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Poli S, Mbroh J, Baron JC, Singhal AB, Strbian D, Molina C, Lemmens R, Turc G, Mikulik R, Michel P, Tatlisumak T, Audebert HJ, Dichgans M, Veltkamp R, Hüsing J, Graessner H, Fiehler J, Montaner J, Adeyemi AK, Althaus K, Arenillas JF, Bender B, Benedikt F, Broocks G, Burghaus I, Cardona P, Deb-Chatterji M, Cviková M, Defreyne L, De Herdt V, Detante O, Ernemann U, Flottmann F, García Guillamón L, Glauch M, Gomez-Exposito A, Gory B, Sylvie Grand S, Haršány M, Hauser TK, Heck O, Hemelsoet D, Hennersdorf F, Hoppe J, Kalmbach P, Kellert L, Köhrmann M, Kowarik M, Lara-Rodríguez B, Legris L, Lindig T, Luntz S, Lusk J, Mac Grory B, Manger A, Martinez-Majander N, Mengel A, Meyne J, Müller S, Mundiyanapurath S, Naggara O, Nedeltchev K, Nguyen TN, Nilsson MA, Obadia M, Poli K, Purrucker JC, Räty S, Richard S, Richter H, Schilte C, Schlemm E, Stöhr L, Stolte B, Sykora M, Thomalla G, Tomppo L, van Horn N, Zeller J, Ziemann U, Zuern CS, Härtig F, Tuennerhoff J. Penumbral Rescue by normobaric O = O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial. Int J Stroke 2024; 19:120-126. [PMID: 37515459 PMCID: PMC10759237 DOI: 10.1177/17474930231185275] [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: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs. AIMS PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion. METHODS AND DESIGN Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial. STUDY OUTCOMES Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted. SAMPLE SIZE Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation. DISCUSSION By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia. TRIAL REGISTRATIONS ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31.
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Affiliation(s)
- Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Joshua Mbroh
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jean-Claude Baron
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carlos Molina
- Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Guillaume Turc
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Robert Mikulik
- Department of Neurology, St. Anne’s University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Patrik Michel
- Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Heinrich J Audebert
- Department of Neurology and Center for Stroke Research Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Johannes Hüsing
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
- Landeskrebsregister Nordrhein-Westfalen, Bochum, Germany
| | - Holm Graessner
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Jens Fiehler
- Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Eppdata GmbH, Hamburg, Germany
| | - Joan Montaner
- Vall d’Hebron Institut de Recerca, Neurovascular Research Lab, Barcelona, Spain
| | | | | | | | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Frank Benedikt
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ina Burghaus
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Pere Cardona
- Department of Neurology, Hospital University de Bellvitge, Barcelona, Spain
| | - Milani Deb-Chatterji
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Cviková
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Herdt
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detante
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Fabian Flottmann
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Monika Glauch
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Alexandra Gomez-Exposito
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospital Regional Universitaire de Nancy, Universite de Lorraine, INSERM U1254, Nancy, France
| | - Sylvie Sylvie Grand
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | - Michal Haršány
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
- International Clinical Research Centre, St. Anne’s University Hospital in Brno, Brno, Czech Republic
| | - Till Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Olivier Heck
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | | | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Julia Hoppe
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pia Kalmbach
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Markus Kowarik
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | | | - Loic Legris
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Steffen Luntz
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Jay Lusk
- Duke University School of Medicine, Durham, NC, USA
| | - Brian Mac Grory
- Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Andreas Manger
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | | | - Annerose Mengel
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Johannes Meyne
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susanne Müller
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | | | - Olivier Naggara
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Krassen Nedeltchev
- Department of Neurology, KSA Kantonsspital Aarau and University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Maike A Nilsson
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Michael Obadia
- Department of Neurology and Stroke Center, Hopital fondation Adolphe de Rothschild, Paris, France
| | - Khouloud Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jan C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hardy Richter
- Department of Infectiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Clotilde Schilte
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Stöhr
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marek Sykora
- Department of Neurology, St. John’s Hospital, Vienna, Austria
| | - Götz Thomalla
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Noel van Horn
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Zeller
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Christine S Zuern
- Department of Cardiology, Universitatsspital Basel, Basel, Switzerland
| | - Florian Härtig
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | - Johannes Tuennerhoff
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
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Zeller J, Bogner B, McFadyen JD, Kiefer J, Braig D, Pietersz G, Krippner G, Nero TL, Morton CJ, Shing KSCT, Parker MW, Peter K, Eisenhardt SU. Transitional changes in the structure of C-reactive protein create highly pro-inflammatory molecules: Therapeutic implications for cardiovascular diseases. Pharmacol Ther 2022; 235:108165. [PMID: 35247517 DOI: 10.1016/j.pharmthera.2022.108165] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 02/08/2023]
Abstract
C-reactive protein (CRP) is the prototypic acute-phase reactant that has long been recognized almost exclusively as a marker of inflammation and predictor of cardiovascular risk. However, accumulating evidence indicates that CRP is also a direct pathogenic pro-inflammatory mediator in atherosclerosis and cardiovascular diseases. The 'CRP system' consists of at least two protein conformations with distinct pathophysiological functions. The binding of the native, pentameric CRP (pCRP) to activated cell membranes leads to a conformational change resulting in two highly pro-inflammatory isoforms, pCRP* and monomeric CRP (mCRP). The deposition of these pro-inflammatory isoforms has been shown to aggravate the localized tissue injury in a broad range of pathological conditions including atherosclerosis and thrombosis, myocardial infarction, and stroke. Here, we review recent findings on how these structural changes contribute to the inflammatory response and discuss the transitional changes in the structure of CRP as a novel therapeutic target in cardiovascular diseases and overshooting inflammation.
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Affiliation(s)
- J Zeller
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany; Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - B Bogner
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - J D McFadyen
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kiefer
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - D Braig
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany; Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - G Pietersz
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Krippner
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - T L Nero
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - C J Morton
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - K S Cheung Tung Shing
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - M W Parker
- Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia; ACRF Rational Drug Discovery Centre, St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia.
| | - K Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Department of Immunology, Monash University, Melbourne, Victoria, Australia.
| | - S U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany.
