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Romero Starke K, Hegewald J, Schmauder S, Kaboth P, Uhlmann L, Wegge J, Marquardt G, Seidler A. Health, wellbeing, and the impact of Corona in older adults in Dresden, Germany: the LAB60+ study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.558] [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
Introduction
As the proportion of older people increases, it is necessary to evaluate their health and well-being to identify measures to promote healthy ageing. Moreover, the COVID-19 pandemic has impacted older adults’ health- not just through the infection itself, but also due to infection protection ordinances.
Methods
LAB60+ is a population-based cross-sectional study investigating, among other things, the physical and mental health of older adults. Residents of Dresden aged 60 years and older were invited to participate in the first half of 2021. Participants answered questions on their habits, health status and wellbeing, using, among others, the Short Form-8 Health Survey and the WHO wellbeing index.
Results
2399 people participated in the study (40% response). Participants assessed their physical health similar to the German population. The most common chronic conditions were hypertension (54%), chronic pain (32%) and osteoarthritis (31%). 42% of the participants were overweight and 20% were obese. One-fifth did not engage in physical activity: this number increased with age and decreased socioeconomic status. Participants reported lower levels of wellbeing compared to the German population (58 vs. 67 pts.). One-third had higher levels of depressiveness and half reported an increase in their experienced loneliness due to the pandemic. 34% participated in risky alcohol consumption, but it did not markedly change during the pandemic. The greatest negative impact of the pandemic on health behaviors was physical activity: more than one-third exercised less compared to the time before the pandemic.
Conclusions
Physical health was comparable to the German population, while depressivity was higher, perhaps due to the pandemic. Age-appropriate interventions should especially target an increase in physical activity. It is important to take measures to reduce the possible negative effects of the pandemic, such as increased loneliness or reduced physical activity.
Key messages
• This is the first study on health and wellbeing on older adults (60+ years) in the city of Dresden, Germany.
• The COVID-19 pandemic had a high impact on older adults’ physical activity and loneliness.
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Affiliation(s)
- K Romero Starke
- Institute for Occupational Social Medicine TU-Dresden, , Dresden, Germany
| | - J Hegewald
- Institute for Occupational Social Medicine TU-Dresden, , Dresden, Germany
| | - S Schmauder
- Institute for Occupational Social Medicine TU-Dresden, , Dresden, Germany
| | - P Kaboth
- Institute for Occupational Social Medicine TU-Dresden, , Dresden, Germany
| | - L Uhlmann
- Chair of Work and Organisational Psychology TU-Dresden, , Dresden, Germany
| | - J Wegge
- Chair of Work and Organisational Psychology TU-Dresden, , Dresden, Germany
| | - G Marquardt
- Chair of Social and Healthcare Buildings and Design TU-Dresden, , Dresden, Germany
| | - A Seidler
- Institute for Occupational Social Medicine TU-Dresden, , Dresden, Germany
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Romero Starke K, Hegewald J, Schmauder S, Kaboth P, Uhlmann L, Wegge J, Marquardt G, Seidler A. Physical health, wellbeing, and the impact of the Covid-19 pandemic
in older adults: results from the LAB60+ Study in
Dresden. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753595] [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: 12/12/2022]
Affiliation(s)
- K Romero Starke
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - J Hegewald
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - S Schmauder
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - P Kaboth
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
| | - L Uhlmann
- Technische Universität Dresden, Professur für Arbeits-
und Organisationspsychologie, Dresden, Deutschland
| | - J Wegge
- Technische Universität Dresden, Professur für Arbeits-
und Organisationspsychologie, Dresden, Deutschland
| | - G Marquardt
- Technische Universität Dresden, Professur für Sozial-
und Gesundheitsbauen, Dresden, Deutschland
| | - A Seidler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin (IPAS), Dresden,
Deutschland
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Simonsen CZ, Schönenberger S, Hendén PL, Yoo AJ, Uhlmann L, Rentzos A, Bösel J, Valentin J, Rasmussen M. Patients Requiring Conversion to General Anesthesia during Endovascular Therapy Have Worse Outcomes: A Post Hoc Analysis of Data from the SAGA Collaboration. AJNR Am J Neuroradiol 2020; 41:2298-2302. [PMID: 33093133 DOI: 10.3174/ajnr.a6823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy for acute ischemic stroke is often performed with the patient under conscious sedation. Emergent conversion from conscious sedation to general anesthesia is sometimes necessary. The aim of this study was to assess the functional outcome in converted patients compared with patients who remained in conscious sedation and to identify predictors associated with the risk of conversion. MATERIALS AND METHODS Data from 368 patients, included in 3 trials randomizing between conscious sedation and general anesthesia before endovascular therapy (SIESTA, ANSTROKE, and GOLIATH) constituted the study cohort. Twenty-one (11%) of 185 patients randomized to conscious sedation were emergently converted to general anesthesia. RESULTS Absence of hyperlipidemia seemed to be the strongest predictor of conversion to general anesthesia, albeit a weak predictor (area under curve = 0.62). Sex, hypertension, diabetes, smoking status, atrial fibrillation, blood pressure, size of the infarct, and level and side of the occlusion were not significantly associated with conversion to general anesthesia. Neither age (mean age, 71.3 ± 13.8 years for conscious sedation versus 71.6 ± 12.3 years for converters, P = .58) nor severity of stroke (mean NIHSS score, 17 ± 4 versus 18 ± 4, respectively, P = .27) were significantly different between converters and those who tolerated conscious sedation. The converters had significantly worse outcome with a common odds ratio of 2.67 (P = .015) for a shift toward a higher mRS score compared with the patients remaining in the conscious sedation group. CONCLUSIONS Patients undergoing conversion had significantly worse outcome compared with patients remaining in conscious sedation. No factor was identified that predicted conversion from conscious sedation to general anesthesia.
