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Gandhi RT, Hirsch M. Treating Acute Covid-19 - Final Chapters Still Unwritten. N Engl J Med 2024; 390:1234-1236. [PMID: 38598581 DOI: 10.1056/nejme2402224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Rajesh T Gandhi
- From Massachusetts General Hospital and Harvard Medical School - both in Boston
| | - Martin Hirsch
- From Massachusetts General Hospital and Harvard Medical School - both in Boston
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Coenen VA, Jarc N, Hirsch M, Reinacher PC, Steinhoff BJ, Bast T, Schulze-Bonhage A, Sajonz BEA. Technical note: preliminary surgical experience with a new implantable epicranial stimulation device for chronic focal cortex stimulation in drug-resistant epilepsy. Acta Neurochir (Wien) 2024; 166:145. [PMID: 38514531 PMCID: PMC10957708 DOI: 10.1007/s00701-024-06022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE This study is to report some preliminary surgical considerations and outcomes after the first implantations of a new and commercially available implantable epicranial stimulation device for focal epilepsy. METHODS We retrospectively analyzed data from clinical notes. Outcome parameters were as follows: wound healing, surgery time, and adverse events. RESULTS Five patients were included (17-52 y/o; 3 female). Epicranial systems were uneventfully implanted under neuronavigation guidance. Some minor adverse events occurred. Wound healing in primary intention was seen in all patients. Out of these surgeries, certain concepts were developed: Skin incisions had to be significantly larger than expected. S-shaped incisions appeared to be a good choice in typical locations behind the hairline. Preoperative discussions between neurologist and neurosurgeon are mandatory in order to allow for the optimal coverage of the epileptogenic zone with the electrode geometry. CONCLUSION In this first small series, we were able to show safe implantation of this new epicranial stimulation device. The use of neuronavigation is strongly recommended. The procedure is simple but not trivial and ideally belongs in the hands of a neurosurgeon.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany.
- Medical Faculty of Freiburg University, Freiburg, Germany.
- Center for Deep Brain Stimulation, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany.
| | - Nadja Jarc
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany
- Medical Faculty of Freiburg University, Freiburg, Germany
| | - Martin Hirsch
- Epilepsy Center, Neurocenter, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany
- Medical Faculty of Freiburg University, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany
- Medical Faculty of Freiburg University, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Bernhard J Steinhoff
- Medical Faculty of Freiburg University, Freiburg, Germany
- Kork Epilepsy Center, Kehl-Kork, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, Neurocenter, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany
- Medical Faculty of Freiburg University, Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Straße, 64-79106, Freiburg, Germany
- Medical Faculty of Freiburg University, Freiburg, Germany
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Novitskaya Y, Schütz E, Metternich B, Schulze-Bonhage A, Hirsch M. Add-on treatment with cenobamate is already effective at low doses in refractory focal epilepsy: A prospective observational study. Epilepsia 2024; 65:630-640. [PMID: 38135903 DOI: 10.1111/epi.17874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Cenobamate, a novel antiseizure medication with a dual mechanism of action, has been shown in pivotal trials to significantly improve seizure control in treatment-resistant focal epilepsy. We aimed to evaluate whether these promising results could be confirmed in a real-world setting with a follow-up period of up to 12 months. METHODS Patients from a tertiary epilepsy center who received cenobamate add-on between June 2021 and October 2023 were followed up prospectively at 3, 6, and 12 months after treatment initiation for assessment of seizure outcomes and treatment-related adverse events. RESULTS The clinical cohort included 112 adult patients with 30% nonlesional cases and a wide spectrum of epileptogenic lesions underlying refractory focal epilepsy. We observed a significant reduction in monthly seizure frequency of all seizure types already after 3 months of treatment at a median cenobamate dose of 100 mg/day. Forty-six percent of patients were responders with a ≥50% seizure reduction, 26% had a ≥75% seizure reduction, and 9% became seizure-free. Among the 74 patients with available follow-up of 12 months, the responder rates reached 55%, 35%, and 19% for ≥50%, ≥75%, and 100% seizure reduction, respectively. After 3 months of treatment, 38% of patients reported adverse effects, mainly (84%) mild to moderate in intensity. Adjustment of comedication allowed successful management of adverse effects in 32% of patients. At a group level, there was no correlation between the cenobamate daily dose and the incidence of adverse events. SIGNIFICANCE We found a clinically relevant response to cenobamate already at a low daily dose of 100 mg also in a patient cohort with a higher degree of drug resistance than in pivotal trials. Our prospectively collected data provide real-world evidence for high efficacy and good tolerability of the drug, although no standardized treatment protocol or comparison with a control group was applied.
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Affiliation(s)
- Yulia Novitskaya
- Department of Neurosurgery, Freiburg Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Elisa Schütz
- Department of Neurosurgery, Freiburg Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Birgitta Metternich
- Department of Neurosurgery, Freiburg Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Department of Neurosurgery, Freiburg Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Hirsch
- Department of Neurosurgery, Freiburg Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
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Hirsch M, Novitskaya Y, Schulze‐Bonhage A. Value of ultralong-term subcutaneous EEG monitoring for treatment decisions in temporal lobe epilepsy: A case report. Epilepsia Open 2023; 8:1616-1621. [PMID: 37842739 PMCID: PMC10690663 DOI: 10.1002/epi4.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
Treatment decisions in epilepsy critically depend on information on the course of the disease, its severity and options for specific local interventions. We here report a patient with pharmaco-resistant non-lesional temporal lobe epilepsy with evidence for predominant right temporal epileptogenesis. While seizure frequency had been grossly underestimated for many years, ultralong-term monitoring with a subcutaneous EEG device revealed actual seizure frequency (66 over 11 months vs four patient-documented seizures), providing objective data on treatment efficacy and additional supportive lateralizing information that played a decisive role for the choice of surgical treatment, which had been rejected by the patient prior to this information.
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Affiliation(s)
- Martin Hirsch
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
| | - Yulia Novitskaya
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
| | - Andreas Schulze‐Bonhage
- Epilepsy Center, University Medical CenterUniversity of FreiburgFreiburgGermany
- European Reference Network EpiCareBronFrance
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Heinemann S, Hirsch M. [Deep healing-Comments on the ethical risks and chances of artificial intelligence]. Inn Med (Heidelb) 2023; 64:1072-1076. [PMID: 37801097 DOI: 10.1007/s00108-023-01603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
Hardly any other field of application of artificial intelligence (AI) needs more ethics by design than medicine; however, if a deep integration of ethical principles succeeds there is a chance of "deep healing", for each individual and also for medicine and the healthcare system itself. Thus, AI in medicine could also become a blueprint for how AI should enter society and culture.
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Affiliation(s)
- Stefan Heinemann
- FOM Hochschule für Oekonomie & Management, Leimkugelstr. 6, 45141, Essen, Deutschland.
| | - Martin Hirsch
- Institut für Künstliche Intelligenz in der Medizin, Universitätsklinikum Gießen-Marburg, Medizinische Fakultät, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland.
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Hirsch M, Immisch I, Knake S, Schulze-Bonhage A. A Prospective Longitudinal Study of the Effects of Eslicarbazepine Acetate Treatment on Bone Density and Metabolism in Patients with Focal-Onset Epilepsy. CNS Drugs 2023; 37:973-980. [PMID: 37921919 PMCID: PMC10667382 DOI: 10.1007/s40263-023-01045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Eslicarbazepine acetate (ESL) is a third-generation anti-seizure medication for patients with focal-onset epilepsy. There are known short-term impacts of classic enzyme-inducing drugs on bone health. For oxcarbazepine, which like ESL is a less potent inducer of cytochrome P450 (CYP450) than carbamazepine, some studies have shown that treatment is associated with increased bone metabolic parameters. The effects of ESL on bone health have not been systematically evaluated so the objective of this study was to investigate whether adverse effects of ESL on bone mineral density (BMD) could be measured after a 12-month exposure period. In addition, the effects of ESL on bone turnover were investigated using laboratory indicators of bone metabolism. METHODS BONAPARTE was a prospective, longitudinal, observational study that enrolled patients with focal-onset epilepsy with or without secondary generalization who started treatment with ESL, either as adjunctive treatment or monotherapy, at two tertiary epilepsy centres in Germany between February 2018 and July 2020. Standardised osteodensitometry and biochemical bone metabolism parameters at the time of ESL initiation and 1 year after continuation of therapy were assessed. Comparisons between biochemical and densitometric parameters at baseline and after 12 months of treatment were performed using the paired samples t test. RESULTS In total, 26 patients (15 male; mean age 41.4 ± 12.5 years) newly treated with ESL were evaluated. Six of these patients had osteopenia at baseline. The mean daily dose of ESL at the 12-month follow-up was 1438 ± 1406 mg. At the group level, there were no significant effects of treatment with ESL on laboratory markers or on BMD. Mean values of BMD in g/cm2 at baseline and after 12 months of ESL treatment were 1.17 (± 0.16) and 1.16 (± 0.16) in the lumbar spine, and 0.98 (± 0.15) and 0.96 (± 0.15) in the proximal femur, respectively. Intra-individually, two patients developed de novo osteopenia measured at the femoral neck associated with relevant changes in bone metabolic parameters. CONCLUSION Neither osteodensitometry nor bone metabolism parameters showed significant group effects after 1 year of treatment with ESL. Individual fluctuations were observed, however, which may warrant monitoring for longer follow-up periods. The study was registered in the German register for clinical studies under the number DRKS00010430 with the official name BONAPARTE.
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Affiliation(s)
- Martin Hirsch
- Faculty of Medicine, Epilepsy Center, University of Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.
| | - Ilka Immisch
- Department of Neurology, Epilepsy Center Hessen, Klinik und Poliklinik für Neurologie, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Klinik und Poliklinik für Neurologie, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, University of Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany
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Lazaridis A, Hirsch M, Pistofidis G, Odejinmi F. Surgical management of uterine fibroids. Curr Opin Obstet Gynecol 2023; 35:440-445. [PMID: 37548229 DOI: 10.1097/gco.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW Fibroids are benign pelvic masses and constitute the most common gynaecological condition. They create a significant health and social burden to many women because of heavy menstrual bleeding and fibroid pressure symptoms. Many women will be faced with the dilemma of surgical management to improve their symptoms at some point of their reproductive age. The aim of this article is to identify current surgical management of fibroids describing the technical steps, advantages, disadvantages and risks of each method. RECENT FINDINGS The surgical management of fibroids remains challenging, as the overall prevalence, the clinical experience and the patient awareness is increasing because of an upgrade in our sonographic and magnetic resonance diagnostic tools. Unfortunately not every patient is able to benefit from tailor-made surgery that holistically evaluates individual needs including fertility aspirations. SUMMARY This article provides the most current synopsis of every available surgical modality for fibroid management. Large prospective multicentre cohort studies are needed to definitely determine the most suitable operation for any individual suffering with fibroids; and perhaps artificial intelligence may offer a valuable tool in the future data analysis.