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Schuermann E, Tippelt S, Zeller J, Geismar D, Jazmati D, Peters S, Timmermann B, Mikasch R, Fleischhack G. RONC-17. Feasibility of proton therapy with and without simultaneous chemotherapy in CNS malignancies of children and adolescents. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Proton therapy (PT) is a valuable alternative to photon radiotherapy in treatment of CNS tumors in children and adolescents. The aim of this study was to investigate the feasibility of recent treatment strategies with a particular focus on the acute toxicity of a simultaneous radiotherapy and chemotherapy (sRCT). PATIENTS AND METHODS: We investigated 199 patients (116 male, 83 female, median age 7.4 years) who received in total 200 cycles of PT (60.5% at new diagnosis, 39.5% at relapse) from September 2013 to February 2017. Entities included ependymomas (34%), medulloblastomas (16%), low grade gliomas (13%), ATRTs (12%), craniopharyngiomas (9%), germ cell tumors (6%), and other entities (10%). SRCT was administered in 52 (26%) treatment cycles. The target tumor was predominantly localized infratentorial (53%), supratentorial (23.5%) and supra-/intrasellar (18%). 38 patients received additional CSI and 8 patients a boost to metastases. Data were collected retrospectively based on patient records. Toxicity was documented according to CTCAE version 4.03. RESULTS: Severe adverse events (SAE ≥ grade 3) occurred in 33.5% of all patients, in particular in form of hematotoxicity (64.1%) and infections (26.8%). In-patient treatment for unexpected SAEs was necessary in 33 patients (16.5%). In the group treated with sRCT 15 out of 52 (28.8%) patients couldn’t receive the recommended dose or time schedule of planned chemotherapy due to SAEs. Comparing the SAE frequency in both groups, the children who have been treated with sRCT had a significantly higher risk of SAEs than the patients who have received proton therapy only (63.5% vs. 23.0%, p=0.001). CONCLUSIONS: PT and concomitant chemotherapy are feasible, but require an interdisciplinary team with continuous out-/inpatient management of patients, as the risk of toxicity is significantly increased. Risk-adapted adjustment of simultaneous chemotherapy is necessary to reduce relevant interruptions of radiotherapy.
Funded by the German Childhood Cancer Foundation
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Affiliation(s)
- Eicke Schuermann
- University Hospital of Essen, Pediatrics III, Pediatric Hematology and Oncology , Essen, NRW , Germany
| | - Stephan Tippelt
- University Hospital of Essen, Pediatrics III, Pediatric Hematology and Oncology , Essen, NRW , Germany
| | - Julia Zeller
- University Hospital of Essen, Pediatrics III, Pediatric Hematology and Oncology , Essen, NRW , Germany
| | - Dirk Geismar
- West German Proton Therapy Center Essen (WPE), University Hospital Essen , Essen, NRW , Germany
- Clinic for Particle Therapy, University Hospital Essen , Essen, NRW , Germany
| | - Danny Jazmati
- West German Proton Therapy Center Essen (WPE), University Hospital Essen , Essen, NRW , Germany
- Clinic for Particle Therapy, University Hospital Essen , Essen, NRW , Germany
| | - Sarah Peters
- West German Proton Therapy Center Essen (WPE), University Hospital Essen , Essen, NRW , Germany
- Clinic for Particle Therapy, University Hospital Essen , Essen, NRW , Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen (WPE), University Hospital Essen , Essen, NRW , Germany
- Clinic for Particle Therapy, University Hospital Essen , Essen, NRW , Germany
| | - Ruth Mikasch
- University Hospital of Essen, Pediatrics III, Pediatric Hematology and Oncology , Essen, NRW , Germany
| | - Gudrun Fleischhack
- University Hospital of Essen, Pediatrics III, Pediatric Hematology and Oncology , Essen, NRW , Germany
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Kopczak A, Schindler A, Sepp D, Bayer-Karpinska A, Malik R, Koch ML, Zeller J, Strecker C, Janowitz D, Wollenweber FA, Hempel JM, Boeckh-Behrens T, Cyran CC, Helck A, Harloff A, Ziemann U, Poli S, Poppert H, Saam T, Dichgans M. Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA. J Am Coll Cardiol 2022; 79:2189-2199. [PMID: 35523659 DOI: 10.1016/j.jacc.2022.03.376] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. OBJECTIVES The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA). METHODS The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA. RESULTS Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke. CONCLUSIONS Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933).
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Affiliation(s)
- Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Schindler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Dominik Sepp
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Klinikum Fürstenfeldbruck, Neurology, Fürstenfeldbruck, Germany
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Mia L Koch
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Julia Zeller
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Department of Neurology, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Helck
- Radiology and Neuroradiology Zurich, Hirslanden/Klinik im Park, Zurich, Switzerland
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Department of Neurology, Helios Klinikum München West, Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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Eisenhardt AE, Schmid A, Esser J, Brugger Z, Lausch U, Kiefer J, Braig M, Runkel A, Wehrle J, Claus R, Bronsert P, Leithner A, Liegl-Atzwanger B, Zeller J, Papini R, von Laffert M, Pfitzner BM, Koulaxouzidis G, Giunta RE, Eisenhardt SU, Braig D. Targeted next-generation sequencing of circulating free DNA enables non-invasive tumor detection in myxoid liposarcomas. Mol Cancer 2022; 21:50. [PMID: 35164780 PMCID: PMC8842903 DOI: 10.1186/s12943-022-01523-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
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6
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Naegel S, Zeller J, Hougard A, Weise CM, Zuelow S, Kleinschnitz C, Obermann M, Solbach K, Holle D. No structural brain alterations in new daily persistent headache - a cross sectional VBM/SBM study. Cephalalgia 2021; 42:335-344. [PMID: 34601946 DOI: 10.1177/03331024211045653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification. METHOD Magnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches. RESULTS No grey matter changes were detected using this sophisticated and cross-checked method. CONCLUSION The absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.
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Affiliation(s)
- Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.,Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julia Zeller
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Paediatric Haematology and Oncology, Paediatrics III, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Anders Hougard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Stefan Zuelow
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Mark Obermann
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Neurology, Klinikum Weser-Egge, Höxter, Germany
| | - Kasja Solbach
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Department of Neurology, Westgerman Headache Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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7
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Thiele JR, Weiß J, Braig D, Zeller J, Stark GB, Eisenhardt SU. Evaluation of the Suprafascial Thin ALT Flap in Foot and Ankle Reconstruction. J Reconstr Microsurg 2021; 38:151-159. [PMID: 34404104 DOI: 10.1055/s-0041-1731763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Distal lower extremity reconstruction can be challenging in terms of flap design. Bulky flaps result in limited mobility accompanied with the need of customized footwear. Raising the ALT-flap in a superficial fascial plane (thin ALT-flap) can be beneficial. This study evaluates thin ALT-flaps for lower distal extremity reconstruction. METHODS In a retrospective study, patients that underwent microvascular extremity reconstruction at the level of the ankle and dorsal foot at the University of Freiburg from 2008-2018 were reviewed. RESULTS 95 patients could be included in the study (35 perforator flaps, 8 fascia flaps and 54 muscle flaps).Among the perforator flaps, 21 ALT-flaps were elevated conventionally and 14 in the superficial fascial plane (thin ALT-flap). Among the conventional ALT-flaps, there was one flap loss (5%) and one successful revision (5%). 5(24%) flaps received secondary thinning. 57%(n = 12) were able to wear conventional footwear. There were 2(15%) successful revisions of thin ALT-flaps. 100% of thin ALT-flaps survived and 85%(n = 11) of the patients wore ordinary footwear after defect coverage.Among fascial flaps, 50%(n = 4) had to be revised with 2(25%) complete and 1 (13%) partial flap loss. All patients achieved mobility in ordinary shoes (n = 8).In muscle flaps, there were 7(13%) revisions and 5(9%) flap losses. 5(9%) flaps received secondary thinning. Only 33%(n = 18) were mobile in ordinary footwear. CONCLUSION The thin ALT-flap is a save one-stage evolution for lower distal extremity reconstruction with a favorable flap survival rate. Compared with conventional ALT-flaps it might be beneficial in reducing the need for expensive custom fitted shoes and secondary thinning procedures.
