sciences and Arts, Fakultät III, Department Information and Communication, Medical Information Management, Hannover.,5Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Foundation, Hannover; and
| | - Daniel Jussen
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Heike Schneider
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Tizian Rosenstock
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin.,2Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin
| | - Vera Mueller
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
| | - Thomas Picht
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin.,6Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin, Germany
| | - Peter Vajkoczy
- 1Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Berlin
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Grin-Yatsenko V, Ponomarev V, Kara O, Wandernoth B, Gregory M, Ilyukhina V, Kropotov J, Schneider H. P 57. Effect of Infra-Low Frequency Neurofeedback on Infra-Slow EEG Fluctuations. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meyer J, Crumrine D, Schneider H, Dick A, Schmuth M, Gruber R, Radner F, Grond S, Wakefield J, Mauro T, Elias P. 133 Unbound corneocyte lipid envelopes in 12R-lipoxygenase deficiency support a direct role in lipid-protein crosslinking. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schneider H, Paul T. Infection prevention in catheter-interventional treatment of children and adults. GMS Hyg Infect Control 2021; 16:Doc14. [PMID: 33884254 PMCID: PMC8051590 DOI: 10.3205/dgkh000385] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Catheter-interventional treatment is a growing field in pediatric cardiology and cardiology, replacing an increasing number of operations. This article provides an overview of the general practice of hygienic measures and antimicrobial prophylaxis in the cardiac catheterization laboratory to prevent post-procedural infection, particularly if foreign material is utilized.
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Affiliation(s)
- Heike Schneider
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center Göttingen, Göttingen, Germany,*To whom correspondence should be addressed: Heike Schneider, Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center Göttingen, Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany, Phone: +49 551-3962580, Fax: +49 551-3922561, E-mail:
| | - Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, University Medical Center Göttingen, Göttingen, Germany
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Nordmeyer J, Ewert P, Gewillig M, AlJufan M, Carminati M, Kretschmar O, Uebing A, Dähnert I, Röhle R, Schneider H, Witsenburg M, Benson L, Gitter R, Bökenkamp R, Mahadevan V, Berger F. Acute and midterm outcomes of the post-approval MELODY Registry: a multicentre registry of transcatheter pulmonary valve implantation. Eur Heart J 2020; 40:2255-2264. [PMID: 31005985 DOI: 10.1093/eurheartj/ehz201] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 04/25/2018] [Revised: 08/14/2018] [Accepted: 04/03/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS The post-approval MELODY Registry aimed to obtain multicentre registry data after transcatheter pulmonary valve implantation (TPVI) with the Melody™ valve (Medtronic plc.) in a large-scale cohort of patients with congenital heart disease (CHD). METHODS AND RESULTS Retrospective analysis of multicentre registry data after TPVI with the Melody™ valve. Eight hundred and forty-five patients (mean age: 21.0 ± 11.1 years) underwent TPVI in 42 centres between December 2006 and September 2013 and were followed-up for a median of 5.9 years (range: 0-11.0 years). The composite endpoint of TPVI-related events during follow-up (i.e. death, reoperation, or reintervention >48 h after TPVI) showed an incidence rate of 4.2% per person per year [95% confidence interval (CI) 3.7-4.9]. Transcatheter pulmonary valve implantation infective endocarditis (I.E.) showed an incidence rate of 2.3% per person per year (95% CI 1.9-2.8) and resulted in significant morbidity and in nine deaths. In multivariable Cox proportional hazard models, the invasively measured residual right ventricle (RV)-to-pulmonary artery (PA) pressure gradient (per 5 mmHg) was associated with the risk of the composite endpoint (adjusted hazard ratio: 1.21, 95% CI 1.12-1.30; P < 0.0001) and the risk of TPVI I.E. (adjusted hazard ratio: 1.19, 95% CI 1.07-1.32; P = 0.002). Major procedural complications (death, surgical, or interventional treatment requirement) occurred in 0.5%, 1.2%, and 2.0%, respectively. Acutely, the RV-to-PA pressure gradient and the percentage of patients with pulmonary regurgitation grade >2 improved significantly from 36 [interquartile range (IQR) 24-47] to 12 (IQR 7-17) mmHg and 47 to 1%, respectively (P < 0.001 for each). CONCLUSION The post-approval MELODY Registry confirms the efficacy of TPVI with the Melody™ valve in a large-scale cohort of CHD patients. The residual invasively measured RV-to-PA pressure gradient may serve as a target for further improvement in the composite endpoint and TPVI I.E. However, TPVI I.E. remains a significant concern causing significant morbidity and mortality.
