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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, 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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Iyer K, Zubizarreta N, Nisenholtz M, Tappenden K, Tosi M, Lubarda J, Winkler M. Knowledge Of Chronic Intestinal Failure Among European And United Kingdom Gastroenterologists. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.073] [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: 03/29/2023]
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Bass E, Connor M, Adzawoloo-Andersson I, Bertonelli Tanaka M, Bhola-Stewart H, Brown D, Eldred-Evans D, Hosking-Jervis F, Jaipuria J, Mendoza R, Pegers E, Leelamany D, Powell L, Ahmad S, Wong K, Tam H, Gordon S, Qazi H, Hrouda D, Mccracken S, Winkler M, Ahmed H. Can we predict when non-targeted systematic prostate biopsies need to be performed? Outcomes from the multicentre RAPIDOnline 3,853 patient cohort. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00227-0] [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: 02/12/2023]
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Uthman A, Connor M, Khoo C, Rai A, Bass E, Agarwal S, Dasgupta R, Winkler M, Abboudi H, El-Husseiny T, Ahmed H. Rezum thermotherapy for large prostate volumes (>/= 80 cc): 2-year clinical outcomes. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00282-8] [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: 02/12/2023]
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Bertoncelli Tanaka M, Smith A, Mannion E, Yeung M, Lloyd J, Silvanto A, Asakra R, Winkler M, Ahmed H. Is immunohistochemistry relevant for the diagnosis of prostate cancer? A 2-year retrospective analysis in a single tertiary centre in the UK. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01274-5] [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: 02/12/2023]
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Light A, Kanthabalan A, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Payne H, Mitra A, Bomanji J, Winkler M, Horan G, Punwani S, Ahmed H, Shah T. Tumor characteristics of multiparametric MRI-detected and -undetected lesions in patients with suspected radiorecurrent prostate cancer: An analysis from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01283-6] [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: 02/12/2023]
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Mansour M, Chammas E, Winkler M, Aljaroudi W. Clinical significance of the hemodynamic gain index in patients undergoing exercise stress testing and coronary computed tomography angiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2455] [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: 11/12/2022] Open
Abstract
Abstract
Background
Many hemodynamic parameters are used during exercise stress testing but provide limited information regarding obstructive coronary artery disease (CAD) when exercise is suboptimal. Hemodynamic gain index (HGI) is a recently developed and sensitive indicator of ischemia which has been associated with increased mortality.
Purpose
This study sought to evaluate the clinical impact of HGI in patients who underwent concomitant exercise testing and coronary computed tomography angiography (CCTA).
Methods
Consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) and systolic blood pressure (SBP) were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI [(HRpeak × SBPpeak) − (HRrest × SBPrest)] / (HRrest × SBPrest) were calculated. The latter was divided into quartiles. The presence or absence of any CAD on CCTA was confirmed. Multivariate analysis and artificial neural network were used to determine the independent predictors of obstructive CAD.
Results
There were 284 patients (mean age 53 years, 83% male). Mean HGI was 1.74±0.67, with severely blunted HGI cut-off of ≤1.25 (Quartile 4). Patients with blunted HGI were older, had higher FRS, and worse DTS. Patients with obstructive CAD showed lower HGI when compared to control (1.36±0.53 vs. 1.77±0.67, P-value 0.005) and had more prevalence of severely blunted HGI ≤1.25 (44% vs. 22%, P-value 0.019). In the multivariate analysis, after adjusting for traditional risk factors, HGI remained independent predictor of obstructive CAD while severely blunted HGI ≤1.25 was associated with 3-fold increased odds of obstructive CAD (P-value 0.05). Using artificial intelligence analysis, blunted HGI remained an independent predictor of obstructive CAD an area under the curve of 0.83 and 0.96, and normalized importance of HGI of 100% and 63%, respectively for different models.
Conclusions
Among patients who underwent concomitant exercise testing and CCTA, blunted HGI ≤1.25 was strongly associated with obstructive CAD after adjusting for traditional risk factors. HGI is robust, practical, and allows clinicians to reclassify patients, change management, and thus improve prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mansour
- Montreal University Hospital Center, Department of Cardiology , Montreal , Canada
| | - E Chammas
- Clemenceau Medical Center, Division of Cardiology , Beirut , Lebanon
| | - M Winkler
- Medical College of Georgia, Department of Cardiovascular Medicine , Augusta , United States of America
| | - W Aljaroudi
- Medical College of Georgia, Department of Cardiovascular Medicine , Augusta , United States of America
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Winkler M, Kneuer JM, Meinecke T, Moebius-Winkler MN, Weiss R, Haas J, Garfias-Veitl T, Von Haehling S, Keller T, Thiele H, Lurz P, Speer T, Laufs U, Boeckel JN. The long non-coding RNA Heat4 is dynamically regulated during cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2902] [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: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI), with high mortality rates of 40–50%. The long non-coding RNA (lncRNA) Heat4 is associated with the inflammatory response of non-classical monocytes. Previous experimental work shows that this mechanism may be important in heart failure (HF) and during regeneration after vascular injury. Here, we investigate the association of Heat4 with survival in patients with chronic HF and assessed its regulation in AMI and CS.
Methods and results
Heat4 was elevated in the blood of HF patients compared to age-matched non-failing controls (+5.2-fold; HF: N=63; Controls: N=38; p<0.05). Heat4 showed a positive correlation with systemic inflammation (hsCRP; r=0.41; p<0.05) and was negatively associated with LVEF (r=−0.45; p<0.001). Heat4 blood levels showed good discriminatory power for prevalence of HF (AUC = 0.734; p<0.05) and mortality prediction after 4-year follow-up (AUC = 0.789; HF: Death N=32; Controls: Death N=0; p<0.05). Furthermore, Heat4 was elevated in the blood of patients with AMI compared to controls (+1.85-fold; AMI: N=42; Controls: N=23; p<0.05). Heat4 showed a very strong induction in patients suffering from CS (+284.5-fold; CS: N=4; Controls: N=5; p<0.05). In agreement with an anti-inflammatory signaling, Heat4 showed a dynamic regulation in patients with CS with a 284.5-fold increase during acute shock and a decrease 24 hours after revascularization (−82.3% compared to day of revascularization). This regulation was validated in an independent second cohort.
