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Oldroyd AGS, Callen JP, Chinoy H, Chung L, Fiorentino D, Gordon P, Machado PM, McHugh N, Selva-O'Callaghan A, Schmidt J, Tansley SL, Vleugels RA, Werth VP, Aggarwal R. Author Correction: International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative. Nat Rev Rheumatol 2024; 20:315. [PMID: 38548933 DOI: 10.1038/s41584-024-01111-x] [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: 04/28/2024]
Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA
- Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro M Machado
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens 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 Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rohit Aggarwal
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Zeng R, Schlaeger S, Türk M, Baum T, Deschauer M, Janka R, Karampinos D, Kassubek J, Keller-Yamamura S, Kornblum C, Lehmann H, Lichtenstein T, Nagel AM, Reimann J, Rosenbohm A, Schlaffke L, Schmidt M, Schneider-Gold C, Schoser B, Trollmann R, Vorgerd M, Weber MA, Kirschke JS, Schmidt J. [Expert recommendations for magnetic resonance imaging of muscle disorders]. Radiologie (Heidelb) 2024:10.1007/s00117-024-01276-2. [PMID: 38639916 DOI: 10.1007/s00117-024-01276-2] [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] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.
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Affiliation(s)
- Rachel Zeng
- Klinik für Neurologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Sarah Schlaeger
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland, Ismaningerstr. 22, 81675
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, München, Deutschland
| | - Matthias Türk
- Neurologische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Zentrum für seltene Erkrankungen Erlangen (ZSEER), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Thomas Baum
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland, Ismaningerstr. 22, 81675
| | - Marcus Deschauer
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, TUM School of Medicine and Health, Technische Universität München, München, Deutschland
| | - Rolf Janka
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Dimitrios Karampinos
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Jan Kassubek
- Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Sarah Keller-Yamamura
- Klinik für Radiologie, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Cornelia Kornblum
- Klinik und Poliklinik für Neurologie, Sektion Neuromuskuläre Erkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Helmar Lehmann
- Neurologische Klinik, Klinikum Leverkusen, akademisches Lehrkrankenhaus der Universität zu Köln, Köln, Deutschland
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Thorsten Lichtenstein
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Jens Reimann
- Klinik und Poliklinik für Neurologie, Sektion Neuromuskuläre Erkrankungen, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Angela Rosenbohm
- Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Lara Schlaffke
- Klinik für Neurologie, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Manuel Schmidt
- Neuroradiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | | | - Benedikt Schoser
- Friedrich-Baur-Institut an der Neurologischen Klinik und Poliklinik, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Regina Trollmann
- Zentrum für seltene Erkrankungen Erlangen (ZSEER), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
- Abteilung Neuropädiatrie und Sozialpädiatrisches Zentrum am Universitätsklinikum, Kinder- und Jugendklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Matthias Vorgerd
- Klinik für Neurologie, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Jan S Kirschke
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland, Ismaningerstr. 22, 81675.
| | - Jens Schmidt
- Klinik für Neurologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
- Abteilung für Neurologie und Schmerztherapie, Neuromuskuläres Zentrum, Zentrum für Translationale Medizin, Immanuel Klinik Rüdersdorf, Universitätsklinikum der Medizinischen Hochschule Brandenburg, Rüdersdorf bei Berlin, Deutschland, Seebad 82/83, 15562.
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland.
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Lilleker JB, Naddaf E, Saris CGJ, Schmidt J, de Visser M, Weihl CC. 272nd ENMC international workshop: 10 Years of progress - revision of the ENMC 2013 diagnostic criteria for inclusion body myositis and clinical trial readiness. 16-18 June 2023, Hoofddorp, The Netherlands. Neuromuscul Disord 2024; 37:36-51. [PMID: 38522330 DOI: 10.1016/j.nmd.2024.03.001] [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: 02/25/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Since the publication of the 2013 European Neuromuscular Center (ENMC) diagnostic criteria for Inclusion Body Myositis (IBM), several advances have been made regarding IBM epidemiology, pathogenesis, diagnostic tools, and clinical trial readiness. Novel diagnostic tools include muscle imaging techniques such as MRI and ultrasound, and serological testing for cytosolic 5'-nucleotidase-1A antibodies. The 272nd ENMC workshop aimed to develop new diagnostic criteria, discuss clinical outcome measures and clinical trial readiness. The workshop started with patient representatives highlighting several understudied symptoms and the urge for a timely diagnosis. This was followed by presentations from IBM experts highlighting the new developments in the field. This report is composed of two parts, the first part providing new diagnostic criteria on which consensus was achieved. The second part focuses on the use of outcome measures in clinical practice and clinical trials, highlighting current limitations and outlining the goals for future studies.
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Affiliation(s)
- James B Lilleker
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christiaan G J Saris
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jens Schmidt
- Department of Neurology and Pain Treatment, Neuromuscular Center and Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School MHB, Rüdersdorf bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Marianne de Visser
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Conrad C Weihl
- Neuromuscular Division, Washington University School of Medicine, Saint Louis, MO, USA.
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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] [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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Loganathan A, Zanframundo G, Yoshida A, Faghihi-Kashani S, Bauer Ventura I, Dourado E, Bozan F, Sambataro G, Yamano Y, Bae SS, Lim D, Ceribelli A, Isailovic N, Selmi C, Fertig N, Bravi E, Kaneko Y, Saraiva AP, Jovani V, Bachiller-Corral J, Cifrian J, Mera-Varela A, Moghadam-Kia S, Wolff V, Campagne J, Meyer A, Giannini M, Triantafyllias K, Knitza J, Gupta L, Molad Y, Iannone F, Cavazzana I, Piga M, De Luca G, Tansley S, Bozzalla-Cassione E, Bonella F, Corte TJ, Doyle TJ, Fiorentino D, Gonzalez-Gay MA, Hudson M, Kuwana M, Lundberg IE, Mammen AL, McHugh NJ, Miller FW, Montecucco C, Oddis CV, Rojas-Serrano J, Schmidt J, Scirè CA, Selva-O'Callaghan A, Werth VP, Alpini C, Bozzini S, Cavagna L, Aggarwal R. Agreement between local and central anti-synthetase antibodies detection: results from the Classification Criteria of Anti-Synthetase Syndrome project biobank. Clin Exp Rheumatol 2024; 42:277-287. [PMID: 38488094 DOI: 10.55563/clinexprheumatol/s14zq8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES The CLASS (Classification Criteria of Anti-Synthetase Syndrome) project is a large international multicentre study that aims to create the first data-driven anti-synthetase syndrome (ASSD) classification criteria. Identifying anti-aminoacyl tRNA synthetase antibodies (anti-ARS) is crucial for diagnosis, and several commercial immunoassays are now available for this purpose. However, using these assays risks yielding false-positive or false-negative results, potentially leading to misdiagnosis. The established reference standard for detecting anti-ARS is immunoprecipitation (IP), typically employed in research rather than routine autoantibody testing. We gathered samples from participating centers and results from local anti-ARS testing. As an "ad-interim" study within the CLASS project, we aimed to assess how local immunoassays perform in real-world settings compared to our central definition of anti-ARS positivity. METHODS We collected 787 serum samples from participating centres for the CLASS project and their local anti-ARS test results. These samples underwent initial central testing using RNA-IP. Following this, the specificity of ARS was reconfirmed centrally through ELISA, line-blot assay (LIA), and, in cases of conflicting results, protein-IP. The sensitivity, specificity, positive likelihood ratio and positive and negative predictive values were evaluated. We also calculated the inter-rater agreement between central and local results using a weighted κ co-efficient. RESULTS Our analysis demonstrates that local, real-world detection of anti-Jo1 is reliable with high sensitivity and specificity with a very good level of agreement with our central definition of anti-Jo1 antibody positivity. However, the agreement between local immunoassay and central determination of anti-non-Jo1 antibodies varied, especially among results obtained using local LIA, ELISA and "other" methods. CONCLUSIONS Our study evaluates the performance of real-world identification of anti-synthetase antibodies in a large cohort of multi-national patients with ASSD and controls. Our analysis reinforces the reliability of real-world anti-Jo1 detection methods. In contrast, challenges persist for anti-non-Jo1 identification, particularly anti-PL7 and rarer antibodies such as anti-OJ/KS. Clinicians should exercise caution when interpreting anti-synthetase antibodies, especially when commercial immunoassays test positive for non-anti-Jo1 antibodies.