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Affiliation(s)
- Alexandros Lazaridis
- Second Department of Obstetrics and Gynecology, 'Aretaieion' Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Funlayo Odejinmi
- Whipps Cross Hospital, Barts Health, NHS Trust, Leytonstone, London, UK
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Hirsch M, Beck J, Brandt A, Papadopoulou G, Wagner K, Urbach H, Schulze-Bonhage A. Trends in referral patterns to presurgical evaluation at a European reference center. Seizure 2023; 111:78-86. [PMID: 37549617 DOI: 10.1016/j.seizure.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE To determine if growing evidence for epilepsy surgery as an early treatment option is reflected in the decrease of latencies between epilepsy onset and referral for presurgical evaluation METHODS: Retrospective analysis of latencies in 1646 patients (children and adults) from the time of epilepsy diagnosis to first presurgical workup in the period from 1999 to 2019 based on electronic patient charts at a tertiary epilepsy center. Time spans 1999-2009 and 2010-2019, prior to and following the ILAE definition of pharmacoresistance, and the role of etiological factors were assessed. RESULTS Over the whole period, the mean latency between diagnosis and a presurgical workup was 15.3 y. There was a significant reduction in the latencies between the periods 1999-2009 (16.9 y) and 2010-2019 (13.4 y), (p < 0.0001). In a linear regression analysis, the latency decreased by 2.6 months/year from 17.4 in 1999 to 13.1 y in 2019 (p < 0.001). Subgroup analyses showed significant decreases in latency to presurgical evaluation in patients with hippocampal sclerosis from 24.4 to 19.5 y, in malformations of cortical development from 16.4 to 13.2 y, and in nonlesional patients from 18.1 to 12.8 y, in contrast to patients with MR evidence for brain tumors with similar latencies across time (10.5 vs. 9.5 y, n.s.). CONCLUSION The reduction of the time span to a first presurgical evaluation was highly significant over time, yet moderate in its degree. Overall, the aim of early diagnostic evaluation for epilepsy surgery options after established pharmacoresistance was only achieved for a minority of patients.
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Affiliation(s)
- Martin Hirsch
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Armin Brandt
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Georgia Papadopoulou
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Kathrin Wagner
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Farkas W, Lazaridis A, Odejinmi F, Hirsch M. Perioperative hormone treatment of endometriosis. Curr Opin Obstet Gynecol 2023; 35:434-439. [PMID: 37610988 DOI: 10.1097/gco.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW The use of hormonally suppressive medication to reduce levels of reproductive hormones around the time of surgery is widely used in the management of endometriosis. This review summarizes the current evidence concerning the perioperative use of hormonal treatment in the management of endometriosis. RECENT FINDINGS European Society of Human Reproduction and Embryology (ESHRE) guidanceSurgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: A Multicentre Cohort StudyPre and postsurgical medical therapy for endometriosis surgery. Cochrane 2020Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021. SUMMARY The literature highlights the importance of hormonal treatment for symptom relief, reduced surgical complications and postoperative benefits, including a reduction in pain, disease recurrence and improved pregnancy rates. The treatment of endometriosis can be broadly categorized into medical, commonly using hormonal suppression medications and surgical, in which endometriosis tissue is excised or ablated. This review aims to outline current management strategies and examines the relationship between the two treatment modalities.
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Affiliation(s)
- William Farkas
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Alexandros Lazaridis
- Second Department of Obstetrics and Gynaecology, Aretaieion Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Funlayo Odejinmi
- Whipps Cross Hospital, Barts Health NHS Trust, Leytonstone, London, UK
| | - Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Rauh R, Domschke K, Hirsch M, Schulze-Bonhage A. Listening to anxiety in persons with epilepsy. Development of an integrative assessment model based on qualitative interviews. Epilepsy Behav 2023; 145:109319. [PMID: 37406558 DOI: 10.1016/j.yebeh.2023.109319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE The differentiation and assessment of anxiety in persons with epilepsy is the subject of current research. There is no consensus on which forms of anxiety are epilepsy-specific, what pathological significance they have, and how they should be conceptually systematized. The aim of this study was to detect formal landmarks that organize and further distinguish the clinical multitude of epilepsy-related anxiety, thereby establishing a basis on which an integrative assessment of epilepsy-specific fears can be developed. METHOD Twenty-six patients with epilepsy-related fears were recruited for qualitative interviews at the Epilepsy Center of Freiburg in Germany. Prevalent types of anxiety included both periictal and interictal anxiety. Patients reported how living with epilepsy is associated with anxiety and to what extent. After an open interview, semi-structured questions were asked concerning epilepsy-specific anxiety, referring to established concepts and items. The contents of the interviews relating to anxiety were transcribed. RESULTS The reported fears associated with epilepsy reflect the individual "pathography" of each patient. The potentially anxiety-inducing events within this pathography include the first seizure(s), especially in cases involving the amygdalae; the process of diagnostic procedures; therapy, including side effects of antiseizure medication, surgery as a therapeutic option, or a difficult physician-patient relationship; and the further course of the disease, including the fear of disease progression with brain damage, cognitive deterioration, or professional and social disintegration. The integrative assessment model derived from the pathography of the interviewed patients thus reflects the dynamics and quality of epilepsy-specific fears, especially in relation to the healthcare system, without instantly pathologizing them. It highlights that anxiety, to a variable degree, is perceived as an adequate and comprehensible emotion and might be a problem long before the diagnosis is made in the case of ictal fear. Furthermore, anxiety symptoms may (re-)emerge, consolidate, modulate, diminish, or even aggravate during the course of the disease. The integrative assessment model maps crucial events inherent to the healthcare system that may become relevant as objects of prevention, intervention, and therapy. CONCLUSION The integrative assessment model can serve as a heuristic framework from which an integrative self-report questionnaire of epilepsy-specific anxiety might be designed. On the one hand, this would help to better understand the interrelation between epilepsy and anxiety in terms of their temporal occurrence and interdependence scientifically. On the other hand, it would allow for the enhancement of individual preventive and therapeutic measures for affected patients.
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Affiliation(s)
- Raphael Rauh
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany; Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße 5, 79104 Freiburg, Germany.
| | - Katharina Domschke
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße 5, 79104 Freiburg, Germany
| | - Martin Hirsch
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany
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Schulze-Bonhage A, Hirsch M, Knake S, Kaufmann E, Kegele J, Rademacher M, Vonck K, Coenen VA, Glaser M, Jenkner C, Winter Y, Groppa S. Focal Cortex Stimulation With a Novel Implantable Device and Antiseizure Outcomes in 2 Prospective Multicenter Single-Arm Trials. JAMA Neurol 2023; 80:588-596. [PMID: 37010826 PMCID: PMC10071400 DOI: 10.1001/jamaneurol.2023.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/13/2022] [Indexed: 04/04/2023]
Abstract
Importance For the large population of people with drug-refractory epilepsy, alternative treatment approaches are needed. Clinical trial outcomes of a novel stimulation device, which is newly available in Europe for the treatment of patients with a predominant seizure focus, are reported for the first time. Objective To perform a pooled analysis of the results of 2 prospective, multicenter, single-arm trials, A Pilot Study to Assess the Feasibility of Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (EASEE II) and A Pilot Study to Assess the Feasibility of Patient-Controlled Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (PIMIDES I), assessing the safety and efficacy of epicranial focal cortex stimulation (FCS) with a novel implantable device (EASEE [Precisis]) as adjunctive treatment for adult patients with drug-refractory focal epilepsy. Design, Setting, and Participants This study was a pooled analysis of 2 nonrandomized uncontrolled trials, EASEE II and PIMIDES I, which began on January 15, 2019, and January 14, 2020, respectively, and ended on July 28, 2021. EASEE II and PIMIDES I were the first in-human, prospective, single-arm trials with an 8-month evaluation period. Patients were recruited at 7 European epilepsy centers. Consecutive participants with drug-refractory focal epilepsy were enrolled. Study data were analyzed from September 29, 2021, to February 2, 2022. Interventions After a 1-month prospective baseline period, patients were implanted with the neurostimulation device. After a 1-month postimplantation recovery period, unblinded FCS was activated using both high-frequency and direct current (DC)-like components performed via electrode arrays placed epicranially above the individual epileptic focus region. Main Outcomes and Measures Efficacy was prospectively assessed by the responder rate in the sixth month of stimulation compared with baseline; safety and additional end points were assessed after device implantation and during the stimulation period. Results Of the 34 adult patients enrolled at 6 German and 1 Belgian investigational site, 33 (mean [SD] age, 34.6 [13.5] years; 18 male patients [54.5%]) received the neurostimulation device implant. A total of 32 patients underwent combined high-frequency direct current-like stimulation at least until the 8-month postimplant follow-up visit. After 6 months of stimulation, 17 of 32 patients (53.1%) were responders to treatment with at least a 50% reduction in seizure frequency compared with baseline, corresponding to a significant median seizure reduction by 52% (95% CI, 0.37%-0.76%; P < .001). No device- or procedure-related serious adverse events were reported (0; 95% CI, 0%-10.58%). There were no significant alterations in cognition, mood, or overall quality of life. Conclusions and Relevance Results of this pooled analysis of 2 nonrandomized uncontrolled trials suggest that FCS with a novel neurostimulation device was associated with an effective reduction in seizure frequency in patients with drug-refractory focal epilepsy and may offer a promising treatment option for patients with a predominant epileptic focus. Trial Registration German Clinical Trials Register: DRKS00015918 and DRKS00017833, respectively, and jointly under PROSPERO: CRD42021266440.
