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Van de Glind G, Crilly J, Galenkamp N, Schut B, Werner L, Chan E, Hilton E, Schoonhoven L, Scheepers FE, Muir R, Baden D, van Veen M, Ham WHW. Defining the concept of mental dysregulation in patients requiring ambulance and/or emergency department care: protocol for a Delphi consensus study. BMJ Open 2024; 14:e077666. [PMID: 38262647 PMCID: PMC10824022 DOI: 10.1136/bmjopen-2023-077666] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. METHODS AND ANALYSIS A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). ETHICS AND DISSEMINATION This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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Affiliation(s)
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Niek Galenkamp
- University of Applied Sciences, Utrecht, The Netherlands
| | - Bart Schut
- Person With Lived Experience, Utrecht, The Netherlands
| | - Lente Werner
- Person With Lived Experience, Utrecht, The Netherlands
| | - Eric Chan
- Foothills Medical Centre, Calgary, Alberta, Canada
| | - Emily Hilton
- Person With Lived Experience, Calgary, Alberta, Canada
| | - Lisette Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- UMC Utrecht, Utrecht, The Netherlands
| | | | - Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Baden
- Emergency Department, Diakonessenhuis Utrecht Zeist Doorn Locatie Utrecht Spoedeisende hulp, Utrecht, The Netherlands
| | - Mark van Veen
- University of Applied Sciences, Utrecht, The Netherlands
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Werner L, Hillal E, Moebus S. Kinderfreundliche Gestaltung von städtischen Umwelten: Ein
Leitfadencheck. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Schillen P, Dehnen A, Danielzik K, Werner L. Analyse der räumlichen Verteilung von ärztlichen
Primärversorgungsangeboten in sozial und gesundheitlich benachteiligten
Stadtteilen am Beispiel der kreisfreien Stadt Essen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753646] [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)
- P Schillen
- Universitätsklinikum Essen (AöR), Institut für
Allgemeinmedizin, Essen, Deutschland
| | - A Dehnen
- Universitätsklinikum Essen (AöR), Institut für
Allgemeinmedizin, Essen, Deutschland
| | - K Danielzik
- Universitätsklinikum Essen (AöR), Institut für
Allgemeinmedizin, Essen, Deutschland
| | - L Werner
- Universitätsklinikum Essen (AöR), Institut für
Urban Public Health, Essen, Deutschland
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Werner L. OP0204-PARE MEANINGFUL PATIENT INVOLVEMENT IS CRITICAL TO SUCCESSFUL INTERNATIONAL GRANT APPLICATIONS: THE CASE OF THE HIPPOCRATES CONSORTIUM. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHIPPOCRATES is a large, international research project addressing the unmet needs of people with psoriatic arthritis (PsA). It aims to improve early identification of PsA in people with psoriasis, as well as therapeutic options and outcomes for people living with PsA. The project will run for five years with a budget of € 21 million provided by the Innovative Medicines Initiative (IMI) – a joint undertaking of the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). During the evaluation of the HIPPOCRATES grant application, the patient involvement was highly praised: “A strength of this proposal is that patient representative organisations seem highly integrated in the proposal and will be important avenues for dissemination.”ObjectivesTo explore the components of an effective strategy for incorporating the patient perspective in an international research consortium.MethodsThe experiences of the first six months of patient involvement in HIPPOCRATES were examined. We organized a survey and an online workshop with all participating patient research partners (PRPs) to gather data on the experiences of participation in the different working groups of the project, as well as to discuss common challenges and solutions.ResultsPatient involvement was visible and reported from the very beginning of the project, including participation of PRPs in the first consortium meeting for study design. The chosen strategy is characterized by an integrated approach containing multiple layers of patient involvement [Figure 1], with the consortium following the EULAR recommendations for the inclusion of patient representatives in scientific projects.The active participation of 13 PRPs with well-defined roles and responsibilities ensures the preservation of the patient perspective during the entire duration of the project. Together they form the HIPPOCRATES Patient Advisory Council (PAC). PRPs are represented in the project’s management team, in all work packages and in the External Advisory Board. Three patient organisations support the project: GRAPPA-EU (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) and EULAR PARE (People with Arthritis/Rheumatism in Europe) as consortium partners, and EUROPSO (European Federation of Psoriasis Patients’ Associations). EULAR is co-leading the work package focusing on Communication, Dissemination, Exploitation and Sustainability, and especially those activities targeting patients, PRPs (regular educational sessions), patient organisations and the general public. Finally, people with PsO will be recruited for a large European cohort study (HIPPOCRATES Prospective Observational Study, HPOS) which aims to identify clinical and molecular risk factors for developing PsA.Results from the PRP survey were positive. Almost all PRPs have been invited to their work package meetings and included in email exchanges, and all feel well-included in their assigned groups and roles. Nevertheless, it was reported that some PRPs may be reluctant to raise their voice or to be involved in discussions at virtual meetings. This was one of the topics addressed during the online workshop, together with discussions on ethics and recruitment strategies for HPOS.ConclusionIt has been central to the HIPPOCRATES ethos that highly experienced PRPs were involved from its initial conception. PRPs with leading responsibilities in patient organisations or representing relevant academic backgrounds have contributed substantially to the definition of research priorities and will have active on-going engagement in the interpretation and implementation of future results. By demonstrating the pervasive benefit of the patient voice throughout the project, HIPPOCRATES will be an example for future projects in RMD and health research.AcknowledgementsMeaningful patient involvement is critical to successful international grant applications: the case of the HIPPOCRATES consortium [“Health initiatives in Psoriasis and PsOriatic arthritis ConsorRTium European States”]Lars Werner on behalf of the HIPPOCRATES Patient Advisory Council (PAC)Disclosure of InterestsLars Werner Speakers bureau: Novartis, Janssen, LEO Pharma, Consultant of: Novartis, Janssen, LEO Pharma, B-I, UCB, Grant/research support from: Novartis, Janssen, LEO Pharma, UCB, AbbVie, Sanofi, B-I, BMS, Pfizer, Employee of: LEO Pharma, AbbVie
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Bausewein C, Hodiamont F, Berges N, Ullrich A, Gerlach C, Oechsle K, Pauli B, Weber J, Stiel S, Schneider N, Krumm N, Rolke R, Gebel C, Jansky M, Nauck F, Wedding U, van Oorschot B, Roch C, Werner L, Fischer M, Schallenburger M, Reuters MC, Schwartz J, Neukirchen M, Gülay A, Maus K, Jaspers B, Radbruch L, Heckel M, Klinger I, Ostgathe C, Kriesen U, Junghanß C, Lehmann E, Gesell D, Gauder S, Boehlke C, Becker G, Pralong A, Strupp J, Leisse C, Schloesser K, Voltz R, Jung N, Simon ST. National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project. BMC Palliat Care 2022; 21:10. [PMID: 35027041 PMCID: PMC8756412 DOI: 10.1186/s12904-021-00898-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). Methods Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. Discussion For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00898-w.
