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O'Driscoll JM, Edwards JJ, Greenhough E, Smith E, May M, Gupta S, Marciniak A, Sharma R. The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end-stage renal disease. Eur J Sport Sci 2023:1-10. [PMID: 36815759 DOI: 10.1080/17461391.2023.2184727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m2) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO2 (9.80 ± 2.10 vs. 15.90 ± 4.30 ml·kg-1·min-1, P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09-8.70; P = 0.03) and peak VO2 (HR 0.73; 95% CI 0.64-0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. HIGHLIGHTSWe aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality.Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality.This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.
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Affiliation(s)
- J M O'Driscoll
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - J J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - E Greenhough
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - E Smith
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - M May
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - S Gupta
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Marciniak
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - R Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
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Badrick T, Shirley K, Quagliotto G, May M, Meumann E, Leonard N, Simos P, MacDougall R, Bursle E. Paracoccidioidomycosis: an Australian case. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.330] [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: 01/28/2023]
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Daniel S, May M, Uder M, Kopp M, Taubmann O. Automatisierte Textanalyse für die personalisierte Protokollauswahl der thorakalen Computertomographie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749776] [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)
- S Daniel
- Universitätsklinikum Erlangen, nstitut für diagnostische und interventionelle Radiologie,, Erlangen
| | - M May
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum, Erlangen
| | - M Uder
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum, Erlangen
| | - M Kopp
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum, Erlangen
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Green E, Chase A, Robinson M, Callagy S, Lundstedt C, Dykstra L, Van Andel D, Noyes C, Rostama B, Miller W, May M. Molecular Methodology for Tick Speciation and Tickborne Pathogen Surveillance. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cutting R, May M. Pandemic Parallels: Common Threads between the emergence of SARS-CoV-2 and HIV. Int J Infect Dis 2022. [PMCID: PMC8884813 DOI: 10.1016/j.ijid.2021.12.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose This analysis explored the parallels between the emergence of human immunodeficiency virus (HIV) and its associated disease (acquired immune deficiency syndrome [AIDS]), and SARS-CoV-2 and its associated disease (Coronavirus disease 2019 [COVID-19]) in order to highlight common patterns that enabled the epidemics of novel pathogens. Methods & Materials Our laboratory developed a core set of ten questions that focused on common features found in major disease epidemics, including the affected populations, the response parameters and dynamics of governments, the natural source of the infectious agent, and the impacts of epidemics on societies as a whole. We utilized contemporary accounts including news coverage, written descriptions, documentary accounts, and primary literatures to determine full answers to the core questions. Results Eight of the ten questions identified commonalities between the AIDS and COVID-19 pandemics. These include slow government policy responses that negatively impacted the timing and the epidemic trajectory, involvement of marginalized populations of societies who were disproportionately affected by the diseases, discovery of existence of persistent economic and social inequalities, and introduction of lifelong morbidities in patients. Most importantly, this analysis found the importance of collaborative, scientifically driven political leadership as evidenced by the improved pace of disease control measures and research for therapeutic and vaccine discovery following adoption of evidence-based policy. Conclusion This analysis identifies multiple factors that paralleled the trajectory of the HIV/AIDS epidemic and SARS-CoV-2/COVID-19 pandemic. In order to prepare for potential pandemics or large-scale outbreaks in the future, policies mindful of these lessons outlined will help provide guidance for future responses to emerging pathogens.
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Feng Q, Kim JH, Omiyale W, Bešević J, Conroy M, May M, Yang Z, Wong SYS, Tsoi KKF, Allen N, Lacey B. Raw and Cooked Vegetable Consumption and Risk of Cardiovascular Disease: A Study of 400,000 Adults in UK Biobank. Front Nutr 2022; 9:831470. [PMID: 35265657 PMCID: PMC8901125 DOI: 10.3389/fnut.2022.831470] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Higher levels of vegetable consumption have been associated with a lower risk of cardiovascular disease (CVD), but the independent effect of raw and cooked vegetable consumption remains unclear. Methods From the UK Biobank cohort, 399,586 participants without prior CVD were included in the analysis. Raw and cooked vegetable intakes were measured with a validated dietary questionnaire at baseline. Multivariable Cox regression was used to estimate the associations between vegetable intake and CVD incidence and mortality, adjusted for socioeconomic status, health status, and lifestyle factors. The potential effect of residual confounding was assessed by calculating the percentage reduction in the likelihood ratio (LR) statistics after adjustment for the confounders. Results The mean age was 56 years and 55% were women. Mean intakes of raw and cooked vegetables were 2.3 and 2.8 tablespoons/day, respectively. During 12 years of follow-up, 18,052 major CVD events and 4,406 CVD deaths occurred. Raw vegetable intake was inversely associated with both CVD incidence (adjusted hazard ratio (HR) [95% CI] for the highest vs. lowest intake: 0.89 [0.83–0.95]) and CVD mortality (0.85 [0.74–0.97]), while cooked vegetable intake was not (1.00 [0.91–1.09] and 0.96 [0.80–1.13], respectively). Adjustment for potential confounders reduced the LR statistics for the associations of raw vegetables with CVD incidence and mortality by 82 and 87%, respectively. Conclusions Higher intakes of raw, but not cooked, vegetables were associated with lower CVD risk. Residual confounding is likely to account for much, if not all, of the observed associations. This study suggests the need to reappraise the evidence on the burden of CVD disease attributable to low vegetable intake in the high-income populations.
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Affiliation(s)
- Qi Feng
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Qi Feng
| | - Jean H. Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wemimo Omiyale
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Jelena Bešević
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Megan Conroy
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Margaret May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Samuel Yeung-shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kelvin Kam-fai Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Naomi Allen
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Ben Lacey
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
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Beynon RA, Ingle SM, Langdon R, May M, Ness A, Martin RM, Suderman M, Ingarfield K, Marioni RE, McCartney DL, Waterboer T, Pawlita M, Relton C, Smith GD, Richmond RC. Epigenetic biomarkers of ageing are predictive of mortality risk in a longitudinal clinical cohort of individuals diagnosed with oropharyngeal cancer. Clin Epigenetics 2022; 14:1. [PMID: 34980250 PMCID: PMC8725548 DOI: 10.1186/s13148-021-01220-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epigenetic clocks are biomarkers of ageing derived from DNA methylation levels at a subset of CpG sites. The difference between age predicted by these clocks and chronological age, termed "epigenetic age acceleration", has been shown to predict age-related disease and mortality. We aimed to assess the prognostic value of epigenetic age acceleration and a DNA methylation-based mortality risk score with all-cause mortality in a prospective clinical cohort of individuals with head and neck cancer: Head and Neck 5000. We investigated two markers of intrinsic epigenetic age acceleration (IEAAHorvath and IEAAHannum), one marker of extrinsic epigenetic age acceleration (EEAA), one optimised to predict physiological dysregulation (AgeAccelPheno), one optimised to predict lifespan (AgeAccelGrim) and a DNA methylation-based predictor of mortality (ZhangScore). Cox regression models were first used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of epigenetic age acceleration with all-cause mortality in people with oropharyngeal cancer (n = 408; 105 deaths). The added prognostic value of epigenetic markers compared to a clinical model including age, sex, TNM stage and HPV status was then evaluated. RESULTS IEAAHannum and AgeAccelGrim were associated with mortality risk after adjustment for clinical and lifestyle factors (HRs per standard deviation [SD] increase in age acceleration = 1.30 [95% CI 1.07, 1.57; p = 0.007] and 1.40 [95% CI 1.06, 1.83; p = 0.016], respectively). There was weak evidence that the addition of AgeAccelGrim to the clinical model improved 3-year mortality prediction (area under the receiver operating characteristic curve: 0.80 vs. 0.77; p value for difference = 0.069). CONCLUSION In the setting of a large, clinical cohort of individuals with head and neck cancer, our study demonstrates the potential of epigenetic markers of ageing to enhance survival prediction in people with oropharyngeal cancer, beyond established prognostic factors. Our findings have potential uses in both clinical and non-clinical contexts: to aid treatment planning and improve patient stratification.