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Affiliation(s)
- Andreas Schulze-Bonhage
- Epilepsy Center, Neurocenter, University Medical Center, University of Freiburg, Freiburg, Germany
- NeuroModul Basic, University of Freiburg, Freiburg, Germany
- Bernstein Center of Computational Neuroscience, University of Freiburg, Freiburg, Germany
- European Reference Network EpiCare
| | - Martin Hirsch
- Epilepsy Center, Neurocenter, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Susanne Knake
- Neurology, University Hospital Marburg, Marburg, Germany
| | - Elisabeth Kaufmann
- Department of Neurology, University Hospital, Ludwig-Maximilan’s University, Munich, Germany
| | - Josua Kegele
- Hertie Institute for Clinical Brain Research, Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
| | | | - Kristl Vonck
- Neurology, University Hospital Ghent, Ghent, Belgium
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany
- Medical Faculty of the University of Freiburg, Frieburg im Breisgau, Germany
- Center for Deep Brain Stimulation, Medical Center of the University of Freiburg, Freiburg, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Carolin Jenkner
- Study Center, University Medical Center, University of Freiburg, Freiburg, Germany
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Yaroslav Winter
- Neurology, University Hospital Marburg, Marburg, Germany
- Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sergiu Groppa
- Neurology, University Hospital Mainz, Mainz, Germany
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12
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Hirsch M, Coenen VA, Schulze-Bonhage A. Termination of seizures by ictal transcranial focal cortex stimulation. Epilepsia Open 2023. [PMID: 36929857 DOI: 10.1002/epi4.12728] [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] [Received: 10/30/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Whereas high-level evidence exists on chronic neuromodulatory effects of different brain stimulation approaches in reducing seizure frequency, evidence for acute antiseizure effects of electrical brain stimulation during seizures is sparse. As part of an ongoing trial, we implanted a patient with a novel focal cortex stimulation (FCS) device with a Laplacian electrode placed over a precentral focal cortical dysplasia. The baseline seizure frequency was 125 per month, consisting of (i) focal aware sensory seizures that invariably progressed to uni- or bilateral tonic contraction and clonic jerking, and (ii) primary motor seizures. Besides an overall reduction in seizure frequency, on-demand stimulation had an immediate effect on seizures with a sensory phase, whereby 63-86% of these seizures were terminated by ictal stimulation. These observations provide the first evidence that ictal self-triggered transcranial focal cortex stimulation can significantly interfere with the progression of seizure semiology.
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Affiliation(s)
- Martin Hirsch
- University of Freiburg, Epilepsy Center, Faculty of Medicine
| | - Volker Arnd Coenen
- University of Freiburg, Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine
| | - Andreas Schulze-Bonhage
- University of Freiburg, Epilepsy Center, Faculty of Medicine.,Neuromodule Basics, University of Freiburg
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13
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Manobharath N, Lewin J, Hirsch M, Naftalin J, Vashisht A, Cutner A, Saridogan E. Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis. Facts Views Vis Obgyn 2023; 15:35-43. [PMID: 37010333 PMCID: PMC10392119 DOI: 10.52054/fvvo.15.1.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: There is no agreed consensus on the optimal surgical treatment for pain associated with endometriosis.
Objectives: To compare improvement in symptoms and quality-of-life in patients undergoing excisional endometriosis surgery (EES) versus EES with hysterectomy and bilateral salpingo-oophorectomy (EES-HBSO).
Methods: This study evaluated patients undergoing EES and EES-HBSO at a single endometriosis centre between 2009 and 2019. Data was obtained from the British Society for Gynaecological Endoscopy database. Adenomyosis was assessed by blinded re-analysis of imaging and/or histology data.
Main outcome measures: Pain scores (numeric rating scale 0-10) and quality-of-life scores (EQ-VAS) before and after EES and EES-HBSO.
Results: We included 120 patients undergoing EES and 100 patients undergoing EES-HBSO. After controlling for baseline characteristics and the presence of adenomyosis, there was greater post-op improvement in non-cyclical pelvic pain amongst patients undergoing EES-HBSO compared to EES alone.The baseline pain scores had improved in the EES-HBSO cohort by 2.106/10 at 6 months (95%CI 0.469-3.742, p=0.012), 2.642/10 at 12 months (95%CI 0.871-4.413, p=0.004), and 2.548/10 at 24 months (95%CI 0.681-4.414, p=0.008), when compared to the EES group. Greater improvement amongst EES-HBSO patients was also seen for dyspareunia, non-cyclical dyschaezia and bladder pain. Patients undergoing EES-HBSO had greater improvement in EQ-VAS, although this was no longer statistically significant after controlling for adenomyosis.
Conclusion: EES-HBSO appears to provide greater benefit than EES alone for symptoms including non-cyclical pelvic pain as well as for quality-of-life. Further research is required to determine which patients benefit the most from EES-HBSO, and whether removal of the ovaries, uterus or both is the key to this additional benefit in symptom control.
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14
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Delanerolle G, McCauley M, Hirsch M, Zeng Y, Cong X, Cavalini H, Sajid S, Shetty A, Rathod S, Shi JQ, Hapangama DK, Phiri P. The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis. BMC Pregnancy Childbirth 2023; 23:76. [PMID: 36709255 PMCID: PMC9883834 DOI: 10.1186/s12884-022-05243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women. METHODS All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed. RESULTS This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic. DISCUSSION It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times. OTHER The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.
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Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Health Care Sciences, Uuniversity of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Mary McCauley
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Martin Hirsch
- University College London, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Xu Cong
- Southern University of Science and Technology, Shenzhen, China
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Sana Sajid
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Ashish Shetty
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China
- National Center for Applied Mathematics, Shenzhen, China
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK.
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
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15
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Kühne F, Becker LL, Bast T, Bertsche A, Borggraefe I, Boßelmann CM, Fahrbach J, Hertzberg C, Herz NA, Hirsch M, Holtkamp M, Janello C, Kluger GJ, Kurlemann G, Lerche H, Makridis KL, von Podewils F, Pringsheim M, Schubert-Bast S, Schulz J, Schulze-Bonhage A, Steinbart D, Steinhoff BJ, Strzelczyk A, Syrbe S, De Vries H, Wagner C, Wagner J, Wilken B, Prager C, Klotz KA, Kaindl AM. Real-world data on cannabidiol treatment of various epilepsy subtypes: A retrospective, multicenter study. Epilepsia Open 2023. [PMID: 36693811 DOI: 10.1002/epi4.12699] [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: 09/13/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Cannabidiol (CBD) is approved for treatment of Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC). Several studies suggest antiseizure effects also beyond these three epilepsy syndromes. METHODS In a retrospective multicenter study, we analyzed the efficacy and tolerability of CBD in patients with epilepsy at 16 epilepsy centers. RESULTS The study cohort comprised 311 patients with epilepsy with a median age of 11.3 (0-72) years (235 children and adolescents, 76 adults). Therapy with CBD was off-label in 91.3% of cases due to age, epilepsy subtype, lack of adjunct therapy with clobazam, and/or higher dose applied. CBD titration regimens were slower than recommended, with good tolerability of higher doses particularly in children. Of all patients, 36.9% experienced a reduction in seizure frequency of >50%, independent of their epilepsy subtype or clobazam co-medication. The median observation period was 15.8 months. About one third of all patients discontinued therapy within the observation period due to adverse effects or lack of efficacy. Adverse effects were reported frequently (46.9%). SIGNIFICANCE Our study highlights that CBD has an antiseizure effect comparable to other antiseizure medications with a positive safety profile independent of the epilepsy subtype. Comedication with clobazam was not associated with a better outcome. Higher doses to achieve seizure frequency reduction were safe, particularly in children. These findings call for further trials for an extended approval of CBD for other epilepsy subtypes and for children <2 years of age.
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Affiliation(s)
- Fabienne Kühne
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Lena-Luise Becker
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
| | | | - Astrid Bertsche
- Department of Pediatric Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Borggraefe
- Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Jörg Fahrbach
- Vivantes Hospital Neukölln, Socialpediatric Centre (DBZ), Berlin, Germany
| | | | - Nina A Herz
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Martin Hirsch
- Epilepsy Center, Medical Center-University of Freiburg, Freiburg, Germany
| | - Martin Holtkamp
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Christine Janello
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Gerhard Josef Kluger
- Schön Klinik Vogtareuth, Center for Pediatric Neurology, Neurorehabilitation and Epileptology, PMU, Vogtareuth, Salzburg, Germany
| | - Gerhard Kurlemann
- Department of Pediatrics, Bonifatius Hospital Lingen, Lingen, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany
| | - Konstantin L Makridis
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Milka Pringsheim
- Schön Klinik Vogtareuth, Center for Pediatric Neurology, Neurorehabilitation and Epileptology, PMU, Vogtareuth, Salzburg, Germany.,Deparment for Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Munich, Germany
| | - Susanne Schubert-Bast
- University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | | | - David Steinbart
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork, Germany.,Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Frankfurt am Main, Germany
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Heike De Vries
- Department of Pediatric Neurology, University Medicine Jena, Jena, Germany
| | | | - Johanna Wagner
- Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Bernd Wilken
- Department of Neuropediatrics, Clinic Kassel, Kassel, Germany
| | - Christine Prager
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Charité - University Medicine Berlin, Center for Chronically Sick Children, Berlin, Germany.,Charité - University Medicine Berlin, German Epilepsy Center for Children and Adolescents, Berlin, Germany.,Charité - University Medicine, Institute of Cell- and Neurobiology, Berlin, Germany
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16
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Chaudhary N, Hirsch M, Andreeva T, Geiger J, Hoefel U, Rahbarnia K, Wurden GA, Wolf RC. Radial localization of electron temperature pedestal and ELM-like events using ECE measurements at Wendelstein 7-X. EPJ Web Conf 2023. [DOI: 10.1051/epjconf/202327703004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
A magnetic configuration scan was performed at Wendelstein 7-X stellarator by varying the rotational transform to analyze the plasma confinement for magnetic configurations with different edge magnetic island locations and sizes. For the magnetic configurations, where the 5/5 island chain was moved inside the last closed flux surface, it was observed with electron cyclotron emission measurements that an electron temperature, Te, pedestal develops in the plasma buildup phase and followed by the edge localized mode (ELM)-like crashes. From the mapping of the island to the plasma radius from HINT equilibrium, it was found that the Te pedestal is formed at the island location on the high field side of the plasma. The ELM-like crashes occur at the location of the pedestal and the transport barrier is broken typically with an energy loss of 3-4% during a single ELM-like event. The frequency and the amplitude of the ELM-like crashes were observed to be changing with island size, plasma heating power and density. Additionally during the plasma decay, after the heating was switched-off, a transition to degraded plasma confinement state was observed with changed Te profile gradients, faster decay rate of diamagnetic energy, and increased H-alpha levels.
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17
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Krychowiak M, König R, Barbui T, Brezinsek S, Brunner J, Effenberg F, Endler M, Feng Y, Flom E, Gao Y, Gradic D, Hacker P, Harris J, Hirsch M, Höfel U, Jakubowski M, Kornejew P, Otte M, Pandey A, Pedersen T, Puig A, Reimold F, Schmitz O, Schröder T, Winters V, Zhang D. First feedback-controlled divertor detachment in W7-X: Experience from TDU operation and prospects for operation with actively cooled divertor. Nuclear Materials and Energy 2023. [DOI: 10.1016/j.nme.2023.101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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18
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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Schuetz E, Wagner K, Metternich B, Papadopoulou G, Kravalis K, Heers M, Martínez-Lizana E, Castillo-Rodriguez M, Altenmüller DM, Schulze-Bonhage A, Hirsch M. Effects of cenobamate on cognitive performance of epilepsy patients. Seizure 2022; 102:129-133. [DOI: 10.1016/j.seizure.2022.10.004] [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] [Received: 07/07/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 10/31/2022] Open
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20
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Oosterbeek J, Stern M, Braune H, Ewert K, Hirsch M, Hollmann F, Laqua H, Marsen S, Meier A, Moseev D, Noke F, Reintrog A, Stange T, Wolf R. Microwave stray radiation losses in vacuum windows. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To review the recent evidence around the treatment of infertility in patients with endometriosis. RECENT FINDINGS The management of endometriosis associated infertility remains challenging. There have been an increasing number of prospective observational studies highlighting the role of surgery to enhance assisted conception amongst those with deep rectovaginal endometriosis. Further validation studies confirm the role of the endometriosis fertility index in prediction of reproductive outcomes after surgery, and confirm that it can be employed in counselling patients prior to surgery on their likelihood of spontaneous conception. Further randomized trials are required to establish the role of surgically treating superficial and deep endometriosis and both spontaneous and assisted conception outcomes. SUMMARY Endometriosis continues to present challenges in counselling patients with regards to their fertility prospects. This article reviews the recent research findings that may assist in the management of patients with endometriosis associated infertility.