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Regan M, Mantia C, Werner L, Tarhini A, Rao S, Moshyk A, Ritchings C, Rizzo J, Atkins M, Grob JJ, Mcdermott D. Estimation de la survie sans traitement (SST) sur un suivi prolongé chez les patients (pts) atteints de mélanome avancé (MEL) traités par inhibiteurs du point de contrôle immunitaire (CPI) : suivi à 5 ans de la CheckMate 067. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.086] [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: 11/15/2022]
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Garin M, Heinonen J, Werner L, Pasanen TP, Vähänissi V, Haarahiltunen A, Juntunen MA, Savin H. Black-Silicon Ultraviolet Photodiodes Achieve External Quantum Efficiency above 130. Phys Rev Lett 2020; 125:117702. [PMID: 32976002 DOI: 10.1103/physrevlett.125.117702] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/07/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
At present, ultraviolet sensors are utilized in numerous fields ranging from various spectroscopy applications via biotechnical innovations to industrial process control. Despite this, the performance of current UV sensors is surprisingly poor. Here, we break the theoretical one-photon-one-electron barrier and demonstrate a device with a certified external quantum efficiency above 130% in UV range without external amplification. The record high performance is obtained using a nanostructured silicon photodiode with self-induced junction. We show that the high efficiency is based on effective utilization of multiple carrier generation by impact ionization taking place in the nanostructures. While the results can readily have a significant impact on the UV-sensor industry, the underlying technological concept can be applied to other semiconductor materials, thereby extending above unity response to longer wavelengths and offering new perspectives for improving efficiencies beyond the Shockley-Queisser limit.
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Affiliation(s)
- M Garin
- Department of Electronics and Nanoengineering, Aalto University, Tietotie 3, 02150 Espoo, Finland
- Department of Engineering, Universitat de Vic-Universitat Central de Catalunya, Carrer de la Laura 13, 08500 Vic, Spain
- Universitat Politècnica de Catalunya, Carrer del Gran Capità, 08034 Barcelona, Spain
| | - J Heinonen
- Department of Electronics and Nanoengineering, Aalto University, Tietotie 3, 02150 Espoo, Finland
- ElFys Inc., Tekniikantie 12, 02150 Espoo, Finland
| | - L Werner
- Physikalisch-Technische Bundesanstalt, Abbestrasse 2-12, 10587 Berlin, Germany
| | - T P Pasanen
- Department of Electronics and Nanoengineering, Aalto University, Tietotie 3, 02150 Espoo, Finland
| | - V Vähänissi
- Department of Electronics and Nanoengineering, Aalto University, Tietotie 3, 02150 Espoo, Finland
| | | | - M A Juntunen
- ElFys Inc., Tekniikantie 12, 02150 Espoo, Finland
| | - H Savin
- Department of Electronics and Nanoengineering, Aalto University, Tietotie 3, 02150 Espoo, Finland
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Regan M, Jegede O, Mantia C, Powles T, Werner L, Huo S, Del Tejo V, Stwalley B, Atkins M, McDermott D. 713P Treatment-free survival, with and without toxicity, after immuno-oncology vs targeted therapy for advanced renal cell carcinoma (aRCC): 42-month results of CheckMate 214. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.785] [Citation(s) in RCA: 4] [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: 11/24/2022] Open
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Regan M, Atkins M, Powles T, Werner L, Mantia C, Yang S, Johansen J, Rao S, Gooden K, McDermott D. Treatment-free survival, with and without toxicity, as a novel outcome applied to immuno-oncology agents in advanced renal cell carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Werner L, Nunberg MY, Rechavi E, Lev A, Braun T, Haberman Y, Lahad A, Shteyer E, Schvimer M, Somech R, Weiss B, Lee YN, Shouval DS. Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis. Clin Exp Immunol 2019; 196:1-11. [PMID: 30556140 DOI: 10.1111/cei.13247] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/06/2023] Open
Abstract
The antigenic specificity of T cells occurs via generation and rearrangement of different gene segments producing a functional T cell receptor (TCR). High-throughput sequencing (HTS) allows in-depth assessment of TCR repertoire patterns. There are limited data concerning whether TCR repertoires are altered in inflammatory bowel disease. We hypothesized that pediatric ulcerative colitis (UC) patients possess unique TCR repertoires, resulting from clonotypical expansions in the gut. Paired blood and rectal samples were collected from nine newly diagnosed treatment-naive pediatric UC patients and four healthy controls. DNA was isolated to determine the TCR-β repertoire by HTS. Significant clonal expansion was demonstrated in UC patients, with inverse correlation between clinical disease severity and repertoire diversity in the gut. Using different repertoire variables in rectal biopsies, a clear segregation was observed between patients with severe UC, those with mild-moderate disease and healthy controls. Moreover, the overlap between autologous blood-rectal samples in UC patients was significantly higher compared with overlap among controls. Finally, we identified several clonotypes that were shared in either all or the majority of UC patients in the colon. Clonal expansion of TCR-β-expressing T cells among UC patients correlates with disease severity and highlights their involvement in mediating intestinal inflammation.
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Affiliation(s)
- L Werner
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Y Nunberg
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Rechavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Immunology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - A Lev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Immunology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - T Braun
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Haberman
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Lahad
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Shteyer
- Juliet Keidan Institute of Pediatric Gastroenterology, Hepatology and Nutrition, Shaare Zedek Medical Center and The Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Schvimer
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
| | - R Somech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Immunology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - B Weiss
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y N Lee
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Immunology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - D S Shouval
- Pediatric Gastroenterology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mueller I, Horansky RD, Lehman JH, Nam SW, Vayshenker I, Werner L, Wuebbeler G, White M. Verification of calibration methods for determining photon-counting detection efficiency using superconducting nano-wire single photon detectors. Opt Express 2017; 25:21483-21495. [PMID: 29041446 DOI: 10.1364/oe.25.021483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
In recent years several ways to radiometrically calibrate optical fiber-coupled detectors have been developed. However, fiber-coupled calibration methods for single photon detectors have not been compared by national metrology institutes in order to validate their equivalence or traceability to the international systems of units yet.. Here, we present the comparison of radiometric calibration methods traceable to a NIST cryogenic radiometer at the 'few-photon' level. The calibration methods are based on metrology grade optical power meters. The expanded (k = 2) relative standard uncertainties of the calibration methods for the detection efficiency are of the order of 0.5%. However, the results changed relatively by 10% with a different set of optical fibers and mating connectors. These results stress the importance of fiber-core dimensions and fiber-connector repeatability.