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Affiliation(s)
- Johannes Nordmeyer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Lazarettstraße 36, Munich, Germany.,TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, Germany.,Munich Heart Alliance, Partner Site of the DZHK (German Centre for Cardiovascular Research), Biedersteiner Str. 29, Munich, Germany
| | - Marc Gewillig
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Mansour AlJufan
- King Faisal Specialist Hospital and Research Centre, Heart Centre, MBC-16, Riyadh, Kingdom of Saudi Arabia
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Via Morandi, 30, San Donato Milanese, Milan, Italy
| | - Oliver Kretschmar
- Department of Paediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - Anselm Uebing
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | - Ingo Dähnert
- Department of Pediatric Cardiology, University of Leipzig - Heart Centre, Strümpellstr. 39, Leipzig, Germany
| | - Robert Röhle
- Coordination Center of Clinical Studies, KKS, Charité University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Heike Schneider
- Department of Pediatric Cardiology, University Medical Centre, Robert-Koch-Str. 40, Göttingen, Germany
| | - Maarten Witsenburg
- Department of Paediatric Cardiology, Erasmus University Medical Centre, Dr. Molewaterplein 40, GD Rotterdam, Netherlands
| | - Lee Benson
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada
| | - Roland Gitter
- Department of Pediatric Cardiology, Kepler University Hospital, Krankenhausstr. 9, Linz, Austria
| | - Regina Bökenkamp
- Department of Pediatric Cardiology, Leiden University Medical Centre, Albinusdreef 2, ZA Leiden, Netherlands
| | - Vaikom Mahadevan
- Central Manchester University Hospitals, Manchester Royal Infirmary, Oxford Rd, Manchester, UK
| | - Felix Berger
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, Berlin, Germany.,Division of Cardiology, Department of Pediatrics, Charité University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Augustenburger Platz 1, Berlin, Germany
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Lorenz G, Moog P, Bachmann Q, La Rosée P, Schneider H, Schlegl M, Spinner C, Heemann U, Schmid RM, Algül H, Lahmer T, Huber W, Schmaderer C. Title: Cytokine release syndrome is not usually caused by secondary hemophagocytic lymphohistiocytosis in a cohort of 19 critically ill COVID-19 patients. Sci Rep 2020; 10:18277. [PMID: 33106497 PMCID: PMC7589537 DOI: 10.1038/s41598-020-75260-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023] Open
Abstract
Severe COVID-19 associated respiratory failure, poses the one challenge of our days. Assessment and treatment of COVID-19 associated hyperinflammation may be key to improve outcomes. It was speculated that in subgroups of patients secondary hemophagocytic lymphohistiocytosis (sHLH) or cytokine release syndrome (CRS) with features of macrophage activation syndrome might drive severe disease trajectories. If confirmed, profound immunosuppressive therapy would be a rationale treatment approach. Over a median observation period of 11 (IQR: 8; 16) days, 19 consecutive confirmed severe COVID-19-patients admitted to our intensive-care-unit were tested for presence of sHLH by two independent experts. HScores and 2004-HLH diagnostic criteria were assessed. Patients were grouped according to short-term clinical courses: discharge from ICU versus ongoing ARDS or death at time of analysis. The median HScore at admission was 157 (IQR: 98;180), without the key clinical triad of HLH, i.e. progressive cytopenia, persistent fever and organomegaly. Independent expert chart review revealed the absence of sHLH in all cases. No patient reached more than 3/6 of modified HLH 2004 criteria. Nevertheless, patients presented hyperinflammation with peripheral neutrophilic signatures (neutrophil/lymphocyte-ratio > 3.5). The latter best paralleled their short-term clinical courses, with declining relative neutrophil numbers prior to extubation (4.4, [IQR: 2.5;6.3]; n = 8) versus those with unfavourable courses (7.6, [IQR: 5.2;31], n = 9). Our study rules out virus induced sHLH as the leading cause of most severe-COVID-19 trajectories. Instead, an associated innate neutrophilic hyperinflammatory response or virus-associated-CRS appears dominant in patients with an unfavourable clinical course. Therapeutic implications are discussed.
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Affiliation(s)
- Georg Lorenz
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,School of Medicine, Klinikum rechts der Isar, Division of Rheumatology, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Philipp Moog
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,School of Medicine, Klinikum rechts der Isar, Division of Rheumatology, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Quirin Bachmann
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,School of Medicine, Klinikum rechts der Isar, Division of Rheumatology, Ismaninger Straße 22, 81675, Munich, Germany
| | - Paul La Rosée
- Clinic for Internal Medicine II, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - Heike Schneider
- School of Medicine, Klinikum rechts der Isar, Department for Clinical Chemistry, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michaela Schlegl
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Spinner
- School of Medicine, Klinikum rechts der Isar, II. Department for Internal Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Uwe Heemann
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Roland M Schmid
- School of Medicine, Klinikum rechts der Isar, II. Department for Internal Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hana Algül
- School of Medicine, Klinikum rechts der Isar, II. Department for Internal Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Comprehensive Cancer Center Munich at the Klinikum rechts der Isar, Technische Universität München, 81675, Munich, Germany
| | - Tobias Lahmer
- School of Medicine, Klinikum rechts der Isar, II. Department for Internal Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang Huber
- School of Medicine, Klinikum rechts der Isar, II. Department for Internal Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Schmaderer
- School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,German Center for Infectious Research (DZIF), Technische Universität München, 81675, Munich, Germany
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Rothe K, Spinner CD, Waschulzik B, Janke C, Schneider J, Schneider H, Braitsch K, Smith C, Schmid RM, Busch DH, Katchanov J. A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The "Triple F" approach supported by Procalcitonin and paired blood and urine cultures. PLoS One 2020; 15:e0240981. [PMID: 33091046 PMCID: PMC7580978 DOI: 10.1371/journal.pone.0240981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
