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Boukovala M, Modest DP, Ricard I, Fischer von Weikersthal L, Decker T, Vehling-Kaiser U, Uhlig J, Schenk M, Freiberg-Richter J, Peuser B, Denzlinger C, Peveling Genannt Reddemann C, Graeven U, Schuch G, Schwaner I, Heinrich K, Neumann J, Jung A, Held S, Stintzing S, Heinemann V, Michl M. Evaluation of the inflammation-based modified Glasgow Prognostic Score (mGPS) as a prognostic and predictive biomarker in patients with metastatic colorectal cancer receiving first-line chemotherapy: a post hoc analysis of the randomized phase III XELAVIRI trial (AIO KRK0110). ESMO Open 2024; 9:103374. [PMID: 38744100 DOI: 10.1016/j.esmoop.2024.103374] [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: 12/07/2023] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The inflammation-based modified Glasgow Prognostic Score (mGPS) combines serum levels of C-reactive protein and albumin and was shown to predict survival in advanced cancer. We aimed to elucidate the prognostic impact of mGPS on survival as well as its predictive value when combined with gender in unselected metastatic colorectal cancer (mCRC) patients receiving first-line chemotherapy in the randomized phase III XELAVIRI trial. PATIENTS AND METHODS In XELAVIRI, mCRC patients were treated with either fluoropyrimidine/bevacizumab followed by additional irinotecan at first progression (sequential treatment arm; Arm A) or upfront combination of fluoropyrimidine/bevacizumab/irinotecan (intensive treatment arm; Arm B). In the present post hoc analysis, survival was evaluated with respect to the assorted mGPS categories 0, 1 or 2. Interaction between mGPS and gender was analyzed. RESULTS Out of 421 mCRC patients treated in XELAVIRI, 362 [119 women (32.9%) and 243 men (67.1%)] were assessable. For the entire study population a significant association between mGPS and overall survival (OS) was observed [mGPS = 0: median 28.9 months, 95% confidence interval (CI) 25.9-33.6 months; mGPS = 1: median 21.4 months, 95% CI 17.6-26.1 months; mGPS = 2: median 16.8 months, 95% CI 14.3-21.2 months; P < 0.00001]. Similar results were found when comparing progression-free survival between groups. The effect of mGPS on survival did not depend on the applied treatment regimen (P = 0.21). In female patients, a trend towards longer OS was observed in Arm A versus Arm B, with this effect being clearly more pronounced in the mGPS cohort 0 (41.6 versus 25.5 months; P = 0.056). By contrast, median OS was longer in male patients with an mGPS of 1-2 treated in Arm B versus Arm A (20.8 versus 17.4 months; P = 0.022). CONCLUSION We demonstrate the role of mGPS as an independent predictor of OS regardless of the treatment regimen in mCRC patients receiving first-line treatment. mGPS may help identify gender-specific subgroups that benefit more or less from upfront intensive therapy.
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Affiliation(s)
- M Boukovala
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | - D P Modest
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité-Universitaetsmedizin, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - I Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | | | - T Decker
- Private Oncological Practice, Ravensburg
| | | | - J Uhlig
- Private Oncological Practice, Naunhof
| | - M Schenk
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg
| | | | - B Peuser
- Onkologische Praxis am Diakonissenhaus, Leipzig
| | | | | | - U Graeven
- Kliniken Maria Hilf GmbH, Mönchengladbach
| | - G Schuch
- Hämatologisch-Onkologische Praxis Altona, Hamburg
| | - I Schwaner
- Onkologische Schwerpunktpraxis Kurfürstendamm, Berlin
| | - K Heinrich
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München
| | - J Neumann
- Institute of Pathology, Ludwig-Maximilians-University of Munich
| | - A Jung
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg; Institute of Pathology, Ludwig-Maximilians-University of Munich
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - S Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CCM), Charité-Universitaetsmedizin, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - M Michl
- Department of Medicine III, University Hospital, LMU Munich, München; Comprehensive Cancer Center, University Hospital, LMU Munich, München.