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Affiliation(s)
- J R Thiele
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - J Weiß
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - D Braig
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.,Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - J Zeller
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - G B Stark
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - S U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
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8
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Adolph JE, Fleischhack G, Mikasch R, Zeller J, Warmuth-Metz M, Bison B, Mynarek M, Rutkowski S, Schüller U, von Hoff K, Obrecht D, Pietsch T, Pfister SM, Pajtler KW, Witt O, Witt H, Kortmann RD, Timmermann B, Krauß J, Frühwald MC, Faldum A, Kwiecien R, Bode U, Tippelt S. Local and systemic therapy of recurrent ependymoma in children and adolescents: short- and long-term results of the E-HIT-REZ 2005 study. Neuro Oncol 2021; 23:1012-1023. [PMID: 33331885 DOI: 10.1093/neuonc/noaa276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Survival in recurrent ependymomas in children and adolescents mainly depends on the extent of resection. Studies on repeated radiotherapy and chemotherapy at relapse have shown conflicting results. METHODS Using data from the German multi-center E-HIT-REZ-2005 study, we examined the role of local therapy and the efficacy of chemotherapy with blockwise temozolomide (TMZ) in children and adolescents with recurrent ependymomas. RESULTS Fifty-three patients with a median age of 6.9 years (1.25-25.4) at first recurrence and a median follow-up time of 36 months (2-115) were recruited. Gross- and near-total resection (GTR/NTR) were achieved in 34 (64.2%) patients and associated with a markedly improved 5-year overall survival (OS) of 48.7% vs. 5.3% in less than GTR/NTR. Radiotherapy showed no improvement in OS following complete resection (OS: 70 (CI: 19.9-120.1) vs. 95 (CI: 20.7-169.4) months), but an advantage was found in less than GTR/NTR (OS: 22 (CI: 12.7-31.3) vs. 7 (CI: 0-15.8) months). Following the application of TMZ, disease progression was observed in most evaluable cases (18/21). A subsequent change to oral etoposide and trofosfamide showed no improved response. PF-A EPN were most abundant in relapses (n = 27). RELA-positive EPN (n = 5) had a 5-year OS of 0%. CONCLUSION The extent of resection is the most important predictor of survival at relapse. Focal re-irradiation is a useful approach if complete resection cannot be achieved, but no additional benefit was seen after GTR/NTR. Longer-term disease stabilization (>6 months) mediated by TMZ occurred in a small number of cases (14.3%).
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Affiliation(s)
- Jonas E Adolph
- Department of Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Gudrun Fleischhack
- Department of Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Ruth Mikasch
- Department of Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Julia Zeller
- Department of Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology and Neurosurgical Clinic, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology and Neurosurgical Clinic, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics and Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics and Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics and Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine Berlin, Berlin, Germany
| | - Denise Obrecht
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics and Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center and Department of Pediatric Hematology and Oncology, University Hospital of Bonn, Bonn, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Kristian W Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Olaf Witt
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Hendrik Witt
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
| | - Jürgen Krauß
- Institute of Diagnostic and Interventional Neuroradiology and Neurosurgical Clinic, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Udo Bode
- Institute of Neuropathology, DGNN Brain Tumor Reference Center and Department of Pediatric Hematology and Oncology, University Hospital of Bonn, Bonn, Germany
| | - Stephan Tippelt
- Department of Pediatrics III, University Hospital of Essen, Essen, Germany
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9
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Zeller J, Krueger C, Lamounier-Zepter V, Fenk S, Strack C, Mohr M, Loew T, Schmitz G, Maier L, Fischer M, Baessler A. 108The adipo-fibrokine Activin A is associated with metabolic abnormalities and left ventricular diastolic dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Zeller
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - C Krueger
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | | | - S Fenk
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - C Strack
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - M Mohr
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - T Loew
- University Hospital Regensburg, Department of Psychosomatics, Regensburg, Germany
| | - G Schmitz
- University Hospital Regensburg, Central Institute for Clinical Chemistry and Laboratory Medicine, Regensburg, Germany
| | - L Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - M Fischer
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - A Baessler
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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10
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Fenk S, Mueller S, Wallner S, Strack C, Hubauer U, Mohr M, Zeller J, Rehli M, Loew T, Maier LS, Fischer M, Baessler A. 111The cardiometabolic consequences of obesity susceptibility gene variants in severe obesity. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Fenk
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - S Mueller
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - S Wallner
- University Hospital Regensburg, Institute of Clinical Chemistry and Laboratory Medicine, Regensburg, Germany
| | - C Strack
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - U Hubauer
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - M Mohr
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - J Zeller
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - M Rehli
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany
| | - T Loew
- University Hospital Regensburg, Department of Psychosomatic Medicine, Regensburg, Germany
| | - L S Maier
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - M Fischer
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - A Baessler
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
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11
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Bérard L, Zeller J, Schaeffer M. Décès et limitations thérapeutiques aux urgences : étude rétrospective des pratiques dans un centre hospitalier français pendant quatre ans. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectifs : Nous avons analysé les caractéristiques médicoadministratives et la prise en charge des patients décédés dans le service d’accueil des urgences (SAU) d’un centre hospitalier français.
Matériels et méthodes : Il s’agissait d’une étude rétrospective observationnelle des patients décédés aux urgences entre janvier 2012 et décembre 2015. Nous avons analysé les procédures de limitation et d’arrêt des thérapeutiques actives (LATA) et comparé les caractéristiques des groupes de patients « LATA » et « Non LATA ».
Résultats : Deux cent trente-deux patients sont décédés au SAU en quatre ans. Vingt pour cent des décès sont survenus très rapidement malgré les soins de réanimation, et 80 % sont survenus après une décision de LATA. Les LATA étaient décidées par un urgentiste seul dans 56 % des cas et avec un délai de réflexion très court : 13 % en préhospitalier et 28 % au cours de la première heure au SAU. Quatorze pour cent des LATA n’étaient pas inscrites dans le dossier médical. Les patients en LATA étaient plus âgés, plus souvent déments, venaient de maison de retraite et étaient adressés pour des motifs plus graves (p < 0,01). Ils ont généralement bénéficié de soins de confort en unité d’hospitalisation de courte durée : antalgiques, hypnotiques et antisécrétoires lorsque cela était nécessaire.
Conclusion : Deux tiers des procédures de LATA ne respectaient pas les recommandations de bonne pratique en termes de collégialité et de traçabilité. Une amélioration des pratiques est possible au SAU par l’élaboration d’une nouvelle procédure de LATA prenant en compte les contraintes de l’urgence.
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12
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Mohr M, Zeller J, Fenk S, Strack C, Loew T, Maier LS, Fischer M, Baessler A. 5218Epicardial adipose tissue is related to left ventricular diastolic dysfunction in healthy obese and metabolic syndrome obese. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Mohr
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - J Zeller
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - S Fenk
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - C Strack
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - T Loew
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - L S Maier
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - M Fischer
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - A Baessler
- University of Regensburg, Department of Internal Medicine II, Regensburg, Germany
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Abstract
ZusammenfassungDie aktuellen Konzepte zur Behandlung der akuten zerebralen Ischämie sowie der Hirnblutung werden dargestellt. Die Indikationsstellung zur Thrombolyse im Standardfall und in besonderen Situationen, die Anwendung moderner MRT-Diagnostik und differenzialtherapeutische Überlegungen werden dargelegt. Bei der Therapie der Hirnblutung wird auf die Indikationsstellung zur neurochirurgischen Hämatomevakuation eingegangen und die akute hämostatische Therapie besprochen.