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Affiliation(s)
- Aravinthan Loganathan
- Royal National Hospital for Rheumatic Diseases, Bath; Department of Life Sciences, University of Bath, UK; and Arthritis Australia, Broadway, Glebe, NSW, Australia
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Sara Faghihi-Kashani
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro; Aveiro Rheumatology Research Centre, Egas Moniz Health Alliance, Aveiro; and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Francisca Bozan
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Rheumatology, Chile
| | - Gianluca Sambataro
- Regional Referral Center for Rare Lung Disease, Policlinico G. Rodolico-San Marco, University of Catania, Italy
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan
| | - Sharon Sangmee Bae
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Darosa Lim
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Natasa Isailovic
- Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele; and Rheumatology and Clinical Immunology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Noreen Fertig
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elena Bravi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Yuko Kaneko
- Keio University School of Medicine, Tokyo, Japan
| | | | - Vega Jovani
- Department of Rheumatology, Hospital General Universitario Dr. Balmis Alicante, ISABIAL, Alicante, Spain
| | | | - Jose Cifrian
- Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Alain Meyer
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | - Margherita Giannini
- Exploration Fonctionnelle Musculaire, Service de Physiologie, Service de Rhumatologie, Centre de Référence des Maladies Auto-Immunes Systémiques Rares RESO Hôpitaux Universitaires de Strasbourg, France
| | | | | | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Yair Molad
- Rabin Medical Center, Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Matteo Piga
- University Clinic and AOU of Cagliari, Italy
| | - Giacomo De Luca
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Bath, and Department of Life Sciences, University of Bath, UK
| | - Emanuele Bozzalla-Cassione
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Tamera J Corte
- University of Sydney, NSW, and Royal Prince Alfred Hospital, NSW, Australia
| | - Tracy J Doyle
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Miguel Angel Gonzalez-Gay
- Medicine and Psychiatry Department, University of Cantabria, and Division of Rheumatology, IIS-Fundacion Jiménez Díaz, Madrid, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Andrew L Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Disorders, National Institutes of Health, Bethesda, MD, and Departments of Medicine and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Fredrick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Units, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, México City, México
| | | | - Carlo Alberto Scirè
- IRCCS San Gerardo dei Tintori Foundation, Monza, and School of Medicine, University of Milano Bicocca, Milan, Italy
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Spain
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine & Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Claudia Alpini
- Laboratory of Biochemical-Chemistry, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Sara Bozzini
- US Transplant Center, Laboratorio di Biologia Cellulare e Immunologia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia; and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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8
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Conticini E, Dourado E, Bottazzi F, Cardelli C, Bruno L, Schmidt J, Carli L, Cavagna L, Barsotti S. Idiopathic inflammatory myopathies: one year in review 2023. Clin Exp Rheumatol 2024; 42:213-224. [PMID: 38488099 DOI: 10.55563/clinexprheumatol/dh5o6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024]
Abstract
Idiopathic inflammatory myopathies are a group of rare, autoimmune, diseases typically involving striate muscle and also variously affecting several other systems or organs, such as joints, skin, lungs, heart and gastrointestinal tract. IIM are mainly characterised by subacute onset and chronic course and are burdened by significant morbidity and mortality. Despite the rarity of these conditions, several efforts have been undertaken in the last years to better understand their pathogenesis, as well as to achieve a more precise classification and to define the optimal therapeutic approach. The aim of this review is to provide an up-to-date digest of the most relevant studies published on this topic over the last year.
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Affiliation(s)
- Edoardo Conticini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Italy
| | - Eduardo Dourado
- Rheumatology Department, Unidade Local de Saúde da Região de Aveiro; Aveiro Rheumatology Research Center, Egas Moniz Health Alliance; and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Francesca Bottazzi
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cardelli
- Rheumatology Unit, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Lorenza Bruno
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Jens Schmidt
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Germany
| | - Linda Carli
- Rheumatology Unit, University of Pisa, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Barsotti
- Rheumatology Outpatient Clinic and Internal Medicine, Livorno Hospital, Italy.
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9
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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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10
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Oldroyd AGS, Callen JP, Chinoy H, Chung L, Fiorentino D, Gordon P, Machado PM, McHugh N, Selva-O'Callaghan A, Schmidt J, Tansley SL, Vleugels RA, Werth VP, Aggarwal R. International Guideline for Idiopathic Inflammatory Myopathy-Associated Cancer Screening: an International Myositis Assessment and Clinical Studies Group (IMACS) initiative. Nat Rev Rheumatol 2023; 19:805-817. [PMID: 37945774 PMCID: PMC10834225 DOI: 10.1038/s41584-023-01045-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Adult-onset idiopathic inflammatory myopathy (IIM) is associated with an increased cancer risk within the 3 years preceding and following IIM onset. Evidence- and consensus-based recommendations for IIM-associated cancer screening can potentially improve outcomes. This International Guideline for IIM-Associated Cancer Screening provides recommendations addressing IIM-associated cancer risk stratification, cancer screening modalities and screening frequency. The international Expert Group formed a total of 18 recommendations via a modified Delphi approach using a series of online surveys. First, the recommendations enable an individual patient's IIM-associated cancer risk to be stratified into standard, moderate or high risk according to the IIM subtype, autoantibody status and clinical features. Second, the recommendations outline a 'basic' screening panel (including chest radiography and preliminary laboratory tests) and an 'enhanced' screening panel (including CT and tumour markers). Third, the recommendations advise on the timing and frequency of screening via basic and enhanced panels, according to risk status. The recommendations also advise consideration of upper or lower gastrointestinal endoscopy, nasoendoscopy and 18F-FDG PET-CT scanning in specific patient populations. These recommendations are aimed at facilitating earlier IIM-associated cancer detection, especially in those who are at a high risk, thus potentially improving outcomes, including survival.
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Affiliation(s)
- Alexander G S Oldroyd
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine and Dermatology, Stanford University, Stanford, CA, USA
- Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro M Machado
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
- Department of Neuromuscular Diseases, Division of Medicine, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Neil McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall D'Hebron General Hospital, Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust Bath, Bath, UK
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Division of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rohit Aggarwal
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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11
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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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12
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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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13
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Wilcke H, Glaubitz S, Kück F, Anten C, Liebetanz D, Schmidt J, Zschüntzsch J. Female sex and overweight are associated with a lower quality of life in patients with myasthenia gravis: a single center cohort study. BMC Neurol 2023; 23:366. [PMID: 37817097 PMCID: PMC10563278 DOI: 10.1186/s12883-023-03406-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/11/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Myasthenia gravis (MG) affects individuals as a chronic autoimmune disease for many years. Commonly, chronic diseases significantly reduce the patients' quality of life. Aiming to improve the future quality of life in MG, this study assessed the factors impacting quality of life. As gender-specific medicine is becoming increasingly important, this study also focused on understanding gender differences in the outcome of MG. METHODS The study is a combined monocentric, retrospective and prospective database analysis of patient records based on 2,370 presentations of 165 patients with clinically, serologically and/or electrophysiologically confirmed MG over an observation period of up to 47 years. The data collection included the following parameters: antibody status, disease severity, age, medication use, gender, and disease duration. In addition, a prospective survey was conducted on the quality of life using the Myasthenia gravis-specific 15-item Quality of Life scale (MG-QoL15) and on the activities of daily living using the MG-specific Activities of Daily Living scale (MG-ADL). RESULTS Of the 165 patients, 85 were male (51.5%) and 80 were female (48.5%). The remaining baseline characteristics (e.g. age and antibody status) were consistent with other myasthenia gravis cohorts. A high body mass index (BMI) (p = 0.005) and a high disease severity (p < 0.001) were significantly associated with lower disease-specific quality of life. Additionally, the quality of life in women with MG was significantly reduced compared to male patients (19.7 vs. 13.0 points in the MG-QoL15, p = 0.024). Gender differences were also observable in terms of the period between initial manifestation and initial diagnosis and women were significantly more impaired in their activities of daily living (MG-ADL) than men (4.8 vs. 3.0 points, p = 0.032). CONCLUSION Women with MG had significantly poorer disease specific quality of life compared to men as well as patients with a higher BMI. In order to improve the quality of life, gender-specific medicine and further investigation regarding a modification of the quality of life by lowering the BMI are essential and necessary. TRIAL REGISTRATION Study approval by the Ethics Committee of the University Medical Center Göttingen was granted (number 6/5/18).