For acute medicine physicians, distinguishing between asymptomatic bacteriuria (ABU) and clinically relevant urinary tract infections (UTI) is challenging, resulting in overtreatment of ABU and under-recognition of urinary-source bacteraemia without genitourinary symptoms (USB). We conducted a retrospective analysis of ED encounters in a university hospital between October 2013 and September 2018 who met the following inclusion criteria: Suspected UTI with simultaneous collection of paired urinary cultures and blood cultures (PUB) and determination of Procalcitonin (PCT). We sought to develop a simple algorithm based on clinical signs and PCT for the management of suspected UTI. Individual patient presentations were retrospectively evaluated by a clinical "triple F" algorithm (F1 ="fever", F2 ="failure", F3 ="focus") supported by PCT and PUB. We identified 183 ED patients meeting the inclusion criteria. We introduced the term UTI with systemic involvement (SUTI) with three degrees of diagnostic certainty: bacteremic UTI (24.0%; 44/183), probable SUTI (14.2%; 26/183) and possible SUTI (27.9%; 51/183). In bacteremic UTI, half of patients (54.5%; 24/44) presented without genitourinary symptoms. Discordant bacteraemia was diagnosed in 16 patients (24.6% of all bacteremic patients). An alternative focus was identified in 67 patients, five patients presented with S. aureus bacteremia. 62 patients were diagnosed with possible UTI (n = 20) or ABU (n = 42). Using the proposed "triple F" algorithm, dichotomised PCT of < 0.25 pg/ml had a negative predictive value of 88.7% and 96.2% for bacteraemia und accordant bacteraemia respectively. The application of the algorithm to our cohort could have resulted in 33.3% reduction of BCs. Using the diagnostic categories "possible" or "probable" SUTI as a trigger for initiation of antimicrobial treatment would have reduced or streamlined antimicrobial use in 30.6% and 58.5% of cases, respectively. In conclusion, the "3F" algorithm supported by PCT and PUB is a promising diagnostic and antimicrobial stewardship tool.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Christoph D. Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Birgit Waschulzik
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Janke
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Heike Schneider
- Department of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Krischan Braitsch
- Department of Internal Medicine III, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christopher Smith
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roland M. Schmid
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Juri Katchanov
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, Munich, Germany
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Giampiccolo D, Howells H, Bährend I, Schneider H, Raffa G, Rosenstock T, Vergani F, Vajkoczy P, Picht T. Preoperative transcranial magnetic stimulation for picture naming is reliable in mapping segments of the arcuate fasciculus. Brain Commun 2020; 2:fcaa158. [PMID: 33543136 PMCID: PMC7846168 DOI: 10.1093/braincomms/fcaa158] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
In preoperative planning for neurosurgery, both anatomical (diffusion imaging tractography) and functional tools (MR-navigated transcranial magnetic stimulation) are increasingly used to identify and preserve eloquent language structures specific to individuals. Using these tools in healthy adults shows that speech production errors occur mainly in perisylvian cortical sites that correspond to subject-specific terminations of the major language pathway, the arcuate fasciculus. It is not clear whether this correspondence remains in oncological patients with altered tissue. We studied a heterogeneous cohort of 30 patients (fourteen male, mean age 44), undergoing a first or second surgery for a left hemisphere brain tumour in a language-eloquent region, to test whether speech production errors induced by preoperative transcranial magnetic stimulation had consistent anatomical correspondence to the arcuate fasciculus. We used navigated repetitive transcranial magnetic stimulation during picture naming and recorded different perisylvian sites where transient interference to speech production occurred. Spherical deconvolution diffusion imaging tractography was performed to map the direct fronto-temporal and indirect (fronto-parietal and parieto-temporal) segments of the arcuate fasciculus in each patient. Speech production errors were reported in all patients when stimulating the frontal lobe, and in over 90% of patients in the parietal lobe. Errors were less frequent in the temporal lobe (54%). In all patients, at least one error site corresponded to a termination of the arcuate fasciculus, particularly in the frontal and parietal lobes, despite distorted anatomy due to a lesion and/or previous resection. Our results indicate that there is strong correspondence between terminations of the arcuate fasciculus and speech errors. This indicates that white matter anatomy may be a robust marker for identifying functionally eloquent cortex, particularly in the frontal and parietal lobe. This knowledge may improve targets for preoperative mapping of language in the neurosurgical setting.
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Affiliation(s)
- Davide Giampiccolo
- Department of Neurosurgery, Verona University Hospital, University of Verona, Verona, Italy
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | | | - Ina Bährend
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Heike Schneider
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Giovanni Raffa
- Department of Neurosurgery, Messina University Hospital, Italy
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
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Affiliation(s)
- E. Streicher
- Department of Nephrology and Hypertension Katherinen-Hospital Stuttgart, Federal Republic of Germany
| | - H. Schneider
- Department of Nephrology and Hypertension Katherinen-Hospital Stuttgart, Federal Republic of Germany
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Lam V, Hales R, Feliciano J, Voong K, Shin E, Smith K, Anagnostou V, Velculescu V, Thompson E, Sears C, Pardoll D, Rodavia H, Schneider H, Hu C, Amjad A, Guerrieri P, Jobe B, Zaidi A, Kelly R. 1497TiP REACTION – a phase Ib pilot study of nivolumab or nivolumab in combination with relatlimab after targeted radiation in patients with advanced esophagogastric cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2003] [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: 11/16/2022] Open
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Ortner M, Stange M, Schneider H, Schröder C, Buerger K, Müller C, Müller-Sarnowski F, Diehl-Schmid J, Förstl H, Grimmer T, Steimer W. Therapeutic Drug Monitoring of Rivastigmine and Donepezil Under Consideration of CYP2D6 Genotype-Dependent Metabolism of Donepezil. Drug Des Devel Ther 2020; 14:3251-3262. [PMID: 32848364 PMCID: PMC7431170 DOI: 10.2147/dddt.s247259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background The efficacy of acetylcholinesterase inhibitors (AChE-I) might depend on blood concentration. While rivastigmine metabolism is independent of the cytochrome P450 system, its isoenzymes, especially CYP2D6, metabolize donepezil. CYP2D6 polymorphisms can cause altered enzyme activity resulting in lower or higher than expected drug concentrations of donepezil. Objective We investigated correlations between clinical efficacy and serum concentrations of rivastigmine and donepezil under special consideration of CYP2D6 genotype or gene dose–dependent metabolism of donepezil. Methods Serum concentrations of donepezil and rivastigmine were measured by liquid chromatography – tandem mass spectrometry (LC-MS/MS). Real-time quantitative polymerase chain reaction (PCR) and allele-specific PCR were performed to assess CYP2D6 genotype and gene dose. Results Patients treated with rivastigmine (n=28) or donepezil (n=48) were included in the study. Both gene dose and metabolism type significantly predicted the level of donepezil serum concentration (p=0.019 and p=0.013, respectively). In the rivastigmine group, changes of the word list delayed recall subtest before treatment and under stable medication were significantly associated with rivastigmine serum levels (β=0.465; p=0.018). Drug serum concentrations were outside the recommended range in a substantial percentage of participants, which might have contributed to poor correlations between changes in cognitive measures and drug concentrations. Donepezil serum concentrations significantly depended on CYP2D6 gene dose. Conclusion Testing AChE-I serum concentration should be considered in patients without clinical response to treatment or those with severe side effects. Patients with donepezil drug levels outside the recommended range might additionally profit from CYP2D6 genotyping or treatment with an AChE-I independent of CYP metabolism.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Marion Stange