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14
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Abstract
Intestinal spirochetosis, an infection of the mucosa by spiral-shaped organisms, was studied in clinically normal rhesus monkeys (Macaca mulatta) by histology, transmission and scanning electron microscopy. The incidence of intestinal spirochetosis was 42% in 221 monkeys. Spiral organisms stained with hematoxylin and eosin (HE) appeared as a broad basophilic haze on the colonic surface and were strongly positive by the Warthin-Starry stain. Spiral-shaped bacteria include two structurally different organisms: spirochetes and flagellated microbes. They intimately populated the brush border of the surface of the epithelium of the large intestine. They were absent in the crypts and in the small intestine. Infection by spirochetes produced no alteration of cytocomponents of the underlying host structures. Spirochetes and flagellates infrequently penetrated beyond the brush border into the epithelial cytoplasm and also into the lamina propria. Even in cases where invasion was documented, no inflammatory response was found.
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Affiliation(s)
- J. Zeller
- Department of Pathology, Veterans Administration Medical Center, Washington, D.C., and Department of Experimental Pathology, Division of Pathology, Walter Reed Army Institute of Research, Washington, D.C
| | - A. Takeuchi
- Department of Pathology, Veterans Administration Medical Center, Washington, D.C., and Department of Experimental Pathology, Division of Pathology, Walter Reed Army Institute of Research, Washington, D.C
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15
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Üçeyler N, Zeller J, Kewenig S, Kittel-Schneider S, Fallgatter AJ, Sommer C. Increased cortical activation upon painful stimulation in fibromyalgia syndrome. BMC Neurol 2015; 15:210. [PMID: 26486985 PMCID: PMC4618366 DOI: 10.1186/s12883-015-0472-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain and associated symptoms. We investigated cerebral activation in FMS patients by functional near-infrared spectroscopy (fNIRS). METHODS Two stimulation paradigms were applied: a) painful pressure stimulation at the dorsal forearm; b) verbal fluency test (VFT). We prospectively recruited 25 FMS patients, ten patients with unipolar major depression (MD) without pain, and 35 healthy controls. All patients underwent neurological examination and all subjects were investigated with questionnaires (pain, depression, FMS, empathy). RESULTS FMS patients had lower pressure pain thresholds than patients with MD and controls (p < .001) and reported higher pain intensity (p < 0.001). Upon unilateral pressure pain stimulation fNIRS recordings revealed increased bilateral cortical activation in FMS patients compared to controls (p < 0.05). FMS patients also displayed a stronger contralateral activity over the dorsolateral prefrontal cortex in direct comparison to patients with MD (p < 0.05). While all three groups performed equally well in the VFT, a frontal deficit in cortical activation was only found in patients with depression (p < 0.05). Performance and cortical activation correlated negatively in FMS patients (p < 0.05) and positively in patients with MD (p < 0.05). CONCLUSION Our data give further evidence for altered central nervous processing in patients with FMS and the distinction between FMS and MD. TRIAL REGISTRATION ISRCTN registry ID ISRCTN15015327 (24.09.2015).
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Affiliation(s)
- Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany.
| | - Julia Zeller
- Department of Psychiatry, University of Würzburg, Würzburg, Germany.
| | - Susanne Kewenig
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany.
| | | | | | - Claudia Sommer
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany.
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16
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Schirmer M, Zeller J, Krause D, Jekle M, Becker T. In situ monitoring of starch gelatinization with limited water content using confocal laser scanning microscopy. Eur Food Res Technol 2014. [DOI: 10.1007/s00217-014-2213-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Zeller J, Hetzenecker A, Arzt M. Schlafbezogene Atmungsstörungen bei Patienten mit Herzinsuffizienz: Epiphänomen oder wechselseitige Krankheitsbeeinflussung. Pneumologie 2013; 67:150-156. [DOI: 10.1055/s-0032-1326221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Zeller
- Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)
| | - A. Hetzenecker
- Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)
| | - M. Arzt
- Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)
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18
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Zeller J, Polak T, Fallgatter A. IC‐P‐081: Near‐infrared spectroscopy: a reliable tool to assess cortical changes in Alzheimer's disease and their progression over time. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.147] [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: 11/30/2022]
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19
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Zeller J, Polak T, Fallgatter A. IC‐P‐080: Prefrontal lateralization during a verbal fluency task predicts neuropsychological changes in healthy elderly controls: a fNIRS study. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Zeller J, Polak T, Fallgatter A. P1‐365: Near‐infrared spectroscopy: a reliable tool to assess cortical changes in Alzheimer's disease and their progression over time. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.645] [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: 11/28/2022]
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Majkrzak A, Johnston J, Kacey D, Zeller J. Variability of the lateral femoral cutaneous nerve: An anatomic basis for planning safe surgical approaches. Clin Anat 2010; 23:304-11. [DOI: 10.1002/ca.20943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abecassis S, Bastuji-Garin S, Khosrotehrani K, Zeller J, Revuz J, Wolkenstein P. Age at diagnosis of neurofibromatosis 1: an audit of practice. Dermatology 2008; 216:347-8. [PMID: 18277076 DOI: 10.1159/000116622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- S Abecassis
- Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Université Paris-XII, Créteil , France
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Vetter S, Zeller J, Fellbaum C. [Angioma of the spleen as an accidental finding]. ROFO-FORTSCHR RONTG 2007; 179:1195-6. [PMID: 17948199 DOI: 10.1055/s-2007-963396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Stingele R, Eschenfelder CC, Zeller J. [Therapy of acute stroke]. Hamostaseologie 2006; 26:316-25. [PMID: 17146545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Current therapeutic concepts for acute cerebral ischaemia and cerebral haemorrhage are summarized. Patient selection for thrombolysis, the role of stroke MRI and the choice of recanalization techniques are discussed. The treatment of intracerebral haemorrhage with particular emphasis on evacuation of haematoma and acute haemostatic therapy are discussed.