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Affiliation(s)
- Hannah Wilcke
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Christoph Anten
- Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - David Liebetanz
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center, Göttingen, Germany
- Department of Neurology and Pain Treatment, Immanuel Clinic 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
| | - Jana Zschüntzsch
- Department of Neurology, University Medical Center, Göttingen, Germany.
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14
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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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15
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Hum RM, Lilleker JB, Lamb JA, Oldroyd AGS, Wang G, Wedderburn LR, Diederichsen LP, Schmidt J, Danieli MG, Oakley P, Griger Z, Phuong TNT, Kodishala C, Vazquez-Del Mercado M, Andersson H, De Paepe B, De Bleecker JL, Maurer B, McCann L, Pipitone N, McHugh N, New RP, Ollier WE, Krogh NS, Vencovsky J, Lundberg IE, Chinoy H. Comparison of clinical features between patients with anti-synthetase syndrome and dermatomyositis: Results from the MYONET registry. Rheumatology (Oxford) 2023:kead481. [PMID: 37698987 DOI: 10.1093/rheumatology/kead481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES To compare clinical characteristics, including the frequency of cutaneous, extramuscular manifestations, and malignancy, between adults with anti-synthetase syndrome (ASyS) and dermatomyositis (DM). METHODS Using data regarding adults from the MYONET registry, a cohort of DM patients with anti-Mi2/-TIF1ɣ/-NXP2/-SAE/-MDA5 autoantibodies, and a cohort of ASyS patients with anti-tRNA synthetase autoantibodies (anti-Jo1/-PL7/-PL12/-OJ/-EJ/-Zo/-KS) were identified. Patients with DM sine dermatitis or with discordant dual autoantibody specificities were excluded. Sub-cohorts of patients with ASyS with or without skin involvement were defined based on presence of DM-type rashes (heliotrope rash, Gottron's papules/sign, violaceous rash, shawl sign, V sign, erythroderma, and/or periorbital rash). RESULTS In total 1,054 patients were included (DM, n = 405; ASyS, n = 649). In ASyS cohort, 31% (n = 203) had DM-type skin involvement (ASyS-DMskin). A higher frequency of extramuscular manifestations, including Mechanic's hands, Raynaud's phenomenon, arthritis, interstitial lung disease, and cardiac involvement differentiated ASyS-DMskin from DM (all p< 0.001), whereas higher frequency of any of four DM-type rashes: heliotrope rash (n = 248, 61% vs n = 90, 44%), violaceous rash (n = 166, 41% vs n = 57, 9%), V sign (n = 124, 31% vs n = 28, 4%), and shawl sign (n = 133, 33% vs n = 18, 3%) differentiated DM from ASyS-DMskin (all p< 0.005). Cancer-associated myositis (CAM) was more frequent in DM (n = 67, 17%) compared with ASyS (n = 21, 3%) and ASyS-DMskin (n = 7, 3%) cohorts (both p< 0.001). CONCLUSION DM-type rashes are frequent in patients with ASyS; however, distinct clinical manifestations differentiate these patients from classical DM. Skin involvement in ASyS does not necessitate increased malignancy surveillance. These findings will inform future ASyS classification criteria and patient management.
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Affiliation(s)
- Ryan Malcolm Hum
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
- The University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, Manchester, UK
| | - James B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Manchester Centre for Clinical Neuroscience, Salford Royal Hospital, Salford, Manchester, UK
| | - Janine A Lamb
- The University of Manchester Faculty of Biology Medicine and Health, Epidemiology and Public Health Group, Manchester, Manchester, UK
| | - Alexander G S Oldroyd
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
- The University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, Manchester, UK
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, Beijing, CN
| | - Lucy R Wedderburn
- Great Ormond Street Hospital for Children NHS Foundation Trust, Infection, Immunity and Inflammation, London, London, UK
| | - Louise P Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Kobenhavn, DK
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Gottingen, Niedersachsen, DE
| | - Maria Giovanna Danieli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Universita Politecnica delle Marche, Ancona, IT
| | | | - Zoltan Griger
- Department of Immunology, University of Debrecen, Debrecen, Hajdú-Bihar, HU
| | | | - Chanakya Kodishala
- Clinical Immunology and Rheumatology, St John's National Academy of Health Sciences, Bangalore, Karnataka, IN
- Department of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Monica Vazquez-Del Mercado
- Division de Medicina Interna, Servicio de Reumatologia, Hospital Civil Dr. Juan I. Menchaca, Universidad de Guadalajara, Guadalajara, Jalisco, MX
| | | | - Boel De Paepe
- Department of Neurology, Universitair Ziekenhuis Gent, Ghent, BE
| | | | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Bern, CH
| | - Liza McCann
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Nicolo Pipitone
- Department of Rheumatology, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, IT, Emilia-Romagna
| | - Neil McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Robert Paul New
- MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - William E Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, Manchester, UK
| | | | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, Charles University, Praha, Praha, CZ
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, SE
- Department of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, SE
| | - Hector Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Department of Rheumatology, Salford Royal Hospital, Salford, Manchester, UK
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16
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Carstens PO, Müllar LM, Wrede A, Zechel S, Wachowski MM, Brandis A, Krause S, Zierz S, Schmidt J. Skeletal muscle fibers produce B-cell stimulatory factors in chronic myositis. Front Immunol 2023; 14:1177721. [PMID: 37731487 PMCID: PMC10508232 DOI: 10.3389/fimmu.2023.1177721] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/16/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction We aimed to identify B-cell-mediated immunomechanisms in inclusion body myositis (IBM) and polymyositis (PM) as part of the complex pathophysiology. Materials and methods Human primary myotube cultures were derived from orthopedic surgery. Diagnostic biopsy specimens from patients with IBM (n=9) and PM (n=9) were analyzed for markers of B cell activation (BAFF and APRIL) and for chemokines that control the recruitment of B cells (CXCL-12 and CXCL-13). Results were compared to biopsy specimens without myopathic changes (n=9) and hereditary muscular dystrophy (n=9). Results The mRNA expression of BAFF, APRIL, and CXCL-13 was significantly higher in IBM and PM compared to controls. Patients with IBM displayed the highest number of double positive muscle fibers for BAFF and CXCL-12 (48%) compared to PM (25%), muscular dystrophy (3%), and non-myopathic controls (0%). In vitro, exposure of human myotubes to pro-inflammatory cytokines led to a significant upregulation of BAFF and CXCL-12, but APRIL and CXCL-13 remained unchanged. Conclusion The results substantiate the hypothesis of an involvement of B cell-associated mechanisms in the pathophysiology of IBM and PM. Muscle fibers themselves seem to contribute to the recruitment of B cells and sustain inflammation.