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Bsteh G, Macher S, Krajnc N, Marik W, Michl M, Müller N, Zaic S, Harreiter J, Novak K, Wöber C, Pemp B. An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension - an assessment of sick leave, presenteeism, and health care utilization. J Headache Pain 2024; 25:73. [PMID: 38714920 PMCID: PMC11075215 DOI: 10.1186/s10194-024-01780-9] [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: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop- concept. Here, we aimed to evaluate effects of this concept on sick leave, presenteeism, and health care utilization. METHODS In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding economic outcome parameters assessed over 6 months. Multivariate binary logistic regression models were used to adjust for confounders. RESULTS Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, the IC group showed significantly fewer days with sick leave or presenteeism (-5 days/month), fewer unscheduled contacts for IIH-specific problems (-2.3/month), and fewer physician or hospital contacts in general (-4.1 contacts/month). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of the IC concept in these groups. CONCLUSIONS Interdisciplinary integrated management significantly improves the burden of IIH in terms of sick leave, presenteeism and healthcare consultations - particularly in socioeconomically underprivileged patient groups.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Sina Zaic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Division of Endocrinology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Macher S, Marik W, Krajnc N, Mitsch C, Michl M, Mueller N, Novak K, Zaic S, Woeber C, Pemp B, Bsteh G. The additive value of complementing diagnostic idiopathic intracranial hypertension criteria by MRI - an external validation study. J Headache Pain 2024; 25:70. [PMID: 38711044 DOI: 10.1186/s10194-024-01781-8] [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: 03/22/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Recently, diagnostic criteria including a standardized MRI criterion were presented to identify patients suffering from idiopathic intracranial hypertension (IIH) proposing that IIH might be defined by two out of three objective findings (papilledema, ≥ 25 cm cerebrospinal fluid opening pressure (CSF-OP) and ≥ 3/4 neuroimaging signs). METHODS To provide independent external validation, we retrospectively applied the proposed diagnostic criteria to our cohort of patients with clinical suspicion of IIH from the Vienna IIH database. Neuroimaging was reevaluated for IIH signs according to standardized definitions by a blinded expert neuroradiologist. We determined isolated diagnostic accuracy of the neuroimaging criterion (≥ 3/4 signs) as well as overall accuracy of the new proposed criteria. RESULTS We included patients with IIH (n = 102) and patients without IIH (no-IIH, n = 23). Baseline characteristics were balanced between IIH and no-IIH groups, but papilledema and CSF-OP were significantly higher in IIH. For the presence of ≥ 3/4 MRI signs, sensitivity was 39.2% and specificity was 91.3% with positive predictive value (PPV) of 95.2% and negative predictive value (NPV) 25.3%. Reclassifying our cohort according to the 2/3 IIH definition correctly identified 100% of patients without IIH, with definite IIH and suggested to have IIH without papilledema by Friedman criteria, respectively. CONCLUSION The standardized neuroimaging criteria are easily applicable in clinical routine and provide moderate sensitivity and excellent specificity to identify patients with IIH. Defining IIH by 2/3 criteria significantly simplifies diagnosis without compromising accuracy.
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Affiliation(s)
- Stefan Macher
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Mueller
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Sina Zaic
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christian Woeber
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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Seeböck P, Orlando JI, Michl M, Mai J, Schmidt-Erfurth U, Bogunović H. Anomaly guided segmentation: Introducing semantic context for lesion segmentation in retinal OCT using weak context supervision from anomaly detection. Med Image Anal 2024; 93:103104. [PMID: 38350222 DOI: 10.1016/j.media.2024.103104] [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: 10/12/2022] [Revised: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
Automated lesion detection in retinal optical coherence tomography (OCT) scans has shown promise for several clinical applications, including diagnosis, monitoring and guidance of treatment decisions. However, segmentation models still struggle to achieve the desired results for some complex lesions or datasets that commonly occur in real-world, e.g. due to variability of lesion phenotypes, image quality or disease appearance. While several techniques have been proposed to improve them, one line of research that has not yet been investigated is the incorporation of additional semantic context through the application of anomaly detection models. In this study we experimentally show that incorporating weak anomaly labels to standard segmentation models consistently improves lesion segmentation results. This can be done relatively easy by detecting anomalies with a separate model and then adding these output masks as an extra class for training the segmentation model. This provides additional semantic context without requiring extra manual labels. We empirically validated this strategy using two in-house and two publicly available retinal OCT datasets for multiple lesion targets, demonstrating the potential of this generic anomaly guided segmentation approach to be used as an extra tool for improving lesion detection models.
