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Lévesque H, Viallard JF, Houivet E, Bonnotte B, Voisin S, Le Cam-Duchez V, Maillot F, Lambert M, Liozon E, Hervier B, Fain O, Guillet B, Schmidt J, Luca LE, Ebbo M, Ferreira-Maldent N, Babuty A, Sailler L, Duffau P, Barbay V, Audia S, Benichou J, Graveleau J, Benhamou Y. Cyclophosphamide vs rituximab for eradicating inhibitors in acquired hemophilia A: A randomized trial in 108 patients. Thromb Res 2024; 237:79-87. [PMID: 38555718 DOI: 10.1016/j.thromres.2024.03.012] [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: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against Factor VIII, with a high mortality risk. Treatments aim to control bleeding and eradicate antibodies by immunosuppression. International recommendations rely on registers and international expert panels. METHODS CREHA, an open-label randomized trial, compared the efficacy and safety of cyclophosphamide and rituximab in association with steroids in patients with newly diagnosed AHA. Participants were treated with 1 mg/kg prednisone daily and randomly assigned to receive either 1.5-2 mg/kg/day cyclophosphamide orally for 6 weeks, or 375 mg/m2 rituximab once weekly for 4 weeks. The primary endpoint was complete remission over 18 months. Secondary endpoints included time to achieve complete remission, relapse occurrence, mortality, infections and bleeding, and severe adverse events. RESULTS Recruitment was interrupted because of new treatment recommendations after 108 patients included (58 cyclophosphamide, 50 rituximab). After 18 months, 39 cyclophosphamide patients (67.2 %) and 31 rituximab patients (62.0 %) were in complete remission (OR 1.26; 95 % CI, 0.57 to 2.78). In the poor prognosis group (FVIII < 1 IU/dL, inhibitor titer > 20 BU mL-1), significantly more remissions were observed with cyclophosphamide (22 patients, 78.6 %) than with rituximab (12 patients, 48.0 %; p = 0.02). Relapse rates, deaths, severe infections, and bleeding were similar in the 2 groups. In patients with severe infection, cumulative doses of steroids were significantly higher than in patients without infection (p = 0.03). CONCLUSION Cyclophosphamide and rituximab showed similar efficacy and safety. As first line, cyclophosphamide seems preferable, especially in poor prognosis patients, as administered orally and less expensive. FUNDING French Ministry of Health. CLINICALTRIALS gov number: NCT01808911.
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Affiliation(s)
- H Lévesque
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France.
| | - J F Viallard
- Service de Médecine Interne et Maladies Infectieuses Hôpital Haut-Lévêque, CHU Bordeaux, 5 avenue de Magellan, 33604 Pessac, France
| | - E Houivet
- Department of Biostatistics, CHU Rouen, F-76031 Rouen, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - S Voisin
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - V Le Cam-Duchez
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - F Maillot
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - M Lambert
- CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reerence Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), F-59000 Lille, France
| | - E Liozon
- Department of Internal Medicine, Dupuytren Hospital, F-87000 Limoges, France
| | - B Hervier
- Service de Médecine Interne, Hôpital Saint-Louis, APHP, 75010 Paris & INSERM UMR-S 976, Human Immunology, Pathophysiology, Immunotherapy, Saint-Louis Research Institute, F-75000 Paris, France
| | - O Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris F-75000, France
| | - B Guillet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR-S 1085, F-35000 Rennes, France
| | - J Schmidt
- Department of Internal Medicine, Amiens University Hospital, F-80000 Amiens, France
| | - L E Luca
- Department of Internal Medicine, Poitiers University Hospital, F-86000 Poitiers, France
| | - M Ebbo
- Service de Médecine Interne, Hôpital La Timone, CHU Marseille, Aix-Marseille Université, F-13000 Marseille, France
| | - N Ferreira-Maldent
- Département de Médecine Interne et immunologie clinique, CHRU Tours, Université de Tours, F-37044 Tours, France
| | - A Babuty
- Service d'Hématologie Biologique, CRC-MHC, CHU de Nantes, Nantes Cedex 1, France
| | - L Sailler
- Department of Internal Medicine, CHU Toulouse, F-31059 Toulouse. France
| | - P Duffau
- Service de Médecine Interne-Immunologie Clinique Hôpital Saint-André, CHU Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France
| | - V Barbay
- Normandie Univ, UNIROUEN, Hématologie biologique, F-76031 Rouen, France
| | - S Audia
- Service de médecine interne et immunologie clinique, CHU Dijon-Bourgogne, Université de Dijon, F-21079 Dijon, France
| | - J Benichou
- Department of Biostatistics, CHU Rouen and CESP UMR 1018, University of Rouen and University Paris-Saclay, F-76031 Rouen, France
| | - J Graveleau
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes, France
| | - Y Benhamou
- Normandie Univ, UNIROUEN, U 1096, CHU Rouen, Department of Internal Medicine, F-76000 Rouen, France
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Schmidt J, Proesl S, Schulz-Kornas E, Haak R, Meyer-Lueckel H, Campus G, Esteves-Oliveira M. Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions. J Dent 2024; 142:104776. [PMID: 37977410 DOI: 10.1016/j.jdent.2023.104776] [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: 01/19/2023] [Revised: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
AIM This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence. MATERIALS AND METHODS A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed. RESULTS 547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low. CONCLUSION An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.
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Affiliation(s)
- J Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - S Proesl
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - E Schulz-Kornas
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - R Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - G Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - M Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, Giessen, Germany.
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Boulu X, Perrin H, Schmidt J, Renard C. Superior vena cava syndrome of unusual cause. Rev Med Interne 2024; 45:174-175. [PMID: 38395715 DOI: 10.1016/j.revmed.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 11/04/2023] [Indexed: 02/25/2024]
Affiliation(s)
- X Boulu
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France.
| | - H Perrin
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France
| | - J Schmidt
- Service de médecine interne, CHU Amiens-Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens-Picardie, 80054 Amiens, France
| | - C Renard
- Service de radiologie et imagerie médicale, CHU Amiens-Picardie, 80054 Amiens, France
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Starling LT, Tucker R, Quarrie K, Schmidt J, Hassanein O, Smith C, Flahive S, Morris C, Lancaster S, Mellalieu S, Curran O, Gill N, Clarke W, Davies P, Harrington M, Falvey E. The World Rugby and International Rugby Players Contact Load Guidelines: From conception to implementation and the future. S Afr J Sports Med 2023; 35:v35i1a16376. [PMID: 38249755 PMCID: PMC10798596 DOI: 10.17159/2078-516x/2023/v35i1a16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Managing training load in rugby union is crucial for optimising performance and injury prevention. Contact training warrants attention because of higher overall injury and head impact risk, yet players must develop physical, technical, and mental skills to withstand the demands of the game. To help coaches manage contact loads in professional rugby, World Rugby and International Rugby Players convened an expert working group. They conducted a global survey with players to develop contact load guidelines. This commentary aims to describe the contact load guidelines and their implementation, and identify areas where future work is needed to support their evolution.
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Affiliation(s)
- LT Starling
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- Department for Health, University of Bath, Bath,
UK
| | - R Tucker
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, University of Stellenbosch,
South Africa
| | - K Quarrie
- New Zealand Rugby, Wellington,
New Zealand
| | - J Schmidt
- New Zealand Rugby, Wellington,
New Zealand
| | - O Hassanein
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - C Smith
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - S Flahive
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - C Morris
- C J Morris Consulting Ltd, Cheshire,
UK
| | | | - S Mellalieu
- Centre for Health, Activity and Wellbeing Research (CAWR), Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff,
UK
| | - O Curran
- Irish Rugby Football Union, High Performance Centre, National Sports Campus, Dublin 15,
Ireland
| | - N Gill
- New Zealand Rugby, Wellington,
New Zealand
- University of Waikato, Tauranga,
New Zealand
| | - W Clarke
- New Zealand Rugby, Wellington,
New Zealand
| | - P Davies
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
| | - M Harrington
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
| | - E Falvey
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- College of Medicine & Health, University College Cork, Cork,
Ireland
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Nicoletti D, Magdo C, Schmidt J. Comment in response to "The critical adenosine triphosphate (ATP) concentration in treated ballast water" by L. Peperzak (2023). Mar Pollut Bull 2023; 197:115687. [PMID: 37924733 DOI: 10.1016/j.marpolbul.2023.115687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Affiliation(s)
- D Nicoletti
- LuminUltra Technologies Ltd., Fredericton, Canada.
| | - C Magdo
- LuminUltra Technologies Ltd., Fredericton, Canada
| | - J Schmidt
- LuminUltra Technologies Ltd., Fredericton, Canada
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Boulu X, Vaysse B, El Esper I, Meyer ME, Duhaut P, Salle V, Schmidt J. [Inflammatory syndrome of unknown origin and PET/CT: Economic and iatrogenic impacts of false positive]. Rev Med Interne 2023:S0248-8663(23)01275-4. [PMID: 38000918 DOI: 10.1016/j.revmed.2023.11.009] [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: 08/01/2023] [Revised: 10/23/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION PET/CT is regularly used to investigate inflammatory syndrome of unknown origin (IUO), but hypermetabolisms found are not always consistent with the final diagnosis. The objective of the study was to assess the cost attributed to the diagnostic work-up for these false positives. MATERIALS AND METHODS We conducted an ancillary study on a previous retrospective cohort from the internal medicine department at Amiens university hospital in patients who had a PET/CT scan between October 2004 and April 2017. Patients were included if PET/CT had been prescribed to investigate IUO. Among the 763 PET/CT performed, 144 met the inclusion criteria and a false-positive rate of 17.4% (n=25) was reported. RESULTS Among these 25 patients, 21 underwent further investigations. The most frequently found hypermetabolic territories were digestive (n=12, mean SUVmax 8 [±4.33]) and osteoarticular (n=11, mean SUVmax 4.33 [±1.15]). The total cost of the 13 prescribed consultations was €390, the total cost of the 40 additional tests was €4,476 (mainly digestive endoscopies and radiological tests) and the total cost of medical transport was €572. The total cost of the 35 days of hospitalization specifically required to investigate these false positives was €22,952. In 23.8% (n=5), these investigations led to the incidental discovery of tumor lesions. CONCLUSION The economic impact of false-positive PET/CT results does not appear to be negligible and merits a genuine prospective medico-economic study.