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Affiliation(s)
- Per-Ole Carstens
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Luisa M. Müllar
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Wrede
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Institute of Neuropathology, Saarland University Medical Center and Medical Faculty of Saarland University, Homburg, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin M. Wachowski
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Almuth Brandis
- Department of Pathology, Klinikum Region Hannover, Hannover, Germany
- Institute of Pathology and Neuropathology, Medical University Hannover, Hannover, Germany
| | - Sabine Krause
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of München, München, Germany
| | - Stephan Zierz
- Department of Neurology, University Hospital Halle/Saale, Halle, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology and Pain Treatment, Neuromuscular Center, Center for Translational Medicine, 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
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Kummer K, Bertram I, Zechel S, Hoffmann DB, Schmidt J. Inflammasome in Skeletal Muscle: NLRP3 Is an Inflammatory Cell Stress Component in Inclusion Body Myositis. Int J Mol Sci 2023; 24:10675. [PMID: 37445853 DOI: 10.3390/ijms241310675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 07/15/2023] Open
Abstract
Inclusion body myositis (IBM) is a chronic, mostly treatment-resistant, inflammatory myopathy with a pathology that centers around specific interactions between inflammation and protein accumulation. The study aimed to identify the inflammasome as a key event in the complex network of pathomechanisms. Regulation of the inflammasome was assessed in a well-established pro-inflammatory cell culture model using human myoblasts and primary human myotubes. By quantitative PCR, western blot and immunocytochemistry, inflammasome markers including NLRP3 were assessed in muscle cells exposed to the cytokines IL-1β and IFN-γ. The data were corroborated by analysis of muscle biopsies from patients with IBM compared to other myositis subtypes. In the cell culture model of IBM, the NLRP3 inflammasome was significantly overexpressed, as evidenced by western blot (p = 0.03) and quantitative PCR (p < 0.01). Target genes that play a role in inflammasome assembly, T-cell migration, and MHC-I expression (p = 0.009) were highly co-upregulated. NLRP3 was significantly overexpressed in muscle biopsies from IBM samples compared to disease controls (p = 0.049), including other inflammatory myopathies. Due to the extraordinary features of the pathogenesis and the pronounced upregulation of NLRP3 in IBM, the inflammasome could serve as a key molecule that drives the inflammatory cascade as well as protein accumulation in the muscle. These data can be useful for future therapeutic developments.
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Affiliation(s)
- Karsten Kummer
- Department of Neurology and Pain Treatment, Neuromuscular Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Imke Bertram
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Sabrina Zechel
- Department of Neuropathology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Daniel B Hoffmann
- Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology and Pain Treatment, Neuromuscular Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, 37075 Göttingen, Germany
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18
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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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19
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Schmidt J, Müller-Felber W. [Myositis: from diagnosis to treatment]. Nervenarzt 2023:10.1007/s00115-023-01490-8. [PMID: 37222759 DOI: 10.1007/s00115-023-01490-8] [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] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Inflammatory diseases of the skeletal muscle are important, often severe diseases with a considerable impact on the quality of life. In addition to muscle weakness there is often involvement of other organs, such as the heart, lungs and esophagus with symptoms such as dyspnea or dysphagia. PURPOSE A fast and effective treatment is only possible by an early and reliable diagnosis according to current national and international standards. METHODS The diagnostic repertoire includes autoantibody testing, imaging, muscle biopsy, detection of extramuscular manifestations, e.g., by high-resolution lung computed tomography (CT) and an individualized tumor search. An optimal treatment and the avoidance of irreversible damage, such as a loss of walking ability, are only possible through a good interdisciplinary cooperation including neurology or pediatrics, rheumatology, dermatology, neuropathology, pulmonology and cardiology. RESULTS In addition to standard immunosuppression with glucocorticosteroids, azathioprine or methotrexate, escalation treatment with rituximab is now well established. Interdisciplinary treatment according to national and international standards, such as guidelines on myositis, should be coordinated at qualified centers of excellence. DISCUSSION Helpful resources are the MYOSITIS NETZ ( www.myositis-netz.de ) and the International Myositis Society (iMyoS; www.imyos.org ).
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Affiliation(s)
- Jens Schmidt
- Abteilung für Neurologie und Schmerztherapie, Immanuel Klinik Rüdersdorf, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Deutschland.
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf, Deutschland.
- Klinik für Neurologie, Neuromuskuläres Zentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland.
| | - Wolfgang Müller-Felber
- Abteilung Neuropädiatrie, Dr. von Hauner'sches Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
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20
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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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21
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Madhusanka D, McEwan C, Broadbent D, Schmidt J, Andersen J. Abstract 1383: Mechanisms of ATG9 mediated aggrephagy initiation. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1383] [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: 04/07/2023]
Abstract
Abstract
Highly biosynthetic cancer cells produce proteins at a rate that may exceed the capacity of protein folding machinery, resulting in an accumulation of misfolded proteins that are poly-ubiquitinated and clustered into phase-separated ‘ubiquitin-rich’ condensates. These condensates are the initiation point for a form of autophagy called aggrephagy, which maintains cancer cell homeostasis by degrading the misfolded protein condensates via the lysosome. Aggrephagy is a cancer cell vulnerability, yet its mechanisms are poorly understood, particularly the mechanisms by which autophagy machinery recognizes the ubiquitin-rich condensates to initiate aggrephagy. Among 15 core autophagy proteins, ATG9A is the only multi-pass transmembrane protein and is essential for all known forms of autophagy. Recent evidence indicates that ATG9A is a lipid scramblase, in complex with ATG2A, that channels lipids to a growing autophagosome, which ultimately engulfs the ubiquitin-rich condensate. However, the mechanism of ATG9A recruitment to these condensates is not understood. Our data indicate that genetic or chemical manipulations of cells that cause ubiquitin-rich condensates to accumulate causing a corresponding accumulation of ATG9A. Furthermore, the induction of artificial ubiquitin-rich condensates, composed of chains of M1-linked ubiquitin, is sufficient to recruit ATG9A. Using a CRISPR knockout and reconstitution approach, we show that ATG9A is essential for assembling other autophagy machinery at ubiquitin-rich condensates. Together, our data support a model in which ATG9A recruitment is the initiating step for aggrephagy. Furthermore, our data suggest a signal or molecular pattern within the condensate promotes ATG9A recruitment to initiate aggrephagy. Our current work focuses on identifying features of ATG9A and components of the ubiquitin-rich condensate that cooperate to recruit ATG9A to these sites of aggrephagy initiation.
Citation Format: Deshan Madhusanka, Colton McEwan, David Broadbent, Jens Schmidt, Joshua Andersen. Mechanisms of ATG9 mediated aggrephagy initiation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1383.
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Roy B, Lucchini M, Lilleker JB, Goyal NA, Naddaf E, Adler B, Alfano LN, Malandraki GA, Focht Garand KL, Mochel D, Badrising U, Machado PM, Pagkatipunan R, Ramdharry G, Wang L, Funaro MC, Schmidt J, Kushlaf H, Schiopu E, Stipancic K, Goyal N, d'Alessandro M, Conticini E, Cruz-Coble B, Lloyd TE. Current status of clinical outcome measures in inclusion body myositis: a systematised review. Clin Exp Rheumatol 2023; 41:370-378. [PMID: 36762744 DOI: 10.55563/clinexprheumatol/ifacv3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/05/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Sporadic inclusion body myositis (IBM) is a debilitating idiopathic inflammatory myopathy (IIM) which affects hand function, ambulation, and swallowing. There is no approved pharmacological therapy for IBM, and there is a lack of suitable outcome measure to assess the effect of an intervention. The IBM scientific interest group under IMACS reviewed the previously used outcome measures in IBM clinical studies to lay the path for developing a core set of outcome measures in IBM. METHODS In this systematised review, we have extracted all outcome measures reported in IBM clinical studies to determine what measures were being used and to assess the need for optimising outcome measures in IBM. RESULTS We found 13 observational studies, 17 open-label clinical trials, and 15 randomised control trials (RCTs) in IBM. Six-minute walk distance, IBM-functional rating scale (IBM-FRS), quantitative muscle testing, manual muscle testing, maximal voluntary isometric contraction testing, and thigh muscle volume measured by MRI were used as primary outcome measures. Twelve different outcome measures of motor function were used in IBM clinical trials. IBM-FRS was the most used measure of functionality. Swallowing function was reported as a secondary outcome measure in only 3 RCTs. CONCLUSIONS There are inconsistencies in using outcome measures in clinical studies in IBM. The core set measures developed by the IMACS group for other IIMs are not directly applicable to IBM. As a result, there is an unmet need for an IBM-specific core set of measures to facilitate the evaluation of new potential therapeutics for IBM.