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Affiliation(s)
- Rhona A Beynon
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryan Langdon
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Margaret May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Richard M Martin
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Ingarfield
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
- Centre for Trials Research, Neuadd Meirionnydd, Heath Park Way, Cardiff, UK
- Community Oral Health, University of Glasgow Dental School, Sauchiehall Street, Glasgow, UK
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Daniel L McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Feng Q, Yang Z, May M, Tsoi KK, Ingle S, Lee EK, Wong SY, Kim JH. The role of body mass index in the association between dietary sodium intake and blood pressure: A mediation analysis with NHANES. Nutr Metab Cardiovasc Dis 2021; 31:3335-3344. [PMID: 34629246 DOI: 10.1016/j.numecd.2021.08.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Recent research demonstrated that obesity and high dietary sodium intake, the two established risk factors for hypertension, were associated with each other. The objective was to investigate the potential indirect effect of sodium intake on blood pressure via body mass index (BMI). METHODS AND RESULTS Using ten years data from US NHANES (2007-2016), the study included adult participants (>20 years old) who were not taking antihypertensive medications and without baseline diseases (n = 12,262). BMI was modelled as the mediator of sodium intake on systolic and diastolic blood pressure, adjusted for age, sex, socioeconomic status, smoking, drinking, physical activity, calorie intake, fluid intake and potassium intake. Mediation analysis was performed to evaluate total effect, direct effect and indirect effect via BMI. Subgroup analyses based on three age subgroups (20-40, 41-60 and ≥61 years old) were performed. The mean age was 39.29 (13.4) years and 53.1 (0.45) % were males. The mean BMI was 27.8 (6.20) kg/m2. Overall, 1 g/d increase in sodium intake was associated with an increased systolic blood pressure by 0.36 (95% confidence interval 0.14 to 0.58) mmHg, with a direct effect (0.14 (0.09-0.19)) and an indirect effect via BMI (0.23 (0.02-0.44)). The indirect effect was mainly observed in participants ≤60 years old. CONCLUSION Sodium intake showed both direct effect and indirect effect (via BMI) on systolic blood pressure in US NHANES. The findings provide evidence for combining sodium restriction and weight reduction measures for prevention of hypertension. Cautions should be taken when generalizing the findings to other populations with lower average BMI.
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Affiliation(s)
- Qi Feng
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zuyao Yang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Margaret May
- Population Health Sciences, University of Bristol, UK
| | - Kelvin K Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Suzanne Ingle
- Population Health Sciences, University of Bristol, UK
| | - Eric K Lee
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Y Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean H Kim
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Shoaib S, Hyder M, May M. An Atypical Long-Term Thiamine Treatment Regimen for Wernicke Encephalopathy. Fed Pract 2020; 37:405-409. [PMID: 33029065 PMCID: PMC7535953 DOI: 10.12788/fp.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A patient with rapidly changing mental status responded to treatment with intramuscular or IV thiamine but not oral dosages, suggesting that presentation of thiamine deficiency can be highly variable, which can complicate the correct diagnosis and treatment.
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Affiliation(s)
- Samra Shoaib
- is a Clinical Extern; is a Staff Psychiatrist, Inpatient Psychiatry; and is a Staff Psychiatrist, Inpatient Psychiatry and Mental Health Evaluation Clinic; all at the Veterans Affairs Palo Alto Health Care System in California. Margaret May also is a Clinical Instructor (Affiliate), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine in California
| | - Mehnaz Hyder
- is a Clinical Extern; is a Staff Psychiatrist, Inpatient Psychiatry; and is a Staff Psychiatrist, Inpatient Psychiatry and Mental Health Evaluation Clinic; all at the Veterans Affairs Palo Alto Health Care System in California. Margaret May also is a Clinical Instructor (Affiliate), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine in California
| | - Margaret May
- is a Clinical Extern; is a Staff Psychiatrist, Inpatient Psychiatry; and is a Staff Psychiatrist, Inpatient Psychiatry and Mental Health Evaluation Clinic; all at the Veterans Affairs Palo Alto Health Care System in California. Margaret May also is a Clinical Instructor (Affiliate), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine in California
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Schellong S, Kretzschmar A, Heinken A, May M, Kolbe K, Schreiber S, Riess H. Anticoagulation treatment of cancer patients with deep or superficial leg vein thrombosis - a retrospective observational study of German statutory health insurance claims data (the CERTIFICAT initiative). VASA 2020; 49:403-409. [PMID: 32520658 DOI: 10.1024/0301-1526/a000878] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Thrombosis is a common complication of cancer with a negative impact on quality of life and overall prognosis. Guidelines recommend low-molecular-weight heparin (LMWH) as initial and prolonged anticoagulation treatment. Little is known about current treatment patterns of these patients in ambulatory care. Patients and methods: The current retrospective observational study interrogates a large German statutory health insurance claims database in order to understand which kind of data can be extracted and analysed. An age- and sex-adjusted sample of about 4.1 million insured people from 2011 to 2016 could be used. Cancer patients with incident deep and superficial leg vein thrombosis were identified. Patients with preexisting cancer were allocated to a normal risk group; those who suffered from simultaneously diagnosed cancer and thrombosis were classified as high-risk group. Results: We identified 322,600 patients with inpatient or outpatient documented cancer diagnosis in at least two different quarters within one year. 87,755 patients were identified with an incident deep or superficial vein thrombosis. 8,201 patients suffered from both cancer and incident thrombosis. 56.9% of the patients received an anticoagulation regimen with predominant LMWH prescription, 24.2% vitamin K antagonists, 17.2% direct oral anticoagulants; in 1.7% of patients, no predominant anticoagulant drug/regime could be identified. On average, patients were prescribed anticoagulants for 4.5 months. An estimate of clinically relevant gastrointestinal bleeding could be derived (1.8% of patients). Conclusions: The dataset allows assigning detailed information of anticoagulant prescriptions in ambulatory care to well-defined groups of cancer patients. A first analysis suggests that in Germany current medical care of patients with cancer-related deep or superficial vein thrombosis does not entirely comply with guideline recommendations regarding type and duration of anticoagulation.
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Affiliation(s)
- S Schellong
- Medical Clinic Department for Cardiovascular Disease, Städtisches Klinikum Dresden, Germany
| | - A Kretzschmar
- Department for Haematology and Internist Oncology, Klinikum St. Georg, Leipzig, Germany
| | | | - M May
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - K Kolbe
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - S Schreiber
- HGC Healthcare Consultants GmbH, Duesseldorf, Germany
| | - H Riess
- Medical Department, Division of Oncology and Hematology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany
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Moure-Fernandez A, Hollinghurst S, Carroll FE, Downing H, Young G, Brookes S, May M, El-Gohary M, Harnden A, Kendrick D, Lafond N, Little P, Moore M, Orton E, Thompson M, Timmins D, Wang K, Hay AD. Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care. BMJ Open 2020; 10:e033567. [PMID: 32075830 PMCID: PMC7045138 DOI: 10.1136/bmjopen-2019-033567] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo. DESIGN Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work. SETTING Fifty-four National Health Service (NHS) general practices in England. PARTICIPANTS 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days. INTERVENTIONS 2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets. OUTCOME MEASURES Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up. RESULTS 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms. CONCLUSIONS The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms. TRIAL REGISTRATION NUMBERS EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.
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Affiliation(s)
- Aida Moure-Fernandez
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Fran E Carroll
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Harriet Downing
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Grace Young
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sara Brookes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Magdy El-Gohary
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Anthony Harnden
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Natasher Lafond
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Paul Little
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Orton
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - David Timmins
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Schneider F, Schulz CM, May M, Schneider G, Jacob M, Mutlak H, Pawlik M, Zoller M, Kretzschmar M, Koch C, Kees MG, Burger M, Lebentrau S, Novotny A, Hübler M, Koch T, Heim M. [Is the discipline associated with self-confidence in handling rational antibiotic prescription? : Results from the MR2 study in German hospitals]. Anaesthesist 2020; 69:162-169. [PMID: 32055886 DOI: 10.1007/s00101-020-00736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Besides public awareness and specialist knowledge and training of physicians, their self-confidence plays a key role for clinical decision-making in the respective area. OBJECTIVE This exploratory study investigated the influence of the discipline on differences in self-confidence in dealing with antibiotics and in the self-rated knowledge. METHODS In 2015 the multi-institutional reconnaissance of practice with multiresistant bacteria (MR2) questionnaire containing items on antibiotic prescription and multiresistant pathogens was sent out to 1061 physicians working in departments for internal medicine, general surgery, gynecology and obstetrics and urology. In 2017 a similar MR2 survey was sent to 1268 specialist and assistant physicians in anesthesiology in Germany. Besides demographic data 4 items on self-confidence in the use of antibiotic treatment and 11 items concerning self-rated knowledge about rational antibiotic therapy and multiresistant pathogens were included in the present analysis. Logistic regression analysis, the χ2-test and the Kruskal-Wallis test were used for statistical analysis of the influence of the discipline on these items. RESULTS The response rates were 43% (456 out of 1061) from the non-anesthetists and 56% (705 out of 1268) from the anesthetists. Of the non-anesthetists 44% and 57% of the anesthetists had had no advanced training on antibiotic stewardship during the year before the study. In the overall analysis anesthetists (mean±SD: 2.53±0.54) were significantly less self-confident about antibiotics than colleagues from other departments (internal medicine: 3.10±0.50, general surgery: 2.97±0.44, gynecology and obstetrics: 3.12±0.42 and urology: 3.15±0.44) in the unadjusted (all p<0.001) and adjusted comparison. The analysis of self-rated knowledge about rational antibiotic prescription showed similar results. Senior consultant status and advanced training in infectiology were significantly associated with self-confidence and self-rated knowledge about antibiotics. CONCLUSION Anesthetists showed significantly less self-confidence in dealing with antibiotics than colleagues from other disciplines. Advanced training on a rational prescription of antibiotics was associated with a greater self-confidence, so that the implementation of compulsory courses on rational antibiotic stewardship in the respective residency curriculum needs to be considered.