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Jay R, McKay RR, Werner L, Atkins MB, Van Allen EM, Olivier KM, Song J, Signoretti S, McDermott DF, Choueiri TK. Phase 2 trial of sunitinib and gemcitabine in patients with sarcomatoid and/or poor-risk metastatic renal cell carcinoma. Michaelson MD, McKay RR, Werner L, Atkins MB, Van Allen EM, Olivier KM, Song J, Signoretti S, McDermott DF, Choueiri TK.Cancer. 2015 Oct 1;121(19):3435-43. [Epub 2015 Jun 8]. doi: 10.1002/cncr.29503. Urol Oncol 2017; 35:117-118. [DOI: 10.1016/j.urolonc.2016.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hicks RM, Padayatchi N, Shah NS, Wolf A, Werner L, Sunkari VB, O'Donnell MR. Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children. Int J Tuberc Lung Dis 2016; 18:1074-83. [PMID: 25189555 DOI: 10.5588/ijtld.14.0231] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Pediatric multidrug-resistant tuberculosis (MDR-TB) is complicated by difficult diagnosis, complex treatment, and high mortality. In South Africa, these challenges are amplified by human immunodeficiency virus (HIV) co-infection; however, evidence on treatment outcomes among co-infected children is limited. OBJECTIVE Using conventional and new pediatric definitions, to describe treatment outcomes and identify risk factors for unfavorable outcome and mortality in children aged <15 years with MDR-TB or extensively drug-resistant TB (XDR-TB) in KwaZulu-Natal, South Africa. DESIGN Retrospective cohort study in a regional TB referral hospital. RESULTS From January 2009 to June 2010, 84 children (median age 8 years, IQR 4-12) with MDR-TB (n = 78) or XDR-TB (n = 6) initiated treatment. Sixty-four (77%) were HIV-positive and 62 (97%) received antiretroviral therapy. Sixty-six (79%) achieved favorable treatment outcomes. Overall mortality was 11% (n = 9) at 18 months after initiation of treatment. Malnutrition (aOR 27.4, 95%CI 2.7-278.7) and severe radiographic findings (aOR 4.68, 95%CI 1.01-21.9) were associated with unfavorable outcome. New pediatric outcome definitions increased the proportion classified as cured. CONCLUSION It is possible to successfully treat pediatric MDR-TB-HIV even in resource-poor settings. Malnutrition is a marker for severe TB-HIV disease, and is a potential target for future interventions in these patients.
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Affiliation(s)
- R M Hicks
- Albert Einstein College of Medicine, New York, New York, USA
| | - N Padayatchi
- Centre for AIDS Programme of Research in South Africa, Durban, South Africa
| | - N S Shah
- Albert Einstein College of Medicine, New York, New York, USA
| | - A Wolf
- Albert Einstein College of Medicine, New York, New York, USA
| | - L Werner
- Centre for AIDS Programme of Research in South Africa, Durban, South Africa
| | - V B Sunkari
- King DinuZulu Hospital, Sydenham, South Africa
| | - M R O'Donnell
- Albert Einstein College of Medicine, New York, New York, USA
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Archary D, Seaton KE, Passmore JS, Werner L, Deal A, Dunphy LJ, Arnold KB, Yates NL, Lauffenburger DA, Bergin P, Liebenberg LJ, Samsunder N, Mureithi MW, Altfeld M, Garrett N, Abdool Karim Q, Abdool Karim SS, Morris L, Tomaras GD. Distinct genital tract HIV-specific antibody profiles associated with tenofovir gel. Mucosal Immunol 2016; 9:834. [PMID: 27116933 DOI: 10.1038/mi.2016.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Archary D, Seaton KE, Passmore JS, Werner L, Deal A, Dunphy LJ, Arnold KB, Yates NL, Lauffenburger DA, Bergin P, Liebenberg LJ, Samsunder N, Mureithi MW, Altfeld M, Garrett N, Karim QA, Karim SSA, Morris L, Tomaras GD. Distinct genital tract HIV-specific antibody profiles associated with tenofovir gel. Mucosal Immunol 2016; 9:821-833. [PMID: 26813340 PMCID: PMC4848129 DOI: 10.1038/mi.2015.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
The impact of topical antiretrovirals for pre-exposure prophylaxis on humoral responses following HIV infection is unknown. Using a binding antibody multiplex assay, we investigated HIV-specific IgG and IgA responses to envelope glycoproteins, p24 Gag and p66, in the genital tract (GT) and plasma following HIV acquisition in women assigned to tenofovir gel (n=24) and placebo gel (n=24) in the CAPRISA 004 microbicide trial to assess if this topical antiretroviral had an impact on mucosal and systemic antibody responses. Linear mixed effect modeling and partial least squares discriminant analysis was used to identify multivariate antibody signatures associated with tenofovir use. There were significantly higher response rates to gp120 Env (P=0.03), p24 (P=0.002), and p66 (P=0.009) in plasma and GT in women assigned to tenofovir than placebo gel at multiple time points post infection. Notably, p66 IgA titers in the GT and plasma were significantly higher in the tenofovir compared with the placebo arm (P<0.05). Plasma titers for 9 of the 10 HIV-IgG specificities predicted GT levels. Taken together, these data suggest that humoral immune responses are increased in blood and GT of individuals who acquire HIV infection in the presence of tenofovir gel.