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Heike Schneider
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Charlotte Schröder
- Institute for Clinical Chemistry and Pathobiochemistry, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research (ISD), University of Munich, School of Medicine, Klinikum der Universität München, Munich, Germany
| | - Claudia Müller
- Institute for Stroke and Dementia Research (ISD), University of Munich, School of Medicine, Klinikum der Universität München, Munich, Germany
| | - Felix Müller-Sarnowski
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Hans Förstl
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Werner Steimer
- Institute for Clinical Chemistry and Pathobiochemistry, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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Backhoff D, Müller MJ, Dakna M, Leha A, Schneider H, Krause U, Paul T. Value of defibrillation threshold testing in children with nontransvenous implantable cardioverter defibrillators: Are routine DFT tests indicated? Pacing Clin Electrophysiol 2020; 43:805-813. [DOI: 10.1111/pace.14003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Matthias J. Müller
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Mohammed Dakna
- Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
| | - Andreas Leha
- Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
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Rosenstock T, Picht T, Schneider H, Vajkoczy P, Thomale UW. Pediatric navigated transcranial magnetic stimulation motor and language mapping combined with diffusion tensor imaging tractography: clinical experience. J Neurosurg Pediatr 2020; 26:583-593. [PMID: 32707554 DOI: 10.3171/2020.4.peds20174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In adults, navigated transcranial magnetic stimulation (nTMS) has been established as a preoperative examination method for brain tumors in motor- and language-eloquent locations. However, the clinical relevance of nTMS in children with brain tumors is still unclear. Here, the authors present their initial experience with nTMS-based surgical planning and family counseling in pediatric cases. METHODS The authors analyzed the feasibility of nTMS and its influence on counseling and surgical strategy in a prospective study conducted between July 2017 and September 2019. The main inclusion criterion was a potential benefit from functional mapping data derived from nTMS and/or nTMS-enhanced tractography in pediatric patients who presented to the authors' department prior to surgery for lesions close to motor- and/or speech-eloquent areas. The study was undertaken in 14 patients (median age 7 years, 8 males) who presented with different brain lesions. RESULTS Motor mapping combined with cortical seed area definition could be performed in 10 children (71%) to identify the corticospinal tract by additional diffusion tensor imaging (DTI). All motor mappings could be performed successfully without inducing relevant side effects. In 7 children, nTMS language mapping was performed to detect language-relevant cortical areas and DTI fiber tractography was performed to visualize the individual language network. nTMS examination was not possible in 4 children because of lack of compliance (n = 2), syncope (n = 1), and preexisting implant (n = 1). After successful mapping, the spatial relation between lesion and functional tissue was used for surgical planning in all 10 patients, and 9 children underwent nTMS-DTI integrated neuronavigation. No surgical complications or unexpected neurological deterioration was observed. In all successful nTMS cases, better function-based counseling was offered to the families. In 6 of 10 patients the surgical strategy was adapted according to nTMS data, and in 6 of 10 cases the extent of resection (EOR) was redefined. CONCLUSIONS nTMS and DTI fiber tracking were feasible for the majority of children. Presurgical counseling as well as surgical planning for the approach and EOR were improved by the nTMS examination results. nTMS in combination with DTI fiber tracking can be regarded as beneficial for neurosurgical procedures in eloquent areas in the pediatric population.
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Affiliation(s)
- Tizian Rosenstock
- 1Department of Neurosurgery, Charité University Medicine.,2Berlin Institute of Health; and
| | - Thomas Picht
- 1Department of Neurosurgery, Charité University Medicine
| | | | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité University Medicine
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Bährend I, Muench MR, Schneider H, Moshourab R, Dreyer FR, Vajkoczy P, Picht T, Faust K. Incidence and linguistic quality of speech errors: a comparison of preoperative transcranial magnetic stimulation and intraoperative direct cortex stimulation. J Neurosurg 2020; 134:1409-1418. [PMID: 32470943 DOI: 10.3171/2020.3.jns193085] [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] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area-related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites. METHODS Twenty-five patients with brain tumors in speech-related areas were prospectively evaluated with preoperative rnTMS (5 Hz, train of five, average 105% resting motor threshold) and navigated direct cortical stimulation (DCS; bipolar, 50 Hz, 6-8 mA, 200-μsec pulse width) during awake surgeries employing a picture-naming task. Positive and negative stimulation spots within the craniotomy were documented in the same MRI data set. TMS and DCS language-positive areas were compared with regard to their spatial overlap, their allocation in a cortical parcellation system, and their linguistic qualities. RESULTS There were over twofold more positive language spots within the exposed area on rnTMS than on DCS. The comparison of positive rnTMS and DCS (ground truth) overlaps revealed low sensitivity (35%) and low positive predictive value (16%) but high specificity (90%) and high negative predictive value (96%). Within the overlaps, there was no correlation in error quality. On DCS, 73% of language-positive spots were located in the pars opercularis and pars triangularis of the frontal operculum and 24% within the supramarginal gyrus and dorsal portion of the superior temporal gyrus, while on rnTMS language positivity was distributed more evenly over a large number of gyri. CONCLUSIONS The current protocol for rnTMS for language mapping identified language-negative sites with good dependability but was unable to reliably detect language-positive spots. Further refinements of the technique will be needed to establish rnTMS language mapping as a useful clinical tool.