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Affiliation(s)
- F Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland. .,Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - C M Schulz
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M May
- Urologische Klinik, St. Elisabeth-Klinikum Straubing, Straubing, Deutschland
| | - G Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M Jacob
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerzmedizin, Klinikum St. Elisabeth Straubing, Straubing, Deutschland
| | - H Mutlak
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Deutschland
| | - M Pawlik
- Klinik für Anästhesiologie, Krankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - M Zoller
- Klinik für Anästhesiologie der Universität München, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Kretzschmar
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Koch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M G Kees
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - M Burger
- Urologische Klinik, Caritas St. Josef Krankenhaus, Universität Regensburg, Regensburg, Deutschland
| | - S Lebentrau
- Urologische Klinik, Ruppiner Kliniken GmbH, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - A Novotny
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Technische Universität München, München, Deutschland
| | - M Hübler
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M Heim
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
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Distler FA, Pahernik S, Gakis G, Hutterer G, Lebentrau S, Rink M, Nuhn P, Brookman-May S, Burger M, Gratzke C, Wolff I, May M. Adherence to the EAU guideline recommendations for systemic chemotherapy in penile cancer: results of the E-PROPS study group survey. World J Urol 2019; 38:2523-2530. [PMID: 31834472 DOI: 10.1007/s00345-019-03052-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To validate the adherence of urologists to chemotherapy recommendations given in the EAU guidelines on PeCa. The European Association of Urology (EAU) guidelines on penile cancer (PeCa) are predominantly based on retrospective studies with low level of evidence. MATERIALS AND METHODS A 14-item-survey addressing general issues of PeCa treatment was developed and sent to 45 European hospitals. 557 urologists participated in the survey of which 43.5%, 19.3%, and 37.2% were in-training, certified, and in leading positions, respectively. Median response rate among participating departments was 85.7% (IQR 75-94%). Three of 14 questions addressed clinical decisions on neoadjuvant, adjuvant, and palliative chemotherapy. Survey results were analyzed by bootstrap-adjusted multivariate logistic-regression-analysis to identify predictors for chemotherapy recommendations consistent with the guidelines. RESULTS Neoadjuvant, adjuvant, and palliative chemotherapy was recommended according to EAU guidelines in 21%, 26%, and 48%, respectively. For neoadjuvant chemotherapy, urologists holding leading positions or performing chemotherapy were more likely to recommend guideline-consistent treatment (OR 1.85 and 1.92 with p(bootstrap) = 0.007 and 0.003, respectively). Supporting resources (i.e., guidelines, textbooks) were used by 23% of survey participants and significantly improved consistency between treatment recommendations and Guideline recommendations in all chemotherapy settings (p(bootstrap) = 0.010-0.001). Department size and university center status were no significant predictors for all three endpoints. CONCLUSIONS In this study, we found a very low rate of adherence to the EAU guidelines on systemic treatment for PeCa. Further investigations are needed to clarify whether this missing adherence is a consequence of limited individual knowledge level or of the low grade of guideline recommendations.
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Affiliation(s)
- F A Distler
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - S Pahernik
- Department of Urology, Klinikum Nuremberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - G Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany
| | - G Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - S Lebentrau
- Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Brookman-May
- Department of Urology, Großhadern, LMU Munich, Munich, Germany
| | - M Burger
- Department of Urology, St. Josef-Hospital Regensburg, Medical University Regensburg, Regensburg, Germany
| | - C Gratzke
- Department of Urology, University of Freiburg, Freiburg, Germany
| | - I Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - M May
- Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany
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Abstract
OBJECTIVES To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV. DESIGN Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care. SETTING 404 general practices in England. PARTICIPANTS 5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation. OUTCOMES Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015. RESULTS HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK. CONCLUSIONS HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men. IMPLICATIONS AND FURTHER RESEARCH NEEDED Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
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Affiliation(s)
- Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Skevi Michael
- Institute of Statistical Science, School of Mathematics, University of Bristol, Bristol, UK
| | - Charlotte Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John Macleod
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Margaret May
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
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May M, Schönthaler M, Gilfrich C, Wolff I, Peter J, Miernik A, Fritsche HM, Burger M, Schostak M, Lebentrau S. [Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]. Urologe A 2019; 57:172-180. [PMID: 29322235 DOI: 10.1007/s00120-017-0565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
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Affiliation(s)
- M May
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M Schönthaler
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Gilfrich
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - I Wolff
- Urologische Kliniken, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland
| | - J Peter
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - A Miernik
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - H-M Fritsche
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland.,Urologische Abteilung der Chirurgischen Klinik München-Bogenhausen, München, Deutschland
| | - M Burger
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland
| | - M Schostak
- Urologische Kliniken, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Kliniken, Ruppiner Kliniken GmbH, Hochschulklinikum der MHB, Neuruppin, Deutschland
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Beynon RA, Richmond RC, Santos Ferreira DL, Ness AR, May M, Smith GD, Vincent EE, Adams C, Ala‐Korpela M, Würtz P, Soidinsalo S, Metcalfe C, Donovan JL, Lane AJ, Martin RM. Investigating the effects of lycopene and green tea on the metabolome of men at risk of prostate cancer: The ProDiet randomised controlled trial. Int J Cancer 2019; 144:1918-1928. [PMID: 30325021 PMCID: PMC6491994 DOI: 10.1002/ijc.31929] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022]
Abstract
Lycopene and green tea consumption have been observationally associated with reduced prostate cancer risk, but the underlying mechanisms have not been fully elucidated. We investigated the effect of factorial randomisation to a 6-month lycopene and green tea dietary advice or supplementation intervention on 159 serum metabolite measures in 128 men with raised PSA levels (but prostate cancer-free), analysed by intention-to-treat. The causal effects of metabolites modified by the intervention on prostate cancer risk were then assessed by Mendelian randomisation, using summary statistics from 44,825 prostate cancer cases and 27,904 controls. The systemic effects of lycopene and green tea supplementation on serum metabolic profile were comparable to the effects of the respective dietary advice interventions (R2 = 0.65 and 0.76 for lycopene and green tea respectively). Metabolites which were altered in response to lycopene supplementation were acetate [β (standard deviation difference vs. placebo): 0.69; 95% CI = 0.24, 1.15; p = 0.003], valine (β: -0.62; -1.03, -0.02; p = 0.004), pyruvate (β: -0.56; -0.95, -0.16; p = 0.006) and docosahexaenoic acid (β: -0.50; -085, -0.14; p = 0.006). Valine and diacylglycerol were lower in the lycopene dietary advice group (β: -0.65; -1.04, -0.26; p = 0.001 and β: -0.59; -1.01, -0.18; p = 0.006). A genetically instrumented SD increase in pyruvate increased the odds of prostate cancer by 1.29 (1.03, 1.62; p = 0.027). An intervention to increase lycopene intake altered the serum metabolome of men at risk of prostate cancer. Lycopene lowered levels of pyruvate, which our Mendelian randomisation analysis suggests may be causally related to reduced prostate cancer risk.
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Affiliation(s)
- Rhona A. Beynon
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
| | - Rebecca C. Richmond
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
| | - Diana L. Santos Ferreira
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
| | - Andrew R. Ness
- The National Institute for Health Research (NIHR) Bristol Biomedical Research CentreUpper Maudlin Street, BristolUnited Kingdom
| | - Margaret May
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - George Davey Smith
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
| | - Emma E. Vincent
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
- School of Cellular and Molecular MedicineUniversity of BristolBristolUnited Kingdom
| | - Charleen Adams
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
| | - Mika Ala‐Korpela
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
- Computational MedicineUniversity of Oulu and Biocenter OuluOuluFinland
- NMR Metabolomics Laboratory, School of PharmacyUniversity of Eastern FinlandKuopioFinland
- Systems EpidemiologyBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health SciencesThe Alfred Hospital, Monash UniversityMelbourneVictoriaAustralia
| | - Peter Würtz
- Research Programs Unit, Diabetes and ObesityUniversity of HelsinkiHelsinkiFinland
- Nightingale Health Ltd.HelsinkiFinland
| | | | - Christopher Metcalfe
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Bristol Randomised Trials Collaboration, School of Social and Community MedicineUniversity of BristolBristolUnited Kingdom
| | - Jenny L. Donovan
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Athene J. Lane
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Bristol Randomised Trials Collaboration, School of Social and Community MedicineUniversity of BristolBristolUnited Kingdom
| | - Richard M. Martin
- Present address:
Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
- Medical Research Council Integrative Epidemiology Unit at the University of BristolBristolUnited Kingdom
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May M, Brown DR. International Committee on Systematics of Prokaryotes Subcommittee on the taxonomy of Mollicutes: Minutes of the closed meeting, 8 July 2018, Portsmouth, New Hampshire, USA. Int J Syst Evol Microbiol 2019; 69:2169-2171. [PMID: 30856090 DOI: 10.1099/ijsem.0.003342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This report documents the International Committee on Systematics of Prokaryotes Subcommittee on the taxonomy of Mollicutes by recording the minutes of the meeting, held 8 July 2018, Portsmouth, New Hampshire, USA.