Conclusion
The lncRNA Heat4 is upregulated in the blood of patients with chronic heart failure, acute myocardial infarction and cardiogenic shock. In CS, Heat4 is dynamically regulated. These data set the stage to further assess Heat4 blood levels as a strategy for risk stratification and potential treatment target in HF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Projektfoerderung im Bereich der Herzmedizin, Leipzig
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Affiliation(s)
- M Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J M Kneuer
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - T Meinecke
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M N Moebius-Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - R Weiss
- University of Leipzig, Institute of Clinical Immunology , Leipzig , Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - T Garfias-Veitl
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - S Von Haehling
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - T Speer
- Saarland University Medical Center, Department of Internal Medicine, Nephrology and Hypertension , Homburg/Saar , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
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Kneuer JM, Winkler M, Meinecke T, Moebius-Winkler MN, Weiss R, Haas J, Garfias-Veitl T, Von Haehling S, Keller T, Thiele H, Lurz P, Speer T, Laufs U, Boeckel JN. The long non-coding RNA Heat4 is elevated in heart failure patients and mediates anti-inflammatory functions thereby promoting vascular regeneration. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2964] [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 purpose
Activation of the immune system correlates with the severity and the prognosis of patients with heart failure (HF). Here, we aim to identify and characterize long non-coding RNAs (lncRNAs) as a potential mechanistic link between the activation of the immune system and the pathophysiology of HF.
Methods and results
Using next-generation sequencing we found a yet uncharacterized lncRNA to be significantly upregulated in peripheral blood mononuclear cells of ischemic cardiomyopathy patients compared to controls, which we named Heat4 – Heart-disease associated transcript 4 (N=4; 2.05-fold increase; p<0.05). In the blood, monocytes show the highest expression of Heat4 and here in particular the non-classical monocytes compared to classical monocytes (N=4; 3.37-fold; p<0.05). Matching the known anti-inflammatory properties of this monocyte subpopulation we found that overexpression of Heat4 in monocytes resulted in decreased levels of inflammation (TNFα: −38.6%; p<0.05). Accordingly, a knockdown of Heat4 increased levels of inflammatory cytokine expression (TNFα: +4.14-fold; p<0.05). Non-classical monocytes are known to maintain vascular homeostasis by patrolling the endothelium in search of injury. Indeed, overexpression of Heat4 in human monocytes increased vascular regeneration after injury of the carotid artery in NOD-SCID mice (N=6; +1.85-fold compared to injection of control monocytes; p<0.05). We found Heat4 enriched in the cytoplasm of monocytes compared to the nuclear fraction. Using biotin-labelled RNA probes containing 2$'$O-Me-RNA oligonucleotides we performed RNA antisense affinity selection and subsequent mass spectrometry to identify proteins interacting with Heat4. We found two proteins, namely IP1 and IP2, enriched in the Heat4 fraction (+1.20 and +1.45-fold, respectively compared to the control probe). Knockdown of IP1 resulted in reduced induction of inflammatory gene expression (IL-6: −49.2%; p<0.05) after stimulation of monocytes with TNFα. Mechanistically, overexpression of Heat4 resulted in reduced extracellular levels of the IP1/IP2 heterodimer (IP1/IP2: −23.6%; p<0.05) as determined by ELISA.
Conclusion
The lncRNA Heat4 is elevated in the blood of patients with HF. Heat4 limits the extent of the inflammatory response of non-classical monocytes and leads to a faster regeneration after vascular injury. Heat4 is located in the cytoplasm of monocytes interacting with the pro-inflammatory proteins IP1/IP2 and repealing their extracellular release. Modulating Heat4 levels may represent a novel strategy for treatment of cardiovascular diseases with impaired vascular functions.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Projektfoerderung im Bereich der Herzmedizin, Leipzig
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Affiliation(s)
- J M Kneuer
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - T Meinecke
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M N Moebius-Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - R Weiss
- University of Leipzig, Institute of Clinical Immunology , Leipzig , Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - T Garfias-Veitl
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - S Von Haehling
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - T Speer
- Saarland University Medical Center, Department of Internal Medicine, Nephrology and Hypertension , Homburg/Saar , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
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Winkler M, Kappes-Horn K, Reimann J. TEMPORARY REMOVAL: VP.47 Interleukin 31 (IL-31) inhibition as a trigger for an immune-mediated myopathy? Neuromuscul Disord 2022; 32 Suppl 1:S84. [DOI: 10.1016/j.nmd.2022.07.178] [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: 11/07/2022]
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Steinbauer K, Lamprecht A, Winkler M, Di Cecco V, Fasching V, Ghosn D, Maringer A, Remoundou I, Suen M, Stanisci A, Venn S, Pauli H. Recent changes in high-mountain plant community functional composition in contrasting climate regimes. Sci Total Environ 2022; 829:154541. [PMID: 35302025 DOI: 10.1016/j.scitotenv.2022.154541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
High-mountain plant communities are strongly determined by abiotic conditions, especially low temperature, and are therefore susceptible to effects of climate warming. Rising temperatures, however, also lead to increased evapotranspiration, which, together with projected shifts in seasonal precipitation patterns, could lead to prolonged, detrimental water deficiencies. The current study aims at comparing alpine plant communities along elevation and water availability gradients from humid conditions (north-eastern Alps) to a moderate (Central Apennines) and a pronounced dry period during summer (Lefka Ori, Crete) in the Mediterranean area. We do this in order to (1) detect relationships between community-based indices (plant functional leaf and growth traits, thermic vegetation indicator, plant life forms, vegetation cover and diversity) and soil temperature and snow duration and (2) assess if climatic changes have already affected the vegetation, by determining directional changes over time (14-year period; 2001-2015) in these indices in the three regions. Plant community indices responded to decreasing temperatures along the elevation gradient in the NE-Alps and the Apennines, but this elevation effect almost disappeared in the summer-dry mountains of Crete. This suggests a shift from low-temperature to drought-dominated ecological filters. Leaf trait (Leaf Dry Matter Content and Specific Leaf Area) responses changed in direction from the Alps to the Apennines, indicating that drought effects already become discernible at the northern margin of the Mediterranean. Over time, a slight increase in vegetation cover was found in all regions, but thermophilisation occurred only in the NE-Alps and Apennines, accompanied by a decline of cold-adapted cushion plants in the Alps. On Crete, xeromorphic shrubs were increasing in abundance. Although critical biodiversity losses have not yet been observed, an intensified monitoring of combined warming-drought impacts will be required in view of threatened alpine plants that are either locally restricted in the south or weakly adapted to drought in the north.