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Affiliation(s)
| | | | | | | | - Felix R Dreyer
- 3Brain Language Laboratory, Freie Universität Berlin, Germany
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Mittwollen R, Wohlfart S, Park J, Grosch E, Has C, Hohenester E, Schneider H, Hammersen J. Aberrant splicing as potential modifier of the phenotype of junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:2127-2134. [PMID: 32124492 DOI: 10.1111/jdv.16332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A lack or dysfunction of the anchoring protein laminin-332 in the basement membrane leads to the skin blistering disorder junctional epidermolysis bullosa (JEB). The mutation c.628G>A in the gene LAMB3 encoding the laminin β3-chain is associated with generalized intermediate JEB; it may introduce an amino acid substitution (p.Glu210Lys) or disrupt splicing. OBJECTIVE This retrospective study aimed at determining the effects of aberrant splicing on the JEB phenotype. METHODS LAMB3 transcription was analysed in two siblings compound heterozygous for the LAMB3 mutations p.Glu210Lys and p.Arg635* with a diverging JEB phenotype from late childhood on. Laminin-332 levels in skin sections and in cultured keratinocytes were investigated by immunofluorescence staining. Real-time PCR was used to quantify LAMB3 expression in keratinocytes. RNA splice variants were identified by subcloning of a LAMB3 cDNA fraction and subsequent DNA sequencing. Structural models of laminin-332 helped to assess the impact of certain mutations on laminin-332 folding. RESULTS Both siblings showed diminished LAMB3 expression. Laminin-332 was equally reduced in skin sections obtained during infancy but differed in keratinocytes isolated during adolescence. Although aberrant LAMB3 splicing with 26 variants was detected in both patients, splicing differed significantly: the full-length LAMB3 transcript harbouring the p.Glu210Lys mutation was found more often in the patient affected less severely (14/108 vs. 5/106 clones; P = 0.03). Structural modelling predicted that several deletions in LAMB3, but not the point mutation p.Glu210Lys, have an effect on laminin-332 folding and secretion. CONCLUSIONS Differential LAMB3 mRNA splicing in the patients may explain the disparate JEB phenotype. By elucidating the regulation of laminin-332 gene expression, these findings may contribute to the development of therapeutic strategies for JEB and might help to understand phenotype modification by splice-site mutations in other hereditary diseases.
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Affiliation(s)
- R Mittwollen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - S Wohlfart
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - J Park
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - E Grosch
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - C Has
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - E Hohenester
- Department of Life Sciences, Imperial College London, London, UK
| | - H Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - J Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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Ortner M, Stange M, Schneider H, Schroeder C, Buerger K, Müller C, Dorn B, Goldhardt O, Diehl-Schmid J, Förstl H, Steimer W, Grimmer T. Serum Concentrations of Cholinesterase Inhibitors in Patients With Alzheimer's Dementia Are Frequently Below the Recommended Levels. Front Pharmacol 2020; 11:691. [PMID: 32508640 PMCID: PMC7253642 DOI: 10.3389/fphar.2020.00691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/27/2020] [Indexed: 01/14/2023] Open
Abstract
Background Acetylcholinesterase inhibitors (AChE-I) are recommended for the treatment of cognitive symptoms but also of behavioral and psychological symptoms in dementia. They are widely used not only in Alzheimer's disease, but also in other forms of dementia. Efficacy of treatment might depend on serum concentration of the respective AChE-I. Objective In patients with mild to moderate Alzheimer's dementia, we measured serum concentrations of hepatically metabolized donepezil and renally excreted rivastigmine and investigated possible modifiers. Additionally, we looked at correlations between serum concentrations and efficacy for both drugs. Methods Serum concentrations of donepezil and rivastigmine were measured by liquid chromatography – tandem mass spectrometry (LC-MS/MS). Real-time quantitative polymerase chain reaction (PCR). Allele specific PCR were performed to determine CYP2D6 genotype and gene dose. Clinical efficacy was assessed by changes of the subtest wordlist delayed recall of the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB). Results Sixty-seven patients treated with a stable dosage of donepezil 10 mg (n=41) or rivastigmine 9.5 mg (n=26) were included. Mean serum concentration of donepezil and rivastigmine were 41.2 and 6.5 ng/ml, respectively. Serum concentrations were below the recommended range in 73% of the subjects in the donepezil group and in 65% of the participants in the rivastigmine group. When applying a dose-related reference, ranges 63% of patients in the donepezil group and 32% in the rivastigmine group had concentrations below the expected range. Gene dose, sex, and duration of treatment significantly predicted donepezil serum concentration (p=0.046, p=0.001, p=0.030 respectively). Only for rivastigmine did the serum concentration significantly contribute to the regression model predicting changes on the subtest word list delayed recall (β=0.472; p=0.019). Conclusions Serum concentrations of about two thirds of the patients were below the recommended range. When not looking at absolute values but at the dose-related reference ranges, these numbers improved but still 32%, respectively 63% of patients had low serum concentrations. High serum concentrations of rivastigmine predicted clinical response to cognition. Therapeutic drug monitoring might help to identify the cause of poor clinical response to cognition and behavioral and psychological symptoms in patients with AChE-I treatment.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marion Stange
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heike Schneider
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Schroeder
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katharina Buerger
- Institut for Stroke and Dementia Research, University of Munich, Munich, Germany.,DZNE - German Center for Neurodegenerative Diseases, Munich, Germany
| | - Claudia Müller
- Institut for Stroke and Dementia Research, University of Munich, Munich, Germany
| | - Bianca Dorn
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oliver Goldhardt
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Förstl
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Werner Steimer
- Institute for Clinical Chemistry and Pathobiochemistry, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Mirbagheri A, Schneider H, Zdunczyk A, Vajkoczy P, Picht T. NTMS mapping of non-primary motor areas in brain tumour patients and healthy volunteers. Acta Neurochir (Wien) 2020; 162:407-416. [PMID: 31768755 DOI: 10.1007/s00701-019-04086-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) has been increasingly used for presurgical cortical mapping of the primary motor cortex (M1) but remains controversial for the evaluation of non-primary motor areas (NPMA). This study investigates clinical and neurophysiological parameters in brain tumour patients and healthy volunteers to decide whether single-pulse biphasic nTMS allows to reliably elicite MEP outside from M1 or not. MATERIALS AND METHODS Twelve brain tumour patients and six healthy volunteers underwent M1 nTMS mapping. NPMA nTMS mapping followed using 120% and 150% M1 resting motor threshold (RMT) stimulation intensity. Spearman's correlation analysis tested the association of clinical and neurophysiological parameters between M1 and NPMA mapping. RESULTS A total of 88.81% of nTMS stimulations in NPMA in patients/83.87% in healthy volunteers in patients/83.87% in healthy volunteers did not result in MEPs ≥ 50 μV. Positive nTMS mapping in NPMA correlated with higher stimulation intensity and larger M1 areas in patients (120% M1 RMT SI p = 0.005/150% M1 RMT SI p = 0.198). CONCLUSION Our findings indicate that in case of positive nTMS mapping in NPMA, MEPs originate mostly from M1. For future studies, MEP parameters and TMS coil rotation should be studied closely to assess the risk for postoperative motor deterioration.