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Affiliation(s)
- M May
- 1University of New England, USA
| | - D R Brown
- 2University of Florida College of Veterinary Medicine, USA
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18
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Kretzschmar A, May M, Heinken A, Riess H. Anticoagulant treatment of patients (pts) with cancer associated thromboembolism (CAT) in Germany: Real world data from a 4 million people sample generated by insurance captured data. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morris NP, Johansen SL, May M, Gold JA. Media-Related Education in Psychiatry Residency Programs. Acad Psychiatry 2018; 42:679-685. [PMID: 30155603 DOI: 10.1007/s40596-018-0973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - Margaret May
- Stanford University School of Medicine, California, USA
| | - Jessica A Gold
- Washington University School of Medicine, St. Louis, MO, USA
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Mutlak H, Zacharowski K, Ernst C, May M. Kenntnisse deutscher Anästhesisten zu Antibiotic Stewardship. Anaesthesist 2018; 67:793-796. [DOI: 10.1007/s00101-018-0491-9] [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: 10/28/2022]
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Beynon RA, Lang S, Schimansky S, Penfold CM, Waylen A, Thomas SJ, Pawlita M, Tim Waterboer, Martin RM, May M, Ness AR. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer. Int J Cancer 2018; 143:1114-1127. [PMID: 29607493 PMCID: PMC6099366 DOI: 10.1002/ijc.31416] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
Tobacco smoking and alcohol consumption are well-established risk factors for head and neck cancer. The prognostic role of smoking and alcohol intake at diagnosis have been less well studied. We analysed 1,393 people prospectively enrolled into the Head and Neck 5000 study (oral cavity cancer, n=403; oropharyngeal cancer, n=660; laryngeal cancer, n=330) and followed up for a median of 3.5 years. The primary outcome was all-cause mortality. We used Cox proportional hazard models to derive minimally adjusted (age and gender) and fully adjusted (age, gender, ethnicity, stage, comorbidity, body mass index, HPV status, treatment, education, deprivation index, income, marital status, and either smoking or alcohol use) mortality hazard ratios (HR) for the effects of smoking status and alcohol intake at diagnosis. Models were stratified by cancer site, stage and HPV status. The fully-adjusted HR for current versus never-smokers was 1.7 overall (95% confidence interval [CI] 1.1, 2.6). In stratified analyses, associations of smoking with mortality were observed for oropharyngeal and laryngeal cancers (fully adjusted HRs for current smokers: 1.8 (95% CI=0.9, 3.40 and 2.3 (95% CI=0.8, 6.4)). We found no evidence that people who drank hazardous to harmful amounts of alcohol at diagnosis had a higher mortality risk compared to non-drinkers (HR=1.2 (95% CI=0.9, 1.6)). There was no strong evidence that HPV status or tumour stage modified the association of smoking with survival. Smoking status at the time of a head and neck cancer diagnosis influenced all-cause mortality in models adjusted for important prognostic factors.
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Affiliation(s)
- Rhona A. Beynon
- Population Health SciencesBristol Medical School, University of Bristol, Canynge HallBristolBS8 2PSUnited Kingdom
- MRC Integrative Epidemiology Unit (IEU)BristolBS8 2BNUnited Kingdom
| | - Samantha Lang
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Sarah Schimansky
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Christopher M. Penfold
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrea Waylen
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
| | - Steven J. Thomas
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections DivisionGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
| | - Tim Waterboer
- Molecular Diagnostics of Oncogenic Infections DivisionGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
| | - Richard M. Martin
- Population Health SciencesBristol Medical School, University of Bristol, Canynge HallBristolBS8 2PSUnited Kingdom
- MRC Integrative Epidemiology Unit (IEU)BristolBS8 2BNUnited Kingdom
| | - Margaret May
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andy R. Ness
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
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22
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Borgmann H, Musquera M, May M, Brookman-May SD. Answer to comment on manuscript "Prognostic significance of Fuhrman grade and age for cancer-specific and overall survival in patients with papillary renal cell carcinoma: results of an international multi-institutional study on 2189 patients". World J Urol 2018; 36:2091-2092. [PMID: 30022407 DOI: 10.1007/s00345-018-2383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- H Borgmann
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - M Musquera
- Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - M May
- Department of Urology, Klinikum St. Elisabeth Straubing, Straubing, Germany
| | - S D Brookman-May
- Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Marchionistrasse 15, 81377, Munich, Germany
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23
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Wolff I, Lebentrau S, Miernik A, Ecke T, Gilfrich C, Hoschke B, Schostak M, May M. Impact of surgeon's experience on outcome parameters following ureterorenoscopic stone removal. Urolithiasis 2018; 47:473-479. [PMID: 29974193 DOI: 10.1007/s00240-018-1073-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Within the BUSTER trial, we analyzed the surgeon's amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01-04/2015. Surgeon's experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien-Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon's experience had no significant impact on the complication rate. We observed no differences in this study's main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists' stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists' more than two-fold higher stone-free rate compared to residents' justifies ongoing efforts to establish structured URS training programs.
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Affiliation(s)
- I Wolff
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany. .,Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany.
| | - S Lebentrau
- Klinik für Urologie und Kinderurologie, Brandenburg Medical School, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - A Miernik
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - T Ecke
- Klinik für Urologie, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - C Gilfrich
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
| | - B Hoschke
- Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany
| | - M Schostak
- Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany
| | - M May
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
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24
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Roiner M, Maurer O, Lebentrau S, Gilfrich C, Schäfer C, Haberl C, Brookman-May S, Burger M, May M, Hakenberg O. [Management of penile cancer patients: new aspects of a rare tumour entity]. Aktuelle Urol 2018; 49:242-249. [PMID: 29237189 DOI: 10.1055/s-0043-121223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Over the past few decades, some principles in the treatment of penile cancer have changed fundamentally. While 15 years ago a negative surgical margin of at least 2 cm was considered mandatory, organ-sparing surgery permitting minimal negative surgical margins has a high priority nowadays. The current treatment principle requires as much organ preservation as possible and as much radicality as necessary. The implementation of organ-sparing and reconstructive surgical techniques has improved the quality of life of surviving patients. However, oncological and functional outcomes are still unsatisfactory. Alongside with adequate local treatment of the primary tumour, a consistent management of inguinal lymph nodes is of fundamental prognostic significance. In particular, clinically inconspicuous inguinal lymph nodes staged T1b and upwards need a surgical approach. Sentinel node biopsy, minimally-invasive surgical techniques and modified inguinal lymphadenectomy have reduced morbidity compared to conventional inguinal lymph node dissection. Multimodal treatment with surgery and chemotherapy is required in all patients with lymph node-positive disease; neoadjuvant chemotherapy has been established for patients with locally advanced lymph node disease, and adjuvant treatment after radical inguinal lymphadenectomy for lymph node-positive disease. An increasing understanding of the underlying tumour biology, in particular the role of the human papilloma virus (HPV) and epidermal growth factor receptor (EGFR) status, has led to a new pathological classification and may further enhance treatment options. This review summarises current aspects in the therapeutic management of penile cancer.