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Affiliation(s)
- Stuart Spencer
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Alexandros Lazaridis
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Alexandros Grammatis
- Centre for Reproductive Medicine, Barts Health NHS Trust, London, United Kingdom
| | - Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
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Abstract
PURPOSE OF REVIEW Adenomyosis is a condition where endometrium-like tissue spreads within the myometrium. Although its prevalence in the general population is not exactly known, its clinical manifestations are well established and include pelvic pain, dysmenorrhea (painful periods), heavy menstrual bleeding and subfertility [1] . Adenomyosis often coexists with other gynaecological conditions, such as endometriosis or fibroids, and may cloud the clinical presentation [2] . The aim of this article is to review current noninterventional, nonsurgical management modalities and wherever possible offer information that allows women to make safe and informed choices regarding their treatment options. RECENT FINDINGS Recent studies support that medical strategies, including the Mirena coil, Dienogest and GnRH antagonists, are efficient in improving adenomyosis-associated symptoms. High-quality evidence is scarce and is needed to properly counsel women with this condition. Future research should prioritize overall pain, menstrual bleeding, quality of life and live birth as primary outcomes and assess women with different grades of adenomyosis. SUMMARY This review provides the most current evidence with regards to the nonsurgical management of adenomyosis. In light of the paucity and low quality of existing data, high-quality trials are needed to definitely determine the impact of conservative and medical treatment on the clinical management of adenomyosis.
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Affiliation(s)
- Alexandros Lazaridis
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | | | - Stuart Spencer
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
| | - Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford
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Schulze-Bonhage A, Winter Y, Hirsch M, Kaufmann E, Kegele J, Knake S, Rademacher M, Vonck K, Groppa S. PO086 / #553 ANTIEPILEPTIC EFFICACY OF TRANSCRANIAL FOCAL CORTICAL STIMULATION IN PHARMACORESISTANT FOCAL EPILEPSY: RESULTS FROM TWO PROSPECTIVE CLINICAL TRIALS. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.08.260] [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: 11/06/2022]
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Zahnert F, Kräling G, Melms L, Belke M, Kleinholdermann U, Timmermann L, Hirsch M, Jansen A, Mross P, Menzler K, Habermehl L, Knake S. Diffusion magnetic resonance imaging connectome features are predictive of functional lateralization of semantic processing in the anterior temporal lobes. Hum Brain Mapp 2022; 44:496-508. [PMID: 36098483 PMCID: PMC9842893 DOI: 10.1002/hbm.26074] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Abstract
Assessment of regional language lateralization is crucial in many scenarios, but not all populations are suited for its evaluation via task-functional magnetic resonance imaging (fMRI). In this study, the utility of structural connectome features for the classification of language lateralization in the anterior temporal lobes (ATLs) was investigated. Laterality indices for semantic processing in the ATL were computed from task-fMRI in 1038 subjects from the Human Connectome Project who were labeled as stronger rightward lateralized (RL) or stronger leftward to bilaterally lateralized (LL) in a data-driven approach. Data of unrelated subjects (n = 432) were used for further analyses. Structural connectomes were generated from diffusion-MRI tractography, and graph theoretical metrics (node degree, betweenness centrality) were computed. A neural network (NN) and a random forest (RF) classifier were trained on these metrics to classify subjects as RL or LL. After classification, comparisons of network measures were conducted via permutation testing. Degree-based classifiers produced significant above-chance predictions both during cross-validation (NN: AUC-ROC[CI] = 0.68[0.64-0.73], accuracy[CI] = 68.34%[63-73.2%]; RF: AUC-ROC[CI] = 0.7[0.66-0.73], accuracy[CI] = 64.81%[60.9-68.5]) and testing (NN: AUC-ROC[CI] = 0.69[0.53-0.84], accuracy[CI] = 68.09[53.2-80.9]; RF: AUC-ROC[CI] = 0.68[0.53-0.84], accuracy[CI] = 68.09[55.3-80.9]). Comparison of network metrics revealed small effects of increased node degree within the right posterior middle temporal gyrus (pMTG) in subjects with RL, while degree was decreased in the right posterior cingulate cortex (PCC). Above-chance predictions of functional language lateralization in the ATL are possible based on diffusion-MRI connectomes alone. Increased degree within the right pMTG as a right-sided homologue of a known semantic hub, and decreased hubness of the right PCC may form a structural basis for rightward-lateralized semantic processing.
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Affiliation(s)
- Felix Zahnert
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Gunter Kräling
- Department of Medical TechnologyUniversity Hospital MarburgMarburgGermany
| | - Leander Melms
- Institute for Artificial IntelligenceUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Marcus Belke
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany,LOEWE Center for Personalized Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt Am MainGermany
| | - Urs Kleinholdermann
- Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Lars Timmermann
- Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany,Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany,Core Facility Brainimaging, Faculty of MedicineUniversity of MarburgMarburgGermany
| | - Martin Hirsch
- Institute for Artificial IntelligenceUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Andreas Jansen
- Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany,Core Facility Brainimaging, Faculty of MedicineUniversity of MarburgMarburgGermany,Department for Psychiatry and PsychotherapyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Peter Mross
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Katja Menzler
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany,Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany,Core Facility Brainimaging, Faculty of MedicineUniversity of MarburgMarburgGermany
| | - Lena Habermehl
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany
| | - Susanne Knake
- Epilepsy Center Hesse, Department for NeurologyUniversity Hospital Marburg, Philipps University MarburgMarburgGermany,LOEWE Center for Personalized Translational Epilepsy Research (CePTER)Goethe‐University FrankfurtFrankfurt Am MainGermany,Center for Mind, Brain and Behavior (CMBB)Philipps‐University MarburgMarburgGermany,Core Facility Brainimaging, Faculty of MedicineUniversity of MarburgMarburgGermany
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Schulze-Bonhage A, Hirsch M, Arnd Coenen V. Severe Recurrence of Seizures Following Pandemic-Related Delay of Stimulator Servicing. Dtsch Arztebl Int 2022; 119:541. [PMID: 36384923 PMCID: PMC9677541 DOI: 10.3238/arztebl.m2022.0063] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Andreas Schulze-Bonhage
- *Epilepsiezentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universitätsklinikum Freiburg,
| | - Martin Hirsch
- *Epilepsiezentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universitätsklinikum Freiburg,
| | - Volker Arnd Coenen
- **Abteilung Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universitätsklinikum Freiburg
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Tellum T, Naftalin J, Chapron C, Dueholm M, Guo SW, Hirsch M, Larby ER, Munro MG, Saridogan E, van der Spuy ZM, Jurkovic D. Development of a core outcome set and outcome definitions for studies on uterus-sparing treatments of adenomyosis (COSAR): an international multistakeholder-modified Delphi consensus study. Hum Reprod 2022; 37:2012-2031. [PMID: 35906919 PMCID: PMC9433836 DOI: 10.1093/humrep/deac166] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION What outcomes should be reported in all studies investigating uterus-sparing interventions for treating uterine adenomyosis? SUMMARY ANSWER We identified 24 specific and 26 generic core outcomes in nine domains. WHAT IS KNOWN ALREADY Research reporting adenomyosis treatment is not patient-centred and shows wide variation in outcome selection, definition, reporting and measurement of quality. STUDY DESIGN, SIZE, DURATION An international consensus development process was performed between March and December 2021. Participants in round one were 150 healthcare professionals, 17 researchers and 334 individuals or partners with lived experience of adenomyosis from 48 high-, middle- and low-income countries. There were 291 participants in the second round. PARTICIPANTS/MATERIALS, SETTING, METHODS Stakeholders included active researchers in the field, healthcare professionals involved in diagnosis and treatment, and people and their partners with lived experience of adenomyosis. The core component of the process was a 2-step modified Delphi electronic survey. The Steering Committee analysed the results and created the final core outcome set (COS) in a semi-structured meeting. MAIN RESULTS AND THE ROLE OF CHANCE A total of 241 outcomes was identified and distilled into a ‘long list’ of 71 potential outcomes. The final COS comprises 24 specific and 26 generic core outcomes across nine domains, including pain, uterine bleeding, reproductive outcomes, haematology, urinary system, life impact, delivery of care, adverse events and reporting items, all with definitions provided by the Steering Committee. Nineteen of these outcomes will apply only to certain study types. Although not included in the COS, the Steering Committee recommended that three health economic outcomes should be recorded. LIMITATIONS, REASONS FOR CAUTION Patients from continents other than Europe were under-represented in this survey. A lack of translation of the survey might have limited the active participation of people in non-English speaking countries. Only 58% of participants returned to round two, but analysis did not indicate attrition bias. There is a significant lack of scientific evidence regarding which symptoms are caused by adenomyosis and when they are related to other co-existent disorders such as endometriosis. As future research provides more clarity, the appropriate review and revision of the COS will be necessary. WIDER IMPLICATIONS OF THE FINDINGS Implementing this COS in future studies on the treatment of adenomyosis will improve the quality of reporting and aid evidence synthesis. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received for this work. T.T. received a grant (grant number 2020083) from the South Eastern Norwegian Health Authority during the course of this work. T.T. receives personal fees from General Electrics and Medtronic for lectures on ultrasound. E.R.L. is the chairman of the Norwegian Endometriosis Association. M.G.M. is a consultant for Abbvie Inc and Myovant, receives research funding from AbbVie and is Chair of the Women’s Health Research Collaborative. S.-W.G. is a board member of the Asian Society of Endometriosis and Adenomyosis, on the scientific advisory board of the endometriosis foundation of America, previous congress chair for the World Endometriosis Society, for none of which he received personal fees. E.S. received outside of this work grants for two multicentre trials on endometriosis from the National Institute for Health Research UK, the Rosetrees Trust, and the Barts and the London Charity, he is a member of the Medicines and Healthcare Products Regulatory Agency (MHRA), Medicines for Women’s Health Expert Advisory Group, he is an ambassador for the World Endometriosis Society, and he received personal fees for lectures from Hologic, Olympus, Medtronic, Johnson & Johnson, Intuitive and Karl Storz. M.H. is member of the British Society for Gynaecological Endoscopy subcommittee. No other conflict of interest was declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - J Naftalin