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Affiliation(s)
- Andia Mirbagheri
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, Berlin, Germany.
| | - Heike Schneider
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Anna Zdunczyk
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité University Medicine, Charitéplatz 1, Berlin, Germany
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Klehs S, Schneider H, Backhoff DJ, Müller M, Paul T, Krause U. Long-Term Follow-up after Radiofrequency Catheter Ablation of Atrial Tachycardias in Patients with Congenital Heart Disease. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mazare A, Park J, Simons S, Mohajernia S, Hwang I, Yoo JE, Schneider H, Fischer MJ, Schmuki P. Black TiO 2 nanotubes: Efficient electrodes for triggering electric field-induced stimulation of stem cell growth. Acta Biomater 2019; 97:681-688. [PMID: 31419565 DOI: 10.1016/j.actbio.2019.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/06/2019] [Revised: 07/19/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022]
Abstract
TiO2 nanostructures represent a key platform for biomedical applications, due to the combination of biocompatibility and high surface area. Especially TiO2 nanotube layers have been widely investigated due to controllable nanotopographic effects as well as for electrodes in electrostimulation experiments. In the present work we produce Ar/H2-reduced 'black' TiO2 nanotube arrays with a strongly enhanced electrical conductivity and explore their interaction with mesenchymal stem cells when used as electrodes to apply electric fields (EF) across the cells. While we observe no significant change in cell adhesion and their focal contact formation on these high conductivity nanotubes, we do observe a rapid stem cell response when EF is engaged using the 'black' TiO2 nanotube arrays as electrodes. Compared to as-formed nanotube arrays, a faster stem cell growth was observed and a lower EF intensity caused an intracellular calcium level elevation. Our results indicate that the increased conductivity in TiO2 nanotubes significantly enhances the early stem cell response to minimal electric field stimuli. STATEMENT OF SIGNIFICANCE: The use of TiO2 nanostructures in biomedical applications is widely investigated, especially considering the nanostructured surface influence on the biomaterial-cell interactions. We have previously shown that an applied electric field (EF) on stem cells grown on TiO2 nanotubes leads to synergistic osteogenic stimulation in the absence of biochemical bone-inducing supplements. Here we report that black (i.e. highly conductive nanotubes obtained by reduction treatments) TiO2 nanotubes enable short-time EF effects on stem cells: we observe a faster stem cell growth and a significantly enhanced early stem cell response to minimal EF stimuli. The application of such nanostructures under electric field is promising for therapeutic interventions for bone regeneration and tissue engineering approaches.
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Affiliation(s)
- A Mazare
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany
| | - J Park
- University Hospital Erlangen, Children Hospital, 91054 Erlangen, Germany
| | - S Simons
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany
| | - S Mohajernia
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany
| | - I Hwang
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany
| | - J E Yoo
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany
| | - H Schneider
- University Hospital Erlangen, Children Hospital, 91054 Erlangen, Germany
| | - M J Fischer
- Medical University of Vienna, Center for Physiology and Pharmacology, 1090 Vienna, Austria
| | - P Schmuki
- Friedrich-Alexander University, Department of Materials Science WW4-LKO, 91058 Erlangen, Germany.
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Le Rhun E, von Achenbach C, Sahm F, Wang SS, Neidert MC, Rushing E, Lawhon T, Schneider H, von Deimling A, Weller M. OS8.6 Sensitivity of human meningioma cells to the cyclin-dependent kinase inhibitor, TG02. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Standards of care for meningioma include surgical resection, which may be curative, and radiotherapy as required. Pharmacotherapy plays only a minor role in this disease; however, novel systemic approaches are urgently needed for patients who are no longer candidates for local therapy.
MATERIAL AND METHODS
We generated primary cultures from surgically removed meningiomas to explore the activity of a novel cyclin-dependent kinase inhibitor, TG02, in meningioma cell cultures. Tumor and cell cultures were characterized by mutation profiling and DNA methylation profiling. DNA methylation data were used to allot each sample to one out of six previously established meningioma methylation classes: benign (ben)-1, 2, 3, intermediate (int)-A, B, and malignant (mal). The activity of TG02 was assessed by standard cell culture assays.
RESULTS
Cell cultures were derived from nine meningiomas. Four tumors assigned to the methylation class ben-2 showed the same class in the cell culture whereas cell cultures from five non-ben-2 tumors showed a different class, a more malignant class in four of five patients. Cell cultures were uniformly sensitive to the growth inhibitory effects of TG02 in the nanomolar range. Assignment of the cell cultures to a more malignant methylation classifier appeared to be more closely associated with TG02 sensitivity than assignment to a higher WHO grade of the primary tumors.
CONCLUSION
Primary cell cultures from meningioma facilitate the investigation of the anti-meningioma activity of novel agents. TG02, an orally available cyclin-dependent kinase inhibitor, warrants further exploration in this disease.