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Affiliation(s)
- K Steinbauer
- GLORIA Coordination, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences, 1190 Vienna, Austria; GLORIA Coordination, Institute for Interdisciplinary Mountain Research, Austrian Academy of Sciences, 1190 Vienna, Austria; UNESCO-Chair on Sustainable Management of Conservation Areas, Carinthia University of Applied Science, 9524 Villach, Austria; E.C.O. - Institut für Ökologie, 9020 Klagenfurt, Austria.
| | - A Lamprecht
- GLORIA Coordination, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences, 1190 Vienna, Austria; GLORIA Coordination, Institute for Interdisciplinary Mountain Research, Austrian Academy of Sciences, 1190 Vienna, Austria
| | - M Winkler
- GLORIA Coordination, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences, 1190 Vienna, Austria; GLORIA Coordination, Institute for Interdisciplinary Mountain Research, Austrian Academy of Sciences, 1190 Vienna, Austria
| | - V Di Cecco
- Maiella Seed Bank, Maiella National Park, Loc. Colle Madonna, Lama dei Peligni 66010, Italy
| | - V Fasching
- GLORIA Coordination, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences, 1190 Vienna, Austria; GLORIA Coordination, Institute for Interdisciplinary Mountain Research, Austrian Academy of Sciences, 1190 Vienna, Austria
| | - D Ghosn
- Department of Geoinformation in Environmental Management - CIHEAM Mediterranean Agronomic Institute of Chania, Alsyllio Agrokepiou, 73100 Chania, Greece
| | - A Maringer
- Gesaeuse National Park, 8911 Admont, Austria
| | - I Remoundou
- Department of Geoinformation in Environmental Management - CIHEAM Mediterranean Agronomic Institute of Chania, Alsyllio Agrokepiou, 73100 Chania, Greece
| | - M Suen
- Gesaeuse National Park, 8911 Admont, Austria
| | - A Stanisci
- Dep. Bioscience and Territory, University of Molise, Termoli 86039, Italy
| | - S Venn
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - H Pauli
- GLORIA Coordination, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences, 1190 Vienna, Austria; GLORIA Coordination, Institute for Interdisciplinary Mountain Research, Austrian Academy of Sciences, 1190 Vienna, Austria
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Halicek M, Hasegawa A, Maghsoodpour A, Fu W, Cortese N, Winkler M. 403 Comparison Of Iterative Reconstruction And Post Reconstruction Deep Learning Noise Reduction Methods Utilizing Philips Brilliance CT 256 Phantom Data And Clinical Images. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peters M, Eldred-Evans D, Connor M, Bertoncelli Tanaka M, Bhola-Stewart H, T Shah T, Ahmad S, Noureldin M, Wong K, Tam H, Hrouda D, Winkler M, van Rossum P, Kurver P, Gordon S, Qazi H, Ahmed H, Giovanni Falagario U, Jambor I, Briganti A, Nordström T, Carrieri G, Powell L, Joshi S, Pegers E. PD-0416 Derivation and external validation of a RAPID Risk score for predicting significant prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02851-1] [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: 10/18/2022]
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Bass E, Bertonelli Tanaka M, Connor M, Walters U, Eldred-Evans D, Sarkar P, Hosking-Jervis F, Bhola-Stewart H, Pegers E, Powell L, Leelamany D, Wong K, Ahmad S, Tam H, Gordon S, Hrouda D, Mccracken S, Winkler M, Ahmed H. Identifying men affected by changes in PSA screening in the COVID-19 pandemic. Eur Urol 2022. [PMCID: PMC9155264 DOI: 10.1016/s0302-2838(22)00455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Reddy D, Eldred-Evans D, Connor M, Hosking-Jervis F, Bertoncelli Tanaka M, Bhola-Stewart H, Maynard W, Khoo C, Shah T, Bass E, Lee H, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Assessing the regional variability of a pre-biopsy mpMRI and targeted prostate cancer diagnostic pathway. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00532-2] [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: 11/27/2022]
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17
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Connor M, Rai A, Khoo C, Bass E, Eldred-Evans D, Agarwal S, Winkler M, Abboudi H, Dasgupta R, El-Husseiny T, Ahmed H. Patient-reported outcome measures and surgical retreatment rates from 181 patients treated with water vapor thermal therapy (Rezūm™). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Bass EJ, Pantovic A, Connor MJ, Loeb S, Rastinehad AR, Winkler M, Gabe R, Ahmed HU. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2021; 25:174-179. [PMID: 34548624 PMCID: PMC9184263 DOI: 10.1038/s41391-021-00449-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 02/10/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022]
Abstract
Background Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI ‘in-bore’ biopsy (IB-TB). It is unknown whether any of these are superior. We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa. Methods A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUS-GB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis. Results For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRI-GB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). There was significant heterogeneity observed between the included studies. Conclusions In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection and reduces detection of insignificant PCa compared to TRUS-GB. No individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required.