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Affiliation(s)
- R Stingele
- Neurologische Abteilung, UK-SH-Campus Kiel, Schittenhelmstrasse 10, 24105 Kiel
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25
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Valeyrie-Allanore L, Ismaïli N, Bastuji-Garin S, Zeller J, Wechsler J, Revuz J, Wolkenstein P. Symptoms associated with malignancy of peripheral nerve sheath tumours: a retrospective study of 69 patients with neurofibromatosis 1. Br J Dermatol 2005; 153:79-82. [PMID: 16029330 DOI: 10.1111/j.1365-2133.2005.06558.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurofibromatosis 1 (NF1) is a common genetic disorder with variable clinical manifestations and an unpredictable course. Plexiform neurofibromas are common complications of NF1. Their malignant transformation is the main cause of mortality in adult patients with NF1. OBJECTIVES To identify clinical factors associated with malignant transformation of plexiform neurofibromas. METHODS Using the database of our neurofibromatosis clinic we included in a retrospective study all patients with NF1 having at least one peripheral nerve sheath tumour for which they underwent surgery or surgical biopsy. Predictive values for malignant transformation of three clinical symptoms, i.e. pain, enlargement of mass and neurological symptoms, were evaluated in association with histological parameters. RESULTS Of 69 patients studied, 48 had at least one plexiform neurofibroma and 21 had a malignant peripheral nerve sheath tumour. Only enlargement of the tumour had high negative and positive predictive values for malignant transformation: 0.92 and 0.95, respectively. In multivariate analysis, tumour enlargement was independently associated with malignant transformation (odds ratio 167.8, 95% confidence interval 14.0-2012.1). CONCLUSIONS From a practical point of view, pain, neurological deficit and enlargement of a pre-existing peripheral nerve sheath tumour in NF1 must lead to deep surgical biopsy to rule out malignant transformation.
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Affiliation(s)
- L Valeyrie-Allanore
- Department of Pathology, Paris XII University, Henri-Mondor Hospital, AP-HP, F-94010 Creteil cedex, France
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26
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Maier P, Fleckenstein K, Li L, Laufs S, Fruehauf S, Zeller J, Wenz F, Herskind C. Microarray Analysis of Differentially Expressed Genes in Response to Retrovirally Mediated Overexpression of MDR1. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.824] [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: 10/25/2022]
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27
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Abstract
OBJECTIVE People with neurofibromatosis type 1 (NF1) have a 10% lifetime risk of developing a malignant peripheral nerve sheath tumor (MPNST). MPNSTs are often metastatic and are a frequent cause of death among people with NF1. Clinical evidence suggests that most MPNSTs in people with NF1 develop from preexisting plexiform neurofibromas. However, it is not known whether an individual's risk of developing an MPNST is associated with the burden of benign neurofibromas. The authors conducted a study to determine whether people with NF1 who have benign neurofibromas of various kinds are at greater risk of developing MPNSTs than patients with NF1 who lack these benign tumors. METHODS Clinical information on 476 NF1 probands in the Henri Mondor Database was analyzed by logistic regression to examine associations between MPNSTs and internal plexiform, superficial plexiform, subcutaneous, and cutaneous neurofibromas. RESULTS Individuals with subcutaneous neurofibromas were approximately three times more likely to have internal plexiform neurofibromas or MPNSTs than individuals without subcutaneous neurofibromas. Individuals with internal plexiform neurofibromas were 20 times more likely to have MPNSTs than individuals without internal plexiform neurofibromas. When this analysis was done with both subcutaneous and internal plexiform neurofibromas as explanatory variables, only the association of MPNSTs with internal plexiform neurofibromas remained significant. CONCLUSIONS The observation that malignant peripheral nerve sheath tumors are strongly associated with internal plexiform neurofibromas suggests that patients with neurofibromatosis type 1 with these benign tumors warrant increased surveillance for malignancy.
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Affiliation(s)
- T Tucker
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
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Leplège A, Ecosse E, Zeller J, Revuz J, Wolkenstein P. [The French version of Skindex (Skindex-France). Adaptation and assessment of psychometric properties]. Ann Dermatol Venereol 2003; 130:177-83. [PMID: 12671579] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The Skindex is an American tool designed to measure the impact of skin diseases on quality of life. The aim of our study was to adapt and validate this questionnaire in French in a population of patients with neurofibromatosis 1. MATERIAL AND METHODS Translation and cultural adaptation: Translations were performed independently by two bilingual persons, then discussed. A preliminary version was obtained and confronted with 5 persons with low level of education and 6 patients with neurofibromatosis 1, before assessment in 24 neurofibromatosis 1 patients. The final version was named Skindex-France. Validation study: a test-retest study (1 month interval) was performed on 129 subjects with neurofibromatosis 1 to assess reliability and validity. RESULTS Acceptability was good with a low rate of missing data (less than 5 p. 100). Ceiling and floor effects were less than 20 p. 100. The scores are sufficiently reliable (Cronbach alpha coefficient: emotions: 0.95, symptoms: 0.86, functioning: 0.94, and test-retest Spearman r: emotions: 0.92, symptoms: 0.84, functioning: 0.90). CONCLUSION Skindex-France can be used to measure with precision the impact of skin diseases.
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Affiliation(s)
- A Leplège
- EA 2494, UFR Cochin-Port Royal, Université Paris V, Paris.
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29
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Wetherall NT, Trivedi T, Zeller J, Hodges-Savola C, McKimm-Breschkin JL, Zambon M, Hayden FG. Evaluation of neuraminidase enzyme assays using different substrates to measure susceptibility of influenza virus clinical isolates to neuraminidase inhibitors: report of the neuraminidase inhibitor susceptibility network. J Clin Microbiol 2003; 41:742-50. [PMID: 12574276 PMCID: PMC149673 DOI: 10.1128/jcm.41.2.742-750.2003] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2002] [Revised: 07/26/2002] [Accepted: 10/15/2002] [Indexed: 12/31/2022] Open
Abstract
The increasing use of influenza virus neuraminidase (NA) inhibitors (NIs) necessitates the development of reliable methods for assessing the NI susceptibility of clinical isolates. We evaluated three NA inhibition assays against a panel of five clinical isolates each of influenza virus A/H1N1, A/H3N2, and B strains and four viruses with a defined resistance genotype (R292K, H274Y, R152K, and E119V). For fluorometric enzyme assay (FA) 1 (FA-1), 2'-(4-methylumbelliferyl)-alpha-D-N-acetylneuraminic acid (MUNANA) at 100 microM was used as the substrate, with pretitration of the virus input. For FA-2, MUNANA at 200 microM was used as the substrate, with a fixed 1:10 dilution of input virus. For the chemiluminescence (CL) assay, the 1,2-dioxetane derivative of sialic acid at 100 microM was used as the substrate, with pretitration of the virus. Four different operators repeated the assays several times in a blinded fashion with both zanamivir and oseltamivir carboxylate (GS4071) to determine intra- and interassay variations. Mean 50% inhibitory concentration (IC(50)) values were lower and generally less variable with the CL assay. FA-1 displayed greater variation than the CL assay or FA-2 and the highest IC(50) values with zanamivir; FA-2 showed the highest values with oseltamivir, particularly for influenza virus B, and was more variable with zanamivir than was the CL assay. All three assays detected 40-fold or greater changes in IC(50) values for the resistant viruses with at least one drug. Mixing experiments, whereby increasing fractions (0, 20, 40, 60, 80, and 100%) of NA from a known NI-resistant virus were mixed with the corresponding NI-sensitive parental NA, indicated that the resolution of IC(50) values was clearer with the CL assay than with FA-2 for two of the resistant variants (R152K and E119V). The FA and CL methods were reliable for the detection of NI resistance, but all assays have certain limitations. Based on reproducibility, ease of automation, time required for the assay, and greater sensitivity, the CL assay was selected for future susceptibility testing of influenza virus isolates circulating globally.