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Affiliation(s)
- E Le Rhun
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - C von Achenbach
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - F Sahm
- University of Heidelberg, and Clinical Cooperation Unit Neuropathology, German Consortium for Transnational Cancer Research (DKTK), German Cancer Research Center (DKFZ), and Hopp Children’s Cancer Center, Heidelberg, Heidelberg, Germany
| | - S S Wang
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - M C Neidert
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - E Rushing
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - T Lawhon
- Adastra Pharmaceuticals, San Diego, CA, United States
| | - H Schneider
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
| | - A von Deimling
- University of Heidelberg, and Clinical Cooperation Unit Neuropathology, German Consortium for Transnational Cancer Research (DKTK), German Cancer Research Center (DKFZ), and Hopp Children’s Cancer Center, Heidelberg, Germany
| | - M Weller
- University Hospital Zurich, Zurich, Switzerland, Zurich, Switzerland
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Vahidnezhad H, Youssefian L, Daneshpazhooh M, Mahmoudi H, Kariminejad A, Fischer J, Christiansen J, Schneider H, Guy A, Liu L, McGrath J, Has C, Uitto J. 307 Homozygous Biallelic KRT5 Mutations in Epidermolysis Bullosa Simplex, Including a Complete Human Keratin 5 “Knock-Out”, in Families with Extensive Consanguinity. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Engelhardt M, Schneider H, Gast T, Picht T. Estimation of the resting motor threshold (RMT) in transcranial magnetic stimulation using relative-frequency and threshold-hunting methods in brain tumor patients. Acta Neurochir (Wien) 2019; 161:1845-1851. [PMID: 31286238 DOI: 10.1007/s00701-019-03997-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Application of transcranial magnetic stimulation is often based on the resting motor threshold. The aim of this study was to validate recent findings on the advantage of resting motor threshold estimation using adaptive threshold-hunting algorithms over the Rossini-Rothwell method in a clinical sample and healthy subjects. METHODS Resting motor thresholds in 115 patients with a brain tumor and 10 healthy subjects were assessed using the Rossini-Rothwell method and compared to an adaptive threshold-hunting algorithm. In healthy subjects, this measurement was repeated twice to capture test-retest reliability of both methods. Efficiency of both methods was assessed by comparing the number of pulses needed for resting motor threshold estimation. RESULTS There was no significant difference between the Rossini-Rothwell method and the adaptive threshold-hunting algorithm in patients and healthy controls with limits of agreement between ± 12 V/m. There was a strong intraclass correlation and both methods showed a good test-retest reliability. However, the adaptive threshold-hunting algorithm was significantly faster. CONCLUSIONS The adaptive threshold-hunting algorithm was more efficient in assessing the resting motor threshold, while reaching comparable results as the Rossini-Rothwell method. Thus, our results support the advantage of adaptive threshold-hunting algorithms to determine the resting motor threshold also in a clinical sample.
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Lehner A, Dashkalova T, Ulrich S, Fernandez Rodriguez S, Mandilaras G, Jakob A, Dalla-Pozza R, Fischer M, Schneider H, Tarusinov G, Kampmann C, Hofbeck M, Dähnert I, Kanaan M, Haas NA. Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience. Expert Rev Med Devices 2019; 16:829-834. [PMID: 31432698 DOI: 10.1080/17434440.2019.1653180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: After encouraging results with the Edwards Sapien and XT valves, this study aimed to review procedural data and early outcomes for the Sapien 3 valves for transcatheter pulmonary valve replacement (TPVR). Methods: We performed a multicenter, retrospective analysis of cases who underwent a Sapien 3 TPVR between 2015 and 2017 in 7 centers in Germany with a follow-up of up to 2 years. Results: 56 patients could be enrolled (weight 58,5 ± 25,0 kg; 53% Tetralogy of Fallot, 45% native RVOT). Most procedures were two-stage procedures (82,1%) with 100% prestenting. Valve sizes were 20 mm (n = 1), 23 mm (n = 15), 26 mm (n = 27), 29 mm (n = 13). Procedural success rate was 96.4%. Two patients underwent surgical valve implantation after balloon rupture during TPVR. Follow-up data were available up to 24-month post TPVR. The rate of patients with ? moderate and severe pulmonary regurgitation decreased to 0% after TPVR, peak systolic gradient decreased from 24,2 (SD±20,9) mmHg to 7,1 mmHg (SD±5,0). There were no endocarditis, severe tricuspid valve impairment or stent fractures. Conclusions: With the Edwards Sapien 3 valve, the patient pool for TPVR can be substantially extended. Continued data collection is necessary to verify long-term results.
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Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Tsvetina Dashkalova
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Silvia Fernandez Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Guido Mandilaras
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Andre Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Robert Dalla-Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Marcus Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
| | - Heike Schneider
- Department for Pediatric Cardiology and Intensive Care, Heart Center Goettingen, Georg-August-University Goettingen , Goettingen , Germany
| | - Gleb Tarusinov
- Department for Pediatric Cardiology, Heart Center Duisburg , Duisburg , Germany
| | - Christoph Kampmann
- Department for Pediatric Cardiology, University Medical Center Mainz , Mainz , Germany
| | - Michael Hofbeck
- Department for Pediatric Cardiology, University Hospital Tuebingen , Tuebingen , Germany
| | - Ingo Dähnert
- Department for Pediatric Cardiology, Heart Center Leipzig , Leipzig , Germany
| | - Majed Kanaan
- Center for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum , Bad Oeynhausen , Germany
| | - Nikolaus A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich , Munich , Germany
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Schneider H, Alfred A, Wandernoth B, Blunck A. FV 9 Therapeutic effect of Infra-Low-Frequency (ILF-) Neurofeedback training on Children and Adolescents with Attention Deficit (Hyperkinetic) Disorder. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.619] [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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Lam S, Lucente G, Schneider H, Picht T. TMS motor mapping in brain tumor patients: more robust maps with an increased resting motor threshold. Acta Neurochir (Wien) 2019; 161:995-1002. [PMID: 30927156 DOI: 10.1007/s00701-019-03883-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) has found widespread usage across many clinical centers as part of their surgical planning routines. NTMS offers a non-invasive approach to delineation of the motor cortex, in which the region is outlined through electromagnetic stimulation and electromyographic recordings of target muscles. Several neurophysiological parameters such as the motor evoked potential (MEP) and its derivatives, the resting motor threshold (RMT) and motor latency, are collected. The present study investigates the clinical feasibility and reproducibility of increasing the MEP threshold in brain tumor patients, with the goal to improve the robustness of the procedure. MATERIALS AND METHODS Twenty-three subjects with peri-motor cortex tumors underwent motor mapping with nTMS. RMT was calculated with both conventional 50-μV and experimental 500-μV MEP amplitude thresholds. Motor mapping was performed with 105% of both RMTs stimulator intensity using the FDI as the target muscle. RESULTS Motor mapping was possible in 20 patients with both the conventional and experimental thresholds. No significant differences in area size were found between motor area maps generated with a conventional 50-μV threshold in comparison to those generated with the higher 500-μV threshold (50 μV 272.56 mm2 [170.47-434.31] vs. 500 μV 240.54 mm2 [169.77-362.84], P = 0.34). Latency time was significantly reduced in 500-μV recordings relative to 50-μV recordings (50 μV 23.38 ms [22.55-24.51] vs. 500 μV 22.57 ms [21.41-23.70], P < 0.001). Both electric field intensity (50 μV 63.81 V/m [54.26-76.11] vs. 500 μV 77.83 V/m [65.21-93.94], P < 0.001) and RMT (50 μV 33 MSO% [28-36] vs. 500 μV 39.5 MSO% [32-44], P < 0.001) were significantly greater with the higher 500-μV threshold. CONCLUSIONS Our study demonstrates the feasibility of increasing the MEP detection threshold to 500 μV in brain tumor patients for RMT determination and motor area mapping with nTMS.