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Affiliation(s)
- X Boulu
- Médecine interne, CHU Amiens Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens Picardie, 80054 Amiens, France.
| | - B Vaysse
- Département d'information médicale, CHU Amiens Picardie, 80054 Amiens, France
| | - I El Esper
- Médecine nucléaire et traitement de l'image, CHU Amiens Picardie, 80054 Amiens, France
| | - M-E Meyer
- Médecine nucléaire et traitement de l'image, CHU Amiens Picardie, 80054 Amiens, France
| | - P Duhaut
- Médecine interne, CHU Amiens Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens Picardie, 80054 Amiens, France
| | - V Salle
- Médecine interne, CHU Amiens Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens Picardie, 80054 Amiens, France
| | - J Schmidt
- Médecine interne, CHU Amiens Picardie, 80054 Amiens, France; RECIF Amiens, CHU Amiens Picardie, 80054 Amiens, France
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Weiss M, Holzer MT, Muehlensiepen F, Ignatyev Y, Fiehn C, Bauhammer J, Schmidt J, Schlüter S, Dihkan A, Scheibner D, Schneider U, Valor-Mendez L, Corte G, Gupta L, Chinoy H, Lundberg I, Cavagna L, Distler JHW, Schett G, Knitza J. Healthcare utilization and unmet needs of patients with antisynthetase syndrome: An international patient survey. Rheumatol Int 2023; 43:1925-1934. [PMID: 37452880 PMCID: PMC10435645 DOI: 10.1007/s00296-023-05372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Antisynthease syndrome (ASSD) is a rare, complex and understudied autoimmune disease. Internet-based studies can overcome barriers of traditional on-site research and are therefore very appealing for rare diseases. The aim of this study was to investigate patient-reported symptoms, diagnostic delay, symptoms, medical care, health status, working status, disease knowledge and willingness to participate in research of ASSD patients by conducting an international web-based survey. The multilingual questionnaire was created by an international group of rheumatologists and patients and distributed online. 236 participants from 22 countries completed the survey. 184/236 (78.0%) were female, mean age (SD) was 49.6 years (11.3) and most common antisynthetase antibody was Jo-1 (169/236, 71.6%). 79/236 (33.5%) reported to work full-time. Median diagnostic delay was one year. The most common symptom at disease onset was fatigue 159/236 (67.4%), followed by myalgia 130/236 (55.1%). The complete triad of myositis, arthritis and lung involvement verified by a clinician was present in 42/236 (17.8%) at disease onset and in 88/236 (37.3%) during the disease course. 36/236 (15.3%) reported to have been diagnosed with fibromyalgia and 40/236 (16.3%) with depression. The most reported immunosuppressive treatments were oral corticosteroids 179/236 (75.9%), followed by rituximab 85/236 (36.0%). 73/236 (30.9%) had received physiotherapy treatment. 71/236 (30.1%) reported to know useful online information sources related to ASSD. 223/236 (94.5%) were willing to share health data for research purposes once a year. Our results reiterate that internet-based research is invaluable for cooperating with patients to foster knowledge in rare diseases.
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Affiliation(s)
- M Weiss
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
| | - M T Holzer
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - F Muehlensiepen
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Y Ignatyev
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - C Fiehn
- Praxis für Rheumatologie, Klinische Immunologie, Medical Center, Baden-Baden, Germany
| | - J Bauhammer
- Praxis für Rheumatologie, Klinische Immunologie, Medical Center, Baden-Baden, Germany
| | - J Schmidt
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology and Pain Treatment, Center for Translational Medicine, Neuromuscular Center, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology, Neuromuscular Center, University Medical Center, Göttingen, Germany
| | - S Schlüter
- Myositis-Gruppe, Deutsche Gesellschaft Für Muskelkranke, Freiburg, Germany
| | - A Dihkan
- The Swedish Working Group for Myositis, The Swedish Rheumatism Association, Stockholm, Sweden
| | - D Scheibner
- Myositis-Gruppe, Deutsche Gesellschaft Für Muskelkranke, Freiburg, Germany
| | - U Schneider
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Valor-Mendez
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
| | - G Corte
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
| | - L Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - H Chinoy
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - I Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - L Cavagna
- Rheumatology Division, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - J H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
| | - G Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
| | - J Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University, Erlangen, Germany
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Couturaud F, Mahé I, Schmidt J, Gleize JC, Lafon T, Saighi A, Sedjelmaci F, Bertoletti L, Mismetti P. Adult breast, lung, pancreatic, upper and lower gastrointestinal cancer patients with hospitalized venous thromboembolism in the national French hospital discharge database. BMC Cancer 2023; 23:531. [PMID: 37301828 DOI: 10.1186/s12885-023-10877-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) and cancer are strongly associated. In France, evidence on patients with pancreatic, upper GI [gastrointestinal], lower GI, lung, or breast cancer-associated VTE and their hospital management is limited. The aims of this study were to provide data on the number of hospitalized VTE events among cancer patients, the patients' characteristics, and their hospital management to estimate the burden of disease and the hospital burden of cancer-related VTE and to provide guidance on research. METHODS This longitudinal, observational, and retrospective study was based on the comprehensive hospital discharge database (PMSI). Adult patients (≥ 18 years old) hospitalized with a cancer of interest in 2016 and hospitalized (within 2 years with VTE (captured a as a principal, related, or significant associated diagnosis) were included in the study. RESULTS We identified 340,946 cancer patients, of which 7.2% (24,433 patients) were hospitalized with VTE. The proportions of hospitalized VTE were 14.6% (3,237) for patients with pancreatic cancer, 11.2% (8,339) for lung cancer, 9.9% (2,232) for upper GI cancer, 6.7% (7,011) for lower GI cancer, and 3.1% (3,614) for breast cancer. Around two thirds of cancer patients with a hospitalized VTE had active cancer (with metastases and/or receiving chemotherapy during the six months prior to the index date): from 62% of patients with pancreatic cancer to 72% with breast cancer. Around a third of patients were admitted to the hospital through the emergency room, up to 3% of patients stayed in an intensive care unit. The average length of stay ranged from 10 (breast cancer) to 15 days (upper GI cancer). Nine (lower GI cancer) to 18% (pancreatic cancer) of patients died during the VTE hospital stay. CONCLUSIONS The burden of cancer-associated VTE is substantial, both in terms of the number of patients affected and in the hospital use. These findings offer guidance on future research on VTE prophylaxis in a very high-risk population, particularly in patients with active cancer.
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Affiliation(s)
- F Couturaud
- Univ Brest, INSERM U1304-GETBO, Département de médecine interne et pneumologie, CHU Brest, Brest, France.
- FCRIN INNOVTE, Saint-Etienne, France.
| | - I Mahé
- FCRIN INNOVTE, Saint-Etienne, France
- Université de Paris, APHP, Hôpital Louis Mourier, Service de Médecine Interne, Colombes, France
- Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - J Schmidt
- FCRIN INNOVTE, Saint-Etienne, France
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | - L Bertoletti
- FCRIN INNOVTE, Saint-Etienne, France
- Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - P Mismetti
- FCRIN INNOVTE, Saint-Etienne, France
- Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France
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Komuczki D, Hesse N, Schmidt J, Satzer P. A step closer to continuous buffer preparation from solids: Predicting powder compaction and how to prevent it. N Biotechnol 2023; 76:98-105. [PMID: 37230177 DOI: 10.1016/j.nbt.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
The preparation of buffer solutions used in the biopharmaceutical industry is typically performed manually by the addition of one or multiple buffering reagents to water. Recently, the adaptation of powder feeders for continuous solid feeding was demonstrated for continuous buffer preparation. However, the intrinsic characteristics of powders can change the stability of the process, due to the hygroscopic nature of some substances and humidity induced caking and compaction behavior, but there is no simple and easy methodology available predicting this behavior for buffer species. To predict which buffering reagents are suitable without special precautions and investigate their behavior, force displacement measurements were conducted with a customized rheometer over 18hours. While most of the eight investigated buffering reagents indicated uniform compaction, especially sodium acetate and dipotassium hydrogen phosphate (K2HPO4) showed a significant increase in yield stress after 2hours. Experiments conducted with a 3D printed miniaturized screw conveyor confirmed the increased yield stress measurement by visible compaction and failure of the feeding. By taking additional precautions and adjusting the design of the hopper, we demonstrated a highly linear profile of all buffering reagents over a duration of 12 and 24hours. We showed that force displacement measurements accurately predict the behavior of buffer components in continuous feeding devices for continuous buffer preparation and are a valuable tool to identify buffer components that need special precautions. Stable, precise feeding of all tested buffer components was demonstrated, showing the importance of identifying buffers that need a specialized setup with a fast methodology.