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Affiliation(s)
- E J Bass
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research -, Belgrade, Serbia
| | - M J Connor
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - S Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, New York, NY, USA
| | - A R Rastinehad
- Department of Urology, Lenox Hill Hospital at Northwell Health, New York, NY, USA
| | - M Winkler
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - H U Ahmed
- Imperial Prostate. Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Bass EJ, Pantovic A, Connor M, Gabe R, Padhani AR, Rockall A, Sokhi H, Tam H, Winkler M, Ahmed HU. A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk. Prostate Cancer Prostatic Dis 2021; 24:596-611. [PMID: 33219368 DOI: 10.1038/s41391-020-00298-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Multiparametric magnetic resonance imaging (mpMRI), the use of three multiple imaging sequences, typically T2-weighted, diffusion weighted (DWI) and dynamic contrast enhanced (DCE) images, has a high sensitivity and specificity for detecting significant cancer. Current guidance now recommends its use prior to biopsy. However, the impact of DCE is currently under debate regarding test accuracy. Biparametric MRI (bpMRI), using only T2 and DWI has been proposed as a viable alternative. We conducted a contemporary systematic review and meta-analysis to further examine the diagnostic performance of bpMRI in the diagnosis of any and clinically significant prostate cancer. METHODS A systematic review of the literature from 01/01/2017 to 06/07/2019 was performed by two independent reviewers using predefined search criteria. The index test was biparametric MRI and the reference standard whole-mount prostatectomy or prostate biopsy. Quality of included studies was assessed by the QUADAS-2 tool. Statistical analysis included pooled diagnostic performance (sensitivity; specificity; AUC), meta-regression of possible covariates and head-to-head comparisons of bpMRI and mpMRI where both were performed in the same study. RESULTS Forty-four articles were included in the analysis. The pooled sensitivity for any cancer detection was 0.84 (95% CI, 0.80-0.88), specificity 0.75 (95% CI, 0.68-0.81) for bpMRI. The summary ROC curve yielded a high AUC value (AUC = 0.86). The pooled sensitivity for clinically significant prostate cancer was 0.87 (95% CI, 0.78-0.93), specificity 0.72 (95% CI, 0.56-0.84) and the AUC value was 0.87. Meta-regression analysis revealed no difference in the pooled diagnostic estimates between bpMRI and mpMRI. CONCLUSIONS This meta-analysis on contemporary studies shows that bpMRI offers comparable test accuracies to mpMRI in detecting prostate cancer. These data are broadly supportive of the bpMRI approach but heterogeneity does not allow definitive recommendations to be made. There is a need for prospective multicentre studies of bpMRI in biopsy naïve men.
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Affiliation(s)
- E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. .,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - A Pantovic
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, Belgrade, Serbia
| | - M Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - A R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK
| | - A Rockall
- Division of Cancer, Department of Surgery and Cancer,Faculty of Medicine, Imperial College London, London, UK
| | - H Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, UK.,Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - H Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Mühling M, Winkler M, Augat P. Prediction of interfragmentary movement in fracture fixation constructs using a combination of finite element modeling and rigid body assumptions. Comput Methods Biomech Biomed Engin 2021; 24:1752-1760. [PMID: 34152892 DOI: 10.1080/10255842.2021.1919883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The amount of interfragmentary movement has been identified as a crucial factor for successful fracture healing. The aim of our study was to combine finite element analysis with a rigid body assumption to efficiently predict interfragmentary movement in fixed tibial fractures. The interfragmentary movement in a transverse tibial shaft fracture (AO/OTA type 42-A3) fixed with a locked plating construct was simulated using finite element analysis. In order to assess the contribution of the components on the resulting interfragmentary movement, the tibia, screws and embedding was either simulated deformable or as rigid body. The rigid and the deformable model accurately predicted the interfragmentary movement (R2 = 0.99). The axial movement ranged between 0.1 mm and 1.3 mm and shear movements were between 0.2 mm and 0.5 mm. Differences between the two models were smaller than 73 μm (axial) and 46 μm (shear). The rigid body assumption reduced computation time and memory usage by up to 61% and 97%, respectively.
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Affiliation(s)
- M Mühling
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - M Winkler
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - P Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
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Bass EJ, Klimowska-Nassar N, Sasikaran T, Day E, Fiorentino F, Sydes MR, Winkler M, Arumainayagam N, Khoubehi B, Pope A, Sokhi H, Dudderidge T, Ahmed HU. PROState Pathway Embedded Comparative Trial: The IP3-PROSPECT study. Contemp Clin Trials 2021; 107:106485. [PMID: 34139356 PMCID: PMC8451266 DOI: 10.1016/j.cct.2021.106485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022]
Abstract
Introduction The traditional double blind RCT is the ‘gold standard’ trial design. For a variety of reasons, these designs often fail to accrue enough participants to conclude. This is particularly challenging in localized prostate cancer. The cohort multiple randomised controlled trial (cmRCT) trial design may represent an alternative approach to delivering robust comparative data in prostate cancer. Patients and methods IP3-PROSPECT is a cmRCT designed to test multiple prostate cancer interventions from eligible men in one cohort. Key to the design is two points of consent. First, at point of consent one, men referred for prostate cancer investigations are invited to join the cohort. They may then be randomly invited at a later date to consider an intervention at point of consent two. In the pilot phase we will test the acceptability and feasibility of developing the cohort. Results Acceptability and feasibility of the study will be measured by a combination of quantitative and qualitative methods. The primary outcome measure is the rate of consent to inclusion to the IP3-PROSPECT cohort. Secondary outcome measures include the completeness of data collection at sites and return rates of patient questionnaires. We will also interview patients and healthcare professionals to explore their thoughts on the implementation, practicality and efficiency of IP3-PROSPECT. Conclusion The IP3-PROSPECT study will evaluate the cmRCT design in prostate cancer. Initially we will pilot the design, assessing for acceptability and feasibility. The cmRCT is an innovative design that offers potential for building a modern comparative evidence base for prostate cancer.