- Institute for Women's Health, University College Hospital, London, UK
| | - C Chapron
- Department of Obstetrics and Gynecology II and Reproductive Medecine, Université Paris Cité, Faculté de Médecine, CHU Cochin, Paris, France
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - S-W Guo
- Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - M Hirsch
- Nuffield Department of Women's & Reproductive Health, Oxford Endometriosis CaRe Centre, University of Oxford, Oxford, UK
| | - E R Larby
- Norwegian Endometriosis Association, Halden, Norway
| | - M G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - E Saridogan
- Institute for Women's Health, University College Hospital, London, UK
| | - Z M van der Spuy
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
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Hirsch M, Duffy JMN, Farquhar CM. Re: A randomized, double-blind, placebo-controlled pilot study of the comparative effects of dienogest and the combined oral contraceptive pill in women with endometriosis. Int J Gynaecol Obstet 2022; 158:230-231. [PMID: 35474187 DOI: 10.1002/ijgo.14188] [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: 03/25/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health,, University of Oxford, Oxford, UK
| | - James M N Duffy
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health,, University of Oxford, Oxford, UK.,King's Fertility, The Fetal Medicine Research Institute, London, UK
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Wojtaszewska A, Lewin J, Jurkovic D, Saridogan E, Vashisht A, Cutner A, Hirsch M. Ultrasound prediction of segmental bowel resection in women with rectovaginal endometriosis: a single centre experience. J Minim Invasive Gynecol 2022; 29:1092-1098. [PMID: 35667556 DOI: 10.1016/j.jmig.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To retrospectively evaluate the ability of routinely collected pre-operative ultrasound data to predict bowel resection during surgery for rectovaginal endometriosis. DESIGN AND SETTING Patients at University College London Hospital (UCLH) who underwent surgery for rectovaginal endometriosis during a 6-year period were identified from the prospectively generated hospital (BSGE) database. Imaging data were collected and analysed to determine associations with the requirement for bowel resection. PATIENTS We evaluated 228 consecutive women undergoing bowel surgery (shave, disc or segmental resection) for rectovaginal endometriosis. INTERVENTIONS The patients in our study underwent surgical resection of rectovaginal endometriosis and interventions included shave, disc resection and segmental resection of the bowel. All patients underwent a pre-operative transvaginal ultrasound to assess the extent of endometriosis. MEASUREMENTS AND MAIN RESULTS There were 206 (90.4%) rectal shaves, 2 (0.9%) disc resections, and 20 (8.8%) segmental bowel resections. A multivariable analysis demonstrated an association between bowel resection and two or more nodules located in the rectovaginal space (odds ratio 6.85, 95% CI 1.37, 34.2), nodules in the vesico-uterine pouch (odds ratio 5.87, 95% CI 1.03, 33.3), and increasing nodule size (odds ratio 2.39 per 1cm increase per 1cm diameter increase, 95% CI 1.56, 3.64). CONCLUSION Ultrasound findings of endometriotic nodule location, number of nodules, and increasing size are independent predictors of segmental bowel resection at the time of surgery for rectovaginal endometriosis. This highlights the importance of accurate diagnostic evaluation to aid counselling and surgical planning in the pre-operative setting for women with rectovaginal endometriosis.
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Affiliation(s)
| | - Jonathan Lewin
- Institute for Women's Health, University College London, London, Oxford, United Kingdom (Drs. Lewin, Jurkovic, Saridogan, Vashisht, and Cutner).
| | - Davor Jurkovic
- Institute for Women's Health, University College London, London, Oxford, United Kingdom (Drs. Lewin, Jurkovic, Saridogan, Vashisht, and Cutner)
| | - Ertan Saridogan
- Institute for Women's Health, University College London, London, Oxford, United Kingdom (Drs. Lewin, Jurkovic, Saridogan, Vashisht, and Cutner)
| | - Arvind Vashisht
- Institute for Women's Health, University College London, London, Oxford, United Kingdom (Drs. Lewin, Jurkovic, Saridogan, Vashisht, and Cutner)
| | - Alfred Cutner
- Institute for Women's Health, University College London, London, Oxford, United Kingdom (Drs. Lewin, Jurkovic, Saridogan, Vashisht, and Cutner)
| | - Martin Hirsch
- The John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom (Dr. Hirsch); Nuffield Department of Women's and Reproductive Health, Oxford Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom (Dr. Hirsch)
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29
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Hirsch M, Becker C, Davies M. Fertility preservation for women with ovarian endometriosis: it is time to adopt this as routine practice. BJOG 2022; 129:1937-1938. [PMID: 35614636 PMCID: PMC9544299 DOI: 10.1111/1471-0528.17166] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Hirsch
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Christian Becker
- Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Melanie Davies
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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30
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Wojtaszewska A, Vashisht A, Hirsch M. Putting patients at the centre of pain management. BJOG 2022; 129:1992. [PMID: 35596695 DOI: 10.1111/1471-0528.17229] [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: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Arvind Vashisht
- Institute for Women's Health, University College London, London, UK
| | - Martin Hirsch
- The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.,Oxford Endometriosis CaRe Centre, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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Stierhof J, Kühn S, Winter M, Micke P, Steinbrügge R, Shah C, Hell N, Bissinger M, Hirsch M, Ballhausen R, Lang M, Gräfe C, Wipf S, Cumbee R, Betancourt-Martinez GL, Park S, Niskanen J, Chung M, Porter FS, Stöhlker T, Pfeifer T, Brown GV, Bernitt S, Hansmann P, Wilms J, Crespo López-Urrutia JR, Leutenegger MA. A new benchmark of soft X-ray transition energies of Ne , CO 2 , and SF 6 : paving a pathway towards ppm accuracy. Eur Phys J D At Mol Opt Phys 2022; 76:38. [PMID: 35273463 PMCID: PMC8888507 DOI: 10.1140/epjd/s10053-022-00355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
ABSTRACT A key requirement for the correct interpretation of high-resolution X-ray spectra is that transition energies are known with high accuracy and precision. We investigate the K-shell features of Ne , CO 2 , and SF 6 gases, by measuring their photo ion-yield spectra at the BESSY II synchrotron facility simultaneously with the 1s-np fluorescence emission of He-like ions produced in the Polar-X EBIT. Accurate ab initio calculations of transitions in these ions provide the basis of the calibration. While the CO 2 result agrees well with previous measurements, the SF 6 spectrum appears shifted by ∼ 0.5 eV, about twice the uncertainty of the earlier results. Our result for Ne shows a large departure from earlier results, but may suffer from larger systematic effects than our other measurements. The molecular spectra agree well with our results of time-dependent density functional theory. We find that the statistical uncertainty allows calibrations in the desired range of 1-10 meV, however, systematic contributions still limit the uncertainty to ∼ 40-100 meV, mainly due to the temporal stability of the monochromator energy scale. Combining our absolute calibration technique with a relative energy calibration technique such as photoelectron energy spectroscopy will be necessary to realize its full potential of achieving uncertainties as low as 1-10 meV.
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Affiliation(s)
- J. Stierhof
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - S. Kühn
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - M. Winter
- Institute of Theoretical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstr. 7/B2, 91058 Erlangen, Germany
- CNRS, Institut NEEL, Université Grenoble Alpes, CNRS, Institut NEEL, 25 rue des Martyrs BP 166, 38042 Grenoble Cedex 9, France
| | - P. Micke
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- CERN, 1211 Geneva 23, Switzerland
| | - R. Steinbrügge
- Deutsches Elektronen-Synchrotron DESY, Notkestr. 85, 22607 Hamburg, Germany
| | - C. Shah
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - N. Hell
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - M. Bissinger
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - M. Hirsch
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - R. Ballhausen
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - M. Lang
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - C. Gräfe
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | - S. Wipf
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
| | - R. Cumbee
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
- Department of Astronomy, University of Maryland, College Park, MD 20742 USA
| | - G. L. Betancourt-Martinez
- Institut de Recherche en Astrophysique et Planétologie, 9, avenue du Colonel Roche BP 44346, 31028 Toulouse Cedex 4, France
| | - S. Park
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, Ulsan, South Korea
| | - J. Niskanen
- Institute for Methods and Instrumentation in Synchrotron Radiation Research G-ISRR, Helmholtz-Zentrum Berlin für Materialien und Energie, Albert-Einstein-Strasse 15, 12489 Berlin, Germany
| | - M. Chung
- Ulsan National Institute of Science and Technology, 50 UNIST-gil, Ulsan, South Korea
| | - F. S. Porter
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
| | - T. Stöhlker
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - T. Pfeifer
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - G. V. Brown
- Lawrence Livermore National Laboratory, 7000 East Ave., Livermore, CA 94550 USA
| | - S. Bernitt
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Institut für Optik und Quantenelektronik, Friedrich-Schiller-Universität Jena, Max-Wien-Platz 1, 07743 Jena, Germany
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
- Helmholtz-Institut Jena, Fröbelstieg 3, 07743 Jena, Germany
| | - P. Hansmann
- Institute of Theoretical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstr. 7/B2, 91058 Erlangen, Germany
| | - J. Wilms
- Dr. Karl Remeis-Observatory and Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Sternwartstr. 7, 96049 Bamberg, Germany
| | | | - M. A. Leutenegger
- NASA Goddard Space Flight Center, 8800 Greenbelt Rd., Greenbelt, MD 20771 USA
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Hirsch M, Reisel D, Saridogan E, David AL. Endoscopic transabdominal cervical cerclage replacement after recurrent late miscarriage. BMJ Case Rep 2022; 15:e247757. [PMID: 35228241 PMCID: PMC8886391 DOI: 10.1136/bcr-2021-247757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/03/2022] Open
Abstract
Transabdominal cerclage (TAC) is a recognised treatment for recurrent spontaneous late miscarriage or preterm birth due to cervical weakness. This can be performed via an open procedure before and during pregnancy, or a laparoscopic technique preconception. Complications include cerclage failure and suture migration. We present a case highlighting these complications where laparoscopic removal of an open TAC and replacement led to two successful term deliveries. A woman in her thirties with a fibroid uterus, adenomyosis and a history of three spontaneous mid-trimester losses, had an open TAC at 13 weeks of gestation. Preterm premature rupture of the membranes occurred shortly after and at 18 weeks of gestation she underwent surgical evacuation of the uterus. Subsequent hysteroscopy confirmed migration of the cerclage through the cervical canal. We demonstrate the application of endoscopic gynaecological surgery to remove and replace the TAC with two successful term births by Caesarean section in the ensuing pregnancies.