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Affiliation(s)
- D Komuczki
- Institute of Bioprocess Engineering and Sciences (IBSE), University of Natural Resources and Life Sciences, Vienna, Austria.
| | - N Hesse
- Institute of Particle Technology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - J Schmidt
- Institute of Particle Technology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - P Satzer
- Institute of Bioprocess Engineering and Sciences (IBSE), University of Natural Resources and Life Sciences, Vienna, Austria; Austrian Centre of Industrial Biotechnology (ACIB), Vienna, Austria
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10
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Boulu X, Karam JD, Dernoncourt A, Duhaut P, Schmidt J. [Platypnea-orthodeoxia syndrome secondary to pneumonia: Two cases]. Rev Med Interne 2023; 44:143-145. [PMID: 36681524 DOI: 10.1016/j.revmed.2023.01.002] [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: 07/19/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.
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Affiliation(s)
- X Boulu
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France.
| | - J D Karam
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - A Dernoncourt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - P Duhaut
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - J Schmidt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
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11
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Traoré NE, Uttinger MJ, Cardenas Lopez P, Drobek D, Gromotka L, Schmidt J, Walter J, Apeleo Zubiri B, Spiecker E, Peukert W. Green room temperature synthesis of silver-gold alloy nanoparticles. Nanoscale Adv 2023; 5:1450-1464. [PMID: 36866254 PMCID: PMC9972530 DOI: 10.1039/d2na00793b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Metallic alloy nanoparticles (NPs) exhibit interesting optical, electrical and catalytic properties, dependent on their size, shape and composition. In particular, silver-gold alloy NPs are widely applied as model systems to better understand the syntheses and formation (kinetics) of alloy NPs, as the two elements are fully miscible. Our study targets product design via environmentally friendly synthesis conditions. We use dextran as the reducing and stabilizing agent for the synthesis of homogeneous silver-gold alloy NPs at room temperature. Our approach is a one-pot, low temperature, reaction-controlled, green and scalable synthesis route of well-controlled composition and narrow particle size distribution. The composition over a broad range of molar gold contents is confirmed by scanning transmission electron microscopy-energy-dispersive X-ray spectroscopy (STEM-EDX) measurements and auxiliary inductively coupled plasma-optical emission spectroscopy measurements (ICP-OES). The distributions of the resulting particles in size and composition are obtained from multi-wavelength analytical ultracentrifugation using the optical back coupling method and further confirmed by high-pressure liquid chromatography. Finally, we provide insight into the reaction kinetics during the synthesis, discuss the reaction mechanism and demonstrate possibilities for scale-up by a factor of more than 250 by increasing the reactor volume and NP concentration.
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Affiliation(s)
- N E Traoré
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - M J Uttinger
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - P Cardenas Lopez
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - D Drobek
- Institute of Micro- and Nanostructure Research (IMN), Center for Nanoanalysis and Electron Microscopy (CENEM), Interdisciplinary Center for Nanostructured Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 3 91058 Erlangen Germany
| | - L Gromotka
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - J Schmidt
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - J Walter
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
| | - B Apeleo Zubiri
- Institute of Micro- and Nanostructure Research (IMN), Center for Nanoanalysis and Electron Microscopy (CENEM), Interdisciplinary Center for Nanostructured Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 3 91058 Erlangen Germany
| | - E Spiecker
- Institute of Micro- and Nanostructure Research (IMN), Center for Nanoanalysis and Electron Microscopy (CENEM), Interdisciplinary Center for Nanostructured Films (IZNF), Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 3 91058 Erlangen Germany
| | - W Peukert
- Institute of Particle Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg Cauerstraße 4 91058 Erlangen Germany
- Interdisciplinary Center for Functional Particle Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg Haberstraße 9a 91058 Erlangen Germany
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12
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Affiliation(s)
- Truman J Milling
- Seton Dell Medical School Stroke Institute, Dell Medical School, University of Texas at Austin (T.J.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Nijmegenthe Netherlands (S.M.)
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Bruce Koch
- Alexion, AstraZeneca Rare Disease, BostonMA (B.K.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AlbertaCanada (A.D.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, University of Leuven, Belgium (P.V.)
| | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, University Hospital Dresden, Germany (J.B-W.)
| | | | - Jose Lopez-Sendon
- Instituto de Investigación Hospital Universitario, La PazMadridSpain (J. L-S.)
| | - Mark Crowther
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (M. Coppens)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, France (J.S.)
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
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Kandalaft L, Fritah H, Graciotti M, Chiang C, Petremand R, Guillaume P, Schmidt J, Stevenson B, Gfeller D, Harari A. 182P Cancer vaccines based on whole-tumor-lysate or neoepitopes with validated HLA-binding outperform those with predicted HLA-binding affinity. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100294] [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: 12/13/2022]
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14
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Zaouzaou L, Constans J, Brochot E, Bourgeois A, Dernoncourt A, Morain M, Boulu X, Karam J, Duhaut P, Schmidt J, Salle V. Troubles mnésiques persistants post-COVID-19 : intérêt de la recherche des anti-SARS-CoV-2 dans le LCR couplée à la spectro-IRM cérébrale ? Rev Med Interne 2022. [PMCID: PMC9724766 DOI: 10.1016/j.revmed.2022.10.377] [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: 12/12/2022]
Abstract
Introduction La maladie post-COVID-19 se développe quelle que soit la gravité de l’infection à SARS-CoV-2 initiale et comporte un large éventail de manifestations cliniques parmi lesquelles figurent de nombreux troubles neurologiques tels que les céphalées, l’anosmie, des troubles de la mémoire…. Observation Nous rapportons le cas d’une patiente âgée de 68 ans adressée en consultation de médecine interne pour asthénie, troubles de la concentration et de la mémoire dans les suites d’une infection à SARS-CoV-2. Ses antécédents sont marqués par une HTA, un asthme, une thrombose veineuse profonde, une cholécystectomie, un œdème de Quincke avec choc anaphylactique aux AINS et une hypogammaglobulinémie modérée. On note une absence d’intoxication alcoolo-tabagique. La patiente a présenté en janvier 2021 une infection à SARS-CoV-2 avec fièvre et céphalées. La recherche de virus par PCR était négative lors de cet épisode avec secondairement une sérologie positive confirmant l’infection. Progressivement sont apparus des troubles de la mémoire et de la concentration. Son MMS était à 27/30. L’IRM cérébrale en juin 2021 montrait de multiples hypersignaux de la substance blanche. Un bilan a été réalisé en hôpital de jour avec réalisation d’une ponction lombaire. Le LCR retrouvait l’absence de leucocytes (< 1 élément/mm3), des hématies à 24 éléments/mm3 et une protéinorachie à 0,45 g/L. Les anticorps anti-rNMDA, anti-CASPR2, anti-rGABAb, anti-DPPX, anti-LGI1 et anti-AMPAr dans le LCR étaient négatifs. Absence de bande surnuméraire à l’isofocalisation. Les anticorps anti-SARS-CoV-2 dans le LCR étaient positifs à 108,7 UA/mL, la recherche de virus par PCR étant négative. Le rapport de Delpech était normal à 0,52 mais n’excluant pas une synthèse intrathécale d’IgG. Par ailleurs, l’index albumine LCR/albumine sérum était normal. Une polysomnographie ne retrouvait pas de syndrome d’apnées du sommeil. Une spectroscopie par IRM cérébrale en mai 2022 a mis en évidence une réaction gliale ainsi qu’une dysfonction neuronale au niveau de l’hippocampe et de la protubérance. Discussion Les séquelles neuropsychologiques post-COVID-19 témoignent d’une neuro-inflammation liée à l’activation de la microglie et à une réaction auto-immune [1]. La persistance de troubles cognitifs associée à la présence d’anticorps anti-SARS-CoV-2 dans le LCR 6 mois après COVID-19 a été rapportée chez une patiente de 57 ans [2]. Dans notre observation, la présence de ces anticorps peut témoigner d’une neuro-inflammation constatée sur la spectroscopie par IRM cérébrale. Une exploration biologique plus approfondie du LCR ainsi qu’une exploration par spectroscopie par IRM cérébrale pourraient être suggérées chez les patients présentant des troubles cognitifs plusieurs mois après une infection à SARS-CoV-2. Conclusion D’autres études seront nécessaires afin de mieux définir la place de la recherche des anticorps anti-SARS-CoV-2 dans le LCR chez les patients ayant des séquelles neurologiques majeures liées au COVID-19.