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Affiliation(s)
| | - S Schönenberger
- Department of Neurology (S.S.), Heidelberg University Hospital, Heidelberg, Germany
| | - P L Hendén
- Department of Anesthesiology and Intensive Care Medicine (P.L.H.)
| | - A J Yoo
- Division of Neurointervention (A.J.Y.), Texas Stroke Institute, Dallas-Fort Worth, Texas
| | - L Uhlmann
- Institute of Medical Biometry and Informatics (L.U.), University of Heidelberg, Heidelberg, Germany
| | - A Rentzos
- Radiology (A.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Bösel
- Department of Neurology (J.B.), Klinikum Kassel, Kassel, Germany
| | - J Valentin
- Department of Clinical Medicine, (J.V.), Danish Center for Clinical Health Services Research, Aalborg University and Aalborg University Hospital, North Denmark Region, Denmark
| | - M Rasmussen
- Anesthesia (M.R.), Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
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Schaeffer K, Uhlmann L, Behzadi A, Boeckel J, Pelegrin P, Wagner U, Rossner S, Laufs U, Gaul S. Extracellular inflammasomes as novel endogenous danger signals that exert pro-inflammatory signaling on vascular cells. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
As part of the innate immune response, NLRP3 inflammasomes are involved in the process of sterile inflammation, IL-1β release and are key mediators of inflammation-related vascular diseases, such as atherosclerosis. Recent data showed the existence of extracellular inflammasomes released from monocytes during pyroptotic cell death. Their biological function in the vascular system is still not known. Here, we established a method to detect extracellular inflammasomes and tested the hypothesis that extracellular NLRP3 inflammasomes can be internalized by vascular cells, such as macrophages, endothelial cells and coronary smooth muscle cells and induce pro-inflammatory signaling.
Methods and result
Stimulation of THP1 monocytes and of isolated primary human monocytes with Lipopolysaccharide and Nigericin activated the NLRP3 inflammasome and induced pyroptosis and the release of inflammasome complexes. Extracellular inflammasomes were isolated from cell-free supernatant and identified as inflammasome complexes (oligomers) by immunoblot. For functional characterization, isolated fluorescent-labeled NLRP3 inflammasome complexes were shown to be internalized by THP1 macrophages (19.7±9.7% pos. cells), primary endothelial cells (HUVEC: 9.0±2.3% pos. cells, coronary artery endothelial cells: 11.0% ± 2.3% pos. cells) and coronary smooth muscle cells (42.8±9.9% pos.cells) using immunofluorescence staining, Z-stacks and imaging flow cytometric analysis. Extracellular NLRP3 inflammasomes (eNLRP3) induced pro-inflammatory signaling in macrophages by increasing IL1b and Tnfa gene expression (3.0- fold) as well as IL-1β release (con: 1.9 pg/ml vs. eNLRP3: 191.0 pg/ml). In coronary smooth muscle cells, treatment with extracellular inflammasomes increased endogenous Nlrp3 and IL1b gene expression as well as upregulation of Cell adhesion molecule 1 (Cadm1). Coronary artery endothelial cells showed also increased protein level of surface adhesion marker Intercellular Adhesion Molecule 1 (ICAM1).