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Affiliation(s)
- E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK.
| | - N Klimowska-Nassar
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - T Sasikaran
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - E Day
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - F Fiorentino
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Clinical Trials Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - N Arumainayagam
- Department of Urology, Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Chertsey, UK
| | - B Khoubehi
- Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
| | - A Pope
- Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - H Sokhi
- Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - T Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Imperial Urology, Division of Cancer, Cardiovascular Medicine and Surgery, Imperial College Healthcare NHS Trust, London, UK
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Connor M, Van Son M, Eldred-Evans D, Bass E, Bertoncelli Tanaka M, Walters U, Sakar P, Hosking-Jervis F, Bhola-Stewart H, Pegers E, Powell L, Leelamany D, Wong K, Ahmad S, Tam H, Mccracken S, Hrouda D, Qasi H, Gordon S, Winkler M, Ahmed H. Impact of non-targeted prostate sampling histology on the probability of receiving invasive local treatment in an mpMRI-targeted pathway – analysis of 1,719 men. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01377-4] [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: 10/20/2022]
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Connor M, Genie M, Gonzalez M, Hosking-Jervis F, Thippu Jayaprakash K, Sarwar N, Horan G, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Rai B, Robinson A, Beresford M, Mangar S, Falconer A, Dudderidge T, Khoo V, Winkler M, Watson V, Ahmed H. Metastatic prostate cancer patients’ Attitudes towards Treatment of the local Tumour and metastasis Evaluative Research (IP5-MATTER): A multicentre, discrete choice experiment trial-in-progress. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01243-4] [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: 10/20/2022]
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Bass E, Klimowska-Nassar N, Day E, Sasikaran T, Fransesca F, Sydes M, Winkler M, Arumainayagam N, Khoubehi B, Pope A, Sokhi H, Dudderidge T. Prostate pathway embedded comparative trial: The ip3-prospect study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01248-3] [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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Shah T, Kanthabalan A, Pavlou M, Adeleke S, Giganti F, Brew-Graves C, Williams N, Haroon A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley R, Virdi J, Arya M, Mitra A, Payne H, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed H. MRI and targeted biopsies compared to transperineal mapping biopsies for targeted ablation in recurrent prostate cancer after radiotherapy: Primary outcomes of the FORECAST trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01566-9] [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: 11/30/2022]
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Raison N, Musollari G, Man K, Bhate N, Forde A, Sethi J, Ahmed H, Morley R, Rashid T, Winkler M. Patient-specific risk factors and post-operative complications have a significant impact on long term functional outcomes following minimally invasive. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01526-8] [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: 10/20/2022]
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Reddy D, Peters M, Shah T, Van Son M, Huber P, Lomas D, Rakauskas A, Miah S, Guillaumier S, Dudderidge T, Hindley R, Emara A, Nigam R, Valerio M, Afzal N, Lewi H, Orczyk C, Ogden C, Persad R, Virdi J, Moore C, Arya M, Winkler M, Emberton M, Ahmed H. Cancer control outcomes following focal therapy using HIFU in 1,829 men with non-metastatic prostate cancer treated over 15 years. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01427-5] [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: 10/20/2022]
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Walters U, Connor M, Bass E, Eldred-Evans D, Maynard W, Sarkar P, Bertoncelli Tanaka M, Hosking-Jervis F, Bhola-Stewart H, Pegers E, Powell L, Leelamany D, Wong K, Ahmad S, Tam H, Mccracken S, Gordon S, Hrouda D, Qazi H, Winkler M, Ahmed H. Switching from sedation to local anaesthetic transperineal prostate biopsies: A cost-benefit analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01262-8] [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: 10/20/2022]
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Raissi D, Winkler M, Yu Q, Gabriel G, Gallien J, Wallace J. Abstract No. 118 A multicenter observational study to determine the incidence of catheter-related venous thrombosis using a novel antimicrobial and anti-thrombogenic peripherally inserted central catheter. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Connor MJ, Eldred-Evans D, van Son M, Hosking-Jervis F, Bertoncelli Tanaka M, Reddy D, Bass EJ, Powell L, Ahmad S, Pegers E, Joshi S, Sri D, Wong K, Tam H, Hrouda D, Qazi H, Gordon S, Winkler M, Ahmed HU. A Multicenter Study of the Clinical Utility of Nontargeted Systematic Transperineal Prostate Biopsies in Patients Undergoing Pre-Biopsy Multiparametric Magnetic Resonance Imaging. J Urol 2020; 204:1195-1201. [PMID: 32516029 DOI: 10.1097/ju.0000000000001184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging. MATERIALS AND METHODS Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging. A transperineal biopsy was advised if multiparametric magnetic resonance imaging PI-RADS® (v.2.0) score was 4 or 5, and score 3 required a prostate specific antigen density 0.12 ng/ml or greater. Primary threshold for clinically significant prostate cancer was defined as any Gleason 3+4 or greater. Multivariable logistic regression analysis identified pre-biopsy predictors of clinically significant prostate cancer in nontargeted systematic prostate biopsies, regardless of targeted pathology (p <0.05, R, version 3.5.1). RESULTS A total of 1,719 men underwent a pre-biopsy multiparametric magnetic resonance imaging, with 679 (39.5%) proceeding to combined targeted systematic prostate biopsies and nontargeted systematic prostate biopsies. In these men clinically significant prostate cancer was detected in 333 (49%) and 139 (20.5%) with targeted systematic prostate biopsies and nontargeted systematic prostate biopsies, respectively. In those men with clinically significant prostate cancer in targeted systematic prostate biopsies, clinically significant prostate cancer was also present in nontargeted systematic prostate biopsies in 117 (17.2%); Gleason 3+3 was present in 50 (7.4%). In 287 men without any cancer in the targeted systematic prostate biopsies, 13 (1.9%) had clinically significant prostate cancer in nontargeted systematic prostate biopsies. In addition 18/679 (2.7%) had Gleason 3+3 disease and no Gleason greater than 4+3 was detected. Predictors associated with clinically significant prostate cancer in nontargeted systematic prostate biopsies were prostate specific antigen 5 ng/ml or greater (OR 2.05, 95% CI 1.13-3.73, p=0.02), PI-RADS score 5 (OR 2.26, 95% CI 1.51-3.38, p <0.001) and prostate volume less than 50 cc (OR 2.47, 95% CI 1.57-3.87, p <0.001). CONCLUSIONS Detection of clinically significant prostate cancer in exclusively nontargeted transperineal systematic biopsies in a pre-biopsy multiparametric magnetic resonance imaging pathway was low (1.9%).