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Affiliation(s)
- N T Wetherall
- ViroMed Laboratories, Inc, Minnetonka, Minnesota, USA
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Arigon V, Binaghi M, Sabouret C, Zeller J, Revuz J, Soubrane G, Wolkenstein P. Usefulness of systematic ophthalmologic investigations in neurofibromatosis 1: a cross-sectional study of 211 patients. Eur J Ophthalmol 2002; 12:413-8. [PMID: 12474925 DOI: 10.1177/112067210201200512] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the usefulness of ophthalmologic examination for diagnosis and for detection of complications in adult patients with neurofibromatosis 1. METHODS PATIENTS with at least one criterion of neurofibromatosis 1 (excluding ophthalmologic criteria) seen at a referral centre had a systematic ophthalmologic examination including best-corrected visual acuity, slit-lamp examination and dilated funduscopy. The ophthalmologist was unaware of all other anamnestic data. RESULTS PATIENTS 211 patients with NF1 were included (mean age: 32 +/- 14 yr.). Ophthalmologic examination in neurofibromatosis 1 patients: Lisch nodules (n = 185) (87.7%); choroidal hamartomas (n = 61) (29%); enlarged corneal nerves (n = 1); 3 plexiform neurofibromas (n = 3); symptomatic optic pathway gliomas (n = 5). Diagnostic contribution of presence of Lisch nodules: 6 (3%) of 211 patients. Detection of complications: none. CONCLUSIONS In adult patients with neurofibromatosis 1, the contribution of ophthalmologic examination to diagnosis and to the detection of complications is low. Ophthalmologic examination should be performed in patients for whom questioning and clinical examination failed to give evidence of NF1 or to determine the NF subtypes.
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Affiliation(s)
- V Arigon
- Department of Dermatology, Henri-Mondor Hospital, Paris XII University, Créteil Cedex, France
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Pinson S, Créange A, Barbarot S, Stalder JF, Chaix Y, Rodriguez D, Sanson M, Bernheim A, D'incan M, Doz F, Stoll CL, Combemale P, Kalifa C, Zeller J, Teillac-Hamel D, Lyonnet S, Zerah M, Lacour JP, Guillot B, Wolkenstein P. [Recommendations for the treatment of neurofibromatosis type 1]. J Fr Ophtalmol 2002; 25:423-33. [PMID: 12011750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- S Pinson
- Génétique Moléculaire, Hôpital Edouard Herriot, Lyon, France
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Zeller J, Wechsler J, Revuz J, Wolkenstein P. [Blue-red macules and pseudoatrophic macules in neurofibromatosis 1]. Ann Dermatol Venereol 2002; 129:180-1. [PMID: 11937955] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Blue-red macules are exception during neurofibromatosis 1. Between October 1988 and March 2000 in our cohort of patients, we systematically looked for these lesions. PATIENTS AND METHODS Presence and number of blue-red macules were evaluated. Biopsies and photographs were proposed to patients. RESULTS Forty-four patients out of 583 (39 y; range: 20-66 y) (7.5 p. 100; CI 95 p. 100: 5.5-9.8 p. 100) had blue-red macules mainly on the trunk. Histologically, blue-red macules corresponded to neurofibromatous tissue infiltrating capillary blood vessels and venules. CONCLUSION Blue-red macules are a peculiar type of neurofibroma and can therefore be considered as a criterion for the diagnosis of neurofibromatosis 1.
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Affiliation(s)
- J Zeller
- Service de Dermatologie, Hôpital Henri-Mondor (AP-HP), Université Paris XII, 94010 Créteil
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Pinson S, Créange A, Barbarot S, Stalder JF, Chaix Y, Rodriguez D, Sanson M, Bernheim A, d'Incan M, Doz F, Stoll C, Combemale P, Kalifa C, Zeller J, Teillac-Hamel D, Lyonnet S, Zerah M, Lacour JP, Guillot B, Wolkenstein P. [Neurofibromatosis 1: recommendations for management]. Arch Pediatr 2002; 9:49-60. [PMID: 11865551 DOI: 10.1016/s0929-693x(01)00695-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Twenty experts, members of a French medical network devoted to neurofibromatosis 1 have elaborated recommendations for the management of the disease. Bibliography was obtained through a Medline of articles from 1966 to 1999 for the terms neurofibromatosis, NF1, neurofibroma and from textbooks. A consensual document was written taking into account extracted data. An annual careful clinical examination is recommended except in cases with complications. Screening investigations are not recommended due to the rarity of complications, generally symptomatic and easily detected during the clinical follow-up. The only controversial exception might be magnetic resonance imaging for early detection of optic pathway gliomas in young children. A co-ordinated follow-up in specialised multidisciplinary centres, providing patients with a rational management, is recommended.
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Affiliation(s)
- S Pinson
- Hôpital Edouard-Herriot, Lyon, France.
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Zeller J. ["Innovative Hospital Management" BCD Seminar, Tuttlingen 25-26 May 2001]. Chirurg 2001; 72:suppl 312. [PMID: 11766673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Wolkenstein P, Zeller J, Revuz J, Ecosse E, Leplège A. Quality-of-life impairment in neurofibromatosis type 1: a cross-sectional study of 128 cases. Arch Dermatol 2001; 137:1421-5. [PMID: 11708944 DOI: 10.1001/archderm.137.11.1421] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 affects quality of life (QoL) through association with severe complications, impact on cosmetic features, and uncertainty of the effects of the disorder. OBJECTIVE To evaluate the impact of the severity and visibility of neurofibromatosis type 1 on QoL. DESIGN Monocenter, cross-sectional study. SETTING One French academic dermatological and neurofibromatoses clinic. PATIENTS A total of 128 adult patients with neurofibromatosis type 1. MAIN OUTCOME MEASURES Evaluation of severity and visibility using, respectively, the Riccardi and Ablon scales. Evaluation of skin disease-specific and general QoL using, respectively, Skindex-France and SF-36 (Short Form 36 health survey) profiles controlled for sex, age, severity, and visibility. RESULTS In a multiple regression model controlling for sex, age, and visibility, visibility remained independently associated with the alteration of 3 aspects of the skin disease-specific QoL (Skindex-France): emotions, physical symptoms, and functioning (P =.03, P =.009, and P =.002, respectively). Patients with more severe neurofibromatosis reported more effects on the following domains of their general health QoL (SF-36): physical function, bodily pain, general health perception, and vitality (P =.006, P =.03, P =.01, and P =.04, respectively). CONCLUSIONS Neurofibromatosis type 1 has a significant impact on QoL through alteration of health and appearance. The consequences of visibility and severity from the viewpoint of patients can be evaluated using Skindex and the SF-36, respectively.
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Affiliation(s)
- P Wolkenstein
- Department of Dermatology, Hôpital Henri-Mondor, F-94010 Créteil CEDEX, France.