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Affiliation(s)
- L. Zaouzaou
- Médecine interne et recif, CHU Amiens, Amiens cedex,Auteur correspondant
| | | | - E. Brochot
- Virologie, CHU Amiens-Picardie Sud, Amiens
| | | | | | - M. Morain
- Médecine interne et recif, CHU Amiens, Amiens cedex
| | - X. Boulu
- Médecine interne et recif, CHU Amiens, Amiens cedex
| | - J.D. Karam
- Médecine interne et recif, CHU Amiens, Amiens cedex
| | - P. Duhaut
- Médecine interne et recif, CHU Amiens, Amiens cedex
| | - J. Schmidt
- Médecine interne et recif, CHU Amiens, Amiens cedex
| | - V. Salle
- Médecine interne et recif, CHU Amiens, Amiens cedex
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Bobisse S, Navarro Rodrigo B, Ngo QA, Chiffelle J, Genolet R, Michel A, Saugy D, Sauvage C, Tarussio D, Arnaud M, Guillaume P, Stevenson B, Bassani-Sternberg M, Tissot S, Rusakiewicz S, Schmidt J, Dangaj D, Kandalaft L, Coukos G, Harari A. 42P Tumor-reactive CD8+ T cells in ovarian and colon cancer in tumors and cell products. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100147] [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: 12/13/2022]
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Zaouzaou L, Schmidt J, Duhaut P, Ammarguellat H, Boulu X. Rechute tumorale atypique révélée par une insuffisance surrénalienne et corticotrope. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.308] [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: 12/12/2022]
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17
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Loiseau P, Morain M, Dernoncourt A, Boulu X, Rogemond V, Millot M, Schmidt J, Duhaut P, Karam J. Astrocytopathie auto-immune à anti-GFAP : une cause rare de méningo-myélite ! Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.220] [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: 12/12/2022]
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18
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Boulu X, Timmerman M, Schmidt J, Duhaut P. Syndrome inflammatoire inexpliqué révélant une thyroïdite de De Quervain : à propos de 2 cas. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.279] [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: 12/12/2022]
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Steel N, BauerStaeb C, Ford J, Gillam T, Schmidt J, Hughes AS. Changing life expectancy in Europe 1990-2019: Global Burden of Disease Study 2019. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Improvements in life expectancy have slowed in high income countries, with uncertain causes. We assessed the contribution of different causes of death to changes in life expectancy, and changes in population exposure to major risk factors in 16 European Economic Area countries plus the 4 nations of the United Kingdom from 1990-2013 and 2013-2019, using the Global Burden of Disease Study. After decades of steady improvements in life expectancy, all countries experienced smaller annual improvements after 2013. Norway experienced the smallest mean annual rate of change in improvement from pre 2013 to post 2013 of 0.03 years, and Northern Ireland (followed closely by Scotland and England) experienced the largest annual reduction from pre to post 2013 of 0.25 years. The cause of death responsible for the largest reductions in life expectancy improvements after 2013 was cardiovascular disease, followed by neoplasms. The largest reductions in deaths from cardiovascular disease were attributable to seven major risk factors: high LDL cholesterol, tobacco, dietary risks, high fasting plasma glucose, high systolic blood pressure, high body mass index, and low physical activity. The risk factors for deaths from neoplasm were similar. Exposure to tobacco remains a high risk but exposure declined steadily. Exposure to the other risks generally worsened after 2013, particularly for BMI and high fasting plasma glucose. The European countries that had better maintained reductions in deaths from cardiovascular disease and neoplasms also experienced larger improvements in life expectancy. These changes were underpinned by changing exposure to major risks. Policy responses to the slowdown in life expectancy improvements should include reducing population exposure to major risks, including the broader risks from diet and low physical activity, through prevention and addressing the broad social and commercial determinants of health as well as adequate funding for health services.
Key messages
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Affiliation(s)
- N Steel
- University of East Anglia, Norwich Medical School , Norwich, UK
| | - C BauerStaeb
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
| | - J Ford
- Primary Care Unit, University of Cambridge , Cambridge, UK
| | - T Gillam
- University of East Anglia, Norwich Medical School , Norwich, UK
| | - J Schmidt
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
| | - AS Hughes
- Office for Health Improvement and Disparaties, Department of Health and Social Care , London, UK
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Lemmer D, Schmidt J, Kummer K, Lemmer B, Wrede A, Seitz C, Balcarek P, Schwarze K, Müller GA, Patschan D, Patschan S. Impairment of muscular endothelial cell regeneration in dermatomyositis. Front Neurol 2022; 13:952699. [PMID: 36330424 PMCID: PMC9623165 DOI: 10.3389/fneur.2022.952699] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background and aim Inflammatory myopathies are heterogeneous in terms of etiology, (immuno)pathology, and clinical findings. Endothelial cell injury, as it occurs in DM, is a common feature of numerous inflammatory and non-inflammatory vascular diseases. Vascular regeneration is mediated by both local and blood-derived mechanisms, such as the mobilization and activation of so-called proangiogenic cells (PACs) or early endothelial progenitor cells (eEPCs). The current study aimed to evaluate parameters of eEPC integrity in dermatomyositis (DM), compared to necrotizing myopathy (NM) and to non-myopathic controls. Methods Blood samples from DM and NM patients were compared to non-myositis controls and analyzed for the following parameters: circulating CD133+/VEGFR-2+ cells, number of colony-forming unit endothelial cells (CFU-ECs), concentrations of angiopoietin 1, vascular endothelial growth factor (VEGF), and CXCL-16. Muscle biopsies from DM and NM subjects underwent immunofluorescence analysis for CXCR6, nestin, and CD31 (PECAM-1). Finally, myotubes, derived from healthy donors, were stimulated with serum samples from DM and NM patients, subsequently followed by RT-PCR for the following candidates: IL-1β, IL-6, nestin, and CD31. Results Seventeen (17) DM patients, 7 NM patients, and 40 non-myositis controls were included. CD133+/VEGFR-2+ cells did not differ between the groups. Both DM and NM patients showed lower CFU-ECs than controls. In DM, intramuscular CD31 abundances were significantly reduced, which indicated vascular rarefaction. Muscular CXCR6 was elevated in both diseases. Circulating CXCL-16 was higher in DM and NM in contrast, compared to controls. Serum from patients with DM but not NM induced a profound upregulation of mRNS expression of CD31 and IL-6 in cultured myotubes. Conclusion Our study demonstrates the loss of intramuscular microvessels in DM, accompanied by endothelial activation in DM and NM. Vascular regeneration was impaired in DM and NM. The findings suggest a role for inflammation-associated vascular damage in the pathogenesis of DM.
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Affiliation(s)
- D. Lemmer
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Immanuel Krankenhaus Berlin, Medical Center of Rheumatology Berlin-Buch, Berlin, Germany
| | - J. Schmidt
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - K. Kummer
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany
| | - B. Lemmer
- Department of Physics, Georg-August-University Göttingen, Göttingen, Germany
| | - A. Wrede
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - C. Seitz
- Department of Dermatology, Allergology and Venereology, University Medical Center Göttingen, Göttingen, Germany
| | - P. Balcarek
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
- Arcus Klinik, Pforzheim, Germany
| | - K. Schwarze
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - G. A. Müller
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - D. Patschan
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Medicine 1, Cardiology, Angiology, and Nephrology, University Hospital Brandenburg of the Brandenburg Medical School Theodor Fontane, Branderburg, Germany
| | - S. Patschan
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Medicine 1, Cardiology, Angiology, and Nephrology, University Hospital Brandenburg of the Brandenburg Medical School Theodor Fontane, Branderburg, Germany
- *Correspondence: S. Patschan
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Schmidt J, Weisbrod M, Fritz M, Aschenbrenner S. Kognition und Kraftfahreignung bei chronischem Schmerzsyndrom. Nervenarzt 2022; 94:335-343. [PMID: 36169672 PMCID: PMC10104908 DOI: 10.1007/s00115-022-01387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
ZusammenfassungKognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.
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Affiliation(s)
- J Schmidt
- Abteilung für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad, Guttmannstr. 1, 76307, Karlsbad-Langensteinbach, Deutschland.