Conclusion
Upon canonical NLRP3 inflammasome activation, mononuclear cells release inflammasome complexes into the extracellular space. Macrophages, endothelial cells and smooth muscle cells are able to internalize these extracellular inflammasome complexes that exert pro-inflammatory effects. These findings support the concept that cell-free NLRP3 inflammasomes act as extracellular signal molecules triggering pro-atherogenic signaling mechanisms in vascular cells.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Leipzig University, Medical Faculty
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Affiliation(s)
- K Schaeffer
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - L Uhlmann
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - A Behzadi
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - J.N Boeckel
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - P Pelegrin
- Hospital Universitario Virgen Arrixaca, BioMedical Research Institute of Murcia, Murcia, Spain
| | - U Wagner
- Leipzig University Hospital, Clinic for Gastroenterology and Rheumatology, Leipzig, Germany
| | - S Rossner
- Leipzig University Hospital, Paul Flechsig Institute, Leipzig, Germany
| | - U Laufs
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - S Gaul
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
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Kayvanpour E, Sedaghat-Hamedani F, Levinson R, Li D, Miersch T, Gi W, Grabe N, Lahrmann B, Taeger T, Frankenstein L, Uhlmann L, Herpel E, Katus H, Saez-Rodriguez J, Meder B. Precision medicine: myocardial fibrosis burden and genotype predict outcome in non-ischemic dilated cardiomyopathy (DCM). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Myocardial fibrosis occurs during pathological remodeling of the heart and can be associated with worse outcome in affected patients. Genetic background is also known to affect patients' survival. In this study we sought to estimate patients' overall fibrosis burden by combining independent modalities including left ventricular endomyocardial biopsy (LV-EMB), circulating biomarkers, and cMRI. We also aimed to use patients' genetics information to predict outcome. Furthermore, we investigated the correlation between cardiac fibrosis and genetic variations to detect novel susceptibility loci for fibrosis in DCM.
Methods
A total number of 542 DCM patients were included. Collagen volume fraction (CVF) was automatically estimated from biopsies. 13 circulating fibrosis biomarkers were measured using Human Magnetic Luminex Screening Assays, and the cMRIs were screened for presence of LGE. Whole exome sequencing (WES) was performed in 410 patients of the cohort using illumina HiSeq 2000. Common (MAF ≥0.05 in the study population OR gnomAD NFE AF ≥0.01) and non-common missense variants (MAF <0.05 in the study population AND gnomAD NFE AF <0.01) in 42 DCM genes were tested for associations with end points using single variants and burden analyses respectively. Analyses were adjusted for age and sex and performed using R and SKAT. End points were all-cause mortality and a composite of heart failure (HF) associated events.
Results
The median follow-up time was 43.2 months (2084 patient-years). Sixty-two patients reached the composite end point and 55 died. LV-EMB proved to be a safe procedure with a total complication rate of 2.3%. Machine learning based characterization of biopsies was highly accurate. Although the 3 different modalities did not significantly correlate with one another, the extent of CVF, levels of MMP-2, TIMP-1, OPN, and GDF-15, and presence of LGE were each significantly associated with worse outcome. Four possible susceptibility loci for cardiac fibrosis in DCM were introduced and underwent eQTL analyses. Rare missense variants in a list of 11 DCM-related genes showed to be associated with the 2 outcome measures or fibrosis burden.
Conclusions
LV-EMB, fibrosis biomarkers, and cMRI likely capture different aspects of a detrimental fibrosis process and may be combined to estimate patients' prognosis and monitor therapeutic success. Phenotype-genotype association studies help elucidate novel disease pathomechanisms and individualize patients' treatment.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): German Centre for Cardiovascular Research: DZHK
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Affiliation(s)
- E Kayvanpour
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - F Sedaghat-Hamedani
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - R.T Levinson
- University of Heidelberg, Institute for Computational Biomedicine, Heidelberg, Germany
| | - D Li
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - T Miersch
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - W.T Gi
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - N Grabe
- University of Heidelberg, Hamamatsu Tissue Imaging and Analysis Center (BIOQUANT), Heidelberg, Germany
| | - B Lahrmann
- University of Heidelberg, Hamamatsu Tissue Imaging and Analysis Center (BIOQUANT), Heidelberg, Germany
| | - T Taeger
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - L Frankenstein
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - L Uhlmann
- University of Heidelberg, Institute of Medical Biometry and Informatics (IMBI), Heidelberg, Germany
| | - E Herpel
- University of Heidelberg, Institute of Pathology, Heidelberg, Germany
| | - H.A Katus
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
| | - J Saez-Rodriguez
- University of Heidelberg, Institute for Computational Biomedicine, Heidelberg, Germany
| | - B Meder
- University Hospital of Heidelberg, Department of Medicine III, Heidelberg, Germany
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6
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Bogert NV, Furkel J, Din S, Braren I, Eckstein V, Müller JA, Uhlmann L, Katus HA, Konstandin MH. A novel approach to genetic engineering of T-cell subsets by hematopoietic stem cell infection with a bicistronic lentivirus. Sci Rep 2020; 10:13740. [PMID: 32792615 PMCID: PMC7426960 DOI: 10.1038/s41598-020-70793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
Lentiviral modification of hematopoietic stem cells (HSCs) paved the way for in vivo experimentation and therapeutic approaches in patients with genetic disease. A disadvantage of this method is the use of a ubiquitous promoter leads not only to genetic modification of the leukocyte subset of interest e.g. T-cells, but also all other subsequent leukocyte progeny of the parent HSCs. To overcome this limitation we tested a bicistronic lentivirus, enabling subset specific modifications. Designed novel lentiviral constructs harbor a global promoter (mPGK) regulating mCherry for HSCs selection and a T-cell specific promoter upstream of eGFP. Two T-cell specific promoters were assessed: the distal Lck—(dLck) and the CD3δ-promoter. Transduced HSCs were FACS sorted by mCherry expression and transferred into sublethally irradiated C57/BL6 mice. Successful transplantation and T-cell specific expression of eGFP was monitored by peripheral blood assessment. Furthermore, recruitment response of lentiviral engineered leukocytes to the site of inflammation was tested in a peritonitis model without functional impairment. Our constructed lentivirus enables fast generation of subset specific leukocyte transgenesis as shown in T-cells in vivo and opens new opportunities to modify other HSCs derived subsets in the future.