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Affiliation(s)
- Steven Lam
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Giuseppe Lucente
- Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Carretera del Canyet s/n, 08916, Badalona, Spain.
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Heike Schneider
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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Müller-Thomas C, Tüchler H, Rudelius M, Schneider H, Pfefferkorn S, Götze KS. Serum Vitamin D Levels in Patients with Myelodysplastic Syndromes: A Retrospective Single-Center Analysis. Acta Haematol 2019; 141:225-231. [PMID: 30965326 DOI: 10.1159/000496014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS There is growing evidence supporting the role of innate immune deregulation and inflammation in the pathogenesis of myelodysplastic syndromes (MDS). Vitamin D (VD) is known to be involved in various immune and epigenetic processes. This analysis aimed to evaluate serum VD levels in patients with MDS and to analyze associations between serum VD levels and disease characteristics. METHODS Serum levels of 25-hydroxyvitamin D3 (25(OH)-D3), the major form of VD in human serum, were measured by chemiluminescence immunoassay in 62 unselected patients with MDS. Associations between serum 25(OH)-D3 levels and disease characteristics were analyzed using Kendall's tau and two-sided p values. RESULTS The median serum 25(OH)-D3 level was markedly reduced (17.5 ng/mL). Patients with lower-risk disease features had lower serum 25(OH)-D3 levels than patients with higher-risk disease features with regard to medullary blast counts (16 vs. 31 ng/mL, p < 0.001), the revised international prognostic scoring system (13 vs. 30.5 ng/mL, p = 0.001), and blood counts. CONCLUSIONS We show that patients with lower-risk disease characteristics exhibit lower serum VD levels than patients with higher-risk disease characteristics. Whether these findings might reflect innate immune deregulation has to be investigated in further studies.
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Affiliation(s)
- Catharina Müller-Thomas
- Department of Medicine III, Hematology and Oncology, Technische Universität München, Munich, Germany,
| | - Heinz Tüchler
- Ludwig Boltzmann Institute for Leukemia Research, Vienna, Austria
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Heike Schneider
- Institute of Clinical Chemistry und Pathobiochemistry, Technische Universität München, Munich, Germany
| | - Sabrina Pfefferkorn
- Department of Medicine III, Hematology and Oncology, Technische Universität München, Munich, Germany
| | - Katharina S Götze
- Department of Medicine III, Hematology and Oncology, Technische Universität München, Munich, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Schneider H, Fischer D, Mathews SR, Failing K, Delehanty DJ, Lierz M. Semen collection, semen analysis and artificial insemination in Columbian sharp-tailed grouse (Tympanuchus phasianellus columbianus) as part of a species conservation project. Theriogenology 2019; 132:128-137. [PMID: 31022602 DOI: 10.1016/j.theriogenology.2019.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022]
Abstract
Columbian sharp-tailed grouse (Tympanuchus phasianellus columbianus; hereafter CSTG) have experienced substantial decreases in population numbers and geographic range during the early 20th century, primarily due to habitat loss. The conservation aim of this project was to re-establish a self-sustaining population of CSTG within an unoccupied portion of their historic range in northeastern Nevada via reintroduction from source populations in Idaho, USA. Female nest initiation rates post-translocation due to low fertilization rates are believed to be one limiting factor in the establishment of some translocated CSTG populations. However, studies on semen collection and artificial insemination in this species are absent. Assisted reproduction was evaluated as an additional tool in this species conservation project in order to gain knowledge on the reproductive status of yearling and adult male CSTG, establish orientation values for semen parameters and evaluate artificial insemination procedures on female CSTG. In two consecutive breeding seasons, semen collection was attempted 51 times in 47 males using the established massage method, and a novel electro-stimulation technique. Semen collection was successful in all attempts, even in yearling grouse, which represents a novel confirmation that yearling male CSTG can produce live spermatozoa in their first breeding season. Volume, color, consistency, contamination, pH of semen, and the motility, concentration, viability and morphology of spermatozoa were analyzed. Extracted semen volume ranged between 6 and 74 μl and the mean pH was 6.9 ± 0.5 (x¯ ± SD). Morphology analysis revealed that on average, 42.8% of sperm was morphologically normal, but 34.8% had malformed tails. Additionally, artificial insemination was practiced in 17 females (sham-insemination group; insemination lacking spermatozoa) and performed in 17 females. Intravenous catheters G20 1.0 mm × 32 mm enabled safe intravaginal insemination under visual control. Significant (p ≤ 0.05) differences in semen parameters between adult and yearling birds were detected. It is well established that adult males receive a majority of copulations during lekking, but our novel findings also indicate that they produce significantly more spermatozoa which is of higher quality than yearling males. This finding offers insights into male reproductive biology in a lekking grouse species.
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Affiliation(s)
- H Schneider
- Clinic for Birds, Reptiles, Amphibians and Fish, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 91, 35392 Giessen, Germany.
| | - D Fischer
- Clinic for Birds, Reptiles, Amphibians and Fish, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 91, 35392 Giessen, Germany
| | - S R Mathews
- Department of Biological Sciences, Idaho State University, 921 S. 8th. Ave, Pocatello, ID 83209-8007, USA
| | - K Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 95, 35392 Giessen, Germany
| | - D J Delehanty
- Department of Biological Sciences, Idaho State University, 921 S. 8th. Ave, Pocatello, ID 83209-8007, USA
| | - M Lierz
- Clinic for Birds, Reptiles, Amphibians and Fish, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Frankfurter Str. 91, 35392 Giessen, Germany
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