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Affiliation(s)
- M J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - D Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - M van Son
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Hosking-Jervis
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - M Bertoncelli Tanaka
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - D Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - E J Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - L Powell
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - S Ahmad
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - E Pegers
- RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom
| | - S Joshi
- RM Partners, West London Cancer Alliance, Royal Marsden Hospital, London, United Kingdom
| | - D Sri
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - K Wong
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - H Tam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Hrouda
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Qazi
- Department of Urology, St. George's Hospital NHS Foundation Trust, London, United Kingdom
| | - S Gordon
- Department of Urology, Epsom and St. Helier's University Hospital Trust, Surrey, United Kingdom
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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Winkler M, von Landenberg C, Kornblum C, Reimann J. AUTOIMMUNE MYOPATHIES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.302] [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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Winkler M, von Landenberg C, Kuchenbecker K, Reimann J, Kornblum C. AUTOPHAGIC MYOPATHIES / MYOFIBRILLAR MYOPATHIES / DISTAL MYOPATHIES / POMPE DISEASE. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.015] [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: 11/17/2022]
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Weber D, Neumann A, Winkler M, Turner N, Rother D. Exploring carboxylate reductases to access aldehydes using in vitro and in vivo approaches. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D. Weber
- Forschungszentrum Jülich IBG-1: Biotechnology Jülich Germany
- RWTH Aachen University, Aachen Germany
| | - A. Neumann
- Forschungszentrum Jülich IBG-1: Biotechnology Jülich Germany
| | | | - N. Turner
- University of Manchester Manchester UK
| | - D. Rother
- Forschungszentrum Jülich IBG-1: Biotechnology Jülich Germany
- RWTH Aachen University, Aachen Germany
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Connor M, Eldred-Evans D, Hosking-Jervis F, Bass E, Reddy D, Bertoncelli Tanaka M, Bhola-Stewart H, Khoo C, Maynard W, Shah T, Lee J, Sri D, Powell L, Ahmad S, Joshi S, Pegers E, Kathie W, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Carton J, Ahmed H. Direct and marginal cost analysis of not aiming for the target in a MRI-targeted prostate biopsy pathway. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34162-8] [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] Open
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Khoo C, Eldred-Evans D, Peters M, Hosking-Jervis F, Connor M, Reddy D, Bertoncelli Tanaka M, Bhola-Stewart H, Maynard W, Bass E, Shah T, Lee J, Sri D, Powell L, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Man vs machine: Comparative effectiveness of cognitive targeted and image-fusion targeted transperineal prostate biopsy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34153-7] [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: 10/23/2022] Open
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Eldred-Evans D, Peters M, Bertoncelli Tanaka M, Hosking-Jervis F, Connor M, Reddy D, Shah T, Khoo C, Maynard W, Bass E, Lee J, Sri D, Bhola-Stewart H, Powell L, Ahmad S, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Qazi H, Gordon S, Ahmed H. The RAPID risk model: A novel risk score to predict significant prostate cancer in men with an mpMRI lesion. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33766-6] [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: 11/17/2022] Open
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Reddy D, Eldred-Evans D, Connor M, Hosking-Jervis F, Bertoncelli-Tanaka M, Bhola-Stewart H, Maynard W, Khoo C, Shah T, Bass E, Lee J, Sri D, Powell L, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Indeterminate mpMRI lesions: Evaluating the optimal PSA density threshold for prostate biopsy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Connor M, Eldred-Evans D, Hosking-Jervis F, Bass E, Reddy D, Bertoncelli Tanaka M, Bhola-Stewart H, Maynard W, Khoo C, Shah T, Lee J, Sri D, Powell L, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Which men should undergo non-targeted systematic sampling in an mpMRI-targeted pathway – an analysis from 1,719 pre-biopsy mpMRI cases? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32674-4] [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: 11/30/2022] Open
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Stavrinides V, Norris J, Bott S, Brown L, Burns-Cox N, Dudderidge T, El-Shater Bosaily A, Frangou E, Freeman A, Ghei M, Henderson A, Hindley R, Kaplan R, Kirkham A, Oldroyd R, Parker C, Persad R, Punwani S, Rosario D, Shergill I, Carmona L, Winkler M, Whitaker H, Ahmed H, Emberton M. MRI index lesions in the cancerous prostate: How do they differ from false positive phenotypes? Lessons from the PROMIS study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33748-4] [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: 10/23/2022] Open
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Maynard W, Eldred-Evans D, Connor M, Reddy D, Bertoncelli Tanaka M, Bhola-Stewart H, Khoo C, Bass E, Shah T, Lee J, Sri D, Powell L, Ahmad S, Noureldin M, Joshi S, Pegers E, Wong K, Tam H, Hrouda D, Winkler M, Gordon S, Qazi H, Ahmed H. Local anaesthetic transperineal prostate biopsy: Optimising patient selection. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34178-1] [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: 10/23/2022] Open
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Norris J, Carmona Echeverria L, Bott S, Brown L, Burns-Cox N, Dudderidge T, El-Shater Bosaily A, Frangou E, Freeman A, Ghei M, Henderson A, Hindley R, Kaplan R, Kirkham A, Oldroyd R, Parker C, Persad R, Punwani S, Rosario D, Shergill I, Stavrinides V, Winkler M, Whitaker H, Ahmed H, Emberton M. Which prostate cancers are overlooked by mpMRI? An analysis from PROMIS. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32877-9] [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: 10/23/2022] Open
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Noureldin M, Eldred-Evans D, Khoo CC, Winkler M, Sokhi H, Tam H, Ahmed HU. Review article: MRI-targeted biopsies for prostate cancer diagnosis and management. World J Urol 2020; 39:57-63. [PMID: 32253585 DOI: 10.1007/s00345-020-03182-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/25/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Transrectal ultrasound (TRUS)-guided biopsy has been the traditional biopsy route in the detection of prostate cancer. However, due to concern regarding overdetection of low-risk cancer and missed clinically significant cancers as well as risk of sepsis, alternative approaches have been explored. Transperineal template biopsy-sampling the gland every 5 m to 10 mm-reduces error by sampling the whole prostate but increases risk of detecting clinically insignificant cancers as well as conferring risks of side effects such as urinary retention and bleeding. METHODS There are various targeted biopsy techniques, each with different cancer detection rates, costs and learning curves. Current research focuses on refining biopsy methodology to maximize detection of significant cancers, whilst minimising invasiveness and complications. In this article, the up-to-date research data about MRI-targeted prostate biopsy were reviewed to show its utilization in prostate cancer management and diagnosis. RESULTS AND CONCLUSION Prostate multiparametric MRI has become an effective tool in the detection of significant cancers and an essential component of the prostate cancer diagnostic pathway incorporating MRI-guided biopsy decisions.