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Affiliation(s)
- Philipp Seeböck
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria; Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria.
| | - José Ignacio Orlando
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria; Yatiris Group at PLADEMA Institute, CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Gral. Pinto 399, Tandil, Buenos Aires, Argentina
| | - Martin Michl
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Julia Mai
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria
| | - Hrvoje Bogunović
- Lab for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria.
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Michl M, Neschi M, Kaider A, Hatz K, Deak G, Gerendas BS, Schmidt-Erfurth U. A systematic evaluation of human expert agreement on optical coherence tomography biomarkers using multiple devices. Eye (Lond) 2023; 37:2573-2579. [PMID: 36577804 PMCID: PMC10397199 DOI: 10.1038/s41433-022-02376-w] [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: 10/14/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess the agreement in evaluating optical coherence tomography (OCT) variables in the leading macular diseases such as neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) among OCT-certified graders. METHODS SD-OCT volume scans of 356 eyes were graded by seven graders. The grading included presence of intra- and subretinal fluid (IRF, SRF), pigment epithelial detachment (PED), epiretinal membrane (ERM), conditions of the vitreomacular interface (VMI), central retinal thickness (CRT) at the foveal centre-point (CP) and central millimetre (CMM), as well as height and location of IRF/SRF/PED. Kappa statistics (κ) and intraclass correlation coefficient (ICC) were used to report categorical grading and measurement agreement. RESULTS The overall agreement on the presence of IRF/SRF/PED was κ = 0.82/0.85/0.81; κ of VMI condition was 0.77, that of ERM presence 0.37. ICC for CRT measurements at CP and CMM was excellent with an ICC of 1.00. Height measurements of IRF/SRF/PED showed robust consistency with ICC = 0.85-0.93. There was substantial to almost perfect agreement in locating IRF/SRF/PED with κ = 0.67-0.86. Between diseases, κ of IRF/SRF presence was 0.69/0.80 for nAMD, 0.64/0.83 for DMO and 0.86/0.89 for RVO. CONCLUSION Even in the optimized setting, featuring certified graders, standardized image acquisition and the use of a professional reading platform, there is a disease dependent variability in biomarker evaluation that is most pronounced for IRF in nAMD as well as DMO. Our findings highlight the variability in the performance of human expert OCT grading and the need for AI-based automated feature analyses.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | | | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Katja Hatz
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Vista Augenklinik Binningen, Binningen, Switzerland
| | - Gabor Deak
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | - Bianca S Gerendas
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
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Krajnc N, Itariu B, Macher S, Marik W, Harreiter J, Michl M, Novak K, Wöber C, Pemp B, Bsteh G. Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. J Headache Pain 2023; 24:89. [PMID: 37460968 DOI: 10.1186/s10194-023-01631-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND In idiopathic intracranial hypertension (IIH), sustained weight loss is the main pillar in modifying disease course, whereby glucagon-like peptide-1 receptor agonists (GLP-1-RAs) could present an attractive treatment option. METHODS In this open-label, single-center, case-control pilot study, patients with IIH (pwIIH) and a body mass index (BMI) of ≥ 30 kg/m2 were offered to receive a GLP-1-RA (semaglutide, liraglutide) in addition to the usual care weight management (UCWM). Patients electing for UCWM only served as a control group matched for age-, sex- and BMI (1:2 ratio). The primary endpoint was the percentage weight loss at six months (M6) compared to baseline. Secondary endpoints included the rate of patients with a weight loss of ≥ 10%, monthly headache days (MHD), the rate of patients with a ≥ 30% and ≥ 50% reduction