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Affiliation(s)
- N V Bogert
- Department of Cardiology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg/Mannheim, Germany.
| | - J Furkel
- Department of Cardiology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg/Mannheim, Germany
| | - S Din
- Department of Cardiology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg/Mannheim, Germany
| | - I Braren
- Vector Core Facility, University Hospital Hamburg-Eppendorf, University Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site, Hamburg, Germany
| | - V Eckstein
- Department of Hematology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - J A Müller
- Department of Hematology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - H A Katus
- Department of Cardiology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg/Mannheim, Germany
| | - M H Konstandin
- Department of Cardiology, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg/Mannheim, Germany
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Haenssle HA, Fink C, Rosenberger A, Uhlmann L. Reply to the letter to the editor 'Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists' by H. A. Haenssle et al. Ann Oncol 2019; 30:854-857. [PMID: 30689691 DOI: 10.1093/annonc/mdz015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg.
| | - C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg
| | - A Rosenberger
- Department of Genetic Epidemiology, University of Goettingen, Goettingen
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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8
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Haenssle HA, Fink C, Schneiderbauer R, Toberer F, Buhl T, Blum A, Kalloo A, Hassen ABH, Thomas L, Enk A, Uhlmann L, Alt C, Arenbergerova M, Bakos R, Baltzer A, Bertlich I, Blum A, Bokor-Billmann T, Bowling J, Braghiroli N, Braun R, Buder-Bakhaya K, Buhl T, Cabo H, Cabrijan L, Cevic N, Classen A, Deltgen D, Fink C, Georgieva I, Hakim-Meibodi LE, Hanner S, Hartmann F, Hartmann J, Haus G, Hoxha E, Karls R, Koga H, Kreusch J, Lallas A, Majenka P, Marghoob A, Massone C, Mekokishvili L, Mestel D, Meyer V, Neuberger A, Nielsen K, Oliviero M, Pampena R, Paoli J, Pawlik E, Rao B, Rendon A, Russo T, Sadek A, Samhaber K, Schneiderbauer R, Schweizer A, Toberer F, Trennheuser L, Vlahova L, Wald A, Winkler J, Wölbing P, Zalaudek I. Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists. Ann Oncol 2019; 29:1836-1842. [PMID: 29846502 DOI: 10.1093/annonc/mdy166] [Citation(s) in RCA: 562] [Impact Index Per Article: 112.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Deep learning convolutional neural networks (CNN) may facilitate melanoma detection, but data comparing a CNN's diagnostic performance to larger groups of dermatologists are lacking. Methods Google's Inception v4 CNN architecture was trained and validated using dermoscopic images and corresponding diagnoses. In a comparative cross-sectional reader study a 100-image test-set was used (level-I: dermoscopy only; level-II: dermoscopy plus clinical information and images). Main outcome measures were sensitivity, specificity and area under the curve (AUC) of receiver operating characteristics (ROC) for diagnostic classification (dichotomous) of lesions by the CNN versus an international group of 58 dermatologists during level-I or -II of the reader study. Secondary end points included the dermatologists' diagnostic performance in their management decisions and differences in the diagnostic performance of dermatologists during level-I and -II of the reader study. Additionally, the CNN's performance was compared with the top-five algorithms of the 2016 International Symposium on Biomedical Imaging (ISBI) challenge. Results In level-I dermatologists achieved a mean (±standard deviation) sensitivity and specificity for lesion classification of 86.6% (±9.3%) and 71.3% (±11.2%), respectively. More clinical information (level-II) improved the sensitivity to 88.9% (±9.6%, P = 0.19) and specificity to 75.7% (±11.7%, P < 0.05). The CNN ROC curve revealed a higher specificity of 82.5% when compared with dermatologists in level-I (71.3%, P < 0.01) and level-II (75.7%, P < 0.01) at their sensitivities of 86.6% and 88.9%, respectively. The CNN ROC AUC was greater than the mean ROC area of dermatologists (0.86 versus 0.79, P < 0.01). The CNN scored results close to the top three algorithms of the ISBI 2016 challenge. Conclusions For the first time we compared a CNN's diagnostic performance with a large international group of 58 dermatologists, including 30 experts. Most dermatologists were outperformed by the CNN. Irrespective of any physicians' experience, they may benefit from assistance by a CNN's image classification. Clinical trial number This study was registered at the German Clinical Trial Register (DRKS-Study-ID: DRKS00013570; https://www.drks.de/drks_web/).