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Affiliation(s)
- M Noureldin
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK. .,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. .,Urology Department, Ain Shams University Hospitals, Cairo, Egypt.
| | - D Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - H Sokhi
- Department of Radiology, Hillingdon Hospitals NHS Foundation Trust, London, UK.,Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - H Tam
- Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Campus, Fulham Palace Road, London, W6 8RF, UK.,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Connor MJ, Winkler M, Ahmed HU. Cytoreductive cryotherapy for newly diagnosed oligometastatic hormone-sensitive prostate cancer. Prostate Cancer Prostatic Dis 2020; 23:537-538. [PMID: 32076122 DOI: 10.1038/s41391-020-0216-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022]
Affiliation(s)
- M J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.
| | - M Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.,Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - H U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.,Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
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Tomescu MS, Davids D, DuPlessis M, Darnhofer B, Birner-Gruenberger R, Archer R, Schwendenwein D, Thallinger G, Winkler M, Rumbold K. High-throughput in-field bioprospecting for cyanogenic plants and hydroxynitrile lyases. BIOCATAL BIOTRANSFOR 2020. [DOI: 10.1080/10242422.2020.1726895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. S. Tomescu
- School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa
| | - D. Davids
- School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa
| | - M. DuPlessis
- School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa
| | - B. Darnhofer
- ACIB GmbH, Graz, Austria
- Institute for Pathology, Medical University of Graz, Graz, Austria
- Omics Center Graz, BioTechMed, Graz, Austria
| | - R. Birner-Gruenberger
- ACIB GmbH, Graz, Austria
- Institute for Pathology, Medical University of Graz, Graz, Austria
- Omics Center Graz, BioTechMed, Graz, Austria
| | - R. Archer
- National Herbarium, South African National Biodiversity Institute, Pretoria, South Africa
| | | | | | - M. Winkler
- ACIB GmbH, Graz, Austria
- Institute of Molecular Biotechnology, Graz University of Technology, NAWI Graz, Graz, Austria
| | - K. Rumbold
- School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa
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Becker J, Winkler M, von Rüden C, Bliven E, Augat P, Resch H. Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis. Arch Orthop Trauma Surg 2020; 140:1947-1954. [PMID: 32270279 PMCID: PMC7674566 DOI: 10.1007/s00402-020-03433-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. METHODS Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch-Schneider reinforcement cage (BSRC) (n = 6). RESULTS During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). CONCLUSIONS The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.
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Affiliation(s)
- Johannes Becker
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany.
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany.
| | - M Winkler
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - C von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - E Bliven
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - P Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - H Resch
- Department of Traumatology and Sports Medicine, Paracelsus Medical University, Salzburg, Austria
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Becker J, Winkler M, von Rüden C, Bliven E, Augat P, Resch H. Correction to: Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis. Arch Orthop Trauma Surg 2020; 140:1955. [PMID: 32462458 PMCID: PMC7674341 DOI: 10.1007/s00402-020-03475-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article unfortunately contained a mistake.
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Affiliation(s)
- Johannes Becker
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany ,Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - M. Winkler
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - C. von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, Murnau, Germany ,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - E. Bliven
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - P. Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany ,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - H. Resch
- Department of Traumatology and Sports Medicine, Paracelsus Medical University, Salzburg, Austria
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Kostyleva D, Mukha I, Acosta L, Casarejos E, Chudoba V, Ciemny AA, Dominik W, Dueñas JA, Dunin V, Espino JM, Estradé A, Farinon F, Fomichev A, Geissel H, Gorshkov A, Grigorenko LV, Janas Z, Kamiński G, Kiselev O, Knöbel R, Krupko S, Kuich M, Litvinov YA, Marquinez-Durán G, Martel I, Mazzocchi C, Nociforo C, Ordúz AK, Pfützner M, Pietri S, Pomorski M, Prochazka A, Rymzhanova S, Sánchez-Benítez AM, Scheidenberger C, Simon H, Sitar B, Slepnev R, Stanoiu M, Strmen P, Szarka I, Takechi M, Tanaka YK, Weick H, Winkler M, Winfield JS, Xu X, Zhukov MV. Towards the Limits of Existence of Nuclear Structure: Observation and First Spectroscopy of the Isotope ^{31}K by Measuring Its Three-Proton Decay. Phys Rev Lett 2019; 123:092502. [PMID: 31524489 DOI: 10.1103/physrevlett.123.092502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/28/2019] [Indexed: 06/10/2023]
Abstract
The most remote isotope from the proton dripline (by 4 atomic mass units) has been observed: ^{31}K. It is unbound with respect to three-proton (3p) emission, and its decays have been detected in flight by measuring the trajectories of all decay products using microstrip detectors. The 3p emission processes have been studied by the means of angular correlations of ^{28}S+3p and the respective decay vertices. The energies of the previously unknown ground and excited states of ^{31}K have been determined. This provides its 3p separation energy value S_{3p} of -4.6(2) MeV. Upper half-life limits of 10 ps of the observed ^{31}K states have been derived from distributions of the measured decay vertices.