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Affiliation(s)
- D Archary
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - KE Seaton
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - JS Passmore
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - L Werner
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - A Deal
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - LJ Dunphy
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - KB Arnold
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - NL Yates
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - DA Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - P Bergin
- Imperial College, International AIDS Vaccine Initiative Core Immune Monitoring Laboratory, London, UK
| | - LJ Liebenberg
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - N Samsunder
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - MW Mureithi
- KAVI Institute of Clinical Research, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - M Altfeld
- Heinrich-Pette Institut, Leibniz Institute for Experimental Virology, University of Hamburg, Hamburg, Germany
| | - N Garrett
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Q Abdool Karim
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - SS Abdool Karim
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - L Morris
- Centre for the AIDS Program of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.,National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - GD Tomaras
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA.,Departments of Surgery, Immunology and Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
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Naranbhai V, de Assis Rosa D, Werner L, Moodley R, Hong H, Kharsany A, Mlisana K, Sibeko S, Garrett N, Chopera D, Carr WH, Abdool Karim Q, Hill AVS, Abdool Karim SS, Altfeld M, Gray CM, Ndung'u T. Killer-cell Immunoglobulin-like Receptor (KIR) gene profiles modify HIV disease course, not HIV acquisition in South African women. BMC Infect Dis 2016; 16:27. [PMID: 26809736 PMCID: PMC4727384 DOI: 10.1186/s12879-016-1361-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 08/13/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Killer-cell Immunoglobulin-like Receptors (KIR) interact with Human Leukocyte Antigen (HLA) to modify natural killer- and T-cell function. KIR are implicated in HIV acquisition by small studies that have not been widely replicated. A role for KIR in HIV disease progression is more widely replicated and supported by functional studies. METHODS To assess the role of KIR and KIR ligands in HIV acquisition and disease course, we studied at-risk women in South Africa between 2004-2010. Logistic regression was used for nested case-control analysis of 154 women who acquired vs. 155 who did not acquire HIV, despite high exposure. Linear mixed-effects models were used for cohort analysis of 139 women followed prospectively for a median of 54 months (IQR 31-69) until 2014. RESULTS Neither KIR repertoires nor HLA alleles were associated with HIV acquisition. However, KIR haplotype BB was associated with lower viral loads (-0.44 log10 copies/ml; SE = 0.18; p = 0.03) and higher CD4+ T-cell counts (+80 cells/μl; SE = 42; p = 0.04). This was largely explained by the protective effect of KIR2DL2/KIR2DS2 on the B haplotype and reciprocal detrimental effect of KIR2DL3 on the A haplotype. CONCLUSIONS Although neither KIR nor HLA appear to have a role in HIV acquisition, our data are consistent with involvement of KIR2DL2 in HIV control. Additional studies to replicate these findings are indicated.
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Affiliation(s)
- V Naranbhai
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. .,Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa.
| | - D de Assis Rosa
- National Institute of Communicable Diseases, Sandringham, South Africa. .,University of the Witwatersrand, Johannesburg, South Africa.
| | - L Werner
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - R Moodley
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa.
| | - H Hong
- Division of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - A Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - K Mlisana
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - S Sibeko
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - N Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - D Chopera
- University of Cape Town, Cape Town, South Africa.
| | - W H Carr
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa. .,City University of New York - Medgar Evers College, New York, USA. .,Ragon Institute of MGH, MIT and Harvard University, Boston, USA.
| | - Q Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. .,Mailman School of Public Health, Columbia University, New York, USA.
| | - A V S Hill
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - S S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. .,Mailman School of Public Health, Columbia University, New York, USA.
| | - M Altfeld
- Ragon Institute of MGH, MIT and Harvard University, Boston, USA. .,Leibniz Institute for Experimental Virology, Heinrich Pette Institute, Hamburg, Germany.
| | - C M Gray
- National Institute of Communicable Diseases, Sandringham, South Africa. .,University of Cape Town, Cape Town, South Africa.
| | - T Ndung'u
- HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa. .,Ragon Institute of MGH, MIT and Harvard University, Boston, USA. .,KwaZulu-Natal Research Institute for Tuberculosis and HIV, University of KwaZulu-Natal, Durban, South Africa. .,Max Planck Institute for Infection Biology, Chariteplatz, D-10117, Berlin, Germany.
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17
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Gurabardhi M, Häberle H, Aurich H, Werner L, Pham DT. Materialtrübung faltbarer Intraokularlinsen seit 2006. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569158] [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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18
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Bellmunt J, Mullane SA, Werner L, Fay AP, Callea M, Leow JJ, Taplin ME, Choueiri TK, Hodi FS, Freeman GJ, Signoretti S. Association of PD-L1 expression on tumor-infiltrating mononuclear cells and overall survival in patients with urothelial carcinoma. Ann Oncol 2015; 26:812-817. [PMID: 25600565 DOI: 10.1093/annonc/mdv009] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway negatively regulates T-cell-mediated responses. The prognostic impact of PD-L1 expression needs to be defined in urothelial carcinoma (UC). PATIENTS AND METHODS Formalin-fixed paraffin-embedded tumor samples from 160 patients with UC were retrieved. PD-L1 expression was evaluated by immunohistochemistry using a mouse monoclonal anti-PD-L1 antibody (405.9A11). PD-L1 positivity on tumor cell membrane was defined as ≥5% of tumor cell membrane staining. The extent of tumor-infiltrating mononuclear cells (TIMCs) as well as PD-L1 expression on TIMCs was scored from 0 to 4. A score of 2, 3, or 4 was considered PD-L1-positive. Clinico-pathological variables were documented. The Cox regression model was used to assess the association of PD-L1 expression with overall survival (OS) in patients who developed metastases. RESULTS TIMCs were present in 143 of the 160 patient samples. Out of 160 samples, 32 (20%) had positive PD-L1 expression in tumor cell membrane. Out of 143 samples with TIMCs, 58 (40%) had positive PD-L1 expression in TIMCs. Smoking history, prior BCG use and chromosome 9 loss did not correlate with PD-L1 expression in either tumor cell membrane or TIMCs. PD-L1 positivity was not different between non-invasive or invasive UC. In patients who developed metastases (M1) and were treated with systemic therapy (n = 100), PD-L1 positivity on tumor cell membrane was seen in 14% of patients and did not correlate with OS (P = 0.45). Out of 89 M1 patients who had evaluable PD-L1 on TIMCs, PD-L1 expression was seen in 33% of patients and was significantly associated with longer OS on multivariate analysis (P = 0.0007). CONCLUSION PD-L1 is widely expressed in tumor cell membrane and TIMCs in UC. PD-L1 in tumor cells was not predictive of OS. However, positive PD-L1 expression in TIMCs was significantly associated with longer survival in those patients who developed metastases.