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Affiliation(s)
- M. Roiner
- Urologische Klinik, Klinikum St. Elisabeth Straubing
| | - O. Maurer
- Urologische Klinik, Klinikum St. Elisabeth Straubing
| | - S. Lebentrau
- Klinik für Urologie und Kinderurologie, Ruppiner Kliniken GmbH Neuruppin, Hochschulklinikum der MHB
| | - C. Gilfrich
- Urologische Klinik, Klinikum St. Elisabeth Straubing
| | - C. Schäfer
- Fachbereich Strahlentherapie, MVZ des Klinikums St. Elisabeth Straubing
| | - C. Haberl
- Sektion Onkologie und Hämatologie der I. Medizinischen Klinik, Klinikum St. Elisabeth Straubing
| | - S. Brookman-May
- Urologische Klinik, Ludwigs-Maximilians-Universität (LMU) München
| | - M. Burger
- Urologische Klinik, Caritas-Krankenhaus St. Josef, Universität Regensburg
| | - M. May
- Urologische Klinik, Klinikum St. Elisabeth Straubing
| | - O. Hakenberg
- Urologische Klinik und Poliklinik, Universitätsklinikum Rostock
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25
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Solone M, Lynd K, Williams KE, May M, Nemecek P, Weitlauf J. Therapist Guided Exposure Treatment for Vaginismus: Simulation and Immersive Learning Applications [36M]. Obstet Gynecol 2018. [DOI: 10.1097/01.aog.0000533092.96380.d9] [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]
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Scott J, Jones T, Ben-Shlomo Y, Redaniel T, May M, Caskey F. SP234ESTIMATING THE RISK OF ACUTE KIDNEY INJURY ASSOCIATED WITH USE OF DIURETICS AND RENIN ANGIOTENSIN ALDOSTERONE SYSTEM BLOCKERS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp234] [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: 11/13/2022] Open
Affiliation(s)
- Jemima Scott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Theresa Redaniel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Margaret May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Fergus Caskey
- UK Renal Registry, UK Renal Registry, Bristol, United Kingdom
- Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Ting A, May M, Mitchell H, Carver C, Kim Y. 0865 Dyadic Effects of Daily Stress and Satisfaction on Sleep Efficiency: A Preliminary Report among Colorectal Cancer Survivors and Their Spouses. Sleep 2018. [DOI: 10.1093/sleep/zsy061.864] [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: 11/13/2022] Open
Affiliation(s)
- A Ting
- University of Miami, Coral Gables, FL
| | - M May
- University of Miami, Coral Gables, FL
| | | | - C Carver
- University of Miami, Coral Gables, FL
| | - Y Kim
- University of Miami, Coral Gables, FL
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Relich R, Schmitt B, Raposo H, Barker L, Blosser S, May M. Legionella indianapolisensis sp. nov., isolated from a patient with pulmonary abscess. Int J Infect Dis 2018; 69:26-28. [DOI: 10.1016/j.ijid.2018.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 11/25/2022] Open
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30
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Stinkens R, van der Kolk BW, Jordan J, Jax T, Engeli S, Heise T, Jocken JW, May M, Schindler C, Havekes B, Schaper N, Albrecht D, Kaiser S, Hartmann N, Letzkus M, Langenickel TH, Goossens GH, Blaak EE. The effects of angiotensin receptor neprilysin inhibition by sacubitril/valsartan on adipose tissue transcriptome and protein expression in obese hypertensive patients. Sci Rep 2018; 8:3933. [PMID: 29500454 PMCID: PMC5834447 DOI: 10.1038/s41598-018-22194-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/17/2017] [Accepted: 02/19/2018] [Indexed: 01/30/2023] Open
Abstract
Increased activation of the renin-angiotensin system is involved in the onset and progression of cardiometabolic diseases, while natriuretic peptides (NP) may exert protective effects. We have recently demonstrated that sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, which blocks the angiotensin II type-1 receptor and augments natriuretic peptide levels, improved peripheral insulin sensitivity in obese hypertensive patients. Here, we investigated the effects of sacubitril/valsartan (400 mg QD) treatment for 8 weeks on the abdominal subcutaneous adipose tissue (AT) phenotype compared to the metabolically neutral comparator amlodipine (10 mg QD) in 70 obese hypertensive patients. Abdominal subcutaneous AT biopsies were collected before and after intervention to determine the AT transcriptome and expression of proteins involved in lipolysis, NP signaling and mitochondrial oxidative metabolism. Both sacubitril/valsartan and amlodipine treatment did not significantly induce AT transcriptional changes in pathways related to lipolysis, NP signaling and oxidative metabolism. Furthermore, protein expression of adipose triglyceride lipase (ATGL) (Ptime*group = 0.195), hormone-sensitive lipase (HSL) (Ptime*group = 0.458), HSL-ser660 phosphorylation (Ptime*group = 0.340), NP receptor-A (NPRA) (Ptime*group = 0.829) and OXPHOS complexes (Ptime*group = 0.964) remained unchanged. In conclusion, sacubitril/valsartan treatment for 8 weeks did not alter the abdominal subcutaneous AT transcriptome and expression of proteins involved in lipolysis, NP signaling and oxidative metabolism in obese hypertensive patients.
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Affiliation(s)
- R Stinkens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - B W van der Kolk
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Jordan
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.,Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - T Jax
- Profil GmbH, Neuss, Germany
| | - S Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | | | - J W Jocken
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M May
- Clinical Research Center Hannover, Hannover Medical School, Hannover, Germany
| | - C Schindler
- Clinical Research Center Hannover, Hannover Medical School, Hannover, Germany
| | - B Havekes
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - N Schaper
- Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D Albrecht
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - S Kaiser
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - N Hartmann
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - M Letzkus
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - T H Langenickel
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - G H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - E E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.
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Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Abstract P1-07-09: Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Everolimus (EVE) plus exemestane (EXE) doubled progression-free survival (PFS) while maintaining quality of life versus EXE alone in postmenopausal women with hormone receptor positive (HR+), HER2-negative metastatic breast cancer (mBC) (BOLERO-2 phase 3; NCT00863655). Pretreatment serum activin A was previously reported as a prognostic factor in first-line hormone therapy (letrozole vs tamoxifen) (Novartis P025) and anti-HER2 mBC (lapatinib vs trastzmab) (CCTG MA.31) trials. Here we investigate the prognostic and predictive ability of activin A in BOLERO-2.
Methods: Activin A levels were determined on pretreatment serum samples using ELISA. Cox-proportional hazards model was used to assess the efficacy of EVE in the activin A low and high subgroups (median cut-point), and the prognostic effect of activin A on PFS and overall survival (OS).
Results: Baseline activin A levels were determined in 513 patients (71% of 725 BOLERO-2 patients randomized 2:1 to EVE+EXE or EXE). Predictive and prognostic signals are shown in the table below
Predictive and prognostic signalsPredictive/PrognosticEnd-pointAct-ivin ATreatmentNEventsMedian PFSHR (95% CI); p valuepredictivePFSHEXE93832.5 (1.5-2.8)-predictivePFSHEVE+EXE1631325.4 (4.1-6.8)0.46 (0.34 - 0.60); <0.0001predictivePFSLEXE89774.2 (2.0 -5.4)-predictivePFSLEVE+EXE1681059.9 (8.1-12.5)0.38 (0.28 - 0.51); <0.0001predictiveOSHEXE936820.1 (13.8-22.6)-predictiveOSHEVE+EXE16312917.7 (15.7-22.3)1.04 (0.78 - 1.40); 0.78predictiveOSLEXE8939NA (34.7-NA)-predictiveOSLEVE+EXE1687241.4 (36.4-NA)1.02 (0.69 - 1.50); 0.93prognosticPFSH 2562154.1 (2.9-4.2)-prognosticPFSL 2571826.9 (6.7-8.5)0.54 (0.45 - 0.66); <0.0001prognosticOSH 25619718.0 (16.5-21.1)-prognosticOSL 25711142.3 (38.5-NA)0.34 (0.27 - 0.42); <0.0001
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In multivariate analysis (including sensitivity to prior hormone therapy and visceral disease), activin A remained a significant independent prognostic factor for PFS and OS [HR 0.57 (0.46-0.69) and 0.34 (0.27-0.43), respectively].
Conclusions: Higher serum activin A was strongly associated with shorter PFS and OS in HR+/HER2- mBC patients. Everolimus was efficacious regardless of serum activin A level. These results are similar to our previous studies in phase 3 trials of letrozole-tamoxifen (Novartis P025), and HER2-targeted therapy, lapatinib vs trastuzmab (CCTG MA.31): pretreatment serum activin A was prognostic for outcome, but was not a predictive factor for treatment arm selection.
Citation Format: Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-09.