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Affiliation(s)
- H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | - C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - R Schneiderbauer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - F Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - T Buhl
- Department of Dermatology, University of Göttingen, Göttingen, Germany
| | - A Blum
- Office Based Clinic of Dermatology, Konstanz, Germany
| | - A Kalloo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Ben Hadj Hassen
- Faculty of Computer Science and Mathematics, University of Passau, Passau, Germany
| | - L Thomas
- Department of Dermatology, Lyons Cancer Research Center, Lyon 1 University, Lyon, France
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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9
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Haenssle HA, Fink C, Uhlmann L. Reply to the letter to the Editor "Reply to 'Man against machine: diagnostic performance of a deep learning convolutional neural network for dermoscopic melanoma recognition in comparison to 58 dermatologists' by H. A. Haenssle et al. " by L. Oakden-Rayner. Ann Oncol 2019; 30:339. [PMID: 32089167 DOI: 10.1093/annonc/mdy520] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle H. Precision and reproducibility of automated computer‐guided Psoriasis Area and Severity Index measurements in comparison with trained physicians. Br J Dermatol 2018; 180:390-396. [DOI: 10.1111/bjd.17200] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 01/05/2023]
Affiliation(s)
- C. Fink
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Alt
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - L. Uhlmann
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - C. Klose
- Institute of Medical Biometry and Informatics University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - A. Enk
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
| | - H.A. Haenssle
- Department of Dermatology University of Heidelberg Im Neuenheimer Feld 440 69120 Heidelberg Germany
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Polychronidis G, Hüttner FJ, Contin P, Goossen K, Uhlmann L, Heidmann M, Knebel P, Diener MK, Büchler MW, Probst P. Network meta-analysis of topical haemostatic agents in thyroid surgery. Br J Surg 2018; 105:1573-1582. [DOI: 10.1002/bjs.10975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/09/2018] [Accepted: 07/10/2018] [Indexed: 01/19/2023]
Abstract
Abstract
Background
The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy.
Methods
A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random-effects model was used for network meta-analysis with minimally informative prior distributions.
Results
Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds ratio (OR) 1·53, 95 per cent credibility interval 0·21 to 10·77); PHA versus control (OR 2·74, 0·41 to 16·62) and AHA versus PHA (OR 1·77, 0·12 to 25·06). No difference was observed in the time required for drain removal, duration of hospital stay, and the rate of postoperative hypocalcaemia or recurrent nerve palsy. AHA led to a significantly lower total postoperative blood loss and reduced operating time in comparison with both the control and PHA groups.
Conclusion
The general use of local haemostatic agents has not been shown to reduce the rate of clinically relevant bleeding.