in MHD, visual outcome parameters, and adverse events (AEs). RESULTS We included 39 pwIIH (mean age 33.6 years [SD 8.0], 92.3% female, median BMI 36.3 kg/m2 [IQR 31.4-38.3]), with 13 patients being treated with GLP-1-RAs. At M6, mean weight loss was significantly higher in the GLP-1-RA group (-12.0% [3.3] vs. -2.8% [4.7]; p < 0.001). Accordingly, weight loss of ≥ 10% was more common in this group (69.2% vs. 4.0%; p < 0.001). Median reduction in MHD was significantly higher in the GLP-1-RA group (-4 [-10.5, 0.5] vs. 0 [-3, 1]; p = 0.02), and the 50% responder rate was 76.9% vs. 40.0% (p = 0.04). Visual outcome parameters did not change significantly from baseline to M6. Median reduction in acetazolamide dosage was significantly higher in the GLP-1-RA group (-16.5% [-50, 0] vs. 0% [-25, 50]; p = 0.04). AEs were mild or moderate and attributed to gastrointestinal symptoms in 9/13 patients. None of the AEs led to premature treatment discontinuation. CONCLUSIONS This open-label, single-center pilot study suggests that GLP-1-RAs are an effective and safe treatment option for achieving significant weight loss with a favorable effect on headache, leading to reduced acetazolamide dosage in pwIIH.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Bianca Itariu
- Department of Internal Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Department of Internal Medicine III, Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences, Medical University of Vienna, & Mental Health, Vienna, Austria.
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Mylonas G, Haj Najeeb B, Goldbach F, Deak GG, Michl M, Brugger J, Schmidt-Erfurth U, Gerendas BS. Reply. Retina 2023; 43:e41-e42. [PMID: 37027826 DOI: 10.1097/iae.0000000000003804] [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: 04/09/2023]
Affiliation(s)
- Georgios Mylonas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Bilal Haj Najeeb
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Felix Goldbach
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabor G Deak
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | | | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Michl M, Liu X, Kaider A, Sadeghipour A, Gerendas BS, Schmidt‐Erfurth U. The impact of structural optical coherence tomography changes on visual function in retinal vein occlusion. Acta Ophthalmol 2021; 99:418-426. [PMID: 32996711 PMCID: PMC8359321 DOI: 10.1111/aos.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/19/2019] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose We aimed to determine the correlation between optical coherence tomography (OCT)‐ and demographic features and baseline best corrected visual acuity (BCVA) in treatment‐naïve patients with retinal vein occlusion (RVO). Methods This was a cross‐sectional posthoc analysis of OCT images that included RVO patients from two prospective, open‐label, multicentre studies. The morphological grading was done manually, in the standardized setting of a reading centre. Main outcome measure was the estimated difference in Early Treatment Diabetic Retinopathy Study letters associated with each individual biomarker. Results Included were 381/301 treatment‐naïve patients with BRVO/CRVO. For BRVO, statistically significant correlations with BCVA were seen for a 100 µm increase in central subfield thickness (CST; −3.1 letters), intraretinal cysts at centre point (CP; +4.1), subretinal fluid (SRF) at CP (+3.0) and hyperreflective foci (HRF) at the central B‐scan (−2.2). In CRVO, a 100 µm increase in CST was associated with a loss of −3.4 letters. In the total cohort, 100 µm increase in CST, SRF at CP and HRF at the central B‐scan correlated with a difference of −3.2,+3.2 and −2.0 letters. A 10‐year increase in age and female gender yielded a −2.0 and −2.5 letter decrease in the total cohort. Adjusted multiple R2 for the respective group was 18.3%/26.3%/23.5%. Conclusions Of all parameters studied, only CST and age were consistently associated with worse BCVA in treatment‐naïve RVO patients. Morphology on OCT explained only a modest part of functional loss in this patient cohort.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Xuhui Liu
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
- Department of Ophthalmology The First Affiliated Hospital of Zhengzhou University Zhengzhou City China