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Affiliation(s)
- SM Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Chen
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Krecko
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Leitzel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Vasekar
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - V Nagabhairu
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Marks
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - H Polimera
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Richardson
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M May
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - W He
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - P Patel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Lavin
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Hofsess
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Sweetman
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Hortobagyi
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Baselga
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Lipton
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
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May M, Gunia S, Helke C, Braun KP, Pickenhain S, Hoschke B. Is it Possible to Provide a Prognosis after Radical Prostatectomy for Prostate Cancer by Means of a Psa Regression Model? Int J Biol Markers 2018; 20:112-8. [PMID: 16011041 DOI: 10.1177/172460080502000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background For over 15 years, studies have been done to evaluate the elimination kinetics of the prostate-specific antigen (PSA) after radical prostatectomy. Even though evaluation of PSA regression in the two-compartment model has become established, no clear data are currently available as to whether a statement can be made with regard to tumor prognosis from a computation of the PSA half-life (PSA-HL). This study focuses on the determination of the PSA-HL in the two-compartment model and on its correlation with the biochemical recurrence-free survival. In addition, a computer program is being developed to simplify the determination of PSA-HL. Material and methods Seventy-seven prospective patients were examined who subsequently had a radical prostatectomy at our facility without neoadjuvant or adjuvant hormone deprivation. In addition to preoperative measurement of the PSA value (d0), PSA determinations were carried out postoperatively on days 5, 10 and 60, and at four-monthly intervals thereafter (mean follow-up: 16 months). By means of the computer program developed for this purpose, CTK. TumW, the PSA half-lives for the first (d0–d5, PSA-HL1) and second (d5–d10, PSA-HL2) compartments were subsequently determined and their effect on biochemical recurrence-free survival was assessed. Results PSA-HL1 and PSA-HL2 were 1.89 (± 0.03) and 3.39 (± 0.14) days, respectively. Whilst PSA-HL1 did not permit any prognostic statement, the median PSA-HL in the second compartment between patients with and without disease progression differed significantly (4.44 versus 3.12 days; p<0.001). Discrimination analysis produced a cutoff of 3.8 days for the second compartment; patients with a PSA-HL2 ≥3.8 days had a significantly worse biochemical recurrence-free survival after 18 months than the other patients (27% versus 93%; p<0.001). Conclusion The PSA regression kinetics after radical prostatectomy follows a two-compartment model in which the prognostic value of the PSA-HL1 is limited. When a cutoff of 3.8 days is used, evaluation of the PSA-HL in compartment 2 (d5–10) appears to permit a prognostic statement. Due to the limited postsurgical follow-up, the disease process was only assessed as biochemical recurrence-free survival, and a longer follow-up will be necessary to generate data on progression-free survival.
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Affiliation(s)
- M May
- Urology Clinic, Carl-Thiem Hospital, Cottbus, Germany. M.
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Hay AD, Little P, Harnden A, Thompson M, Wang K, Kendrick D, Orton E, Brookes ST, Young GJ, May M, Hollinghurst S, Carroll FE, Downing H, Timmins D, Lafond N, El-Gohary M, Moore M. Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection: A Randomized Clinical Trial. JAMA 2017; 318:721-730. [PMID: 28829884 PMCID: PMC5817483 DOI: 10.1001/jama.2017.10572] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence. OBJECTIVE To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma. DESIGN, SETTING, AND PARTICIPANTS Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years. INTERVENTIONS Two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days. MAIN OUTCOMES AND MEASURES The primary outcomes were duration of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]; minimal clinically important difference, 1.66 units). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events. RESULTS Among 401 randomized patients, 2 withdrew immediately after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, -0.20; 95% CI, -0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events. CONCLUSIONS AND RELEVANCE Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity. TRIAL REGISTRATION ISRCTN.com Identifier: ISRCTN57309858.
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Affiliation(s)
- Alastair D. Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Paul Little
- Primary Care and Population Science, NIHR School for Primary Care Research, Faculty of Medicine, University of Southampton, Aldermoor Health Center, Southampton, England
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, England
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, England
| | - Denise Kendrick
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, Nottingham, England
| | - Elizabeth Orton
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, Nottingham, England
| | - Sara T. Brookes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Grace J. Young
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Margaret May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Fran E. Carroll
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Harriet Downing
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - David Timmins
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, England
| | - Natasher Lafond
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, Nottingham, England
| | - Magdy El-Gohary
- Primary Care and Population Science, NIHR School for Primary Care Research, Faculty of Medicine, University of Southampton, Aldermoor Health Center, Southampton, England
| | - Michael Moore
- Primary Care and Population Science, NIHR School for Primary Care Research, Faculty of Medicine, University of Southampton, Aldermoor Health Center, Southampton, England
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Roiko M, May M, Relich RF. Characterization of Pontibacter altruii, sp. nov., isolated from a human blood culture. New Microbes New Infect 2017; 19:71-77. [PMID: 28725439 PMCID: PMC5502793 DOI: 10.1016/j.nmni.2017.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/14/2017] [Accepted: 05/23/2017] [Indexed: 01/25/2023] Open
Abstract
The genus Pontibacter is a recent addition to the family Cytophagaceae, phylum Bacteroidetes. Previous reports of its cultivation and molecular detection are from a variety of environmental sources, including marine and desert habitats. We report the first description of a Pontibacter sp., which was initially identified as Elizabethkingia meningoseptica, isolated from a human clinical specimen. On the basis of 16S rRNA gene sequence, unique mass spectral profile and phenotypic characterization, this isolate represents a novel species within the genus Pontibacter that has been named Pontibacter altruii, sp. nov., strain Grand Forks.
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Affiliation(s)
- M Roiko
- Altru Health System, Department of Pathology and Laboratory Services, Grand Forks, ND, USA
| | - M May
- University of New England College of Osteopathic Medicine, Department of Biomedical Sciences, Biddeford, ME, USA
| | - R F Relich
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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May M, Vetterlein MW, Wagenlehner FM, Brookman-May SD, Gilfrich C, Fritsche HM, Spachmann PJ, Burger M, Schostak M, Lebentrau S. [What is the perception of the 10-point plan of the German Federal Ministry of Health against multidrug-resistant pathogens and measures of antibiotic stewardship? : An interdisciplinary analysis among German clinicians and development of a decision tool for urologists]. Urologe A 2017; 56:1302-1310. [PMID: 28593351 DOI: 10.1007/s00120-017-0425-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to increasing antibiotic resistances, relevant treatment problems are currently emerging in clinical practice. In March 2015, the German Federal Ministry of Health (BMG) published a 10-point plan designed to combat this development. Furthermore, the first German guideline on antibiotic stewardship (ABS) was implemented in 2013 and instructs physicians of different specialties about several treatment considerations. Evidence is scarce on how such concepts (10-point plan/BMG, ABS) are perceived among clinicians. MATERIALS AND METHODS Within the MR2 study (Multiinstitutional Reconnaissance of practice with MultiResistant bacteria - a survey focusing on German hospitals), a questionnaire including 4 + 35 items was sent to 18 German hospitals between August and October 2015, surveying internists, gynecologists, general surgeons, and urologists. Using multivariate logistic regression models (MLRM), the impact of medical specialty and further criteria on the endpoints (1) awareness of the 10-point plan/BMG and (2) knowledge of ABS measures were assessed. Fulfillment of endpoints was predefined when average or full knowledge was reported (reference: poor to no knowledge). RESULTS Overall response rate was 43% (456/1061) for fully evaluable questionnaires. Only 63.0 and 53.6% of urologists and nonurologists (internists, gynecologists, and general surgeons), respectively, attended training courses regarding multidrug-resistance or antibiotic prescribing in the 12 months prior to the study (P = 0.045). The endpoints average and full knowledge regarding 10-point plan/BMG and ABS measures were fulfilled in only 31.4 and 32.8%, respectively. In MLRM, clinicians with at least one previous training course (reference: no training course) were 2.5- and 3.8-fold more likely to meet respective endpoint criteria (all P < 0.001). Medical specialty (urologists vs. nonurologists) did not significantly impact the endpoints in both MLRM. CONCLUSIONS The 10-point plan/BMG and ABS programs should be implemented into clinical practice, but awareness and knowledge of both is insufficient. Thus, it stands to reason that the actual realization of such measures is inadequate and continuous training towards rational prescription of antibiotics is necessary, regardless of medical specialty.
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Affiliation(s)
- M May
- Urologische Klinik, St. Elisabeth Klinikum, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M W Vetterlein
- Urologische Universitätsklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - F M Wagenlehner
- Urologische Universitätsklinik, Justus-Liebig Universitätsklinikum, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland
| | - S D Brookman-May
- Klinik für Urologie, LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - C Gilfrich
- Urologische Klinik, St. Elisabeth Klinikum, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - H-M Fritsche
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - P J Spachmann
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Burger
- Urologische Universitätsklinik, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Schostak
- Urologische Universitätsklinik, Universitätsklinikum Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Klinik, Ruppiner Kliniken, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
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Heyer K, Milde S, Schmitt J, May M, Helfrich J, Augustin M. [A standard data set for the evaluation of venous leg ulcers in selective contracts : National consensus]. Hautarzt 2017; 68:815-826. [PMID: 28567507 DOI: 10.1007/s00105-017-3990-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Selective agreements are becoming increasingly important in health care management. To date, no standard recommendations for the evaluation of selective contracts are available. OBJECTIVES Against this background, a recommendation on the evaluation of selective contracts in patients with leg ulcers (LU) was developed and approved by the nationwide consensus conference. MATERIALS AND METHODS Based on a systematic literature review and followed by a manual search through other possible evaluation indicators in the care of patients with LU, a Delphi-based consensus process was performed by various scientific societies, professional associations, insurances and supply networks. RESULTS For the evaluation of efficiency and quality of care, a recommendation on the evaluation of selective agreements with patients with LU was consented in six meetings and in five multistage online surveys. In total, 44 evaluation indicators were identified in the quality subareas structure, process, and outcome. The outcome indicators are divided into clinical, patient-related, and cost-related indicators. CONCLUSIONS The developed evaluation indicators represent the quality of care in patients with LU. The indicators can be applied individually, depending on the agreed contract-specific supply target. After implementation of this national standard, the comparability of selective agreements in the management of patients with LU can be ensured and consolidated.