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Affiliation(s)
- J Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston.
| | - S A Mullane
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - L Werner
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - A P Fay
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - M Callea
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - J J Leow
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston
| | - M E Taplin
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - T K Choueiri
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Brigham and Women's Hospital, Boston; Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - F S Hodi
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston; Center for Immuno-oncology, Dana-Farber Cancer Institute, Boston, USA
| | - G J Freeman
- Medical Oncology Department, Harvard Medical School, Boston; Medical Oncology Department, Dana-Farber Cancer Institute, Boston
| | - S Signoretti
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston; Medical Oncology Department, Harvard Medical School, Boston; Department of Pathology, Brigham and Women's Hospital, Boston
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19
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McKay RR, Zukotynski KA, Werner L, Voznesensky O, Wu JS, Smith SE, Jiang Z, Melnick K, Yuan X, Kantoff PW, Montgomery B, Balk SP, Taplin ME. Imaging, procedural and clinical variables associated with tumor yield on bone biopsy in metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2014; 17:325-31. [PMID: 25091040 DOI: 10.1038/pcan.2014.28] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/22/2014] [Accepted: 06/16/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Understanding the mechanisms driving disease progression is fundamental to identifying new therapeutic targets for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC). Owing to the prevalence of bone metastases in mCRPC, obtaining sufficient tumor tissue for analysis has historically been a challenge. In this exploratory analysis, we evaluated imaging, procedural and clinical variables associated with tumor yield on image-guided bone biopsy in men with mCRPC. METHODS Clinical data were collected prospectively from men with mCRPC enrolled on a phase II trial with serial metastasis biopsies performed according to standard clinical protocol. Imaging was retrospectively reviewed. We evaluated the percent positive biopsy cores (PPC), calculated as the number of positive cores divided by the total number of cores collected per biopsy. RESULTS Twenty-nine men had 39 bone biopsies. Seventy-seven percent of bone biopsies had at least one positive biopsy core. We determined that lesion size and distance from the skin to the lesion edge correlated with tumor yield on biopsy (median PPC 75% versus 42% for lesions >8.8 cm(3) versus ⩽ 8.8 cm(3), respectively, P=0.05; median PPC 33% versus 71% for distance ⩾ 6.1 versus <6.1 cm, respectively, P = 0.02). There was a trend towards increased tumor yield in patients with increased uptake on radionuclide bone scan, higher calcium levels and shorter duration of osteoclast-targeting therapy, although this was not statistically significant. Ten men had 14 soft tissue biopsies. All soft tissue biopsies had at least one positive biopsy core. CONCLUSIONS This exploratory analysis suggests that there are imaging, procedural and clinical variables that have an impact on image-guided bone biopsy yield. In order to maximize harvest of prostate cancer tissue, we have incorporated a prospective analysis of the metrics described here as part of a multi-institutional project aiming to use the molecular characterization of mCRPC tumors to direct individual therapy.
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Affiliation(s)
- R R McKay
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K A Zukotynski
- 1] Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada [2] Brigham and Women's Hospital, Boston, MA, USA
| | - L Werner
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - O Voznesensky
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - J S Wu
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S E Smith
- 1] Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA [2] Brigham and Women's Hospital, Boston, MA, USA
| | - Z Jiang
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K Melnick
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - X Yuan
- Brigham and Women's Hospital, Boston, MA, USA
| | - P W Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - B Montgomery
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - S P Balk
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M-E Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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20
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Padayatchi N, Gopal M, Naidoo R, Werner L, Naidoo K, Master I, O'Donnell MR. Clofazimine in the treatment of extensively drug-resistant tuberculosis with HIV coinfection in South Africa: a retrospective cohort study. J Antimicrob Chemother 2014; 69:3103-7. [PMID: 24986495 DOI: 10.1093/jac/dku235] [Citation(s) in RCA: 33] [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: 11/12/2022] Open
Abstract
BACKGROUND Extensively drug-resistant (XDR) tuberculosis (TB) and HIV coinfection is associated with low cure rates and high mortality. Clofazimine has shown activity in vitro against Mycobacterium tuberculosis, but clinical experience with clofazimine in XDR-TB and HIV coinfection is limited. METHODS This was a retrospective cohort study of adult XDR-TB patients in KwaZulu-Natal, South Africa, treated with either a clofazimine- or non-clofazimine-containing XDR-TB treatment regimen. The primary outcome measure was TB culture conversion at 6 months. Survival analysis and multivariate logistic regression compared time to event in different strata and identified risk factors for TB culture conversion. RESULTS Between August 2009 and July 2011, eligible XDR-TB patients (n = 85) were initiated on treatment for XDR-TB. Most patients (86%) were HIV-infected and receiving antiretroviral therapy (90%). Patients receiving a clofazimine-containing regimen (n = 50) had a higher percentage of culture conversion (40%) compared with patients (n = 35) receiving a non-clofazimine regimen (28.6%). On multivariate analysis, there was a 2-fold increase in TB culture conversion at 6 months (hazard rate ratio 2.54, 95% CI 0.99-6.52, P = 0.05) in the group receiving a clofazimine-containing regimen. Adverse effects due to clofazimine were minor and rarely life-threatening. CONCLUSIONS Clofazimine was associated with improved culture conversion in the treatment of XDR-TB/HIV. Adverse effects were minor and non-life-threatening. Based on these preliminary data, further study of clofazimine in XDR-TB/HIV treatment is warranted. Given the present low rates of culture conversion in XDR-TB treatment, we recommend empirical inclusion of clofazimine in treatment regimens for XDR-TB.
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Affiliation(s)
- N Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - M Gopal
- Gulf Coast Pulmonary Medicine, Port Charlotte, FL 33952, USA
| | - R Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - L Werner
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa
| | - I Master
- King Dinuzulu Hospital, PO Box Dormerton 4015, South Africa
| | - M R O'Donnell
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa Division of Pulmonary Medicine, Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Schmidinger G, Pemp B, Werner L. [Opacification of an intraocular lens: calcification of hydrophilic intraocular lenses after gas tamponade of the anterior chamber]. Ophthalmologe 2014; 110:1066-8. [PMID: 23552856 DOI: 10.1007/s00347-013-2793-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with endothelial dystrophy was treated with Descemet stripping automated endothelial keratoplasty (DSAEK) combined with cataract extraction and implantation of a hydrophilic intraocular lens (IOL, Lentis-L312, Oculentis) but visual acuity dropped from 0.15 logMAR to 0.52 logMAR 18 months later due to calcification of the IOL. With new methods of lamellar corneal transplantation being used more frequently the number of necessary anterior chamber tamponades with air/gas are increasing. In cataract cases in which a gas tamponade and transplantation might be necessary later on (cornea guttata), hydrophilic IOLs should be avoided.