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Affiliation(s)
- Bhaskar Roy
- Yale University School of Medicine, New Haven, CT, USA.
| | - Matteo Lucchini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - James B Lilleker
- Centre for Musculoskeletal Research, the University of Manchester, UK
| | | | | | - Brittany Adler
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Gita Ramdharry
- Leiden University Medical Center, Leiden, The Netherlands
| | - Leo Wang
- University of Washington Medical Center, Seattle, WA, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | | | | | - Elena Schiopu
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | - Neelam Goyal
- Stanford Neuroscience Health Center, Palo Alto, CA, USA
| | | | | | | | - Thomas E Lloyd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dourado E, Bottazzi F, Cardelli C, Conticini E, Schmidt J, Cavagna L, Barsotti S. Idiopathic inflammatory myopathies: one year in review 2022. Clin Exp Rheumatol 2023; 41:199-213. [PMID: 36826800 DOI: 10.55563/clinexprheumatol/jof6qn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/25/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of disorders in which chronic inflammation of the skeletal muscle, leading to muscle weakness, is a common feature. Different phenotypes have been identified within the IIM spectrum based on extra-muscular manifestations, immunology, muscle histology, responsiveness to therapy, and prognosis. The pathogenesis, classification, treatment, and prognosis of the different IIM subtypes are subject to active discussion and research. This review highlights the most relevant literature published on this topic over the last year.
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Affiliation(s)
- Eduardo Dourado
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal
| | - Francesca Bottazzi
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Edoardo Conticini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Italy
| | - Jens Schmidt
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Germany
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Internal Medicine, Livorno Hospital, Livorno, Italy.
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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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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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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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Pawlitzki M, Acar L, Masanneck L, Willison A, Regner-Nelke L, Nelke C, L’hoest H, Marschall U, Schmidt J, Meuth SG, Ruck T. Myositis in Germany: epidemiological insights over 15 years from 2005 to 2019. Neurol Res Pract 2022; 4:62. [PMID: 36581896 PMCID: PMC9798556 DOI: 10.1186/s42466-022-00226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/25/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The medical care of patients with myositis is a great challenge in clinical practice. This is due to the rarity of these disease, the complexity of diagnosis and management as well as the lack of systematic analyses. OBJECTIVES Therefore, the aim of this project was to obtain an overview of the current care of myositis patients in Germany and to evaluate epidemiological trends in recent years. METHODS In collaboration with BARMER Insurance, retrospective analysis of outpatient and inpatient data from an average of approximately 8.7 million insured patients between January 2005 and December 2019 was performed using ICD-10 codes for myositis for identification of relevant data. In addition, a comparative analysis was performed between myositis patients and an age-matched comparison group from other populations insured by BARMER. RESULTS 45,800 BARMER-insured individuals received a diagnosis of myositis during the observation period, with a relatively stable prevalence throughout. With regard to comorbidities, a significantly higher rate of cardiovascular disease as well as neoplasm was observed compared to the control group within the BARMER-insured population. In addition, myositis patients suffer more frequently from psychiatric disorders, such as depression and somatoform disorders. However, the ICD-10 catalogue only includes the specific coding of "dermatomyositis" and "polymyositis" and thus does not allow for a sufficient analysis of all idiopathic inflammatory myopathies subtypes. CONCLUSION The current data provide a comprehensive epidemiological analysis of myositis in Germany, highlighting the multimorbidity of myositis patients. This underlines the need for multidisciplinary management. However, the ICD-10 codes currently still in use do not allow for specific analysis of the subtypes of myositis. The upcoming ICD-11 coding may improve future analyses in this regard.
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Affiliation(s)
- Marc Pawlitzki
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Laura Acar
- grid.491614.f0000 0004 4686 7283BARMER, Wuppertal, Germany
| | - Lars Masanneck
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany ,grid.500266.7Hasso-Plattner-Institut, Potsdam, Germany
| | - Alice Willison
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Liesa Regner-Nelke
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christopher Nelke
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Helmut L’hoest
- grid.491614.f0000 0004 4686 7283BARMER, Wuppertal, Germany
| | | | - Jens Schmidt
- Department of Neurology and Pain Therapy, Immanuel Clinic Rüdersdorf, University Hospital of the Brandenburg Medical School - Theodor Fontane, Rüdersdorf Berlin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School - Theodor Fontane, Rüdersdorf Berlin, Germany ,grid.411984.10000 0001 0482 5331Department of Neurology, Neuromuscular Centre, University Medical Centre Göttingen, Göttingen, Germany
| | - Sven G. Meuth
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tobias Ruck
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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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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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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Shahriyari M, Islam MR, Sakib SM, Rinn M, Rika A, Krüger D, Kaurani L, Gisa V, Winterhoff M, Anandakumar H, Shomroni O, Schmidt M, Salinas G, Unger A, Linke WA, Zschüntzsch J, Schmidt J, Bassel-Duby R, Olson EN, Fischer A, Zimmermann WH, Tiburcy M. Engineered skeletal muscle recapitulates human muscle development, regeneration and dystrophy. J Cachexia Sarcopenia Muscle 2022; 13:3106-3121. [PMID: 36254806 PMCID: PMC9745484 DOI: 10.1002/jcsm.13094] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/29/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Human pluripotent stem cell-derived muscle models show great potential for translational research. Here, we describe developmentally inspired methods for the derivation of skeletal muscle cells and their utility in skeletal muscle tissue engineering with the aim to model skeletal muscle regeneration and dystrophy in vitro. METHODS Key steps include the directed differentiation of human pluripotent stem cells to embryonic muscle progenitors followed by primary and secondary foetal myogenesis into three-dimensional muscle. To simulate Duchenne muscular dystrophy (DMD), a patient-specific induced pluripotent stem cell line was compared to a CRISPR/Cas9-edited isogenic control line. RESULTS The established skeletal muscle differentiation protocol robustly and faithfully recapitulates critical steps of embryonic myogenesis in two-dimensional and three-dimensional cultures, resulting in functional human skeletal muscle organoids (SMOs) and engineered skeletal muscles (ESMs) with a regeneration-competent satellite-like cell pool. Tissue-engineered muscle exhibits organotypic maturation and function (up to 5.7 ± 0.5 mN tetanic twitch tension at 100 Hz in ESM). Contractile performance could be further enhanced by timed thyroid hormone treatment, increasing the speed of contraction (time to peak contraction) as well as relaxation (time to 50% relaxation) of single twitches from 107 ± 2 to 75 ± 4 ms (P < 0.05) and from 146 ± 6 to 100 ± 6 ms (P < 0.05), respectively. Satellite-like cells could be documented as largely quiescent PAX7+ cells (75 ± 6% Ki67- ) located adjacent to muscle fibres confined under a laminin-containing basal membrane. Activation of the engineered satellite-like cell niche was documented in a cardiotoxin injury model with marked recovery of contractility to 57 ± 8% of the pre-injury force 21 days post-injury (P < 0.05 compared to Day 2 post-injury), which was completely blocked by preceding irradiation. Absence of dystrophin in DMD ESM caused a marked reduction of contractile force (-35 ± 7%, P < 0.05) and impaired expression of fast myosin isoforms resulting in prolonged contraction (175 ± 14 ms, P < 0.05 vs. gene-edited control) and relaxation (238 ± 22 ms, P < 0.05 vs. gene-edited control) times. Restoration of dystrophin levels by gene editing rescued the DMD phenotype in ESM. CONCLUSIONS We introduce human muscle models with canonical properties of bona fide skeletal muscle in vivo to study muscle development, maturation, disease and repair.