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Affiliation(s)
- Martin Hirsch
- Oxford Endometriosis CaRe Centre, Oxford University, Oxford, UK
| | - Dan Reisel
- Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
| | - Ertan Saridogan
- Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
| | - Anna L David
- EGA Institute for Women's Health, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Brunner KJ, Knauer J, Meineke J, Cu Castillo HI, Hirsch M, Kursinski B, Stern M, Wolf RC. Sources for constellation errors in modulated dispersion interferometers. Rev Sci Instrum 2022; 93:023506. [PMID: 35232171 DOI: 10.1063/5.0070041] [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] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
Dispersion interferometry (DI) is being employed on an increasing number of fusion experiments to measure the plasma density with a minimal sensitivity to vibrations. DIs employed in high-density experiments use phase modulation techniques up to several hundred kilohertz to enable quadrature detection and to be unaffected by variations of the signal amplitude. However, the evaluation of the temporal interferogram can be a significant source for phase errors and does not have an established processing method. There are two non-approximation-based methods currently in use: one using the ratio of amplitudes in the signal's Fourier spectrum and the other using its sectioned integration. Previously, the methods could not be used simultaneously since they differ in their respective calibration point. In this paper, we present a technique to use both phase evaluation methods simultaneously using quadrature correction methods. A comparison of their strengths and weaknesses is presented based on identical measurements indicating one to be more reliable in a more static measurement scenario, while the other excels in highly dynamic ones. Several comparative experiments are presented, which identify a significant error source in the phase measurement induced by polarization rotation. Since the same effect may be induced by Faraday rotation, the results may have direct consequence on the design of the ITER dispersion interferometer/polarimeter as well as the European DEMO's interferometer concept.
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Affiliation(s)
- K J Brunner
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - J Knauer
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - J Meineke
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - H I Cu Castillo
- Universidad Autónoma de Yucatán, Calle 60 491A, 97000 Mérida, Yucatan, Mexico
| | - M Hirsch
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - B Kursinski
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - M Stern
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
| | - R C Wolf
- Max-Planck-Institute for Plasma Physics, Wendelsteinstr. 1, 17489 Greifswald, Germany
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Metternich B, Wagner K, Geiger MJ, Schulze-Bonhage A, Hirsch M, Schönenberg M. Affective Empathy, Theory of Mind and Social Functioning in Patients With Focal Epilepsy. Front Psychiatry 2022; 13:887411. [PMID: 35898635 PMCID: PMC9309689 DOI: 10.3389/fpsyt.2022.887411] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Social cognition comprises basic and more complex functions, such as theory of mind (ToM) and affective empathy. Although everyday social interactions may be impaired if such higher-order social cognitive functions are compromised, associations between social functioning and social cognition in people with focal epilepsy (PWFE) are still poorly understood. We used a novel, naturalistic approach to investigate ToM in PWFE by applying the Movie for the Assessment of Social Cognition (MASC). Furthermore, we studied affective empathy, the relationship between social cognitive parameters and measures of social functioning, as well as between epilepsy focus and ToM. METHODS Thirty patients with either temporal (TLE) or frontal lobe epilepsy (FLE) were compared to 29 healthy control subjects (HC). In addition to the MASC, we applied questionnaire measures assessing empathy and everyday social functioning. RESULTS PWFE, especially with FLE, performed significantly worse than HC on the MASC. Perceived social integration and social activities, but not affective empathy, were reduced in PWFE. Regression analyses revealed associations between perceived social integration, clinical group status, affective empathy and ToM. CONCLUSION PWFE displayed ToM deficits during a naturalistic task, whereas affective empathy was unimpaired. FLE may be associated with especially compromised ToM performance. Social cognition and social functioning appear to be interrelated in PWFE, whose self-perceived levels of social integration and social activities are lower than those of HC. More research into the association between social cognition and social functioning in PWFE is needed, in order to develop tailored intervention programs for these patients.
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Affiliation(s)
- Birgitta Metternich
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Freiburg, Germany
| | - Kathrin Wagner
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Freiburg, Germany
| | - Maximilian J Geiger
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Freiburg, Germany
| | - Martin Hirsch
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Schönenberg
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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Drews P, Dittmar T, Killer C, Winters V, Kirschner A, Brezinsek S, Xu S, Wang E, Jakubowski M, Brunner K, Knauer J, Grulke O, Höschen D, Knieps A, Nicolai D, Neubauer O, Satheeswaran G, Hirsch M, Höfel U, Liang Y. Effectiveness of local methane and hydrogen injection into the scrape-off layer of W7-X by means of the multi-purpose manipulator. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Melms L, Falk E, Schieffer B, Jerrentrup A, Wagner U, Matrood S, Schaefer JR, Müller T, Hirsch M. Towards a COVID-19 symptom triad: The importance of symptom constellations in the SARS-CoV-2 pandemic. PLoS One 2021; 16:e0258649. [PMID: 34807925 PMCID: PMC8608328 DOI: 10.1371/journal.pone.0258649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Pandemic scenarios like SARS-Cov-2 require rapid information aggregation. In the age of eHealth and data-driven medicine, publicly available symptom tracking tools offer efficient and scalable means of collecting and analyzing large amounts of data. As a result, information gains can be communicated to front-line providers. We have developed such an application in less than a month and reached more than 500 thousand users within 48 hours. The dataset contains information on basic epidemiological parameters, symptoms, risk factors and details on previous exposure to a COVID-19 patient. Exploratory Data Analysis revealed different symptoms reported by users with confirmed contacts vs. no confirmed contacts. The symptom combination of anosmia, cough and fatigue was the most important feature to differentiate the groups, while single symptoms such as anosmia, cough or fatigue alone were not sufficient. A linear regression model from the literature using the same symptom combination as features was applied on all data. Predictions matched the regional distribution of confirmed cases closely across Germany, while also indicating that the number of cases in northern federal states might be higher than officially reported. In conclusion, we report that symptom combinations anosmia, fatigue and cough are most likely to indicate an acute SARS-CoV-2 infection.
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Affiliation(s)
- Leander Melms
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | - Evelyn Falk
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Cardiology Department, University Hospital Gießen and Marburg, Marburg, Germany
| | - Andreas Jerrentrup
- Emergency Department, University Hospital Gießen and Marburg, Marburg, Germany
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Uwe Wagner
- Department of Gynaecology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Sami Matrood
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps-University, Marburg, Germany
| | - Jürgen R. Schaefer
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Tobias Müller
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Martin Hirsch
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
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Wojtaszewska A, Hirsch M. Guidelines: is it time for a change? BJOG 2021; 129:365. [PMID: 34773347 DOI: 10.1111/1471-0528.17006] [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: 08/19/2021] [Revised: 10/12/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - M Hirsch
- Nuffield Department of Women's & Reproductive Health, Oxford Endometriosis CaRe Centre, University of Oxford, Oxford, UK
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Gilbert S, Fenech M, Hirsch M, Upadhyay S, Biasiucci A, Starlinger J. Algorithm Change Protocols in the Regulation of Adaptive Machine Learning-Based Medical Devices. J Med Internet Res 2021; 23:e30545. [PMID: 34697010 PMCID: PMC8579211 DOI: 10.2196/30545] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 01/29/2023] Open
Abstract
One of the greatest strengths of artificial intelligence (AI) and machine learning (ML) approaches in health care is that their performance can be continually improved based on updates from automated learning from data. However, health care ML models are currently essentially regulated under provisions that were developed for an earlier age of slowly updated medical devices—requiring major documentation reshape and revalidation with every major update of the model generated by the ML algorithm. This creates minor problems for models that will be retrained and updated only occasionally, but major problems for models that will learn from data in real time or near real time. Regulators have announced action plans for fundamental changes in regulatory approaches. In this Viewpoint, we examine the current regulatory frameworks and developments in this domain. The status quo and recent developments are reviewed, and we argue that these innovative approaches to health care need matching innovative approaches to regulation and that these approaches will bring benefits for patients. International perspectives from the World Health Organization, and the Food and Drug Administration’s proposed approach, based around oversight of tool developers’ quality management systems and defined algorithm change protocols, offer a much-needed paradigm shift, and strive for a balanced approach to enabling rapid improvements in health care through AI innovation while simultaneously ensuring patient safety. The draft European Union (EU) regulatory framework indicates similar approaches, but no detail has yet been provided on how algorithm change protocols will be implemented in the EU. We argue that detail must be provided, and we describe how this could be done in a manner that would allow the full benefits of AI/ML-based innovation for EU patients and health care systems to be realized.
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Affiliation(s)
- Stephen Gilbert
- Ada Health GmbH, Berlin, Germany.,Else Kröner-Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthew Fenech
- Ada Health GmbH, Berlin, Germany.,Una Health GmbH, Berlin, Germany
| | - Martin Hirsch
- Ada Health GmbH, Berlin, Germany.,Institute for AI in Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
| | | | - Andrea Biasiucci
- Laboratory for Investigative Neurophysiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland.,confinis ag, Sursee, Switzerland
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Beidler CD, Smith HM, Alonso A, Andreeva T, Baldzuhn J, Beurskens MNA, Borchardt M, Bozhenkov SA, Brunner KJ, Damm H, Drevlak M, Ford OP, Fuchert G, Geiger J, Helander P, Hergenhahn U, Hirsch M, Höfel U, Kazakov YO, Kleiber R, Krychowiak M, Kwak S, Langenberg A, Laqua HP, Neuner U, Pablant NA, Pasch E, Pavone A, Pedersen TS, Rahbarnia K, Schilling J, Scott ER, Stange T, Svensson J, Thomsen H, Turkin Y, Warmer F, Wolf RC, Zhang D. Publisher Correction: Demonstration of reduced neoclassical energy transport in Wendelstein 7-X. Nature 2021; 598:E5. [PMID: 34642470 PMCID: PMC8550957 DOI: 10.1038/s41586-021-04023-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C D Beidler
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany.