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Affiliation(s)
- G Schmidinger
- Abteilung für Augenheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Bodnar ZM, Rozot P, Leishman L, Ollerton A, Michelson J, Plasse-Fauque S, Werner L. Calcification of a hydrophilic acrylic intraocular lens: case report with laboratory analysis. J Fr Ophtalmol 2013; 36:e113-7. [PMID: 23688611 DOI: 10.1016/j.jfo.2012.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 11/05/2012] [Accepted: 11/07/2012] [Indexed: 11/26/2022]
Abstract
We analyzed a single-piece plate-type hydrophilic acrylic posterior chamber intraocular lens (IOL) that was explanted due to a progressive loss of vision, which occurred 6 years after uncomplicated phacoemulsification. Gross and light microscopy, as well as anterior segment optical coherence tomography (OCT) revealed granular deposits below the IOL surface. Light scattering, as measured with Scheimpflug photography and densitometry analyses was found to be increased; spectrophotometry demonstrated a decrease in the light transmittance of the explanted lens. The granular deposits within the IOL material were found to be composed of calcium by histochemical methods (alizarin red and Von Kossa stains). To our knowledge this is the only report of calcification of this IOL design.
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Affiliation(s)
- Z M Bodnar
- John A.-Moran Eye Center, University of Utah, 65, Mario-Capecchi Drive, Salt Lake City, 84132 Utah, USA
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Jeselsohn RM, Regan MM, Werner L, Fatima A, He HH, Brown M, Iglehart JD, Richardson AL, Come S. Abstract P1-07-07: Inflammatory gene expression variations in the interval between core needle biopsy and excisional biopsy in early breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-07-07] [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: 11/16/2022]
Abstract
Abstract
Introduction: Advancements in molecular biology have unveiled multiple breast cancer promoting pathways and potential therapeutic targets. Large randomized clinical trials remain the ultimate means of validating therapeutic efficacy, but they require large cohorts of patients and are lengthy and costly. An alternative approach is to conduct a window of opportunity study in which patients are exposed to a drug pre-surgically during the interval between the core needle biopsy (CNB) and the definitive surgery (excisional biopsy (EB)). These are non-therapeutic studies and the end point is not clinical or pathological response but rather evaluation of molecular changes in the tumor specimens that can predict response. However, since the end points of the non-therapeutic studies are biologic, it is critical to first define any biologic changes that occur in the absence of treatment. In this study, we compared the molecular profiles of breast cancer tumors at the time of the diagnostic biopsy versus the definitive surgery in the absence of any intervention.
Methods: The study was conducted with DFCI/HCC IRB approval and patient consent. Post-menopausal women with a breast lesion suspected to be cancerous were eligible for this study. We obtained a tissue specimen at the time of a CNB and if determined to be consistent with invasive carcinoma a second specimen was obtained at the time of the EB. We used the Nanostring Ncounter system to study the expression level of 148 transcripts. Since we expected that most of the tumors will be hormone receptor positive (HR+), the library included; genes that have been shown to be prognostic in HR+ tumors (Oncotype DX®, PAM50), estrogen receptor (ER) modulators, ER responsive genes and inflammatory genes. The Wilcoxon's signed rank test was used to evaluate for changes in gene expression levels between the paired samples.
Results: 25 patients were enrolled in this study and paired tumor tissue samples were obtained from all patients. 21 of the paired samples were successfully analyzed by the nanostring system. 86% of the patients are HR+/Her2−. We found that the gene expression levels of 14 out of the 148 genes (9%) did change between the CNB and EB without any intervention (p < 0.05). 8 of these 14 genes can be classified as inflammatory genes that also have known functions in tumor progression. The expression of these 8 genes was upregulated between the biopsies and include; CD68, ADM, CD14, IL6, VEGFA, CD52, CD44 and SNAI1. These changes may be due to an inflammatory response to the CNB. Ki67 expression did not change significantly between biopsies.
Conclusions: In this study we found significant gene expression variations between CNBs and EBs in 9% of the genes tested, without any therapeutic intervention. Our findings suggest that when conducting a “Window of Opportunity” clinical study to evaluate for biomarkers of response or resistance, changes in expression of inflammatory genes cannot be attributed to treatment and a control arm should be considered.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-07-07.
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Affiliation(s)
- RM Jeselsohn
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - MM Regan
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - L Werner
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - A Fatima
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - HH He
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - M Brown
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - JD Iglehart
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - AL Richardson
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - S Come
- Beth Israel Deaconess Medical Center, Boston, MA; Dana Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
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Burgers WA, Muller TL, Kiravu A, Naranbhai V, Sibeko S, Werner L, Karim QA, Karim SSA. Infrequent, low magnitude HIV-specific T cell responses in HIV-uninfected participants in the 1% tenofovir microbicide gel trial (CAPRISA004). Retrovirology 2012. [PMCID: PMC3441793 DOI: 10.1186/1742-4690-9-s2-p225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Nguyen P, Yang M, Werner L, Regan M, D'Amico A, Pomerantz M, Freedman M, Lee G, Kantoff P. The Impact of Genetic Variants in the Double-Stranded DNA Break Repair Pathway on Cancer Control in Men Treated with Radiation for Prostate Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Rosenberg JE, Werner L, Selvarajah S, Weir B, Regan MM, Jacobus SJ, Berman DM, Schutz FAB, O'Brien R, Choueiri TK, Barretina J, Signoretti S, Loda M, Guancial EA, Gallardo E, Rojo FG, Lloreta J, Hahn WC, Kantoff PW, Bellmunt J. Identification of a novel urothelial carcinoma (UC) biomarker of lethality. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4569] [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] Open
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Bellmunt J, Selvarajah S, Rodig S, Salido M, Costa I, Bellosillo B, Werner L, Namgyal C, Schutz FAB, Pons F, O'Brien R, Barretina J, Signoretti S, Loda M, Albanell J, Choueiri TK, Berman DM, Kantoff PW, Rosenberg JE. Identification of ALK gene alterations in urothelial carcinoma (UC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4568] [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] Open
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Buckle GC, Werner L, Oh WK, Bubley G, Hayes JH, Weckstein D, Elfiky A, Sims DM, Kantoff P, Taplin M. Phase II trial of RAD001 (R) and bicalutamide (B) for castration-resistant prostrate cancer (CPRC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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James DF, Brown JR, Werner L, Wierda WG, Rai KR, Gould J, Castro JE, Rassenti L, Neuberg DS, Kipps TJ. Lenalidomide and rituximab for the initial treatment of chronic lymphocytic leukemia: Report of an ongoing study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nakabayashi M, Oh WK, Werner L, Xie W, Regan MM, McKearn TJ, Kantoff P, Pomerantz M. Association of genetic polymorphisms in ERCC1 gene with PSA response to carboplatin chemotherapy in men with metastatic castration-resistant prostate cancer (CRPC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4639] [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] Open