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Affiliation(s)
- Mina Shahriyari
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Md Rezaul Islam
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany
| | - Sadman M Sakib
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany
| | - Malte Rinn
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Anastasia Rika
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Dennis Krüger
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany
| | - Lalit Kaurani
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany
| | - Verena Gisa
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany
| | - Mandy Winterhoff
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Harithaa Anandakumar
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Orr Shomroni
- NGS Integrative Genomics Core Unit, Institute of Human Genetics, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Matthias Schmidt
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Gabriela Salinas
- NGS Integrative Genomics Core Unit, Institute of Human Genetics, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Andreas Unger
- Institute of Physiology II, University of Münster, Münster, Germany
| | - Wolfgang A Linke
- Institute of Physiology II, University of Münster, Münster, Germany
| | - Jana Zschüntzsch
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, Neuromuscular Center, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,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
| | - Rhonda Bassel-Duby
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric N Olson
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - André Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany.,Cluster of Excellence 'Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany
| | - Wolfram-Hubertus Zimmermann
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Cluster of Excellence 'Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Göttingen, Germany
| | - Malte Tiburcy
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
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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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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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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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Merckx C, Zschüntzsch J, Meyer S, Raedt R, Verschuere H, Schmidt J, De Paepe B, De Bleecker JL. Exploring the Therapeutic Potential of Ectoine in Duchenne Muscular Dystrophy: Comparison with Taurine, a Supplement with Known Beneficial Effects in the mdx Mouse. Int J Mol Sci 2022; 23:ijms23179567. [PMID: 36076964 PMCID: PMC9455265 DOI: 10.3390/ijms23179567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Duchenne Muscular Dystrophy (DMD) is a debilitating muscle disorder that condemns patients to year-long dependency on glucocorticoids. Chronic glucocorticoid use elicits many unfavourable side-effects without offering satisfying clinical improvement, thus, the search for alternative treatments to alleviate muscle inflammation persists. Taurine, an osmolyte with anti-inflammatory effects, mitigated pathological features in the mdx mouse model for DMD but interfered with murine development. In this study, ectoine is evaluated as an alternative for taurine in vitro in CCL-136 cells and in vivo in the mdx mouse. Pre-treating CCL-136 cells with 0.1 mM taurine and 0.1 mM ectoine prior to exposure with 300 U/mL IFN-γ and 20 ng/mL IL-1β partially attenuated cell death, whilst 100 mM taurine reduced MHC-I protein levels. In vivo, histopathological features of the tibialis anterior in mdx mice were mitigated by ectoine, but not by taurine. Osmolyte treatment significantly reduced mRNA levels of inflammatory disease biomarkers, respectively, CCL2 and SPP1 in ectoine-treated mdx mice, and CCL2, HSPA1A, TNF-α and IL-1β in taurine-treated mdx mice. Functional performance was not improved by osmolyte treatment. Furthermore, ectoine-treated mdx mice exhibited reduced body weight. Our results confirmed beneficial effects of taurine in mdx mice and, for the first time, demonstrated similar and differential effects of ectoine.
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Affiliation(s)
- Caroline Merckx
- Department of Neurology, Ghent University and Ghent University Hospital, 9000 Ghent, Belgium
| | - Jana Zschüntzsch
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Stefanie Meyer
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Robrecht Raedt
- 4BRAIN, Department Head and Skin, Ghent University, 9000 Ghent, Belgium
| | - Hanne Verschuere
- Unit of Molecular Signaling and Cell Death, Center for Inflammation Research, Flemish Institute for Biotechnology, 9052 Ghent, Belgium
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany
| | - Boel De Paepe
- Department of Neurology, Ghent University and Ghent University Hospital, 9000 Ghent, Belgium
- Correspondence:
| | - Jan L. De Bleecker
- Department of Neurology, Ghent University and Ghent University Hospital, 9000 Ghent, Belgium
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Fisse AL, Motte J, Grüter T, Kohle F, Kronlage C, Stahl JH, Winter N, Seeliger T, Gingele S, Stascheit F, Hotter B, Klehmet J, Kummer K, Enax-Krumova EK, Sturm D, Skripuletz T, Schmidt J, Yoon MS, Pitarokoili K, Lehmann HC, Grimm A. Versorgungssituation von CIDP-Patienten in neun deutschen Zentren des Neuritis Netzes. Nervenarzt 2022; 94:320-326. [PMID: 35997784 PMCID: PMC10104951 DOI: 10.1007/s00115-022-01377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Hintergrund
Die Diagnose und Behandlung von Patienten mit immunvermittelten Polyneuropathien ist aufgrund der Heterogenität der Erkrankungen herausfordernd.
Ziel der Arbeit
Ein aktueller epidemiologischer Überblick über die Versorgungssituation von Patienten mit immunvermittelten Polyneuropathien innerhalb des deutschen Neuritis-Netzwerks „Neuritis Netz“.
Material und Methoden
Es erfolgte eine Umfrage in neun deutschen neurologischen Zentren, die auf die Betreuung von Patienten mit Immunneuropathie spezialisiert sind. Wir erfassten Diagnose, Vorgehen in der Diagnostik und Nachsorge, typische Symptome bei Manifestation und im Krankheitsverlauf sowie Therapiedaten.
Ergebnisse
Die Erhebung umfasst Daten von 1529 jährlich behandelten Patienten mit Immunneuropathien, 1320 davon mit chronisch inflammatorisch demyelinisierender Polyneuropathie (CIDP). Die Diagnostik umfasste fast immer Lumbalpunktionen sowie Elektroneuro- und -myografien entsprechend den aktuellen Leitlinien. Der Einsatz von Ultraschall, Biopsie und MRT war unterschiedlich. Wichtigster klinischer Parameter zum Therapiemonitoring in allen Zentren war die motorische Funktion in den klinischen Nachuntersuchungen. Zur Erhaltungstherapie wurde bei rund 15 % der Patienten ein breites Spektrum unterschiedlicher Immunsuppressiva eingesetzt.
Diskussion
Die Studie liefert wichtige epidemiologische Daten zur aktuellen Versorgungsituation von Patienten mit Immunneuropathien in Deutschland. Die Weiterentwicklung spezifischer Empfehlungen zur Therapie und Nachverfolgung von CIDP-Patienten ist notwendig, um einen einheitlichen Standard der Patientenversorgung zu gewährleisten. Dieses wird durch die strukturierte Zusammenarbeit von Exzellenzzentren wie dem deutschen Neuritis Netz erheblich unterstützt.
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Affiliation(s)
- Anna Lena Fisse
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
| | - Jeremias Motte
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Thomas Grüter
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Felix Kohle
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Köln, Köln, Deutschland
| | - Cornelius Kronlage
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Jan-Hendrik Stahl
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Natalie Winter
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Tabea Seeliger
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefan Gingele
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Frauke Stascheit
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Benjamin Hotter
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Juliane Klehmet
- Klinik für Neurologie, Jüdisches Krankenhaus, Berlin, Deutschland
| | - Karsten Kummer
- Klinik für Neurologie, Neuromuskuläres Zentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Elena K Enax-Krumova
- Neurologische Universitätsklinik und Poliklinik, BG Universitätsklinikum Bergmannsheil gGmbH Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Dietrich Sturm
- Klinik für Neurologie, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Deutschland
| | - Thomas Skripuletz
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jens Schmidt
- Klinik für Neurologie, Neuromuskuläres Zentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Abteilung Neurologie und Schmerztherapie, Immanuel Klinik Rüdersdorf, Universitätsklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Min-Suk Yoon
- Klinik für Neurologie, Evangelisches Krankenhaus Hattingen, Hattingen, Deutschland
| | - Kalliopi Pitarokoili
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Köln, Köln, Deutschland
| | - Alexander Grimm
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
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Meyer S, Kaulfuß S, Zechel S, Kummer K, Seif Amir Hosseini A, Ernst MS, Schmidt J, Pauli S, Zschüntzsch J. Evidence of Two Novel LAMA2 Variants in a Patient With Muscular Dystrophy: Facing the Challenges of a Certain Diagnosis. Front Neurol 2022; 13:893605. [PMID: 35928135 PMCID: PMC9344914 DOI: 10.3389/fneur.2022.893605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBenefits and challenges resulting from advances in genetic diagnostics are two sides of the same coin. Facilitation of a correct and timely diagnosis is paralleled by challenges in interpretation of variants of unknown significance (VUS). Focusing on an individual VUS-re-classification pipeline, this study offers a diagnostic approach for clinically suspected hereditary muscular dystrophy by combining the expertise of an interdisciplinary team.MethodsIn a multi-step approach, a thorough phenotype assessment including clinical examination, laboratory work, muscle MRI and histopathological evaluation of muscle was performed in combination with advanced Next Generation Sequencing (NGS). Different in-silico tools and prediction programs like Alamut, SIFT, Polyphen, MutationTaster and M-Cap as well as 3D- modeling of protein structure and RNA-sequencing were employed to determine clinical significance of the LAMA2 variants.ResultsTwo previously unknown sequence alterations in LAMA2 were detected, a missense variant was classified initially according to ACMG guidelines as a VUS (class 3) whereas a second splice site variant was deemed as likely pathogenic (class 4). Pathogenicity of the splice site variant was confirmed by mRNA sequencing and nonsense mediated decay (NMD) was detected. Combination of the detected variants could be associated to the LGMDR23-phenotype based on the MRI matching and literature research.DiscussionTwo novel variants in LAMA2 associated with LGMDR23-phenotype are described. This study illustrates challenges of the genetic findings due to their VUS classification and elucidates how individualized diagnostic procedure has contributed to the accurate diagnosis in the spectrum of LGMD.