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Affiliation(s)
- K Heyer
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - S Milde
- AOK-Bundesverband, Berlin, Deutschland
| | - J Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), TU Dresden, Dresden, Deutschland
| | - M May
- AOK Rheinland/Hamburg, Hamburg, Deutschland
| | | | - M Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie (IVDP), Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Evans M, Methven S, Sjolander A, May M, MacNeill S, Birnie K, Barany P, Carrero JJ, Caskey F. SP349IMPACT OF CINACALCET TREATMENT ON CARDIOVASCULAR OUTCOMES IN CKD PATIENTS WITH SECONDARY HYPERPARATHYROIDISM; THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx147.sp349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Prael I, Wüst W, Uder M, Geissler F, Köhnen J, May M. Bildqualität der Dual Energy Lungenperfusion in pulmonalarterieller und portalvenöser Kontrastmittelphase. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600451] [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: 10/19/2022]
Affiliation(s)
- I Prael
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - W Wüst
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - M Uder
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - F Geissler
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - J Köhnen
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - M May
- Universitätsklinik Erlangen, Radiologie, Erlangen
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Klapsch F, Lurz M, Wüst W, Wiesmüller M, Heiß R, Uder M, May M. Bildqualität in der thorakoabdominellen Staging-Computertomografie – Vergleich zwischen Single Energy mit automatischer Reduktion der Röhrenspannung und Dual Energy. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600211] [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: 10/19/2022]
Affiliation(s)
- F Klapsch
- Universitätsklinik Erlangen, Radiologie, Erlangen
| | - M Lurz
- Universität Erlangen, Radiologisches Institut, Erlangen
| | - W Wüst
- Universität Erlangen, Radiologisches Institut, Erlangen
| | - M Wiesmüller
- Universität Erlangen, Radiologisches Institut, Erlangen
| | - R Heiß
- Universität Erlangen, Radiologisches Institut, Erlangen
| | - M Uder
- Universität Erlangen, Radiologisches Institut, Erlangen
| | - M May
- Universität Erlangen, Radiologisches Institut, Erlangen
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Wiesmüller M, Wüst W, May M, Heiß R, Uder M. Herz-MRT: Interscanner-Reproduzierbarkeit des linksventrikulären T1-Mappings. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600262] [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: 10/19/2022]
Affiliation(s)
| | - W Wüst
- Radiologisches Institut Erlangen
| | - M May
- Radiologisches Institut Erlangen
| | - R Heiß
- Radiologisches Institut Erlangen
| | - M Uder
- Radiologisches Institut Erlangen
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Ellmann S, Kammerer F, Allmendinger T, Hammon M, Brand M, May M, Lell M, Uder M, Kramer M. Bestimmung des Dosisreduktionspotentials iterativer Rekonstruktionen intrakranieller CTA mit einer neuartigen auf paarweisen Bildvergleichen basierenden Methode. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600432] [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: 10/19/2022]
Affiliation(s)
- S Ellmann
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - F Kammerer
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | | | - M Hammon
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - M Brand
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - M May
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - M Lell
- Klinikum Nürnberg, Institut für Radiologie und Nuklearmedizin, Nürnberg
| | - M Uder
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - M Kramer
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
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Getzin T, May M, Schmidbauer M, Gutberlet M, Wacker F, Schindler C, Hueper K. Funktionelle MRT zur Quantifizierung des pharmakotherapeutischen Effektes eines ACE-Hemmers auf die Nierenperfusion und die T1-Relaxationszeit. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600190] [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: 10/19/2022]
Affiliation(s)
- T Getzin
- Medizinische Hochschule Hannover, Radiologie, Hannover
| | - M May
- Medizinische Hochschule Hannover, CRC Core Facility, Hannover
| | - M Schmidbauer
- Medizinische Hochschule Hannover, Diagnostische und Interventionelle Radiologie, Hannover
| | - M Gutberlet
- Medizinische Hochschule Hannover, Diagnostische und Interventionelle Radiologie, Hannover
| | - F Wacker
- Medizinische Hochschule Hannover, Diagnostische und Interventionelle Radiologie, Hannover
| | - C Schindler
- Medizinische Hochschule Hannover, CRC Core Facility, Hannover
| | - K Hueper
- Medizinische Hochschule Hannover, Diagnostische und Interventionelle Radiologie, Hannover
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Kopp M, Löwe T, Wüst W, Schmidt B, Nitsch W, Uder M, May M. Anatomisch basierte Dosiskalkulation und Abschätzung des Malignomrisikos in der Ganzkörper-Computertomografie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600434] [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: 10/19/2022]
Affiliation(s)
- M Kopp
- Universitätsklinikum Erlangen, Radiologisches Institut, Erlangen
| | - T Löwe
- Institut für Medizinische Mikrobiologie und Hygiene TU Dresden
| | - W Wüst
- Radiologisches Institut Universitätsklinikum Erlangen
| | - B Schmidt
- Siemens Healthineers GmbH, Forchheim
| | - W Nitsch
- Fraunhofer Institut für integrierte Schaltungen, Erlangen
| | - M Uder
- Radiologisches Institut Universitätsklinikum Erlangen
| | - M May
- Radiologisches Institut Universitätsklinikum Erlangen
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Schneeweiss A, Park-Simon TW, Albanell J, Lassen U, Cortes J, Dieras V, May M, Schindler C, Marmé F, Cejalvo JM, Martinez-Garcia M, Gonzalez I, Lopez-Martin J, Welt A, Joly F, Michielin F, Jacob W, Adessi C, Moisan A, Meneses-Lorente G, James I, Ceppi M, Hasmann M, Weisser M, Cervantes A. Abstract P6-11-13: Phase Ib study evaluating the safety and clinical activity of lumretuzumab combined with pertuzumab and paclitaxel in HER2-low metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Inhibition of HER2 and HER3 heterodimerisation is a novel treatment concept in HER2-”low” expressing breast cancer (BC). Lumretuzumab, a glycoengineered monoclonal anti-HER3 antibody, in combination with pertuzumab has demonstrated synergistic anti-tumor activity in preclinical HER2–low expressing preclinical BC models.
Methods: This open-label, multicenter phase I study selectively enrolled metastatic BC patients (pts) expressing HER3 protein and low levels of HER2 (defined as IHC 1+ and 2+ and ISH-negative) in a formalin-fixed paraffin-embedded pretreatment tumor biopsy sample. Eligible pts were treated with a combination of paclitaxel (PA) qw plus lumretuzumab (L) and pertuzumab (P) q3w in three dose cohorts. The safety, antitumor activity and tumor biomarkers including protein expression (IHC, MS) and mutational data (NGS) in association with clinical activity were evaluated.
Results: Overall, 35 pts were included in this study. The median age was 60 (range: 33 to 77) years. The median number of prior treatments for metastatic disease ranged from 0 to 5 with 23 pts (65.7%) without prior chemotherapy for metastatic disease. Cohort 1 was treated with PA at 80 mg/m2, L at 1000 mg and P at 840 mg for Cycle 1 followed by 420 mg for the following cycles. This cohort was stopped after two pts both experienced grade 3 diarrhea within the first treatment cycle which was considered a dose-limiting toxicity (DLT). For Cohort 2 the dose of L was reduced to 500 mg based on PK modelling and simulation data. No DLTs were seen for the first 6 pts. A total of 20 pts were recruited with an objective response rate (ORR) and disease control rate (DCR) of 30% and 75%, respectively, and 56% and 78%, respectively, for 1st-line pts (n=9) in this cohort. Diarrhea (≥G3) and hypokalemia (≥G3) occurred in 50% and 55% of pts, respectively, and all pts experienced chronic diarrhea throughout the course of treatment. For Cohort 3 the dose of L was maintained at 500 mg, PA at 80 mg/m2, and P was administered at 420 mg at all cycles. In addition, a prophylactic loperamide regimen was introduced. Altogether, 13 pts - all 1st-line for metastatic disease - were treated. No DLTs were seen for the first 6 pts. Diarrhea (≥G3) and hypokalemia (≥G3) were reduced to 31% and 15%, respectively, but chronic diarrhea was still observed throughout the treatment in all pts. The ORR and DCR were 31% and 77%, respectively. Preliminary mechanistic safety experiments revealed HER2/HER3-dependent chloride channels in the intestine as likely cause of diarrhea. Biomarker data will be presented along with updated clinical and safety data.