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Taplin M, Nakabayashi M, Werner L, Yang M, Xie W, Sun T, Pomerantz M, Freedman M, Lee GM, Kantoff P. Association between genetic polymorphisms in SLCO1B3 gene and response to ketoconazole (K) in men with castration-resistant prostate cancer (CRPC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hill W, Werner L, Marlow F. Investigation of Rhodamine 6G Adsorption at the Fused-Silica/Ethanolic Solution Interface Using Optical Second Harmonic Generation. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19910951126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Eicken JV, Höh H, Werner L. IOL-Belag nach komplikationsloser Kataraktoperation. Klin Monbl Augenheilkd 2008. [DOI: 10.1055/s-0028-1110081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Glass-Maujean M, Klumpp S, Werner L, Ehresmann A, Schmoranzer H. The study of the D(') (1)Pi(u) state of H(2): transition probabilities from the ground state, predissociation yields, and natural linewidths. J Chem Phys 2008; 128:094312. [PMID: 18331098 DOI: 10.1063/1.2835006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [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
The absorption spectrum of the H(2) molecule was studied at high resolution in the 81-72 nm spectral range. A detailed analysis of the D(') (1)Pi(u)-->X (1)Sigma(g) (+) electronic band system is reported. In the spectrum, more than 70 new lines were assigned. For wavelengths longer than 75 nm, the D(') (1)Pi(u) (+) and (1)Pi(u) (-) components show a clearly different behavior: Tauhe (1)Pi(u) (+) one dissociates into H(1s)+H(n=2) whereas the (1)Pi(u) (-) one leads to molecular fluorescence. For shorter wavelengths, both components are predissociated into H(1s)+H(n=3). The predissociation yields, the dissociation widths, and the absolute values of the transition probabilities were measured over the vibrational progression from v(')=3 to 17, i.e., up to the dissociation limit. The comparison between these absolute transition probabilities and the values calculated in the adiabatic and nonadiabatic approximations demonstrates clearly the importance of nonadiabatic couplings.
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Affiliation(s)
- M Glass-Maujean
- Université P. et M. Curie/CNRS, 4 pl Jussieu, F-75252 Paris Cedex 05, France.
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Demekhin FV, Omel’yanenko DV, Lagutin BM, Sukhorukov VL, Werner L, Ehresmann A, Schartner KH, Schmoranzer H. The predissociation of the 2σ u −1 (c 4Σ u − , v states of the oxygen molecular ion. Russ J Phys Chem B 2007. [DOI: 10.1134/s1990793107030049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Glass-Maujean M, Klumpp S, Werner L, Ehresmann A, Schmoranzer H. Study of the B″B¯Σu+1 state of H2: Transition probabilities from the ground state, dissociative widths, and Fano parameters. J Chem Phys 2007; 126:144303. [PMID: 17444708 DOI: 10.1063/1.2715928] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The transition probabilities, the dissociation widths, and the associated Fano parameters for rovibronic lines with J"=0,...,3 of the absorption bands of the B"B 1Sigmau+ state out of the X 1Sigmag+ v"=0 ground state were measured over the complete vibrational progression, showing clearly that only the inner-well state with B" 4psigma character can absorb vuv light and predissociate efficiently. The absolute values of these transition probablities, predissociation widths, and Fano parameters were found to agree well with ab initio calculations if one takes into account that the calculations neglect nonadiabatic couplings.
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Affiliation(s)
- M Glass-Maujean
- Laboratoire de Physique Moléculaire pour l'Atmosphère et l'Astrophysique, Université Pierre et Marie Curie/CNRS, 4, Place Jussieu, F-75252 Paris Cedex 05, France
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Glass-Maujean M, Klumpp S, Werner L, Ehresmann A, Schmoranzer H. Cross sections for the ionization continuum of H2 in the 15.3–17.2eV energy range. J Chem Phys 2007; 126:094306. [PMID: 17362108 DOI: 10.1063/1.2435345] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
Abstract
The absolute values for the cross sections of the ionization continuum of H2 had been measured at low energy (15.3-17.2 eV) Both absorption and ionization spectra were simultaneously recorded with linear response and absolute values, using a 10 m normal incidence monochromator installed on a synchrotron undulator beamline. The vibrational thresholds can be clearly seen as steps in the experimental data. The agreement between experimental values and theoretical ones is very good except around the first and second vibrational thresholds where the experimental data exceed the theoretical ones.
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Affiliation(s)
- M Glass-Maujean
- Laboratoire de Physique Moléculaire pour l'Atmosphère et l'Astrophysique, UMR7092, Université Pierre et Marie Curie /CNRS, 4 Place Jussieu, F-75252 Paris Cedex 05, France
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Werner L. IOL Materials: Manufacturing and More. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-976237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Werner L, Tetz MR, Müller M, Dietze U. Late Postoperative Traumatic Flap Loss. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-976283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Werner L, Tetz MR, Müller M, Chew J. Evaluation of the Geometry of the Anterior Segment of Postmortem Human Eyes with two Imaging Systems. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-976234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Oskay-Oezcelik G, Lehmacher W, Mirz R, Christ H, Kaufmann M, Bamberg M, Werner L, Wallwiener D, Overkamp F, Hindenburg HJ, Sehouli J. What do adjuvant and metastatic breast cancer patients (BC) expect from their doctors? Final results of a german survey in 617 patients:. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6085] [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: 11/20/2022] Open
Abstract
6085 Background: An increasing number of breast cancer patients in western countries are accessing the Internet for medical information. The following study was condcuted to explore the information needs and preferences with special focus on doctor-patient communication. Methods: A questionnaire was developed and validated in a phase-I study and was than administered to breast cancer patients both via internet (online) or via a print-version consisting of 62 questions. Results: A total of 617 patients were interviewed, 552 by online version (online group) and 65 by printed questionnaire (print group). The median age of the online group was 47 years (21–85), for the print group 53 years (40–92). 65% of the patients were treated with the intention of cure, 35% of the patients had a metastatic disease. The median time of consultation communicating the information “You have breast cancer”, was 15 minutes (0–300). The most effective and “patient-relevant source of information and explanations of treatment options was the consultation with their physician (84%). When asked to suggest areas for improvement, most frequent answers were: more alternative therapies should be offered by physician (54%); physicians should have more time for explanations (51%); cooperation between involved physicians should be optimized (39%). Most relevant questions for patients are: “Do I receive the adequate treatment?” (89%); “How many patients with my disease does my physician treat?” (46%); “Can I be enrolled into a trial?” (46%). An independent second opinion centre was desired by 94% of the patients, but only 20% know such an institution. Conclusions: This study underlines the need to give patients with breast cancer all details on treatment options and cancer managements. No significant financial relationships to disclose.