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Affiliation(s)
- Stefanie Meyer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Kaulfuß
- Department of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Sabrina Zechel
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Karsten Kummer
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Marielle Sophie Ernst
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- 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
| | - Silke Pauli
- Department of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Jana Zschüntzsch
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Jana Zschüntzsch
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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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Hum RM, Lilleker JB, Lamb JA, Ollier WE, Wang G, Wedderburn LR, Diederichsen LP, Schmidt J, Oakley P, Benveniste O, Danieli MG, Danko K, Thuy NTP, Mercado MVD, Andersson H, Paepe BD, Bleecker JLD, Maurer B, McCann LJ, Pipitone N, McHugh N, New P, Vencovsky J, Lundberg IE, Chinoy H. P222 Clinical features of extra-muscular disease in dermatomyositis and anti-synthetase syndrome patients with skin involvement classified by presence of disease-specific autoantibodies: results from the EuroMyositis registry. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.221] [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
Background/Aims
Anti-synthetase syndrome (ASS) represents a distinct entity within myositis spectrum disorders; however, correct classification of patients with anti-tRNA synthetase autoantibodies and skin manifestations akin to dermatomyositis (DM) remains uncertain. Our aim was to compare clinical characteristics, skin involvement, and malignancy, between patients with ASS and DM, classified by disease-specific autoantibodies.
Methods
Data from 05/2009-03/2016 from 9 countries from the prospective, myositis EuroMyositis registry were downloaded. Those with anti-tRNA synthetase autoantibodies (Jo-1/PL-7/PL-12/OJ/EJ/KS) were classified as ASS, and those with Mi-2/TIF1-γ/NXP2/SAE/MDA5 autoantibodies as DM. Clinical phenotypes including malignancies (except skin malignancies) were tabulated. Characteristics of patients with skin involvement (excluding mechanic’s hands and Raynaud’s phenomenon) were compared using Fisher’s exact test with Bonferroni corrected p-values.
Results
Of 3,067 patients, 2,028 had autoantibody profiling results (66.1%), of which 783 (38.6%) were positive for at least one of the autoantibodies being considered. Five patients with dual autoantibody specificities were excluded. Of the remaining 778, 320 (41.1%) were classified as DM, and 458 (58.9%) as ASS. Median age at diagnosis was 48.2 years (interquartile range [IQR] 37.5 to 57.8) in the DM cohort and 49 (IQR 38.3 to 62.2) in the ASS cohort. Skin involvement was present in 277 (86.6%) DM patients (DM skin) vs 204 (44.5%) ASS patients (ASS skin) (pcorr<0.01) (Table 1). Whilst relatively high proportions of so-called “DM-specific” rashes were seen in ASS skin, the frequency of heliotrope rash, Gottron’s papules, violaceous rash, periorbital rash, V-sign, shawl sign, and periungual erythema was significantly higher in DM skin (pcorr<0.01 for all). Conversely, mechanic’s hands, Raynaud’s, arthritis, and interstitial lung disease were more frequent in ASS skin (pcorr<0.01 for all). Malignancy was less frequent in ASS skin vs DM skin (pcorr<0.01) and occurred temporally closer to myositis diagnosis in DM skin (median 0.95 months [IQR -6.54. to 19.45]) vs ASS skin (median 12.17 months [IQR -15.85 to 79.31]).
Conclusion
Patients with ASS have frequent skin involvement but also a distinct clinical phenotype compared to DM. These findings may inform the development of future classification criteria for ASS.
Disclosure
R.M. Hum: None. J.B. Lilleker: None. J.A. Lamb: None. W.E. Ollier: None. G. Wang: None. L.R. Wedderburn: None. L.P. Diederichsen: None. J. Schmidt: None. P. Oakley: None. O. Benveniste: None. M.G. Danieli: None. K. Danko: None. N.T.P. Thuy: None. M.V.D. Mercado: None. H. Andersson: None. B.D. Paepe: None. J.L.D. Bleecker: None. B. Maurer: None. L.J. McCann: None. N. Pipitone: None. N. McHugh: None. P. New: None. J. Vencovsky: None. I.E. Lundberg: None. H. Chinoy: None.
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Affiliation(s)
- Ryan M Hum
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UNITED KINGDOM
- National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, UNITED KINGDOM
| | - James B Lilleker
- National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, UNITED KINGDOM
- Manchester Centre for Clinical Neuroscience, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
| | - Janine A Lamb
- Epidemiology and Public Health Group, The University of Manchester, Manchester, UNITED KINGDOM
| | - William E Ollier
- National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, UNITED KINGDOM
| | - Guochung Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Beijing, CHINA
| | - Lucy R Wedderburn
- University College London GOSH Institute of Child Health and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
| | | | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Gottingen, GERMANY
| | - Paula Oakley
- Myositis UK, Myositis UK, Southampton, UNITED KINGDOM
| | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, Paris, FRANCE
| | - Maria G Danieli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche & Ospedali Riuniti, Ancona, ITALY
| | - Katalin Danko
- Division of Immunology, University of Debrecen, Debrecen, HUNGARY
| | - Nguyen T. P Thuy
- Department of Rheumatology, Bach Mai Hospital, Hanoi Medical University, Hanoi, VIET NAM
| | | | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, SWEDEN
| | - Boel D Paepe
- Department of Neurology, Ghent University Hospital, Ghent, BELGIUM
| | | | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, SWITZERLAND
| | - Liza J McCann
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UNITED KINGDOM
| | - Nicolo Pipitone
- Department of Rheumatology, Arcispedale S. Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, ITALY
| | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, University of Bath, Bath, UNITED KINGDOM
| | - Paul New
- MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
| | | | - Ingrid E Lundberg
- Unit of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, SWEDEN
| | - Hector Chinoy
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UNITED KINGDOM
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
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Abstract
Inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM), necrotizing myopathy (NM), antisynthetase syndrome (ASS) and overlap myositis (OM), in short myositis, are rare diseases. All forms of myositis have progressive muscle weakness in common, with each subtype characterized by different autoantibody profiles, histological findings and extramuscular manifestations. Due to better understanding of the pathogenesis of the muscle inflammation in myositis, new molecular pathways for targeted therapy have been discovered. Current therapies aim at different components of the innate or the adaptive immune response. Additionally, non-inflammatory mechanisms in myositis have come into focus as possible treatment targets. The use of therapeutical antibodies in myositis has been examined in various clinical studies, several of them randomized controlled ones: Depletion of B-cells by rituximab has been established as treatment of refractory myositis. IVIG, an antibody therapy in the wider sense, has now been licensed for DM following a recent positive clinical trial. Negative study results were reported in randomized trials with infliximab, sifalimumab and bimagrumab. Studies on basiliximab and eculizumab are currently underway, and are expected to yield results in a couple of years. Despite some promising results of clinical studies with antibody therapy in myositis, further research is crucial to optimize the treatment for this debilitating disease and to find treatment alternatives for treatment-refractory patients.