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Affiliation(s)
- G Polychronidis
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - F J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - P Contin
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - K Goossen
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M Heidmann
- Department of Surgery, Salem Hospital, Heidelberg, Germany
| | - P Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - M K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - P Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
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12
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Fink C, Alt C, Uhlmann L, Klose C, Enk A, Haenssle HA. Intra- and interobserver variability of image-based PASI assessments in 120 patients suffering from plaque-type psoriasis. J Eur Acad Dermatol Venereol 2018; 32:1314-1319. [PMID: 29569769 DOI: 10.1111/jdv.14960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Psoriasis Area and Severity Index (PASI) is the standard for psoriasis severity assessment. However, PASI measurement is complex and subjective, frequently leading to a high intra- and interobserver variability. To date, the precise extent of variability in PASI measurements and its underlying causes remain unknown. OBJECTIVE To determine the inter- and intrarater variability of image-based PASI measurements by calculating Intra-Class-Correlation-Coefficients (ICCs) and to investigate the impact of the different PASI components and specific anatomic regions on the extent of variability. METHODS First, the methodology of 'image-based' vs. commonly used 'live' PASI measurements was validated in a pilot study. Next, in an observational cohort study, PASI scores of 120 patients affected by plaque psoriasis were prospectively evaluated by three formally trained physicians by means of total body images (TBI). Each observer independently performed two rounds of image-based PASI calculations in all patients at two different time points. RESULTS Overall, 720 image-based PASI scores were calculated with a mean PASI of 8.8 (range 0.7-34.8). An interrater variability with an ICC of 0.895 and mean absolute difference (MAD) of 3.3 PASI points were observed. Intrarater variability showed a mean ICC of 0.877 and a MAD of 2.2 points. When considering specific PASI components, the highest agreement was found for the assessment of the involved body surface area (BSA), while the lowest ICCs were calculated for severity scoring of 'scaling' and 'induration'. As BSA scores serve as a multiplier in the calculation of PASI, minor inaccuracies were capable of inducing a large share of variability. CONCLUSION The overall inter- and intrarater reliability of image-based PASI measurements in this study was good. However, physicians were formally trained and experienced, which frequently is not the case in a real-life clinical setting. Therefore, new strategies for higher standardization and objectivity of PASI calculations are needed.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Alt
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - H A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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13
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Hörner-Rieber J, Abbasi-Senger N, Blanck O, Boda-Heggemann J, Duma M, Eble M, Eich H, Flentje M, Gerum S, Haas P, Henkenberens C, Imhoff D, Kahl H, Klass N, Krempien R, Lohaus F, Petersen C, Sackerer I, Schrade E, Uhlmann L, Wittig A, Guckenberger M. PV-0043: Histology as predictor for outcome following SBRT in NSCLC patients with lung oligo-metastases. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Mundiyanapurath S, Hees K, Ahmed N, Wahlgren N, Uhlmann L, Kieser M, Ringleb PA, Hacke W, Nagel S. Predictors of symptomatic intracranial haemorrhage in off-label thrombolysis: an analysis of the Safe Implementation of Treatments in Stroke registry. Eur J Neurol 2017; 25:340-e11. [PMID: 29105904 DOI: 10.1111/ene.13507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis (IVT) is the only approved pharmacological treatment for acute ischemic stroke. Off-label IVT for ischemic stroke is common. We aimed to analyse its safety in a large database. METHODS This was a retrospective analysis of the safe implementation of treatments in stroke (SITS) thrombolysis registry with regard to 11 off-label criteria according to the European licence for alteplase. Symptomatic intracranial haemorrhage (SICH) according to SITS was defined as primary safety endpoint and SICH according to the European Cooperative Acute Stroke Study (ECASS II) definition and the National Institute of Neurological Disorders and Stroke definition as secondary safety endpoints. Multivariable logistic regression analyses after replacing missing values using multiple imputations were performed. RESULTS Patients from 793 centres in 44 countries were included, mainly (95%) in Europe. A total of 56 258 patients who were treated with intravenous alteplase were included. Median age was 71 (IQR 61-78) years and median National Institutes of Health Stroke Scale score was 12 (IQR 7-17). A total of 16 740 (30%) patients received off-label IVT and 1037 (1.8%) patients suffered from SICH according to the SITS definition (SICH SITS). Median percentage of missing values per variable was 0.4%. The only two off-label criteria constituting independent positive and negative predictors for SICH SITS were high blood pressure (odds ratio, 1.39; 95% confidence interval, 1.08-1.80; P = 0.012) and minor stroke (odds ratio, 0.51; 95% confidence interval, 0.33-0.78; P = 0.002). Very severe stroke, previous stroke and diabetes, age and high glucose levels were additional independent predictors of SICH according to the ECASS II and National Institute of Neurological Disorders and Stroke definitions. CONCLUSIONS Thrombolysis appears to be safe with regard to SICH for most of the off-label criteria, especially for minor stroke, but is risky in patients with high blood pressure. Individual risk-benefit evaluation should be performed.