- Medizinische Fakultät Heidelberg der Universität Heidelberg, Heidelberg, Deutschland.
| | - M Weisbrod
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Fritz
- Abteilung für Neurologie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
| | - S Aschenbrenner
- Abteilung für Klinische Psychologie und Neuropsychologie, SRH Klinikum Karlsbad, Guttmannstr. 1, 76307, Karlsbad-Langensteinbach, Deutschland
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad, Karlsbad-Langensteinbach, Deutschland
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Schmidt N, Denecke J, Schmidt J, Davies M, Heidermann T. Large scale experimental investigation on storage tank breathing during sudden cold heavy rain event. J Loss Prev Process Ind 2022. [DOI: 10.1016/j.jlp.2022.104825] [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: 10/17/2022]
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Schmidt J, Pisarczyk K, Leff R, Palaniswamy K, Park E, Long L. AB1279 POOR QUALITY OF LIFE AND REDUCED WORK PRODUCTIVITY IN EUROPEAN PATIENTS WITH DERMATOMYOSITIS AND POLYMYOSITIS: FINDINGS FROM A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDermatomyositis (DM) and polymyositis (PM) are rare heterogenous systemic autoimmune disorders of the skin, muscles, and other organs with few effective treatment options available. They are described as devastating diseases but the full impact on patients’ lives in Europe is not well understood.ObjectivesTo systematically review and summarize evidence on humanistic burden of disease in patients with DM and PM in Europe to better understand patient-relevant aspects of disease and key domains of life impacted by DM and PM in the European setting.MethodsA systematic literature review (SLR) was conducted in MEDLINE and Embase databases to identify studies in children and adults with DM and PM, published in the English language between Jan 1, 2011, and Apr 28, 2021. Only primary studies enrolling 10 or more patients were included, irrespective of country or region. Each eligible article was independently reviewed by two reviewers. The title and study abstracts were reviewed to assess eligibility for full-text review. The topics of interest were clinical, humanistic, and economic burden of disease, as well as current management and unmet needs in DM and PM. Information on geographic scope was extracted from the papers of included studies. The current abstract summarizes SLR results on humanistic burden of DM and PM in European patients.ResultsA total of 2,967 non-duplicated publications were retrieved from medical databases and analyzed against pre-defined study selection criteria. There were 2,574 records excluded at title and abstract screening. Remaining 393 records were analyzed in the full text with 208 papers considered relevant. Additional 21 papers were identified from searching reference list of relevant studies and conference proceedings. In total, 222 studies described in 229 publications were included in data abstraction. Among 43 studies conducted across 14 European countries, 12 studies evaluated health-related quality of life (HRQoL) and work productivity in patients with DM and PM. In 6 studies, patients received standard of care therapy. Six studies enrolled adults with DM and PM and 6 were conducted in patients with juvenile onset of DM. There were 6 cross-sectional analyses, 4 longitudinal cohort studies, 2 case-control studies, with sample size ranging from 11 to 246 patients. Adults with DM and PM had significantly worse HRQoL across multiple domains of 36-Item Short Form Survey (SF-36) compared to controls from general population, with a strong negative impact of muscle weakness on physical functioning. Patients reported high difficulties in performing leisure time activities, moving around and work as indicated by median scores of 4-5 points in a 7-point Myositis Activity Profile (MAP). Reduced grip force in DM and PM adults was significantly associated with worse performance in domestic activities in the MAP assessment (p<0.05). In women with DM and PM, poor grip force additionally impacted vitality and mental health as measured by SF-36 (p<0.05). There were no associations between grip force and any SF-36 domain in men. Approximately 60% of adult patients rated their ability to work as “poor” or “less good” according to the Work Ability Index, 68% of patients had more than one week of sick leave in the past year, and 20.8% of them were permanently not able to work for at least 2 years. Children and adolescents with DM had impaired physical and psychosocial functioning compared to healthy norms with 40% of individuals showing increased emotional distress requiring in-depth psychological assessment.ConclusionEuropean patients with DM and PM experience a muscle weakness that has a detrimental impact on HRQoL, daily activities and ability to work. Similar disease impact on HRQoL was reported in patients in North America. These findings suggest a need for a novel therapy that will restore physical functioning in patients with DM and PM.Disclosure of InterestsJens Schmidt Speakers bureau: Euroimmun, CSL Behring, Consultant of: Alnylam, Argenx, Biotest, CSL Behring, Kezar Life Sciences, LFB, Novartis, Octapharma, UCB, Grant/research support from: CSL Behring, Novartis, Konrad Pisarczyk Consultant of: Kezar Life Sciences, Richard Leff Shareholder of: Kezar Life Sciences, Consultant of: Kezar Life Sciences, Kiruthi Palaniswamy Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Eunmi Park Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Li Long Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences
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Makimoto H, Gerguri S, Hartl S, Kluge S, Clasen L, Bejinariu A, Brinkmeyer C, Schmidt J, Kelm M. Wide antral circumferential re-ablation in case of recurrent atrial fibrillation despite of prior pulmonary vein isolation increases freedom from atrial tachyarrhythmias. Europace 2022. [DOI: 10.1093/europace/euac053.065] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite repeated pulmonary vein isolation (re-PVI) due to recurrent atrial fibrillation (AF) after PVI has been a standard procedure, the detailed ablation strategy in case of re-PVI remains disputable.
Objective
The aim of this study was to assess the efficacy of re-PVI using wide antral circumferential ablation (WACA) supported by high density mapping (HDM) for recurrent AF after PVI as compared to simple repeated PVI supported by circular mapping catheter.
Methods
Consecutive patients with recurrent AF after PVI were prospectively enrolled in this study, who underwent left atrial HDM and subsequently WACA antral (re-)isolation ("Re-WACA" group). The historical controls with re-PVI between 2016 and 2018 using circular mapping catheter, but without HDM were also enrolled ("control group"). These control patients underwent re-PVI with gap ablation at the pulmonary vein ostium. Primary endpoint was defined as any recurrence and ECG documentation of atrial tachyarrhythmias (AT) including AF or atrial tachycardias over 30 seconds. The patients were routinely followed up for 1 year with at least twice annual holter-monitoring.
Results
In total, 116 patients were enrolled in this study (Re-WACA group [N=56, 68±10 years], control group [N=58, 65±10 years]). There were no significant differences in clinical characteristics including the number of previous left atrial ablation procedures between two groups. In all 56 patients with Re-WACA, residual PV antral potentials were demonstrated (100%), whereas 7 patients (13%) showed no electrical potentials inside any PVs. During a mean follow-up period of 402±71 days, 6 out of 56 Re-WACA patients (11%) and 18 out of 58 controls (31%) experienced AT recurrences. Kaplan-Meier analysis demonstrated that the patients who underwent Re-WACA showed significantly lower AT recurrence after the index Re-PVI procedure as compared to the controls (log-rank, P = 0.010). Multivariate Cox regression showed that Re-WACA was an independent predictor of freedom from AT recurrence (hazard ratio = 0.39; 95% confidence-interval 0.16-0.93; P=0.034). The number of previous PVI procedures predicted AT recurrence during follow-up (hazard ratio = 2.35; 95% confidence-interval 1.20-4.46; P=0.010).
Conclusions
Residual pulmonary vein antral potential in patients with recurrent AF after previously performed PVI is a frequent finding. These antral potentials can be easily visualized by HDM. Repeated isolation of wide PV antrum (Re-WACA) is an effective strategy to reduce further AF recurrence as compared to conventional re-PVI without left atrial HDM.