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Affiliation(s)
- Rachel Zeng
- Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefanie Glaubitz
- Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Schmidt
- Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
- 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.
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von Stillfried S, Bülow RD, Röhrig R, Meybohm P, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Schnepper A, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N. Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report. Crit Care 2022; 26:83. [PMID: 35346314 PMCID: PMC8958804 DOI: 10.1186/s13054-022-03945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Background In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID). Methods The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites. Findings The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency. Interpretation Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03945-x.
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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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Schmidt J, Korsten P, Zechel S, Schlüter S. Introducing the international Myositis Society (iMyoS): a novel multiprofessional society to foster the care, education, and research on myositis. Clin Exp Rheumatol 2022; 40:210-213. [DOI: 10.55563/clinexprheumatol/1a7tkf] [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] [Received: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Jens Schmidt
- Muscle Immunobiology Group, Department of Neurology, Neuromuscular Center, University Medical Center Göttingen; Department of Neurology and Pain Treatment, University Hospital of the Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin; and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany
| | - Sabrina Zechel
- Department of Neuropathology, University Medical Center Göttingen, Germany
| | - Silke Schlüter
- Diagnosegruppe Myositis, Deutsche Gesellschaft für Muskelkranke, Freiburg, Germany
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Rademacher JG, Glaubitz S, Zechel S, Oettler M, Tampe B, Schmidt J, Korsten P. Treatment and outcomes in anti-HMG-CoA reductase-associated immune-mediated necrotising myopathy. Comparative analysis of a single-centre cohort and published data. Clin Exp Rheumatol 2022; 40:320-328. [PMID: 35225222 DOI: 10.55563/clinexprheumatol/2ao5ze] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody-associated myopathy was recognised as a new form of immune-mediated necrotising myopathy (IMNM) a decade ago. Due to the rarity of the disease, only limited data on clinical manifestations and therapeutic outcomes are available. METHODS We retrospectively analysed a monocentric cohort of HMGCR-associated IMNM patients treated at the University Medical Centre Göttingen. Clinical, laboratory, and biopsy data, as well as treatment outcomes, were analysed. In addition, a literature search was performed on published HMGCR IMNM cohorts in Medline and Web of Science. RESULTS We identified nine patients; five were female. The median age was 68 years (47-77). Six were statin-exposed and older than statin-naive patients (71 years [65-77] vs. 51 years [47-67]). All had muscle weakness, seven myalgias. Strength (MRC sum score) was 53/65 (46-61) at baseline and increased to 63/65 (50-65) with therapy. Creatine kinase (CK) levels decreased from a median level of 12837 U/L (range 6346-25011) to 624 U/L (35-1564 U/L). All received glucocorticoids (GC) and at least one immunosuppressive therapy. The literature review identified 26 studies comprising 691 patients. 57.9% were female, 61.3% statin exposed. 95.2% had weakness, 39.1% myalgia. Dysphagia affected 28.8%. 84.9% received GC and a median of 1.5 additional immunosuppressants. Compared to published data, our patients had higher baseline CK values (12837 [6346-25011] vs. 6951 [2539-10500], p<0.001), and we used azathioprine and intravenous immunoglobulins (p<0.001) more frequently but methotrexate and rituximab less frequently (p<0.001). CONCLUSIONS HMGCR-associated IMNM is a rare subset of myositis. With systemic treatment, patients usually achieve partial or complete remission. Optimal treatment has not been established, but glucocorticoids, azathioprine, and methotrexate are generally effective with or without intravenous immunoglobulins.
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Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Centre Göttingen, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Centre Göttingen, Germany
| | - Manuela Oettler
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Centre Göttingen; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany.
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von Stillfried S, Bülow RD, Röhrig R, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N. First report from the German COVID-19 autopsy registry. Lancet Reg Health Eur 2022; 15:100330. [PMID: 35531493 PMCID: PMC9073019 DOI: 10.1016/j.lanepe.2022.100330] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Autopsies are an important tool in medicine, dissecting disease pathophysiology and causes of death. In COVID-19, autopsies revealed e.g., the effects on pulmonary (micro)vasculature or the nervous system, systemic viral spread, or the interplay with the immune system. To facilitate multicentre autopsy-based studies and provide a central hub supporting autopsy centres, researchers, and data analyses and reporting, in April 2020 the German COVID-19 Autopsy Registry (DeRegCOVID) was launched. Methods The electronic registry uses a web-based electronic case report form. Participation is voluntary and biomaterial remains at the respective site (decentralized biobanking). As of October 2021, the registry included N=1129 autopsy cases, with 69271 single data points including information on 18674 available biospecimens gathered from 29 German sites. Findings In the N=1095 eligible records, the male-to-female ratio was 1·8:1, with peaks at 65-69 and 80-84 years in males and >85 years in females. The analysis of the chain of events directly leading to death revealed COVID-19 as the underlying cause of death in 86% of the autopsy cases, whereas in 14% COVID-19 was a concomitant disease. The most common immediate cause of death was diffuse alveolar damage, followed by multi-organ failure. The registry supports several scientific projects, public outreach and provides reports to the federal health authorities, leading to legislative adaptation of the German Infection Protection Act, facilitating the performance of autopsies during pandemics. Interpretation A national autopsy registry can provide multicentre quantitative information on COVID-19 deaths on a national level, supporting medical research, political decision-making and public discussion. Funding German Federal Ministries of Education and Research and Health. Hintergrund: Obduktionen sind ein wichtiges Instrument in der Medizin, um die Pathophysiologie von Krankheiten und Todesursachen zu untersuchen. Im Rahmen von COVID-19 wurden durch Obduktionen z.B. die Auswirkungen auf die pulmonale Mikrovaskulatur, das Nervensystem, die systemische Virusausbreitung, und das Zusammenspiel mit dem Immunsystem untersucht. Um multizentrische, auf Obduktionen basierende Studien zu erleichtern und eine zentrale Anlaufstelle zu schaffen, die Obduktionszentren, Forscher sowie Datenanalysen und -berichte unterstützt, wurde im April 2020 das deutsche COVID-19-Autopsieregister (DeRegCOVID) ins Leben gerufen. Methoden: Das elektronische Register verwendet ein webbasiertes elektronisches Fallberichtsformular. Die Teilnahme ist freiwillig und das Biomaterial verbleibt am jeweiligen Standort (dezentrales Biobanking). Im Oktober 2021 umfasste das Register N=1129 Obduktionsfälle mit 69271 einzelnen Datenpunkten, die Informationen über 18674 verfügbare Bioproben enthielten, die von 29 deutschen Standorten gesammelt wurden. Ergebnisse: In den N=1095 ausgewerteten Datensätzen betrug das Verhältnis von Männern zu Frauen 1,8:1 mit Spitzenwerten bei 65-69 und 80-84 Jahren bei Männern und >85 Jahren bei Frauen. Die Analyse der Sequenz der unmittelbar zum Tod führenden Ereignisse ergab, dass in 86 % der Obduktionsfälle COVID-19 die zugrunde liegende Todesursache war, während in 14 % der Fälle COVID-19 eine Begleiterkrankung war. Die häufigste unmittelbare Todesursache war der diffuse Alveolarschaden, gefolgt von Multiorganversagen. Das Register unterstützt mehrere wissenschaftliche Projekte, die Öffentlichkeitsarbeit und liefert Berichte an die Bundesgesundheitsbehörden, was zu einer Anpassung des deutschen Infektionsschutzgesetzes führte und die Durchführung von Obduktionen in Pandemien erleichtert. Interpretation: Ein nationales Obduktionsregister kann multizentrische quantitative Informationen über COVID-19-Todesfälle auf nationaler Ebene liefern und damit die medizinische Forschung, die politische Entscheidungsfindung und die öffentliche Diskussion unterstützen. Finanzierung: Bundesministerien für Bildung und Forschung und für Gesundheit.
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