Conclusions: The combination of L, P and PA was associated with high rates of persistent diarrhea. Dose modifications and prophylactic anti-diarrheal medication led to significantly reduced diarrhea intensity but did not change the incidence and persistence of diarrhea overall. Despite encouraging clinical activity especially in 1st line pts, the therapeutic window of this combination is too low to warrant further clinical development.
Citation Format: Schneeweiss A, Park-Simon T-W, Albanell J, Lassen U, Cortes J, Dieras V, May M, Schindler C, Marmé F, Cejalvo JM, Martinez-Garcia M, Gonzalez I, Lopez-Martin J, Welt A, Joly F, Michielin F, Jacob W, Adessi C, Moisan A, Meneses-Lorente G, James I, Ceppi M, Hasmann M, Weisser M, Cervantes A. Phase Ib study evaluating the safety and clinical activity of lumretuzumab combined with pertuzumab and paclitaxel in HER2-low metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-13.
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Affiliation(s)
- A Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - T-W Park-Simon
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - J Albanell
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - U Lassen
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - J Cortes
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - V Dieras
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - M May
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - C Schindler
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - F Marmé
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - JM Cejalvo
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - M Martinez-Garcia
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - I Gonzalez
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - J Lopez-Martin
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - A Welt
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - F Joly
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - F Michielin
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - W Jacob
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - C Adessi
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - A Moisan
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - G Meneses-Lorente
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - I James
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - M Ceppi
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - M Hasmann
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - M Weisser
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
| | - A Cervantes
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; 2Clinics of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany; Hospital del Mar, Barcelona, Spain; Rigshospitalet, Copenhagen, Denmark; Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institut Curie, Paris, France; Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; West German Cancer Centre, University Hospital Essen, Essen, Germany; Center François Baclesse, Caen, France; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland; Roche Pharmaceutical Research and Early Development, Roche Innovation Center Munich, Penzberg, Germany; Pharma Research and Early Development, Clinical Pharmacology, Roche Innovation Center Welwyn, Welwyn Garden City, United Kingdom; A4P Consulting Ltd, Sandwich, United Kingdom
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Davies C, Gompels M, May M. Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence. ACTA ACUST UNITED AC 2017. [DOI: 10.9734/isrr/2017/36373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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May M, Protzel C, Vetterlein MW, Gierth M, Noldus J, Karl A, Grimm T, Wullich B, Grimm MO, Nuhn P, Bastian PJ, Roigas J, Hadaschik B, Gilfrich C, Burger M, Fisch M, Brookman-May S, Aziz A, Hakenberg OW. Is there evidence for a close connection between side of intravesical tumor location and ipsilateral lymphatic spread in lymph node-positive bladder cancer patients at radical cystectomy? Results of the PROMETRICS 2011 database. Int Urol Nephrol 2016; 49:247-254. [DOI: 10.1007/s11255-016-1469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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Jordan J, Stinkens R, Jax T, Engeli S, Blaak EE, May M, Havekes B, Schindler C, Albrecht D, Pal P, Heise T, Goossens GH, Langenickel TH. Improved Insulin Sensitivity With Angiotensin Receptor Neprilysin Inhibition in Individuals With Obesity and Hypertension. Clin Pharmacol Ther 2016; 101:254-263. [DOI: 10.1002/cpt.455] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/27/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J Jordan
- Institute for Clinical Pharmacology, Hannover Medical School; Hannover Germany
| | - R Stinkens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | | | - S Engeli
- Institute for Clinical Pharmacology, Hannover Medical School; Hannover Germany
| | - EE Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - M May
- Institute for Clinical Pharmacology, Hannover Medical School; Hannover Germany
| | - B Havekes
- Department of Internal Medicine, Division of Endocrinology; Maastricht University Medical Center; Maastricht The Netherlands
| | - C Schindler
- Institute for Clinical Pharmacology, Hannover Medical School; Hannover Germany
| | - D Albrecht
- Translational Medicine, Novartis Pharma AG; Basel Switzerland
| | - P Pal
- Biostatistical Sciences, Integrated Development Functions and Regions; Novartis Healthcare Pvt. Ltd; Hyderabad India
| | | | - GH Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism; Maastricht University Medical Center; Maastricht The Netherlands
| | - TH Langenickel
- Translational Medicine, Novartis Pharma AG; Basel Switzerland
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Simone G, De Nunzio C, Ferriero M, Cindolo L, Brookman-May S, Papalia R, Sperduti I, Collura D, Leonardo C, Anceschi U, Tuderti G, Misuraca L, Dalpiaz O, Hatzl S, Lodde M, Trenti E, Pastore A, Palleschi G, Lotrecchiano G, Salzano L, Carbone A, De Cobelli O, Tubaro A, Schips L, Zigeuner R, Tostain J, May M, Guaglianone S, Muto G, Gallucci M. Trends in the use of partial nephrectomy for cT1 renal tumors: Analysis of a 10-yr European multicenter dataset. Eur J Surg Oncol 2016; 42:1729-1735. [DOI: 10.1016/j.ejso.2016.03.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022] Open
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Lebentrau S, Lebentrau J, May M, Wick AK, Mathew M, Schostak M. [Results of a Questionnaire-Based Study on Guideline Adherence Regarding Adjuvant Treatment Recommendations for Patients with Non-Muscle-Invasive Bladder Cancer: Just a Disturbing Sidelight?]. Aktuelle Urol 2016; 47:408-13. [PMID: 27299426 DOI: 10.1055/s-0042-104785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The EAU guidelines on non-muscle-invasive bladder cancer (NMIBC) provide for risk stratification in low, intermediate and high risk based on infiltration depth, grading, concomitant carcinoma in situ, recurrence status, focality and tumour size. The aim of this study was to evaluate guideline adherence regarding risk stratification and risk-adapted treatment recommendations in NMIBC. MATERIAL AND METHODS An email-based survey distributed over the urological professional associations of Berlin, Brandenburg, Bremen, Hamburg, Mecklenburg-Western-Pomerania, Lower Saxony and Schleswig-Holstein assessed field of activity (doctor's office vs. clinic) and the presence of the additional qualification "Medical Tumour Therapy" (aqMtt). Also it inquired about the tools used for risk stratification in NMIBC. Finally, 3 scenarios were given, 2 of them corresponding to high-risk NMIBC and one corresponding to intermediate-risk NMIBC. Respondents were asked to provide a treatment recommendation. The results were presented comparatively for field of activity (doctor's office vs. clinic) and presence of aqMtt. RESULTS 74 responses were received (response rate of 12.3%). 57 (77.0%) of respondents had aqMtt. 52 (70.3%) worked in doctor's offices or medical care centres, 12 (16.2%) in a urology clinic, and for 10 (13.5%) respondents this information was lacking. The most frequently used tool for risk stratification was the EAU guideline. Accordingly, treatment recommendations for the three scenarios were considered to be correct if according to EAU guideline. In high-risk NMIBC, an average 29.3% (19.3-37.5%) of adequate treatment recommendations were made depending on the comparison group. An average of 69.8% (62.5-77.2%) and 0.9% (0.0-3.9%) treatment recommendations would lead to under- or overtreatment, respectively. The corresponding values for intermediate-risk NMIBC were 56.8% (52.6-62.5%) for adequate treatment, 43.2% (37.5-47.4%) for undertreatment and 0.0% for overtreatment. Field of activity and the presence of aqMtt had no significant impact on the accuracy of treatment recommendations. CONCLUSION The results of our survey provide strong evidence of poor guideline adherence with a consecutive risk for undertreatment of patients with NMIBC. This requires joint efforts of all those involved in the treatment of NMIBC to improve quality of care.
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Affiliation(s)
- S. Lebentrau
- Klinik für Urologie und Kinderurologie, Ruppiner Kliniken GmbH, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Neuruppin
| | | | - M. May
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing
| | - A.-K. Wick
- Klinik für Urologie und Kinderurologie, Ruppiner Kliniken GmbH, Hochschulklinikum der Medizinischen Hochschule Brandenburg, Neuruppin
| | - M. Mathew
- Universitätsklinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg
| | - M. Schostak
- Universitätsklinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg
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