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Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Hartl
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Kluge
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
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Schmidt J, Steindl A, Troger H. Flow induced instabilities of imperfect three-dimensional elastic tubes. Struct Dyn 2022. [DOI: 10.1201/9780203738085-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
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Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
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Demortier J, Vautier M, Chosidow O, Gallay L, Bessis D, Berezne A, Cordel N, Schmidt J, Smail A, Duffau P, Jachiet M, Gottlieb J, Chasset F, Guilain N, Streichenberger N, Léonard-Louis S, Authier J, Boussouar S, Benveniste O, Allenbach Y. Dermatomyosite à anticorps anti-SAE: étude descriptive et comparative à un groupe de dermatomyosites SAE-négatives. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.202] [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: 11/24/2022]
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Boulu X, Brault C, Chan Sui Ko A, Dernoncourt A, Schmidt J, Maizel J, Duhaut P. Maladie de Kawasaki de l’adulte post-COVID 19 avec insuffisance circulatoire : à propos d’un cas. Rev Med Interne 2021. [PMCID: PMC8610712 DOI: 10.1016/j.revmed.2021.10.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Le syndrome d’inflammation multisystémique associé à la COVID-19 et présentant les caractéristiques cliniques d’une maladie de Kawasaki a été essentiellement rapporté chez l’enfant. Nous rapportons ici le cas d’une maladie de Kawasaki de l’adulte dans les suites d’une infection à COVID-19, avec un pseudo choc septique comme mode de révélation. Observation Une femme de 33 ans, assistante de direction dans un collège, est admise initialement pour un rash fébrile. On notait un antécédent d’infection respiratoire non sévère documenté au SARSCoV-2 par PCR nasale cinq semaines avant. La patiente ne fumait pas. Apparition d’une fièvre en plateau à 41 °C avec adénopathies cervicales sensibles (max 1,5 cm) rapidement suivie d’un rash morbiliforme généralisé. Elle était traité en ambulatoire par l’association amoxicilline/acide clavulanique puis azithromycine, sans succès. Au 5e jour, dégradation clinique avec installation d’une insuffisance circulatoire justifiant l’introduction d’amines et d’une surveillance en réanimation. Le tableau clinique s’enrichissait d’une conjonctivite bilatérale, d’une glossite, d’un érythème palmaire, de lésions périnéales et d’une diarrhée profuse. La biologie retrouvait un syndrome inflammatoire majeur (CRP 500 mg/L, neutrophiles 37 000/mm3) avec une éosinophilie (1700/mm3) et une troponinémie à 425 ng/L. Les prélèvements infectieux étaient normaux. Le scanner thoracoabdomino-pelvien et la fibroscopie recto-sigmoïdienne n’apportaient pas plus d’information. L’échographie cardiaque rapportait une hypokinésie diffuse modeste. La probabilité d’activation lymphohistiocytaire était faible. On notait l’absence de réponse à l’antibiothérapie à large spectre. Au 9e jour, apparition d’une desquamation des extrémités après amélioration clinique partielle (sevrage des amines). Au 13e jour, le coroscanner retrouvait une dilatation anévrismale de l’artère interventriculaire antérieure de 5,6 mm. Le traitement par immunoglobulines à 2 g/kg et l’aspirine permettaient l’amélioration clinique et une normalisation des paramètres biologiques. Discussion La maladie de Kawasaki (MK) est une vascularite systémique des vaisseaux de moyen calibre, dont la prévalence chez l’adulte se limite à une centaine de case reports. L’insuffisance circulatoire aiguë est un mode de révélation rare de la maladie, appelé syndrome de choc de la maladie de Kawasaki. Elle est retrouvée dans 7 % des cas chez l’enfant et sa prévalence chez l’adulte n’est pas connue. Le syndrome inflammatoire avec atteinte multisystémique de l’enfant (MIS-C), initialement dénommé “pseudo-Kawasaki”, a été décrit très tôt après le début de l’épidémie COVID-19 et apparaît en moyenne 4 semaines après l’infection par le SARS-CoV-2. C’est une pathologie rare avec une prévalence en France en 2020 chez les moins de 21 ans de 15,4 cas/million d’habitant. La moitié des patients présente une insuffisance circulatoire aiguë au diagnostic [1]. Il existe des critères diagnostiques du MIS-C selon l’OMS, mais pas chez l’adulte de plus de 21 ans. En comparaison avec la forme classique, les patients atteints de MIS-C semblent plus âgés, avec d’avantage d’atteinte cardiaque, d’insuffisance circulatoire, de signes fonctionnels digestifs, résistent plus aux immunoglobulines et justifient davantage d’une corticothérapie [2]. Les diagnostics différentiels à évoquer sont généralement le syndrome de choc toxique ou le syndrome d’activation lymphohistiocytaire. Une sidération myocardique dans un contexte hyperinflammatoire est l’une des hypothèses physiopathologiques de l’insuffisance circulatoire (dysfonctionsystolique et/ou diastolique sans myocardite, corrélation de l’état de choc avec l’élévation des marqueurs de l’inflammation et des marqueurs cardiaques). La plupart des patients répondent correctement à l’association immunoglobulines corticothérapie. Dans notre cas, la patiente satisfaisait les critères de classification de l’American Heart Association pour la MK avec une évolution coronarienne caractéristique et avait un antécédent documenté à SARS-COV-2 cinq semaines auparavant. Conclusion La forme adulte du syndrome d’inflammation multisystémique associée à la COVID19 est rare mais semble grave, avec l’insuffisance circulatoire comme mode d’entrée et les anévrismes coronariens comme complications, tout comme la MK classique.
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Chan Sui Ko A, Pater F, Metzelard M, Smail A, Adjodah C, Schmidt J. Des lésions cutanées à rendre marteau ! Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.095] [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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Delbarre M, Girardon F, Blanc-Durand P, Hubaut M, Roquette L, Hachulla E, Semah F, Huglo D, Marchal E, El Esper I, Kharoubi M, Tribouilloy C, Lamblin N, Duhaut P, Itti E, Schmidt J, Damy T. Détection automatique des amyloses cardiaques en scintigraphie osseuse à l’aide du machine learning. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.314] [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]
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Delbarre M, Zaroui A, Annabi M, Galat A, Duhaut P, Schmidt J, Tribouilloy C, Pibarot P, Damy T. Amylose cardiaque sénile et rétrécissement aortique: l’œuf et la poule. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.315] [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]
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Roth M, Schön N, Jürgens L, Engineer D, Kirchhoff K, Guthoff R, Schmidt J. Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better? BMC Ophthalmol 2021; 21:398. [PMID: 34789189 PMCID: PMC8600723 DOI: 10.1186/s12886-021-02164-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany. METHODS AND MATERIAL This was a retrospective analysis of all patients who underwent surgery because of idiopathic MH between 2011 and 2017 in Augenklinik Tausendfensterhaus, Duisburg, Germany. Statistical evaluation of clinical and OCT-based parameters, including the areas of intraretinal pseudocysts, was conducted. The main statistical outcomes were surgical success and visual acuity. Only parameters with a highly significant correlation to the outcome parameters (postoperative visual acuity (VA); surgical success) in univariate analysis were entered in linear and logistic regression analyses. RESULTS A total of 189 eyes of 178 patients (71.4% female; mean age 67.5 ± 8.2 a) who underwent surgery because of MH were included. The overall closure rate was 86.8%. The mean best corrected VA increased from 0.7 ± 0.3 logMAR before surgery to 0.5 ± 0.3 logMAR (p < 0.0001). While several clinical and OCT-based parameters as well as calculated indices showed a significant correlation with the outcome measures, the regression analysis showed that the minimum linear diameter was the only parameter that both predicted surgical success (p = 0.015) and was correlated with postoperative VA (p < 0.001). CONCLUSION The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis.
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Affiliation(s)
- M Roth
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - N Schön
- Augenklinik Tausendfensterhaus, Duisburg, Germany
| | - L Jürgens
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - D Engineer
- Augenklinik Tausendfensterhaus, Duisburg, Germany
| | - K Kirchhoff
- Augenklinik Tausendfensterhaus, Duisburg, Germany
| | - R Guthoff
- Department of Ophthalmology, Heinrich-Heine University Düsseldorf, Universitätsaugenklinik Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Schmidt
- Augenklinik Tausendfensterhaus, Duisburg, Germany.,Department of Ophthalmology, University Clinic Marburg, Marburg, Germany
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Vogelsberg A, Steinhilber J, Mankel B, Federmann B, Schmidt J, Montes-Mojarro IA, Hüttl K, Rodriguez-Pinilla M, Baskaran P, Nahnsen S, Piris MA, Ott G, Quintanilla-Martinez L, Bonzheim I, Fend F. [Genetic evolution of in situ follicular neoplasia to t(14;18)-positive aggressive B-cell lymphoma]. Pathologe 2021; 42:122-128. [PMID: 34671837 DOI: 10.1007/s00292-021-01011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In situ follicular neoplasia (ISFN) is a t(14;18)(q32;q21)+ precursor lesion of follicular lymphoma (FL), which in turn can transform into diffuse large B‑cell lymphoma (DLBCL). For DLBCL that arise de novo, no precursor lesion is known. Given the high frequency of the t(14;18) translocation in de novo DLBCL as well, we investigated whether they can also arise from ISFN without FL as an intermediate step. OBJECTIVES To investigate the clonal evolution of ISFN to DLBCL - transformed from FL and de novo. MATERIALS AND METHODS Identification of ISFN lesions in patients with DLBCL was performed by BCL2 staining of reactive lymphoid tissues. ISFN and DLBCL were subsequently analyzed by fluorescence in situ hybridization, clonality analyses, sequencing of the t(14;18) breakpoint, and targeted next-generation sequencing. RESULTS 10 cases with paired ISFN and DLBCL samples were identified, 6 of which were de novo DLBCL and 4 transformed from FL. 3 DLBCL carried MYC-rearrangements in addition to the t(14;18) and were classified as high-grade B‑cell lymphoma (HGBL). The clonal relationship of ISFN and DLBCL/HGBL was confirmed for all cases. CREBBP, KMT2D, EZH2, TNFRSF14, and BCL2 were the genes most frequently mutated, with the distribution of private and shared mutations pointing to 2 different scenarios of clonal evolution. In most cases, DLBCL/HGBL, ISFN, and, if also present, FL had evolved divergently from a common progenitor, whereas linear evolution was less frequent. CONCLUSION We show for the first time that t(14;18)+ DLBCL/HGBL can arise directly from ISFN without FL as an intermediate step and that during this progression, divergent evolution is common.
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Affiliation(s)
- A Vogelsberg
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland.
| | - J Steinhilber
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Mankel
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Federmann
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Schmidt
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - I A Montes-Mojarro
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - K Hüttl
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus und Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Deutschland
| | | | - P Baskaran
- Zentrum für Quantitative Biologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - S Nahnsen
- Zentrum für Quantitative Biologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - M A Piris
- Abteilung für Pathologie, Fundación Jiménez Díaz, Madrid, Spanien
| | - G Ott
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus und Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Deutschland
| | - L Quintanilla-Martinez
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - I Bonzheim
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - F Fend
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Makimoto H, Shiraga T, Kohlmann B, Magnisali CE, Schenk R, Gerguri S, Motoyama N, Clasen L, Bejinariu A, Schmidt J, Brinkmeyer C, Westenfeld R, Zeus T, Kelm M. On-device artificial intelligence: mobile solution for detecting severe aortic valve stenosis based on heart sounds. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis is still one of the major causes of sudden cardiac death in the elderly. Noninvasive screening for severe aortic valve stenosis (AS) may result in early cardiac diagnostic leading to an appropriate and timely medical intervention.