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Affiliation(s)
| | - K Hees
- Institute of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - N Ahmed
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.,Department of Neurology, Karolinska University Hospital-Solna, Stockholm, Sweden
| | - N Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.,Department of Neurology, Karolinska University Hospital-Solna, Stockholm, Sweden
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - M Kieser
- Institute of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - P A Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg
| | - W Hacke
- Department of Neurology, University Hospital Heidelberg, Heidelberg
| | - S Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg
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15
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Schönenberger S, Pfaff J, Uhlmann L, Klose C, Nagel S, Ringleb PA, Hacke W, Kieser M, Bendszus M, Möhlenbruch MA, Bösel J. The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial. AJNR Am J Neuroradiol 2017; 38:1580-1585. [PMID: 28596192 DOI: 10.3174/ajnr.a5243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologic selection criteria to identify patients likely to benefit from endovascular stroke treatment are still controversial. In this post hoc analysis of the recent randomized Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA) trial, we aimed to investigate the impact of sedation mode (conscious sedation versus general anesthesia) on the predictive value of collateral status. MATERIALS AND METHODS Using imaging data from SIESTA, we assessed collateral status with the collateral score of Tan et al and graded it from absent to good collaterals (0-3). We examined the association of collateral status with 24-hour improvement of the NIHSS score, infarct volume, and mRS at 3 months according to the sedation regimen. RESULTS In a cohort of 104 patients, the NIHSS score improved significantly in patients with moderate or good collaterals (2-3) compared with patients with no or poor collaterals (0-1) (P = .011; mean, -5.8 ± 7.6 versus -1.1 ± 10.7). Tan 2-3 was also associated with significantly higher ASPECTS before endovascular stroke treatment (median, 9 versus 7; P < .001) and smaller mean infarct size after endovascular stroke treatment (median, 35.0 versus 107.4; P < .001). When we differentiated the population according to collateral status (0.1 versus 2.3), the sedation modes conscious sedation and general anesthesia were not associated with significant differences in the predictive value of collateral status regarding infarction size or functional outcome. CONCLUSIONS The sedation mode, conscious sedation or general anesthesia, did not influence the predictive value of collaterals in patients with large-vessel occlusion anterior circulation stroke undergoing thrombectomy in the SIESTA trial.
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Affiliation(s)
- S Schönenberger
- From the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
| | - J Pfaff
- Neuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany
| | - S Nagel
- From the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
| | - P A Ringleb
- From the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
| | - W Hacke
- From the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
| | - M Kieser
- Institute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany
| | - M Bendszus
- Neuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - M A Möhlenbruch
- Neuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
| | - J Bösel
- From the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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Hatiboglu G, Simpfendörfer T, Uhlmann L, Bergero M, Macher-Goeppinger S, Pahernik S, Hadaschik B, Hohenfellner M, Teber D. A prospective randomized controlled trial for assessment of perineal hydrodissection technique for nervesparing robot assisted radical prostatectomy. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 03/14/2017] [Accepted: 04/05/2017] [Indexed: 11/12/2022]
Affiliation(s)
- G. Hatiboglu
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - T. Simpfendörfer
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - L. Uhlmann
- Department of Medical Biometry; University of Heidelberg, Im Neuenheimer Feld; Heidelberg Germany
| | - M.A. Bergero
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
- Department of Urology; Italian Hospital of Buenos Aires; Buenos Aires Argentina
| | - S. Macher-Goeppinger
- Institute of Pathology; University of Heidelberg, Im Neuenheimer Feld 220/221; Heidelberg Germany
| | - S. Pahernik
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - B. Hadaschik
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - M. Hohenfellner
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
| | - D. Teber
- Department of Urology; University of Heidelberg, Im Neuenheimer Feld 110; Heidelberg Germany
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17
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Fink C, Uhlmann L, Enk A, Gholam P. Pain management in photodynamic therapy using a nitrous oxide/oxygen mixture: a prospective, within-patient, controlled clinical trial. J Eur Acad Dermatol Venereol 2016; 31:70-74. [PMID: 27393707 DOI: 10.1111/jdv.13788] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Photodynamic therapy is an effective treatment for actinic keratoses. Nevertheless, severe pain during the procedure is a serious adverse effect, which leads to interruption or even termination. Complete pain relief remains a difficult challenge. OBJECTIVE To evaluate the effect of a nitrous oxide/oxygen mixture on pain intensity during photodynamic therapy. METHODS This clinical trial has been designed as a prospective, single-centre, explorative, controlled, observational study. RESULTS We were able to detect a significant overall pain reduction of 55.2% after application of a nitrous oxide/oxygen mixture by means of an intra-individual comparison. Furthermore, the total number of therapy interruption significantly decreased by 82% after the inhalation analgesia. Additionally, treatment satisfaction ranged from 'extremely to very satisfied'. CONCLUSIONS This study shows that analgesia by means of a nitrous oxide/oxygen mixture is a very effective and well-tolerated method for achieving significant pain reduction during photodynamic therapy.