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Leroy K, Dumas V, Martin-Garcia N, Falzone MC, Voisin MC, Wechsler J, Revuz J, Créange A, Levy E, Lantieri L, Zeller J, Wolkenstein P. Malignant peripheral nerve sheath tumors associated with neurofibromatosis type 1: a clinicopathologic and molecular study of 17 patients. Arch Dermatol 2001; 137:908-13. [PMID: 11453810] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To identify potential prognostic factors and criteria for early detection of malignant peripheral nerve sheath tumors associated with neurofibromatosis type 1 (NF1). DESIGN Retrospective study of malignant peripheral nerve sheath tumors in a cohort of 395 patients with NF1 followed up between October 1, 1988, and January 1, 1999; review of the clinical and histological characteristics of treatment and course; and analysis of p53 mutations and overexpression in tumors. SETTING Teaching hospital referral neurofibromatosis center for adults. PATIENTS Seventeen patients with NF1 (9 males and 8 females). Mean +/- SD patient age at diagnosis was 32 +/- 14 years. MAIN OUTCOME MEASURES (1) Clinical symptoms, (2) comparison of p53 mutations and overexpression in benign vs malignant tumors; and (3) median survival. RESULTS Twelve patients had high-grade tumors. All tumors except 1 developed on preexisting nodular or plexiform neurofibromas. Pain and enlarging mass were the first and predominant signs. None of the benign tumors displayed significant p53 staining or p53 mutations. Six of 12 malignant tumors significantly overexpressed p53, and 4 of 6 harbored p53 missense mutations. Median survival was 18 months overall, 53 months in peripheral locations, and 21 months in axial locations. CONCLUSIONS Malignant peripheral nerve sheath tumors are highly aggressive in NF1. They mostly arise from plexiform or nodular neurofibromas. Investigations and deep biopsy of painful and enlarging nodular or plexiform neurofibromas should be considered in patients with NF1. Late appearance of p53 mutations and overexpression precludes their use as predictive markers of malignant transformation.
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Affiliation(s)
- K Leroy
- Department of Dermatology, Henri-Mondor Hospital, F-94010 Créteil CEDEX, France
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Moreno JC, Mathoret C, Lantieri L, Zeller J, Revuz J, Wolkenstein P. Carbon dioxide laser for removal of multiple cutaneous neurofibromas. Br J Dermatol 2001; 144:1096-8. [PMID: 11359412 DOI: 10.1046/j.1365-2133.2001.04214.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mahé E, Zeller J, Wechsler J, Wolkenstein P, Revuz J. [Large hairy pigmented spots in neurofibromatosis type 1: an atypical form of neurofibromas]. Ann Dermatol Venereol 2001; 128:619-21. [PMID: 11427796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
INTRODUCTION Large hairy pigmented spots have been observed in patients with neurofibromatosis type 1. In this study we tried to determine the nature and the frequency of these hairy pigmented spots in neurofibromatosis type 1. PATIENTS AND METHODS In patients with neurofibromatosis type 1, hairy pigmented spots with a diameter more than 3 cm were systematically notified. Realisation of the biopsy of the spot was proposed to the patient. RESULTS Among 614 patients with neurofibromatosis type 1, seven (1.1 p. 100) had a large hairy pigmented spot. Biopsy was realized in six cases. In five cases, diagnosis was superficial and plexiform neurofibroma, the 6(th) case was a Becker's nevus. CONCLUSION Large hairy pigmented spot is a rare aspect of superficial and plexiform neurofibroma during neurofibromatosis type 1. A biopsy may be useful if it is necessary for the disorder diagnosis.
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Affiliation(s)
- E Mahé
- Service de Dermatologie, Hôpital Henri-Mondor (AP-HP), Université Paris XII, Créteil
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Pinson S, Créange A, Barbarot S, Stalder JF, Chaix Y, Rodriguez D, Sanson M, Bernheim A, D'incan M, Doz F, Stoll C, Combemale P, Kalifa C, Zeller J, Teillac-Hamel D, Lyonnet S, Zerah M, Lacour JP, Guillot B, Wolkenstein P. [Neurofibromatosis 1: recommendations for management]. Ann Dermatol Venereol 2001; 128:567-75. [PMID: 11395662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- S Pinson
- Génétique Moléculaire, Hôpital Edouard Herriot, Lyon
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Wolkenstein P, Mitrofanoff M, Lantieri L, Zeller J, Wechsler J, Boui M, Revuz J, Mansat E, Stalder JF. Bleeding: a complication of neurofibromatosis 1 tumors. Arch Dermatol 2001; 137:233-4. [PMID: 11176708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
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Paice J, Shott S, Oldenburg F, Zeller J, Swanson B. EFFICACY OF A VIBRATORY STIMULUS FOR THE RELIEF OF HIV‐ASSOCIATED NEUROPATHIC PAIN. J Peripher Nerv Syst 2000. [DOI: 10.1111/j.1529-8027.2000.022-2.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: 11/29/2022]
Affiliation(s)
- Ja Paice
- Pain 84: 291–296, 2000. Reprinted with permission from the International Association for the Study of Pain
| | - S Shott
- Pain 84: 291–296, 2000. Reprinted with permission from the International Association for the Study of Pain
| | - Fp Oldenburg
- Pain 84: 291–296, 2000. Reprinted with permission from the International Association for the Study of Pain
| | - J Zeller
- Pain 84: 291–296, 2000. Reprinted with permission from the International Association for the Study of Pain
| | - B. Swanson
- Pain 84: 291–296, 2000. Reprinted with permission from the International Association for the Study of Pain
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Paice J, Shott S, Oldenburg F, Zeller J, Swanson B. EFFICACY OF A VIBRATORY STIMULUS FOR THE RELIEF OF HIV-ASSOCIATED NEUROPATHIC PAIN. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.00022-2.x] [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: 11/20/2022]
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Girodon-Boulandet E, Pantel J, Cazeneuve C, Gijn MV, Vidaud D, Lemay S, Martin J, Zeller J, Revuz J, Goossens M, Amselem S, Wolkenstein P. NF1 gene analysis focused on CpG-rich exons in a cohort of 93 patients with neurofibromatosis type 1. Hum Mutat 2000; 16:274-5. [PMID: 10980545 DOI: 10.1002/1098-1004(200009)16:3<274::aid-humu21>3.3.co;2-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We studied the NF1 gene in 93 unrelated patients with neurofibromatosis type1, focusing the analysis on four exons that contain the highest number of possible mutations occurring at CpG sites. We used denaturing gradient gel electrophoresis to analyse exons 16, 28, 29 and 49, which contain 45 (25%) of the 183 possible mutations that could occur at the 120 CpG dinucleotides of the coding sequence. Six different mutations were identified, five of which are novel: two truncating mutations, W1810X and 5448insG, located in exon29; two splice defects leading to exon29 skipping, 5206-2A>G and 5546G>A; and one missense mutation, L844F, located in exon16. The already described R1748X mutation located in exon29 was found in two unrelated patients. The 5546G>A and R1748X mutations are located at CpG sites, whereas the W1810X involves a CpNpG site. Four novel polymorphisms, which may be helpful for family studies, were also identified. Overall, all but one mutations were found in exon29, a result which suggests that all the CpG sites of the NF1 coding sequence do not have the same mutability, and that exon29, the most CpG-rich exon, contains mutational hotspots associated with NF1.