Purpose
The aims of this study were 1) to develop an artificial intelligence to detect severe AS based on heart sounds and 2) to build an application to screen patients using electronic stethoscope and smartphones, which will provide an efficient diagnostic workflow for screening as a complementary tool in daily clinical practice.
Methods
We enrolled 100 patients diagnosed with severe AS and 200 patients without severe AS (no echocardiographic sign of AS [n=100], mild AS [n=50], moderate AS [n=50]). The heart sounds were recorded in 4000 Hz waveform audio format at the following 3 sites of each patient; the 2nd intercostal right sternal border, the Erb's area and the apex. Each record was divided into multiple data of 4 seconds duration, which built 10800 sound records in total. We developed multiple convolutional neural networks (CNN) designed to recognize severe AS in heart sounds according to the recorded 3 sites. We adopted a stratified 4-fold cross-validation method by which the CNN was trained with 60% of the whole data, validated with 20% data and tested with the remaining 20% data not used during training and validation. As performance metrics we adopted the accuracy, F1 value and the area under the curve (AUC) calculated as the average of all cross-validation folds.
For the smartphone application, we combined the best CNN-models from each recorded site for the best performance. Further 40 patients were newly enrolled for its clinical validation (no AS [n=10], mild AS [n=10], moderate AS [n=10], severe AS [n=10]).
Results
The accuracy, F1 value and AUC of each model were 88.9±5.7%, 0.888±0.006 and 0.953±0.008, respectively. The sensitivity and specificity were 87.9±2.2% and 89.9±2.4%. The recognition accuracy of moderate AS was significantly lower as compared to the other AS grades (moderate AS 74.1±6.1% vs no AS 98.0±1.4%, mild AS 97.6±1.2%, severe AS 87.9±2.2%, respectively, P<0.05).
Our smartphone application showed a sensitivity of 100% (10/10), a specificity of 73.3% (22/30), and an accuracy of 80.0% (32/40), which implicated a good utility for screening. In the detailed analysis of 8 mistaken decisions, these were highly affected by the presence of severe mitral or tricuspid valve regurgitation despite of non-severe AS (7/8 [87.5%]).
Conclusions
This study demonstrated the promising possibility of an end-to-end screening for severe aortic valve stenosis using an electronic stethoscope and a smartphone application. This technology may improve the efficacy of daily medicine particularly where the human resource is limited or support a remote medical consultation. Further investigations are necessary to increase accuracy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Shiraga
- Mitsubishi Electric Inc., Kamakura, Japan
| | - B Kohlmann
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C.-E Magnisali
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Schenk
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - N Motoyama
- Mitsubishi Electric Inc., Kamakura, Japan
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Westenfeld
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Zeus
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, CARID, Dusseldorf, Germany
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Schnittke N, Schmidt J, Resop D, Neasi E, Damewood S. 379 Reliability of Cardiopulmonary Ultrasound Interpretation During Resuscitation of Patients With Suspected Septic Shock. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.394] [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]
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Mose M, Brodersen K, Rittig N, Schmidt J, Jessen N, Mikkelsen UR, Jørgensen JOL, Møller N. Anabolic effects of oral leucine-rich protein with and without β-hydroxybutyrate on muscle protein metabolism in a novel clinical model of systemic inflammation-a randomized crossover trial. Am J Clin Nutr 2021; 114:1159-1172. [PMID: 34081111 DOI: 10.1093/ajcn/nqab148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/09/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND β-lactoglobulin (BLG) stimulates muscle protein synthesis and β-hydroxybutyrate (BHB) inhibits muscle breakdown. Whether combining the 2 can additively attenuate disease-induced muscle loss is unknown. OBJECTIVE Based on previous observations of anticatabolic effects of protein and ketone bodies during inflammation, and using a novel model combining ongoing systemic inflammation, fasting, and immobilization, we tested whether the anticatabolic muscle response to oral amino acids is altered compared with control conditions, as well as whether coadministration of oral BHB and BLG further improves the muscle anabolic response. Muscle net balance (NBphe) was the primary outcome and intramyocellular signals were assessed. METHODS In a randomized crossover design, 8 young men underwent either preconditioning with LPS (prestudy day: 1 ng/kg, study day: 0.5 ng/kg) combined with a 36-h fast and bed rest to mimic catabolic inflammatory disease (CAT) or an overnight fast (control [CTR]) prior to isocaloric nutritional interventions on 3 occasions separated by ∼6 wk (range 42 to 83 d). RESULTS NBphe increased similarly upon all conditions (interaction P = 0.65). From comparable baseline rates, both Rdphe [muscle synthesis, median ratio (95% CI): 0.44 (0.23, 0.86) P = 0.017] and Raphe [muscle breakdown, median ratio (95% CI): 0.46 (0.27, 0.78) P = 0.005] decreased following BHB + BLG compared with BLG. BLG increased Rdphe more under CAT conditions compared with CTR (interaction P = 0.02). CAT increased inflammation, energy expenditure, and lipid oxidation and decreased Rdphe and anabolic signaling [mammalian target of rapamycin (mTOR) and eukaryotic translation initiation factor 4E-binding protein 1 (4EPB1) phosphorylation]. CONCLUSION In contrast to our initial hypothesis, NBphe increased similarly following BLG during CAT and CTR conditions; CAT however, specifically stimulated the BLG-mediated increase in protein synthesis, whereas BHB coadministration did not affect NBphe, but distinctly dampened the BLG-induced increase in muscle amino acid fluxes thereby liberating circulating amino acids for anabolic actions elsewhere.
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Affiliation(s)
- M Mose
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - K Brodersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - N Rittig
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - J Schmidt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - N Jessen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - J O L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - N Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Salle V, Gomila C, Picard C, Brulé A, Becquet N, Fuzellier D, Cailly A, Quignion D, Rose-Robert F, Schmidt J, Voyer A, Herpe Y, Galmiche A, Duhaut P. Étude prospective de prévalence des anticorps antiphospholipides conventionnels dans une population de sujets sains. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.274] [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: 10/21/2022]
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Serpier M, Boulu X, Gagneur O, Bodeau S, Schmidt J, Dernoncourt A. Tableau de fibromyalgie secondaire à l’implant Essure® : un possible intérêt des dosages urinaires de métaux lourds. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.096] [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: 10/21/2022]
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Metzelard M, Ullmer A, Schmidt J, Salle V, Smail A, Brault C, Duhaut P. Indice de masse corporelle syndrome inflammatoire et maladies autoimmunes. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.270] [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: 11/24/2022]
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40
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Chen C, Ridgeway J, Bocell F, Tanenbaum M, Hood K, Behnken E, Schmidt J, Hanes S, Saha A, Caldwell B, Tarver M, Peiris V, Almond C, Johnson J. Qualitative Exploration of the Pediatric Heart Failure Experience for Development of a Patient-Reported Outcome Measure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.592] [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: 10/21/2022] Open
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Power A, Sweat K, Dykes J, Ma M, Chen S, Schmidt J, Kaufman B, Hollander S, Profita E, Rosenthal D, Chen C, Almond C. Waitlist Mortality for Children Listed for Heart Transplant in the United States: How are We Doing? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zalepugas D, Pizarro C, Kütting D, Tischler V, Schmidt J, Skowasch D. [Test Your Knowledge]. Pneumologie 2021. [PMID: 33728631 DOI: 10.1055/a-1375-5366] [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: 10/21/2022]
Affiliation(s)
- D Zalepugas
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Bonn und Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg
| | - C Pizarro
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn
| | - D Kütting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn
| | - V Tischler
- Institut für Pathologie, Universitätsklinikum Bonn
| | - J Schmidt
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Bonn und Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg
| | - D Skowasch
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn