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Affiliation(s)
- D Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany
| | - I Mukha
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - L Acosta
- INFN, Laboratori Nazionali del Sud, Via S. Sofía, 95123 Catania, Italy
- Instituto de Física, Universidad Nacional Autónoma de México, México, Distrito Federal 01000, Mexico
| | | | - V Chudoba
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
- Institute of Physics, Silesian University Opava, 74601 Opava, Czech Republic
| | - A A Ciemny
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - W Dominik
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - J A Dueñas
- Departamento de Ingenieria Electrica y Centro de Estudios Avanzados en Fisica, Matemáticas y Computación, Universidad de Huelva, 21071 Huelva, Spain
| | - V Dunin
- Veksler and Baldin Laboratory of High Energy Physics, JINR, 141980 Dubna, Russia
| | - J M Espino
- Department of Atomic, Molecular and Nuclear Physics, University of Seville, 41012 Seville, Spain
| | - A Estradé
- University of Edinburgh, EH1 1HT Edinburgh, United Kingdom
| | - F Farinon
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - A Fomichev
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany
| | - A Gorshkov
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
| | - L V Grigorenko
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
- National Research Nuclear University "MEPhI," 115409 Moscow, Russia
- National Research Centre "Kurchatov Institute," Kurchatov square 1, 123182 Moscow, Russia
| | - Z Janas
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - G Kamiński
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
- Heavy Ion Laboratory, University of Warsaw, 02-093 Warszawa, Poland
| | - O Kiselev
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - R Knöbel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany
| | - S Krupko
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
| | - M Kuich
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
- Faculty of Physics, Warsaw University of Technology, 00-662 Warszawa, Poland
| | - Yu A Litvinov
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - G Marquinez-Durán
- Department of Applied Physics, University of Huelva, 21071 Huelva, Spain
| | - I Martel
- Department of Physics, University of Liverpool, Liverpool L69 9ZE, United Kingdom
| | - C Mazzocchi
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - C Nociforo
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - A K Ordúz
- Grand Accélérateur National d'Ions Lourds - GANIL, Bd Henri Becquerel, 14076 Caen, France
| | - M Pfützner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - S Pietri
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - M Pomorski
- Faculty of Physics, University of Warsaw, 02-093 Warszawa, Poland
| | - A Prochazka
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - S Rymzhanova
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
| | - A M Sánchez-Benítez
- Centro de Estudios Avanzados en Física, Matemáticas y Computación (CEAFMC), Department of Integrated Sciences, University of Huelva, 21071 Huelva, Spain
| | - C Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany
| | - H Simon
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - B Sitar
- Faculty of Mathematics and Physics, Comenius University, 84248 Bratislava, Slovakia
| | - R Slepnev
- Flerov Laboratory of Nuclear Reactions, JINR, 141980 Dubna, Russia
| | - M Stanoiu
- IFIN-HH, Post Office Box MG-6, 077125 Bucharest, Romania
| | - P Strmen
- Faculty of Mathematics and Physics, Comenius University, 84248 Bratislava, Slovakia
| | - I Szarka
- Faculty of Mathematics and Physics, Comenius University, 84248 Bratislava, Slovakia
| | - M Takechi
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - Y K Tanaka
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- University of Tokyo, 113-0033 Tokyo, Japan
| | - H Weick
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - M Winkler
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - J S Winfield
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
| | - X Xu
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- II. Physikalisches Institut, Justus-Liebig-Universität, 35392 Gießen, Germany
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - M V Zhukov
- Department of Physics, Chalmers University of Technology, S-41296 Göteborg, Sweden
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Winkler M, Sawicki J, Omelchenko I, Zakharova A, Anishchenko V, Schöll E. Relay synchronization in multiplex networks of discrete maps. ACTA ACUST UNITED AC 2019. [DOI: 10.1209/0295-5075/126/50004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khoo C, Eldred-Evans D, Jaenicke J, Bertoncelli Tanaka M, Shah T, Miah S, Connor M, Reddy D, Sethi J, Forde A, Bhola-Stewart H, Smith A, Carton J, Lloyd J, Mannion E, Hosking-Jervis F, Cullen E, Cartwright R, Clark M, Arya M, Hrouda D, Winkler M, Tam H, Ahmed H. Likert vs. PI-RADS v2: A comparison of two radiological scoring systems for detection of clinically significant prostate cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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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Miah S, Dunford C, Edison M, Eldred-Evans D, Gan C, Shah TT, Lunn P, Winkler M, Ahmed HU, Gibbons N, Hrouda D. A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic. Ann R Coll Surg Engl 2019; 101:30-34. [PMID: 30286648 PMCID: PMC6303818 DOI: 10.1308/rcsann.2018.0151] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. MATERIAL AND METHODS We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. RESULTS In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. CONCLUSIONS Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.
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Affiliation(s)
- S Miah
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Both are first joint authors
| | - C Dunford
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Both are first joint authors
| | - M Edison
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - C Gan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - TT Shah
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P Lunn
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - M Winkler
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - HU Ahmed
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - N Gibbons
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - D Hrouda
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
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