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Affiliation(s)
- G. Oskay-Oezcelik
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - W. Lehmacher
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - R. Mirz
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - H. Christ
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - M. Kaufmann
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - M. Bamberg
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - L. Werner
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - D. Wallwiener
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - F. Overkamp
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - H. J. Hindenburg
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
| | - J. Sehouli
- Medical University Charite, Berlin, Germany; Medical University Cologne, Cologne, Germany; Medical University Frankfurt, Frankfurt, Germany; Medical University Tübingen, Tübingen, Germany; Clinic Recklinghausen, Recklinghausen, Germany
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Werner L. Update on IOL materials and biocompatibility. Klin Monbl Augenheilkd 2006. [DOI: 10.1055/s-2006-946926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Werner L. Intraoperative, early postoperative and late postoperative causes of IOL opacification. Klin Monbl Augenheilkd 2006. [DOI: 10.1055/s-2006-946944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE To report histologic findings in 14 AlphaCor artificial corneas implanted during clinical trials and subsequently explanted from human subjects following complications, so as to evaluate biointegration within the device skirt. METHODS Explants were fixed and sectioned in paraffin. Histologic findings related to the device skirt were compared with earlier histologic results from animal studies and correlated with clinical histories. RESULTS Two devices had been removed due to complications related to the optic alone, 11 following stromal melting overlying the biointegratable sponge skirt and 1 due to a retroprosthetic membrane. All devices demonstrated normal skirt porosity. Biointegration was similar to that found in animal studies but qualitatively appeared reduced in the affected areas in patients with overlying stromal melting prior to explantation. Patients with a longer history of melting prior to explantation demonstrated presence of inflammatory cells around the device. CONCLUSIONS Histologic findings of the AlphaCor skirt in humans are consistent with earlier animal studies. This study confirms that biointegration by host fibroblastic cells, with collagen deposition occurs after AlphaCor implantation in humans. In cases in which stromal melting had occurred, biointegration is seen to be reduced. On correlating preoperative clinical factors with biointegration observed histologically, preoperative vascularization appears not to be required for AlphaCor biointegration.
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Affiliation(s)
- C R Hicks
- Biomaterials Research Centre, Lions Eye Institute, University of Western Australia, Nedlands.
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Hickman MS, Werner L, Mamalis N, Sung E, Goldstein D, Vroman DT, Pandey SK. Intraoperative explantation of two single-piece hydrophobic acrylic intraocular lenses due to surface deposits. Eye (Lond) 2005; 20:1054-60. [PMID: 16294206 DOI: 10.1038/sj.eye.6702124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/08/2022] Open
Abstract
PURPOSE To report clinical, pathological, and laboratory analyses of two cases of single-piece hydrophobic acrylic intraocular lenses (IOLs), which presented with significant surface deposits during implantation. METHODS The lenses were implanted with the manufacturer's recommended injector (loaded with Viscoat and Healon GV, respectively). Immediately after injection into the anterior chamber, areas on the lenses' surfaces were covered by deposits, which could not be entirely removed by irrigation/aspiration. The lenses were explanted and replaced with lenses of the same design. They underwent gross analyses, light microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy for analysis of the elemental composition of the deposits. Liquid chromatography/mass spectroscopy was also performed to identify the presence of proteins. RESULTS The deposits on the first lens had a granular appearance, forming a homogeneous layer mostly on the posterior lens surface. Larger crystal-like deposits were present mostly on the anterior surface of the second lens. Elemental analyses of the deposits in both cases revealed the presence of peaks of sodium, chloride, phosphate, and potassium, in addition to the peaks of carbon and oxygen (normal constituents of the lens material). Only protein components normally found in the anterior chamber during surgery, such as haemoglobin and albumin, were identified. CONCLUSIONS The results obtained suggest that the deposits in both cases may have resulted from crystallization of the ophthalmic viscosurgical device normally used during the loading of the IOLs into the cartridges.
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Affiliation(s)
- M S Hickman
- John A Moran Eye Center, University of Utah, Salt Lake City, USA
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Baillif S, Chiquet C, Werner L, Burillon C, Denis P. [Opacification of a hydrophilic acrylic intraocular lens]. J Fr Ophtalmol 2005; 28:e4. [PMID: 16249756 DOI: 10.1016/s0181-5512(05)81009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report pathological and histochemical analysis of an explanted opacified hydrophilic acrylic intraocular lens. PATIENTS and method: A hydrophilic acrylic intraocular lens--Orion IFP3D6--was explanted 2 years after routine phacoemulsification because of its opacification associated with significant visual impairment (20/40). The intraocular lens was examined by gross and light microscopy. Full-thickness cut sections of the lens were stained with 1% alizarin red (a special stain for calcium). RESULTS Microscopic analyses revealed the presence of granules of various sizes distributed in a line parallel to the anterior and posterior curvatures of the lens. The granules stained positively for alizarin red. CONCLUSION Such opacification has been described with the SC60B-OUV, MDR Inc., which is also a one-piece foldable-design intraocular lens (28% hydrophilic material). The opacification of the intraocular lens occurred over various periods after surgery. Forty percent of these lenses have been explanted. Microscopic and histochemical evaluation of these intraocular lenses revealed the same type of granulation deposits within the lenses. The origin and mechanism of the opacification are still not fully understood.
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Affiliation(s)
- S Baillif
- Service d'0phtalmologie, Centre Hospitalier Universitaire Edouard Herriot, Lyon, France
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Plattner PA, Werner L. Zur Kenntnis der Sesquiterpene. (64. Mitteilung). Über die Anlagerung von Acetylen-dicarbonsäure-ester, Azodicarbon-säure-ester und Maleinsäure-anhydrid an Caryophyllen. Helv Chim Acta 2004. [DOI: 10.1002/hlca.194402701129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ruzicka L, Plattner PA, Werner L. Zur Kenntnis der Sesquiterpene. (59. Mitteilung). Über den oxydativen Abbau des Caryophyllen-Maleinsäure-anhydrid-Addukts. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19430260327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dick B, Tehrani M, Pandey S, Werner L. Faltbare Kapselringe: Die neue Generation. Klin Monbl Augenheilkd 2004. [DOI: 10.1055/s-2004-835473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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