| | - H M Smith
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Alonso
- Laboratorio Nacional de Fusion, CIEMAT, Madrid, Spain
| | - T Andreeva
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Baldzuhn
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | | | - M Borchardt
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - S A Bozhenkov
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - K J Brunner
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H Damm
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - M Drevlak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - O P Ford
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - G Fuchert
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Geiger
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - P Helander
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Hergenhahn
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany.,Fritz-Haber-Institut der Max-Planck-Gesellschaft, Berlin, Germany
| | - M Hirsch
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Höfel
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - Ye O Kazakov
- Laboratory for Plasma Physics (LPP), École royale militaire/Koninklijke Militaire School (ERM/KMS), Brussels, Belgium
| | - R Kleiber
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - M Krychowiak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - S Kwak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Langenberg
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H P Laqua
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Neuner
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - N A Pablant
- Princeton Plasma Physics Laboratory, Princeton, NJ, USA
| | - E Pasch
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Pavone
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - T S Pedersen
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - K Rahbarnia
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Schilling
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - E R Scott
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - T Stange
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Svensson
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H Thomsen
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - Y Turkin
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - F Warmer
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - R C Wolf
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - D Zhang
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
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Tellum T, Naftalin J, Hirsch M, Saridogan E, Jurkovic D. A protocol for developing, disseminating, and implementing a core outcome set for adenomyosis research. Facts Views Vis Obgyn 2021; 13:203-208. [PMID: 34555874 PMCID: PMC8823268 DOI: 10.52054/fvvo.13.3.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Adenomyosis is a common benign gynaecological condition that has been associated with heavy and/or painful periods, subfertility and poor obstetric outcomes including miscarriage and preterm delivery. Studies evaluating treatments for adenomyosis have reported a wide range of outcomes and outcome measures. This variation in outcomes and outcome measures prevents effective data synthesis, thereby hampering the ability of meta-analyses to draw useful conclusions and inform clinical practice. Objectives Our aim is to develop a minimum set of outcomes to be reported in all future studies that investigate any uterus-sparing intervention for treating uterine adenomyosis. Wide adoption of 'core outcomes' into research on adenomyosis would reduce the heterogeneity of studies and make data synthesis easier. This will ultimately lead to comparable, prioritised, and patient-centred conclusions from meta-analyses and guidelines. Materials and Methods Outcomes identified from a systematic review of the literature will form a long list, agreed by an international steering group representing key stakeholders, including healthcare professionals, researchers, and public research partners. Through a modified Delphi process, key stakeholders will score outcomes from the agreed long list on a nine-point Likert scale that ranges from 1 (not important) to 9 (critical). Following the Delphi process, the refined outcome set will be finalised by the steering group. Finally, the steering group will develop recommendations for high-quality measures for each outcome. The study was prospectively registered with Core Outcome Measures in Effectiveness Trials Initiative; number 1649. Conclusion The implementation of the core outcome set for adenomyosis in future trials will enhance the availability of comparable data to facilitate more patient-centred evidence-based care. What is new? The core outcome set will facilitate the generation of clinically important and patient centred outcomes for studies evaluating treatments for adenomyosis.
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Tellum T, Omtvedt M, Naftalin J, Hirsch M, Jurkovic D. A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis. Hum Reprod Open 2021; 2021:hoab030. [PMID: 34466664 PMCID: PMC8398753 DOI: 10.1093/hropen/hoab030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/08/2021] [Indexed: 01/03/2023] Open
Abstract
STUDY QUESTION Which outcomes and outcome measures are reported in interventional trials evaluating the treatment of adenomyosis? SUMMARY ANSWER We identified 38 studies, reporting on 203 outcomes using 133 outcome measures. WHAT IS KNOWN ALREADY Heterogeneity in outcome evaluation and reporting has been demonstrated for several gynaecological conditions and in fertility studies. In adenomyosis, previous systematic reviews have failed to perform a quantitative analysis for central outcomes, due to variations in outcome reporting and measuring. STUDY DESIGN, SIZE, DURATION A systematic search of Embase, Medline and Cochrane Register of Controlled Trials (CENTRAL) was performed with a timeframe from 1950 until February 2021, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). PARTICIPANTS/MATERIALS, SETTING, METHODS Studies reporting on any uterus-sparing intervention to treat adenomyosis, both prospective and retrospective, were eligible for inclusion. Inclusion criteria were a clear definition of diagnostic criteria for adenomyosis and the modality used to make the diagnosis, a clear description of the intervention, a follow-up time of ≥6 months, a study population of n ≥ 20, a follow-up rate of at least 80%, and English language. The population included premenopausal women with adenomyosis. Risk of bias was assessed using the Evidence Project risk of bias tool. MAIN RESULTS AND THE ROLE OF CHANCE We included 38 studies (6 randomized controlled trials and 32 cohort studies), including 5175 participants with adenomyosis. The studies described 10 interventions and reported on 203 outcomes, including 43 classified as harms, in 29 predefined domains. Dysmenorrhoea (reported in 82%), heavy menstrual bleeding (HMB) (in 79%) and uterine volume (in 71%) were the most common outcomes. Fourteen different outcome measures were used for dysmenorrhoea and 17 for HMB. Quality of life was reported in 9 (24%) studies, patient satisfaction with treatment in 1 (3%). A clear primary outcome was stated in only 18%. LIMITATIONS, REASONS FOR CAUTION This review includes studies with a high risk of bias. WIDER IMPLICATIONS OF THE FINDINGS Shortcomings in the definition and choice of outcomes and outcome measures limit the value of the conducted research. The development and implementation of a core outcome set (COS) for interventional studies in adenomyosis could improve research quality. This review suggests a lack of patient-centred research in adenomyosis and people with adenomyosis should be involved in the development and implementation of the COS. STUDY FUNDING/COMPETING INTERESTS No funds specifically for this work were received. T.T. receives fees from General Electrics for lectures on ultrasound independently of this project. TRIAL REGISTRATION NUMBER This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42020177466) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative (registration number 1649).
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Affiliation(s)
- T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - M Omtvedt
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - J Naftalin
- Institute for Women's Health, University College Hospital, London, UK
| | - M Hirsch
- Department of Gynaecology, Oxford University Hospitals, Oxford, UK
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
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Hirsch M, Cutner A, Dhillon-Smith R. Authors' Response. J Pediatr Adolesc Gynecol 2021; 34:581. [PMID: 33636380 DOI: 10.1016/j.jpag.2021.02.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Hirsch
- EGA Institute for Women's Health, University College London, London, UK; The John Radcliffe Hospital, Oxford University Hospitals, Headington, Oxford, UK.
| | - Alfred Cutner
- EGA Institute for Women's Health, University College London, London, UK
| | - Rima Dhillon-Smith
- Birmingham Women's and Children's Foundation Trust, Institute of Metabolism and Systems Research, University of Birmingham, UK
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Beidler CD, Smith HM, Alonso A, Andreeva T, Baldzuhn J, Beurskens MNA, Borchardt M, Bozhenkov SA, Brunner KJ, Damm H, Drevlak M, Ford OP, Fuchert G, Geiger J, Helander P, Hergenhahn U, Hirsch M, Höfel U, Kazakov YO, Kleiber R, Krychowiak M, Kwak S, Langenberg A, Laqua HP, Neuner U, Pablant NA, Pasch E, Pavone A, Pedersen TS, Rahbarnia K, Schilling J, Scott ER, Stange T, Svensson J, Thomsen H, Turkin Y, Warmer F, Wolf RC, Zhang D. Demonstration of reduced neoclassical energy transport in Wendelstein 7-X. Nature 2021; 596:221-226. [PMID: 34381232 PMCID: PMC8357633 DOI: 10.1038/s41586-021-03687-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/30/2020] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
Research on magnetic confinement of high-temperature plasmas has the ultimate goal of harnessing nuclear fusion for the production of electricity. Although the tokamak1 is the leading toroidal magnetic-confinement concept, it is not without shortcomings and the fusion community has therefore also pursued alternative concepts such as the stellarator. Unlike axisymmetric tokamaks, stellarators possess a three-dimensional (3D) magnetic field geometry. The availability of this additional dimension opens up an extensive configuration space for computational optimization of both the field geometry itself and the current-carrying coils that produce it. Such an optimization was undertaken in designing Wendelstein 7-X (W7-X)2, a large helical-axis advanced stellarator (HELIAS), which began operation in 2015 at Greifswald, Germany. A major drawback of 3D magnetic field geometry, however, is that it introduces a strong temperature dependence into the stellarator's non-turbulent 'neoclassical' energy transport. Indeed, such energy losses will become prohibitive in high-temperature reactor plasmas unless a strong reduction of the geometrical factor associated with this transport can be achieved; such a reduction was therefore a principal goal of the design of W7-X. In spite of the modest heating power currently available, W7-X has already been able to achieve high-temperature plasma conditions during its 2017 and 2018 experimental campaigns, producing record values of the fusion triple product for such stellarator plasmas3,4. The triple product of plasma density, ion temperature and energy confinement time is used in fusion research as a figure of merit, as it must attain a certain threshold value before net-energy-producing operation of a reactor becomes possible1,5. Here we demonstrate that such record values provide evidence for reduced neoclassical energy transport in W7-X, as the plasma profiles that produced these results could not have been obtained in stellarators lacking a comparably high level of neoclassical optimization.
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Affiliation(s)
- C D Beidler
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany.
| | - H M Smith
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Alonso
- Laboratorio Nacional de Fusion, CIEMAT, Madrid, Spain
| | - T Andreeva
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Baldzuhn
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | | | - M Borchardt
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - S A Bozhenkov
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - K J Brunner
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H Damm
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - M Drevlak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - O P Ford
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - G Fuchert
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Geiger
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - P Helander
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Hergenhahn
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
- Fritz-Haber-Institut der Max-Planck-Gesellschaft, Berlin, Germany
| | - M Hirsch
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Höfel
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - Ye O Kazakov
- Laboratory for Plasma Physics (LPP), École royale militaire/Koninklijke Militaire School (ERM/KMS), Brussels, Belgium
| | - R Kleiber
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - M Krychowiak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - S Kwak
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Langenberg
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H P Laqua
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - U Neuner
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - N A Pablant
- Princeton Plasma Physics Laboratory, Princeton, NJ, USA
| | - E Pasch
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - A Pavone
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - T S Pedersen
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - K Rahbarnia
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Schilling
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - E R Scott
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - T Stange
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - J Svensson
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - H Thomsen
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - Y Turkin
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - F Warmer
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - R C Wolf
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
| | - D Zhang
- Max-Planck-Institut für Plasmaphysik, Greifswald, Germany
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Delanerolle G, Phiri P, Zeng Y, Marston K, Tempest N, Busuulwa P, Shetty A, Goodison W, Muniraman H, Duffy G, Elliot K, Maclean A, Majumder K, Hirsch M, Rathod S, Raymont V, Shi JQ, Hapangama DK. A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations. EClinicalMedicine 2021; 38:101016. [PMID: 34308317 PMCID: PMC8283332 DOI: 10.1016/j.eclinm.2021.101016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds. METHODS A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few. FINDINGS Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively. INTERPRETATION The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients. FUNDING Not applicable.