| | - Alexandra Kaider
- Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Amir Sadeghipour
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Bianca S. Gerendas
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Ursula Schmidt‐Erfurth
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
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Holch JW, Held S, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, von Einem JC, Michl M, Heinemann V. Relation of cetuximab-induced skin toxicity and early tumor shrinkage in metastatic colorectal cancer patients: results of the randomized phase 3 trial FIRE-3 (AIO KRK0306). Ann Oncol 2021; 31:72-78. [PMID: 31912799 DOI: 10.1016/j.annonc.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/29/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cetuximab-induced skin toxicity (Cet-ST) is positively associated with outcome in metastatic colorectal cancer (mCRC). Besides its predictive relevance for targeted therapy, we investigated its prognostic impact with early tumor shrinkage (ETS) ≥20%, another on-treatment surrogate for clinical outcome in FIRE-3. PATIENTS AND METHODS FIRE-3 evaluated first-line FOLFIRI (folinic acid, fluorouracil and irinotecan) plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumors (i.e. wild-type in KRAS and NRAS exons 2-4). Retrospective data on Cet-ST that occurred during cycles 1-3 of treatment were correlated with efficacy endpoints, including ETS. To control for guarantee-time bias, only patients who had completed three or more treatment cycles were considered. RESULTS Of 199 patients treated with FOLFIRI/Cet, 181 (91.0%) completed three or more treatment cycles. A significant survival benefit of FOLFIRI/Cet over FOLFIRI/Bev was only evident in patients developing Cet-ST grade 2-3 [41.0 versus 26.6 months; hazard ratio (HR) = 0.73; 95% confidence interval (CI): 0.61-0.87; P < 0.001] compared with Cet-ST grade 0-1 (HR = 0.90; 95% CI: 0.67-1.20; P = 0.48). Regarding prognosis, Cet-ST grade 2-3 (n = 75; 41.4%), compared with Cet-ST grade 0-1 (n = 106; 58.6%), was associated with prolonged overall survival (OS; HR = 0.62; 95% CI: 0.42-0.91; P = 0.01). In multivariate analysis, both Cet-ST (HR = 0.66; 95% CI: 0.50-0.87; P = 0.003) and ETS (HR = 0.55; 95% CI: 0.41-0.74; P < 0.0001) were independently prognostic for OS. Absence of both Cet-ST grade ≥2 and ETS identified a subgroup of patients with very poor prognosis (median OS 15.1 months). CONCLUSIONS In FIRE-3, the addition of cetuximab to FOLFIRI was associated with superior OS compared with FOLFIRI/Bev only in patients developing Cet-ST grade ≥2. Regarding prognostic relevance, both Cet-ST and ETS were independent and early predictors of survival. The present analysis supports that a combined evaluation of on-treatment parameters such as Cet-ST and ETS may help to guide treatment of mCRC.
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Affiliation(s)
- J W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - S Stintzing
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - T Decker
- Onkologie Ravensburg, Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - F Kaiser
- Hämato-onkologische Tagesklinik, Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Department of Internal Medicine, Mainz, Germany
| | - J C von Einem
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - M Michl
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Michl M, Fabianska M, Seeböck P, Sadeghipour A, Haj Najeeb B, Bogunovic H, Schmidt-Erfurth UM, Gerendas BS. Automated quantification of macular fluid in retinal diseases and their response to anti-VEGF therapy. Br J Ophthalmol 2020; 106:113-120. [PMID: 33087314 DOI: 10.1136/bjophthalmol-2020-317416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 07/05/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