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Affiliation(s)
- C Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - L Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - P Gholam
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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18
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Zelniker T, Uhlmann L, Spaich S, Friedrich J, Preusch M, Meyer FJ, Katus HA, Giannitsis E. Novel biomarkers for risk stratification in pulmonary arterial hypertension. Pneumologie 2016. [DOI: 10.1055/s-0036-1572121] [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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19
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Hüttner FJ, Tenckhoff S, Jensen K, Uhlmann L, Kulu Y, Büchler MW, Diener MK, Ulrich A. Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer. Br J Surg 2015; 102:735-45. [PMID: 25833333 DOI: 10.1002/bjs.9782] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/23/2014] [Accepted: 01/13/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Options for reconstruction after low anterior resection (LAR) for rectal cancer include straight or side-to-end coloanal anastomosis (CAA), colonic J pouch and transverse coloplasty. This systematic review compared these techniques in terms of function, surgical outcomes and quality of life. METHODS A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until November 2014) was conducted to identify randomized clinical trials comparing reconstructive techniques after LAR. Random-effects meta-analyses were carried out, and results presented as weighted odds ratios or mean differences with corresponding 95 per cent c.i. A network meta-analysis was conducted for the outcome anastomotic leakage. RESULTS The search yielded 965 results; 21 trials comprising data from 1636 patients were included. Colonic J pouch was associated with lower stool frequency and antidiarrhoeal medication use for up to 1 year after surgery compared with straight CAA. Transverse coloplasty and side-to-end CAA had similar functional outcomes to the colonic J pouch. No superiority was found for any of the techniques in terms of anastomotic leak rate. CONCLUSION Colonic J pouch and side-to-end CAA or transverse coloplasty lead to a better functional outcome than straight CAA for the first year after surgery.
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Affiliation(s)
- F J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Study Centre of the German Surgical Society, University of Heidelberg, Heidelberg, Germany
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20
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Purrucker JC, Renzland J, Uhlmann L, Bruckner T, Hacke W, Steiner T, Bösel J. Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study. Br J Anaesth 2015; 114:934-43. [PMID: 25823541 DOI: 10.1093/bja/aev070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The anaesthetic conserving device, AnaConDa(®), allows use of inhaled anaesthetics for sedation in the intensive care unit. We prospectively measured cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from i.v. to inhalative sedation. METHODS 25 patients were switched from i.v. to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h). RESULTS In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, [Formula: see text] increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010]. CONCLUSION Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.
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Affiliation(s)
- J C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Renzland
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Uhlmann
- Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - W Hacke
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Steiner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt am Main, Germany
| | - J Bösel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Laux G, Szecsenyi J, Mergenthal K, Beyer M, Gerlach F, Stock C, Uhlmann L, Miksch A, Bauer E, Kaufmann-Kolle P, Steeb V, Lübeck R, Karimova K, Güthlin C, Götz K. Hausarztzentrierte Versorgung in Baden-Württemberg. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:398-407. [DOI: 10.1007/s00103-015-2122-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Schober L, Radnai D, Spratte J, Kisielewicz A, Schmitt E, Mahnke K, Fluhr H, Uhlmann L, Sohn C, Steinborn A. The role of regulatory T cell (Treg) subsets in gestational diabetes mellitus. Clin Exp Immunol 2014; 177:76-85. [PMID: 24547967 DOI: 10.1111/cei.12300] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 12/16/2022] Open
Abstract
Physiological changes during normal pregnancy are characterized by an inflammatory immune response and insulin resistance. Therefore, we hypothesize that gestational diabetes mellitus (GDM) may be caused by an inappropriate adaption of the maternal immune system to pregnancy. In this study we examined the role of regulatory T cell (Treg) differentiation for the development of GDM during pregnancy. We used six-colour flow cytometric analysis to demonstrate that the total CD4(+) CD127(low+/-) CD25(+) forkhead box protein 3 (FoxP3(+)) T(reg) pool consists of four different T(reg) subsets: naive CD45RA(+) T(regs), HLA-DR(-) CD45RA(-) memory T(regs) (DR(-) T(regs)) and the highly differentiated and activated HLA-DR(low+) CD45RA(-) and HLA-DR(high+) CD45RA(-) memory T(regs) (DR(low+) and DR(high+) T(regs)). Compared to healthy pregnancies, the percentage of CD4(+) CD127(low+/-) CD25(+) FoxP3(+) T(regs) within the total CD4(+) T helper cell pool was not different in patients affected by GDM. However, the suppressive activity of the total CD4(+) CD127(low+/-) CD25(+) T(reg) pool was significantly reduced in GDM patients. The composition of the total T(reg) pool changed in the way that its percentage of naive CD45RA(+) T(regs) was decreased significantly in both patients with dietary-adjusted GDM and patients with insulin-dependent GDM. In contrast, the percentage of DR(-) -memory T(regs) was increased significantly in patients with dietary-adjusted GDM, while the percentage of DR(low+) and DR(high+) memory T(regs) was increased significantly in patients with insulin-dependent GDM. Hence, our findings propose that alterations in homeostatic parameters related to the development and function of naive and memory T(regs) may cause the reduction of the suppressive capacity of the total T(reg) pool in GDM patients. However, as this is an exploratory analysis, the results are only suggestive and require further validation.
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Affiliation(s)
- L Schober
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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23
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Uhlmann L. [The hospital housekeeper; an experiment in England]. Z Krankenpfl 1968; 2:71-2. [PMID: 5184499] [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: 01/14/2023]
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