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Affiliation(s)
| | - Peter Phiri
- Southern Health NHS Foundation Trust, United Kingdom
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Yutian Zeng
- Southern University of Science and Technology, United Kingdom
| | | | - Nicola Tempest
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Paula Busuulwa
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, United Kingdom
- University College London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Hemananda Muniraman
- Department of Pediatrics, Creighton University Medical School, United Kingdom
| | | | | | - Alison Maclean
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | | | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | | | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Jian Qing Shi
- Southern University of Science and Technology, United Kingdom
- Alan Turing Institute, United Kingdom
| | - Dharani K. Hapangama
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
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45
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Süße M, Gag K, Hannich MJ, Hamann L, Nass RD, Malter MP, Quesada CM, Remi J, Möddel G, Knake S, Schmitt FC, Hirsch M, Kunze A, Strzelczyk A, von Podewils F. Informed DEcision for cerebrospinal fluid analysis after epiLeptic seizures- the IDEAL-score: A development and validation study. Seizure 2021; 91:228-232. [PMID: 34233237 DOI: 10.1016/j.seizure.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND This observational study was done to develop a score based on clinical predictors that enables a guided decision for the necessity of cerebrospinal fluid (CSF) analysis after first unprovoked epileptic seizures and to validate this score in a retrospective patient cohort. METHODS Clinical predictors were identified by two panels of epilepsy experts and selected according to content validity ratios. Based on these predictors a score was created and applied to a cohort of patients with first epileptic seizures. RESULTS The "IDEAL score" consists of 9 items (fever, prolonged disturbance of consciousness, headache, imaging results, cognitive dysfunction, status epilepticus, malignancy, autoimmune encephalitis symptoms) that are collected at two different time points (< 3 h [A-score]; > 3 h [B-score] after hospital admittance). A CSF analysis is recommended, if at least one clinical finding is present, either one of the items evaluated during the acute phase (A-score) or later in the diagnostic process (B-score). In 41 patients (13%) CSF analysis provided essential clues to the cause of the seizure. The combined IDEAL score reached a sensitivity of 98%, a specificity of 53%, a positive predictive value of 24% and a negative predictive value of 99% in this patient cohort. CONCLUSIONS A CSF analysis after first epileptic seizures provided decisive etiological findings in only 13% of all investigated patients. The IDEAL score offers clinicians a simple and easy-to-implement algorithm to assess the necessity of a CSF analysis, and to prevent unnecessary diagnostic procedures.
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Affiliation(s)
- Marie Süße
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany.
| | - Konrad Gag
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Malte J Hannich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Laura Hamann
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Robert D Nass
- Clinic for Epileptology, University Hospital Bonn, Bonn, Germany
| | - Michael P Malter
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Carlos M Quesada
- Department of Neurology, Epilepsy Center Essen, University Hospital Essen, Essen, Germany
| | - Jan Remi
- Department of Neurology, University Hospital Munich, Munich, Germany
| | - Gabriel Möddel
- Epilepsy Center, University Hospital Münster, Münster, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, University Hospital Marburg, Marburg, Germany
| | | | - Martin Hirsch
- Faculty of Medicine, Epilepsy Center, University of Freiburg, Freiburg, Germany
| | - Albrecht Kunze
- Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
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46
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Delanerolle G, Ramakrishnan R, Hapangama D, Zeng Y, Shetty A, Elneil S, Chong S, Hirsch M, Oyewole M, Phiri P, Elliot K, Kothari T, Rogers B, Sandle N, Haque N, Pluchino N, Silem M, O'Hara R, Hull ML, Majumder K, Shi JQ, Raymont V. A systematic review and meta-analysis of the Endometriosis and Mental-Health Sequelae; The ELEMI Project. ACTA ACUST UNITED AC 2021; 17:17455065211019717. [PMID: 34053382 PMCID: PMC8182632 DOI: 10.1177/17455065211019717] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 02/05/2023]
Abstract
Background: It is important to evaluate sequalae for complex chronic health conditions such as endometriosis and mental health disorders. Endometriosis impacts 1 in 10 women. Mental health outcomes can be a primary determinant in many physical health conditions although this is an area not well researched particularly in women’s health. This has been problematic for endometriosis patients in particular, who report mental health issues as well as other key comorbidities such as chronic pelvic pain and infertility. This could be partly due to the complexities associated with comprehensively exploring overlaps between physical and mental health disorders in the presence of multiple comorbidities and their potential mechanistic relationship. Methods: In this evidence synthesis, a systematic methodology and mixed-methods approaches were used to synthesize both qualitative and quantitative data to examine the prevalence of the overlapping sequalae between endometriosis and psychiatric symptoms and disorders. As part of this, an evidence synthesis protocol was developed which included a systematic review protocol that was published on PROSPERO (CRD42020181495). The aim was to identify and evaluate mental health reported outcomes and prevalence of symptoms and psychiatric disorders associated with endometriosis. Findings: A total of 34 papers were included in the systematic review and 15 were included in the meta-analysis. Anxiety and depression symptoms were the most commonly reported mental health outcomes while a pooled analysis also revealed high prevalence of chronic pelvic pain and dyspareunia. Interpretation: It is evident that small-scale cross-sectional studies have been conducted in a variety of settings to determine mental health outcomes among endometriosis patients. Further research is required to comprehensively evaluate the mental health sequalae with endometriosis.
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Affiliation(s)
| | - Rema Ramakrishnan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Dharani Hapangama
- University of Liverpool, Liverpool, UK.,Liverpool Women's NHS Foundation, Liverpool, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, London, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Molola Oyewole
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Bryony Rogers
- University of Liverpool, Liverpool, UK.,Liverpool Women's NHS Foundation, Liverpool, UK
| | - Natasha Sandle
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nyla Haque
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nicola Pluchino
- Divisions of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Silem
- University Medical Center Freiburg, Freiburg, Germany
| | - Rebecca O'Hara
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - M Louise Hull
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China.,The Alan Turing Institute, London, UK
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
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47
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Hirsch M, Tariq L, Duffy JM. Effect of Local Anesthetics on Postoperative Pain in Patients Undergoing Gynecologic Laparoscopy: A Systematic Review and Meta-analysis of Randomized Trials. J Minim Invasive Gynecol 2021; 28:1689-1698. [PMID: 33991671 DOI: 10.1016/j.jmig.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Pain remains a common complication after gynecologic laparoscopy. Use of local anesthesia may be beneficial in reducing postoperative pain. We performed a systematic review and meta-analysis to assess whether local anesthetic decreases postoperative pain after laparoscopic gynecologic procedures. DATA SOURCES We searched Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline from inception to November 2020 using Medical Subject Headings and free text combinations. METHODS OF TRIAL SELECTION We included randomized controlled trials of patients undergoing gynecologic laparoscopy receiving port site subcutaneous, subfascial, or intraperitoneal local anesthetic compared with placebo or no intervention. We included 20 trials (1861 participants) with size varying between 28 and 164 participants. TABULATIONS, INTEGRATION, AND RESULTS Meta-analysis was performed with RevMan 5.3 (Cochrane Collaboration, London, United Kingdom), with standard mean differences (SMDs) and random-effects model. Port site infiltration reduces postoperative pain at 4 hours (SMD -0.25; 95% confidence interval [CI], -0.44 to -0.06; 4 trials; 545 participants) and 6 hours (SMD -0.44; 95% CI, -0.82 to -0.06; 4 trials; 455 participants) after surgery. The administration of intraperitoneal local anesthetics reduces pain at 6 hours (-1.42; 95% CI, -3.22 to -0.30; 4 trials; 277 participants) after surgery. CONCLUSIONS The use of port site and intraperitoneal local anesthetic decreases immediate postoperative pain in patients undergoing gynecologic laparoscopy, although its impact on analgesia requirements is unclear. Routine usage of local anesthetics should be considered for people undergoing gynecologic laparoscopy.
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Affiliation(s)
- Martin Hirsch
- EGA Institute for Women's Health (Dr. Hirsch), University College London; Oxford University Hospitals (Dr. Hirsch), Headley way, Oxford, United Kingdom.
| | - Laiba Tariq
- University College London Medical School (Ms. Tariq)
| | - James Mn Duffy
- King's Fertility (Dr. Duffy), Fetal Medicine Research Institute
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48
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Hirsch M, Duffy JMN, Farquhar CM. Re: Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol 2021; 57:849. [PMID: 33939210 DOI: 10.1002/uog.23636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Hirsch
- Institute for Women's Health, University College London, London, UK
| | - J M N Duffy
- Institute for Women's Health, University College London, London, UK
- King's Fertility, The Fetal Medicine Research Institute, London, UK
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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49
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Hirsch M, Duffy JMN, Farquhar C. Re: The effect of new cross linked hyaluronan gel on quality of life of patients after deep infiltrating endometriosis surgery: a randomised controlled pilot study. J OBSTET GYNAECOL 2021; 42:178-179. [PMID: 33455519 DOI: 10.1080/01443615.2020.1839873] [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: 10/22/2022]
Affiliation(s)
- Martin Hirsch
- Institute for Women's Health, University College London, London, United Kingdom
| | - James M N Duffy
- Institute for Women's Health, University College London, London, United Kingdom.,2King's Fertility, Fetal Medicine Research Institute, London, United Kingdom
| | - C Farquhar
- Cochrane Gynaecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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50
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Hirsch M, Berg L, Gamaleldin I, Vyas S, Vashisht A. The management of women with thoracic endometriosis: a national survey of British gynaecological endoscopists. Facts Views Vis Obgyn 2021; 12:291-298. [PMID: 33575678 PMCID: PMC7863691] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES This study evaluates current national opinions on screening, diagnosis, and management of thoracic endometriosis. BACKGROUND Thoracic endometriosis is a rare but serious condition with four main clinical presentations: pneumothorax, haemoptysis, haemothorax, and pulmonary nodules. There are no specialist centres in the United Kingdom despite growing patient desire for recognition, investigation, and treatment. METHODS We distributed a multiple-choice email survey to senior members of the British Society for Gynaecological Endoscopy. Descriptive statistics were used to present the results. Results: We received 67 responses from experienced clinicians having provided over 800 combined years of endometriosis patient care. The majority of respondents managed over 100 endometriosis patients annually, for more than five years. Over one third had never managed a patient with symptomatic thoracic endometriosis; just 9% had managed more than 30 cases over the course of their career. Screening varied by modality with only 4% of clinicians always taking a history of respiratory symptoms while 69% would always screen for diaphragmatic endometriosis during laparoscopy. The management of symptomatic thoracic endometriosis varied widely with the commonest treatment being surgery followed by hormonal therapies. Regarding management, 71% of respondents felt the team should comprise of four or more different specialists, and 56% believed care should be centralised either regionally or nationally. CONCLUSIONS Thoracic endometriosis is poorly screened for amongst clinicians with varied management lacking a common diagnostic or therapeutic pathway in the United Kingdom. Specialists expressed a preference for women to be managed in a large multidisciplinary team setting at a regional or national level.
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Affiliation(s)
- M Hirsch
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
| | - L Berg
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
| | - I Gamaleldin
- Women's Health, Southmead Hospital, Bristol, United Kingdom
| | - S Vyas
- Women's Health, Southmead Hospital, Bristol, United Kingdom
| | - A Vashisht
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, United Kingdom
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