AIM To objectively assess disease activity and treatment response in patients with retinal vein occlusion (RVO), neovascular age-related macular degeneration (nAMD) and centre-involved diabetic macular oedema (DME), using artificial intelligence-based fluid quantification. METHODS Posthoc analysis of 2311 patients (11 151 spectral-domain optical coherence tomography volumes) from five clinical, multicentre trials, who received a flexible antivascular endothelial growth factor (anti-VEGF) therapy over a 12-month period. Fluid volumes were measured with a deep learning algorithm at baseline/months 1, 2, 3 and 12, for three concentric circles with diameters of 1, 3 and 6 mm (fovea, paracentral ring and pericentral ring), as well as four sectors surrounding the fovea (superior, nasal, inferior and temporal). RESULTS In each disease, at every timepoint, most intraretinal fluid (IRF) per square millimetre was present at the fovea, followed by the paracentral ring and pericentral ring (p<0.0001). While this was also the case for subretinal fluid (SRF) in RVO/DME (p<0.0001), patients with nAMD showed more SRF in the paracentral ring than at the fovea up to month 3 (p<0.0001). Between sectors, patients with RVO/DME showed the highest IRF volumes temporally (p<0.001/p<0.0001). In each disease, more SRF was consistently found inferiorly than superiorly (p<0.02). At month 1/12, we measured the following median reductions of initial fluid volumes. For IRF: RVO, 95.9%/97.7%; nAMD, 91.3%/92.8%; DME, 37.3%/69.9%. For SRF: RVO, 94.7%/97.5%; nAMD, 98.4%/99.8%; DME, 86.3%/97.5%. CONCLUSION Fully automated localisation and quantification of IRF/SRF over time shed light on the fluid dynamics in each disease. There is a specific anatomical response of IRF/SRF to anti-VEGF therapy in all diseases studied.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Maria Fabianska
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Seeböck
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Amir Sadeghipour
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Bilal Haj Najeeb
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Bianca S Gerendas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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11
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Affiliation(s)
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
- Vienna Reading Center, Vienna, Austria
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12
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Holch JW, Ricard I, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, Jelas I, Modest DP, Westphalen CB, von Einem JC, Michl M, Heinemann V. Relevance of baseline carcinoembryonic antigen for first-line treatment against metastatic colorectal cancer with FOLFIRI plus cetuximab or bevacizumab (FIRE-3 trial). Eur J Cancer 2018; 106:115-125. [PMID: 30496943 DOI: 10.1016/j.ejca.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Increased baseline carcinoembryonic antigen (CEA) serum level is associated with inferior overall survival (OS) in metastatic colorectal cancer (mCRC). However, limited data exist on its predictive relevance for targeted therapies. Therefore, we analysed its relevance in FIRE-3, a randomised phase III study. EXPERIMENTAL DESIGN FIRE-3 evaluated first-line FOLFIRI plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumour (i.e. wild-type in KRAS and NRAS exons 2-4). Herein, the impact of CEA on patient outcome was investigated. RESULTS Of 400 patients, 356 (89.0%) were evaluable for CEA. High CEA (>10 ng/ml; N = 237) compared to low CEA (≤10 ng/ml; N = 119) was associated with shorter OS in the FOLFIRI/Bev arm (hazard ratio [HR] = 1.50; P = 0.036), while no significant OS difference was observed in the FOLFIRI/Cet arm (HR = 1.07; P = 0.74). In patients with high CEA, FOLFIRI/Cet compared to FOLFIRI/Bev showed a greater OS benefit (HR = 0.56; P < 0.001) than in patients with low CEA (HR = 0.78; P = 0.30). Furthermore, FOLFIRI/Cet exhibited significantly superior objective response rate in patients with high CEA (odds ratio = 2.21; P = 0.006) in contrast to patients with low CEA (odds ratio = 0.90; P = 0.85). CONCLUSION In patients with RAS-WT mCRC receiving first-line chemotherapy with FOLFIRI/Cet versus FOLFIRI/Bev, elevated CEA was associated with inferior survival in the bevacizumab arm, while this was not the case when cetuximab was applied. Comparison of OS and objective response rate according to treatment arms indicated that cetuximab was greatly superior to bevacizumab in patients with elevated CEA, while this effect was markedly lower and lost statistical significance in patients with low CEA.