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Dietz J, Spengler U, Müllhaupt B, Schulze Zur Wiesch J, Piecha F, Mauss S, Seegers B, Hinrichsen H, Antoni C, Wietzke-Braun P, Peiffer KH, Berger A, Matschenz K, Buggisch P, Backhus J, Zizer E, Boettler T, Neumann-Haefelin C, Semela D, Stauber R, Berg T, Berg C, Zeuzem S, Vermehren J, Sarrazin C, Giostra E, Berning M, Hampe J, De Gottardi A, Rauch A, Semmo N, Discher T, Trauth J, Fischer J, Gress M, Günther R, Heinzow H, Schmidt J, Herrmann A, Stallmach A, Hilgard G, Deterding K, Lange C, Ciesek S, Wedemeyer H, Hoffmann D, Klinker H, Schulze P, Kocheise F, Müller-Schilling M, Kodal A, Kremer A, Ganslmayer M, Siebler J, Lammert F, Rissland J, Löbermann M, Götze T, Canbay A, Lohse A, von Felden J, Jordan S, Maieron A, Moradpour D, Chave JP, Moreno C, Müller T, Muche M, Epple HJ, Port K, von Hahn T, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Rockstroh J, Schattenberg J, Sprinzl M, Galle P, Roeb E, Steckstor M, Schmiegel W, Brockmeyer N, Seufferlein T, Stremmel W, Strey B, Thimme R, Teufel A, Vogelmann R, Ebert M, Tomasiewicz K, Trautwein C, Tacke F, Koenen T, Weber T, Zachoval R, Mayerle J, Raziorrouh B, Angeli W, Beckebaum S, Doberauer C, Durmashkina E, Hackelsberger A, Erhardt A, Garrido-Lüneburg A, Gattringer H, Genné D, Gschwantler M, Gundling F, Hametner S, Schöfl R, Hartmann C, Heyer T, Hirschi C, Jussios A, Kanzler S, Kordecki N, Kraus M, Kullig U, Wollschläger S, Magenta L, Beretta-Piccoli BT, Menges M, Mohr L, Muehlenberg K, Niederau C, Paulweber B, Petrides A, Pinkernell M, Piso R, Rambach W, Reiser M, Riecken B, Rieke A, Roth J, Schelling M, Schlee P, Schneider A, Scholz D, Schott E, Schuchmann M, Schulten-Baumer U, Seelhoff A, Stich A, Stickel F, Ungemach J, Walter E, Weber A, Winzer T, Abels W, Adler M, Audebert F, Baermann C, Bästlein E, Barth R, Barthel K, Becker W, Behrends J, Benninger J, Berger F, Berzow D, Beyer T, Bierbaum M, Blaukat O, Bodtländer A, Böhm G, Börner N, Bohr U, Bokemeyer B, Bruch H, Bucholz D, Burkhard O, Busch N, Chirca C, Delker R, Diedrich J, Frank M, Diehl M, Dienethal A, Dietel P, Dikopoulos N, Dreck M, Dreher F, Drude L, Ende K, Ehrle U, Baumgartl K, Emke F, Glosemeyer R, Felten G, Hüppe D, Fischer J, Fischer U, Frederking D, Frick B, Friese G, Gantke B, Geyer P, Schwind H, Glas M, Glaunsinger T, Goebel F, Göbel U, Görlitz B, Graf R, Gruber H, Härter G, Herder M, Heuchel T, Heuer S, Höffl KH, Hörster H, Sonne JU, Hofmann W, Holst F, Hunstiger M, Hurst A, Jägel-Guedes E, John C, Jung M, Kallinowski B, Kapzan B, Kerzel W, Khaykin P, Klarhof M, Klüppelberg U, Klugewitz K, Knapp B, Knevels U, Kochsiek T, Körfer A, Köster A, Kuhn M, Langekamp A, Künzig B, Link R, Littman M, Löhr H, Lutz T, Knecht G, Lutz U, Mainz D, Mahle I, Maurer P, Mayer C, Meister V, Möller H, Heyne R, Moritzen D, Mroß M, Mundlos M, Naumann U, Nehls O, Ningel K, Oelmann A, Olejnik H, Gadow K, Pascher E, Petersen J, Philipp A, Pichler M, Polzien F, Raddant R, Riedel M, Rietzler S, Rössle M, Rufle W, Rump A, Schewe C, Hoffmann C, Schleehauf D, Schmidt K, Schmidt W, Schmidt-Heinevetter G, Schmidtler-von Fabris J, Schnaitmann E, Schneider L, Schober A, Niehaus-Hahn S, Schwenzer J, Seidel T, Seitel G, Sick C, Simon K, Stähler D, Stenschke F, Steffens H, Stein K, Steinmüller M, Sternfeld T, Strey B, Svensson K, Tacke W, Teuber G, Teubner K, Thieringer J, Tomesch A, Trappe U, Ullrich J, Urban G, Usadel S, von Lucadou A, Weinberger F, Werheid-Dobers M, Werner P, Winter T, Zehnter E, Zipf A. Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections. Clin Gastroenterol Hepatol 2021; 19:195-198.e2. [PMID: 31706062 DOI: 10.1016/j.cgh.2019.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.8 However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.
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Affiliation(s)
- Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, and German Center for Infection Research (DZIF), Partner Site, Cologne-Bonn, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Barbara Seegers
- Gastroenterologisch-Hepatologisches Zentrum Kiel, Kiel, Germany
| | | | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany
| | | | - Kai-Henrik Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Johanna Backhus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Eugen Zizer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Semela
- Division of Gastroenterology and Hepatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany; Medizinische Klinik 2, St Josefs-Hospital, Wiesbaden, Germany.
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Aubignat M, Schmidt J, Smail A, Duhaut P, Salle V. Quelle place pour la recherche des anticorps de spécificités étendues (prothrombine, phosphatidyléthanolamine et annexine V) dans le syndrome des antiphospholipides ? Étude rétrospective sur 95 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dernoncourt A, Batteux B, Schmidt J, Duhaut P, Liabeuf S, Gras-Champel V, Masmoudi K, Bennis Y. COVID-19 chez les patients atteints de rhumatismes inflammatoires chroniques et traités par DMARDs : résultats d’une étude de la base de données de pharmacovigilance de l’Organisation Mondiale de la Santé (VigiBase®). Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.037] [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: 10/22/2022]
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Abstract
BACKGROUND The term sepsis was redefined in 2016 as a life-threatening organ dysfunction caused by an inadequate host response to an infection. The German S3 guidelines for the treatment of sepsis were published in 2018. OBJECTIVE What is evidence-based in the treatment of patients with sepsis? MATERIAL AND METHODS Discussion of the S3 guidelines and inclusion of study results after 2018. RESULTS The cornerstones for the treatment of sepsis continue to consist of early hemodynamic stabilization, anti-infection treatment and organ support procedures. Supportive and extracorporeal treatments are controversially discussed and continue to be intensively investigated. CONCLUSION Despite an improved understanding of the pathophysiology, there is still no effective causal sepsis treatment, i.e. directed against the pathological host reaction. The treatment of patients with sepsis is therefore still based on the basic principles of correction of volume deficits, anti-infective agents, source control and organ support, including the symptomatic treatment of vasoplegia with catecholamines.
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Affiliation(s)
- K Stahl
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - B Seeliger
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S David
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland. .,Institut für Intensivmedizin, Universitätsspital Zürich, Rämistrasse 100, Zürich, Schweiz.
| | - J Schmidt
- Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland
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Liang WD, Xu Y, Schmidt J, Zhang LX, Ruddy KL. Upregulating excitability of corticospinal pathways in stroke patients using TMS neurofeedback; A pilot study. Neuroimage Clin 2020; 28:102465. [PMID: 33395961 PMCID: PMC7585154 DOI: 10.1016/j.nicl.2020.102465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 01/22/2023]
Abstract
Upper limb weakness following a stroke affects 80% of survivors and is a key factor in preventing their return to independence. State-of-the art approaches to rehabilitation often require that the patient can generate some activity in the paretic limb, which is not possible for many patients in the early period following stroke. Approaches that enable more patients to engage with upper limb therapy earlier are urgently needed. Motor imagery has shown promise as a potential means to maintain activity in the brain's motor network, when the patient is incapable of generating functional movement. However, as imagery is a hidden mental process, it is impossible for individuals to gauge what impact this is having upon their neural activity. Here we used a novel brain-computer interface (BCI) approach allowing patients to gain an insight into the effect of motor imagery on their brain-muscle pathways, in real-time. Seven patients 2-26 weeks post stroke were provided with neurofeedback (NF) of their corticospinal excitability measured by the size of motor evoked potentials (MEP) in response to transcranial magnetic stimulation (TMS). The aim was to train patients to use motor imagery to increase the size of MEPs, using the BCI with a computer game displaying neurofeedback. Patients training finger muscles learned to elevate MEP amplitudes above their resting baseline values for the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles. By day 3 for ADM and day 4 for FDI, MEP amplitudes were sustained above baseline in all three NF blocks. Here we have described the first clinical implementation of TMS NF in a population of sub-acute stroke patients. The results show that in the context of severe upper limb paralysis, patients are capable of using neurofeedback to elevate corticospinal excitability in the affected muscles. This may provide a new training modality for early intervention following stroke.
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Affiliation(s)
- W D Liang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Y Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - J Schmidt
- Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland
| | - L X Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - K L Ruddy
- Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland.
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Kuttab H, Damewood S, Li Z, Schmidt J, Schnittke N. 120 Cardiopulmonary Ultrasound in Sepsis: A Pilot Study. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Klapdor R, Kruppa M, Kleine M, Imkamp F, Schmidt J, Hertel H, Hillemanns P. Das SOCIUS-Mentoring Programm – Next-Level Förderung des gynäkologisch-onkologischen Nachwuchses. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717168] [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: 10/23/2022] Open
Affiliation(s)
- R Klapdor
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe
| | - M Kruppa
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe
| | - M Kleine
- Medizinische Hochschule Hannover, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie
| | - F Imkamp
- Medizinische Hochschule Hannover, Klinik für Urologie und Urologische Onkologie
| | - J Schmidt
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe
| | - H Hertel
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe
| | - P Hillemanns
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe
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Brebion A, Raconnat J, Gagnaire A, Mourgues C, Pereira B, Schmidt J, Henquell C. Impact du diagnostic moléculaire rapide de grippe dans le service d’Accueil des Urgences adultes (2018–2019). Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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