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Affiliation(s)
- E Girodon-Boulandet
- Service de Biochimie et de Génétique and INSERM U468, Hôpital Henri-Mondor, 94010 Créteil Cedex, France
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Wolkenstein P, Durand-Zaleski I, Moreno JC, Zeller J, Hemery F, Revuz J. Cost evaluation of the medical management of neurofibromatosis 1: a prospective study on 201 patients. Br J Dermatol 2000; 142:1166-70. [PMID: 10848741 DOI: 10.1046/j.1365-2133.2000.03543.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neurofibromatosis 1 (NF1) is associated with many internal complications as well as skin manifestations, and patients may require a variety of medical and surgical interventions. We aimed to assess the medical needs of NF1 patients, and to evaluate the financial cost of the resources used for them in relation to the severity of the disease. We conducted a prospective analysis on a cohort of 201 patients in our referral centre for adults. Severity of the disease was assessed. Therapeutic management was considered as multidisciplinary if it required more than three different specialists. Plastic and dermatological surgery procedures performed were recorded. Hospital costs were computed over a 3-year period and included all hospitalization days, clinic visits and procedures performed in all departments where the patients were admitted. One hundred and thirty-seven patients had at least one out-patient procedure or one hospitalization during the follow-up period. The mean cost per patient per year was pound810 (median 240; range 0-13, 860). Multidisciplinary procedures were more frequent in moderately and severely affected NF1 patients than in milder cases (P < 0. 0001); hence, the costs for moderate and severe cases were higher than for less severe groups (P = 0.005). Plastic and/or dermatological surgery was performed with the same frequency in the different severity groups (71%). Regardless of the presence of serious intractable complications, the patients' priority is for treatment of the disfigurement due to the disease. The management of these patients can be considered relatively inexpensive from the viewpoint of the healthcare system.
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Affiliation(s)
- P Wolkenstein
- Departments of Dermatology and Public Health, and Réseau NF-Mondor, Henri-Mondor Hospital, 94010 Créteil cedex, France.
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Abstract
Pain related to HIV disease is frequently debilitating. Of the many pain syndromes that occur in persons with HIV, distal symmetrical polyneuropathy (DSPN) is particularly devastating. Because DSPN often responds, at best, only partially to available pharmacologic interventions, non-pharmacologic interventions need to be investigated. Vibration has been suggested to be effective for reducing pain in other populations with chronic pain. This randomized, sham-controlled, double-masked study tested the short-term efficacy of a 45-min vibration treatment for DSPN foot pain in persons infected with HIV. Vibration therapy was delivered using a portable platform foot vibrator that provided stimulation at a frequency of 60 Hz. For all patients, the control box for the vibrator emitted an audible hum and part of the control box lit up during treatment, but only patients randomized to active treatment received vibration. Pain intensity (0-10) was measured immediately prior to and after treatment. Subjects were also questioned regarding pain relief (0-100%) immediately after the treatment. The mean percentage pain relief was 61.0+/-33.1% (median 70.0; range 0-100) for all patients, 67.3+/-34.0% (median 80.0; range 0-100) for vibration patients, and 55.0+/-32.0% (median 60.0; range 0-100) for sham patients. No statistically significant differences were found between the vibration and sham groups with respect to percentage pain relief (Mann-Whitney test; P=0.19) or the pre- and post-treatment current-pain difference (Mann-Whitney test; P=0.92). These results underscore the necessity for control groups in studies of non-pharmacologic therapies for pain.
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Affiliation(s)
- J A Paice
- Palliative Care, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, IL, USA.
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Boulandet EG, Pantel J, Cazeneuve C, Gijn MV, Vidaud D, Lemay S, Martin J, Zeller J, Revuz J, Goossens M, Amselem S, Wolkenstein P. NF1 gene analysis focused on CpG-rich exons in a cohort of 93 patients with neurofibromatosis type 1. Hum Mutat 2000. [DOI: 10.1002/1098-1004(200009)16:3<274::aid-humu21>3.0.co;2-f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wolkenstein P, Zeller J. [Clinical diagnosis of neurofibromatosis type 1]. Presse Med 1999; 28:2174-80. [PMID: 10629698] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
UNLABELLED TO DIAGNOSE NEUROFIBROMATOSIS TYPE 1 (NF1) AND TO DETECT ITS COMPLICATIONS: NF1 is the commonest autosomal dominant (1/3000 à 3500 births). Café au lait spots, axillary and inguinal freckling, hamartomas of the iris (Lisch nodules) and multiple cutaneous neurofibromas, characterize NF1. NF1 can be associated with optic gliomas, spinal or peripheral nerve neurofibromas, macrocephaly, cognitive et neurological disorders, une scoliosis and bone abnormalities. Morbidity and mortality of NF1 are linked to multisystemic complications. DIAGNOSIS In adulthood, diagnosis of NF1 is easy with physical examination: presence of café au lait spots, axillary and inguinal frecklings, neurofibromas. In early childhood, diagnosis can be difficult. Penetrance of the gene is complete by the age of 5 and the diagnosis is made during the follow-up. COMPLICATIONS Clinical examination can easily identify complications such as scoliosis, pseudarthrosis, hypertension linked to renal artery stenosis or phaeochromocytoma or learning disabilities. CONCLUSION Annual clinical examination is sufficient for the follow-up of NF1 patients. Screening investigations are not useful because of rare complications, but symptomatic.
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Affiliation(s)
- P Wolkenstein
- Service de Dermatologie et Réseau NF, Hôpital Henri-Mondor, Créteil.
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Abstract
BACKGROUND Acquired cutis laxa is a rare disease characterized by sagging skin, premature wrinkling and reduced skin elasticity. OBSERVATION We report a 21-year-old woman, who presented with acquired cutis laxa on the face and the ear lobes. Urticarial papules had preceded for 6 years. There was no systemic involvement. Skin specimens were obtained from lax skin and urticarial papules, and from healthy controls. Histology showed only few perivascular lymphocytes in lax ear skin and a dense inflammatory infiltrate in urticarial skin. In both biopsies elastic fibres were decreased as demonstrated by computerized morphometric analyses. Elastase activities of fibroblasts in culture were evaluated. There was a 2- to 3-fold increase in elastase activity in urticarial skin fibroblasts, contrasting with a normal elastase activity in lax ear skin. CONCLUSION Our findings suggest that the inflammatory cells could play a significant role in the destruction of elastic fibres.
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Affiliation(s)
- A Bouloc
- Department of Dermatology, Hôpital Henri-Mondor, Créteil, France.
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Gutierrez A, Dorn P, Zeller J, King D, Lester LF, Rudolph W, Sheik-Bahae M. Autocorrelation measurement of femtosecond laser pulses by use of a ZnSe two-photon detector array. Opt Lett 1999; 24:1175-1177. [PMID: 18073977 DOI: 10.1364/ol.24.001175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We demonstrate autocorrelation measurements of 85-fs Ti:sapphire laser pulses, using a 32-pixel ZnSe detector array in a single-shot geometry. The two-photon photoconductor is fabricated by deposition of an array of interdigitated gold fingers on a single-crystal ZnSe substrate.
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Mauger D, Zeller J, Revuz J, Wolkenstein P. [Psychological impact of neurofibromatosis type 1: the analysis of interviews with 12 patients with regard to an evaluation of the quality of life]. Ann Dermatol Venereol 1999; 126:619-20. [PMID: 10530352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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