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Affiliation(s)
- J W Holch
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - I Ricard
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - S Stintzing
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - L Fischer von Weikersthal
- Praxis für Onkologie/Haematologie, Gesundheitszentrum St. Marien GmbH, Mariahilfbergweg 7, 92224 Amberg, Germany
| | - T Decker
- Onkologie Ravensburg, Elisabethenstrasse 19, 88212 Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Preuschwitzer Strasse 101, 95445 Bayreuth, Germany
| | - U Vehling-Kaiser
- Hämato-onkologische Tagesklinik, Dr. Med. Ursula Vehling-Kaiser, Ländgasse 132-135, 84028 Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Preußenstrasse 84, 41462 Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130 Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Söllnerstrasse 16, 92637 Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - I Jelas
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - D P Modest
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C B Westphalen
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - J C von Einem
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - M Michl
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Gadige P, Albert S, Michl M, Bauer T, Lunkenheimer P, Loidl A, Tourbot R, Wiertel-Gasquet C, Biroli G, Bouchaud JP, Ladieu F. Unifying different interpretations of the nonlinear response in glass-forming liquids. Phys Rev E 2018; 96:032611. [PMID: 29346923 DOI: 10.1103/physreve.96.032611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Indexed: 11/07/2022]
Abstract
This work aims at reconsidering several interpretations coexisting in the recent literature concerning nonlinear susceptibilities in supercooled liquids. We present experimental results on glycerol and propylene carbonate, showing that the three independent cubic susceptibilities have very similar frequency and temperature dependences, for both their amplitudes and phases. This strongly suggests a unique physical mechanism responsible for the growth of these nonlinear susceptibilities. We show that the framework proposed by two of us [J.-P. Bouchaud and G. Biroli, Phys. Rev. B 72, 064204 (2005)PRBMDO1098-012110.1103/PhysRevB.72.064204], where the growth of nonlinear susceptibilities is intimately related to the growth of glassy domains, accounts for all the salient experimental features. We then review several complementary and/or alternative models and show that the notion of cooperatively rearranging glassy domains is a key (implicit or explicit) ingredient to all of them. This paves the way for future experiments, which should deepen our understanding of glasses.
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Affiliation(s)
- P Gadige
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 772, 91191 Gif-sur-Yvette Cedex, France
| | - S Albert
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 772, 91191 Gif-sur-Yvette Cedex, France
| | - M Michl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - Th Bauer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - P Lunkenheimer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - A Loidl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - R Tourbot
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 772, 91191 Gif-sur-Yvette Cedex, France
| | - C Wiertel-Gasquet
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 772, 91191 Gif-sur-Yvette Cedex, France
| | - G Biroli
- IPhT, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 774, 91191 Gif-sur-Yvette Cedex, France.,LPS, Ecole Normale Supérieure, 24 Rue Lhomond, 75231 Paris Cedex 05, France
| | - J-P Bouchaud
- Capital Fund Management, 23 Rue de l'Université, 75007 Paris, France
| | - F Ladieu
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay, Bâtiment 772, 91191 Gif-sur-Yvette Cedex, France
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Abstract
Headaches can be so severe that patients and doctors often fear life-threatening underlying cerebral pathologies. The spectrum of causes of headache is very heterogeneous and ranges from harmless situations to severe diseases, so that it is very difficult to consider all differential diagnoses simultaneously; however, a few targeted questions and physical examinations are sufficient to be able to make a better classification of the leading symptom headache. The following article serves as a quick guide for identification of patients at risk. It describes basic findings, red flags and specials warning signs that must immediately lead to emergency admission for further diagnostics.
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Affiliation(s)
- M Michl
- Medizinische Klinik und Poliklinik III für Innere Medizin, Hämatologie und Onkologie, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - G M Michl
- Praxis für Innere Medizin, Hämatologie und Onkologie München-Solln, München, Deutschland
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Albert S, Bauer T, Michl M, Biroli G, Bouchaud JP, Loidl A, Lunkenheimer P, Tourbot R, Wiertel-Gasquet C, Ladieu F. Fifth-order susceptibility unveils growth of thermodynamic amorphous order in glass-formers. Science 2016; 352:1308-11. [DOI: 10.1126/science.aaf3182] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/09/2016] [Indexed: 11/02/2022]
Affiliation(s)
- S. Albert
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay Bat 772, 91191 Gif-sur-Yvette Cedex, France
| | - Th. Bauer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - M. Michl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - G. Biroli
- IPhT, CEA, CNRS, Université Paris-Saclay, CEA Saclay Bat 774, 91191 Gif-sur-Yvette Cedex, France
- LPS, Ecole Normale Supérieure, 24 rue Lhomond, 75231 Paris Cedex 05, France
| | - J.-P. Bouchaud
- Capital Fund Management, 23 rue de l’Université, 75007 Paris, France
| | - A. Loidl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - P. Lunkenheimer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - R. Tourbot
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay Bat 772, 91191 Gif-sur-Yvette Cedex, France
| | - C. Wiertel-Gasquet
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay Bat 772, 91191 Gif-sur-Yvette Cedex, France
| | - F. Ladieu
- SPEC, CEA, CNRS, Université Paris-Saclay, CEA Saclay Bat 772, 91191 Gif-sur-Yvette Cedex, France
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Michl M, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Lerchenmueller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Hielscher J, Scholz M, Mueller S, Lerch MM, Modest DP, Kirchner T, Jung A, Heinemann V. CEA response is associated with tumor response and survival in patients with KRAS exon 2 wild-type and extended RAS wild-type metastatic colorectal cancer receiving first-line FOLFIRI plus cetuximab or bevacizumab (FIRE-3 trial). Ann Oncol 2016; 27:1565-72. [PMID: 27234640 DOI: 10.1093/annonc/mdw222] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To examine the relation of carcinoembryonic antigen (CEA) response with tumor response and survival in patients with (K)RAS wild-type metastatic colorectal cancer receiving first-line chemotherapy in the FIRE-3 trial comparing FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab. PATIENTS AND METHODS CEA response assessed as the percentage of CEA decrease from baseline to nadir was evaluated for its association with tumor response and survival. Receiver operating characteristic analysis revealed an optimal cut-off value of 75% using the maximum of sensitivity and specificity for CEA response to discriminate CEA responders from non-responders. In addition, the time to CEA nadir was calculated. RESULTS Of 592 patients in the intent-to-treat population, 472 were eligible for analysis of CEA (cetuximab arm: 230 and bevacizumab arm: 242). Maximal relative CEA decrease (%) significantly (P = 0.003) differed between the cetuximab arm (median 83.0%; IQR 40.9%-94.7%) and the bevacizumab arm (median 72.3%; IQR 26.3%-91.0%). In a longitudinal analysis, the CEA decrease occurred faster in the cetuximab arm and was greater than in the bevacizumab arm at all evaluated time points until 56 weeks after treatment start. CEA nadir occurred after 3.3 months (cetuximab arm) and 3.5 months (bevacizumab arm), (P = 0.49). In the cetuximab arm, CEA responders showed a significantly longer progression-free survival [11.8 versus 7.4 months; hazard ratio (HR) 1.53; 95% Cl, 1.15-2.04; P = 0.004] and longer overall survival (36.6 versus 21.3 months; HR 1.73; 95% Cl, 1.24-2.43; P = 0.001) than CEA non-responders. Analysis of extended RAS wild-type patients revealed similar results. CONCLUSION In the FIRE-3 trial, CEA decrease was significantly faster and greater in the cetuximab arm than in the bevacizumab arm and correlated with the prolonged survival observed in patients receiving FOLFIRI plus cetuximab. CLINICAL TRIALS NUMBER NCT00433927 (ClinicalTrials.gov); AIO KRK0306 FIRE-3.
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Affiliation(s)
- M Michl
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich
| | - S Stintzing
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | | | - T Decker
- Practice for Hematology and Medical Oncology, Onkonet-Onkologie Ravensburg, Ravensburg
| | - A Kiani
- Department of Hematology and Medical Oncology, Klinik Herzoghöhe, Bayreuth
| | | | - S-E Al-Batran
- Department of Hematology and Medical Oncology, Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt
| | - T Heintges
- Department of Gastroenterology and Oncology, Medical Department II, Lukaskrankenhaus, Städtisches Klinikum Neuss, Neuss
| | | | - C Kahl
- Department of Hematology and Medical Oncology, Klinikum Magdeburg, Magdeburg
| | - G Seipelt
- Practice for Hematology and Medical Oncology, Bad Soden
| | - F Kullmann
- Department of Gastroenterology, Hematology and Medical Oncology, Klinikum Weiden, Weiden
| | - M Stauch
- Practice for Hematology and Medical Oncology, Kronach, Germany
| | - W Scheithauer
- Department of Hematology and Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - J Hielscher
- Department of Surgery, Klinikum Chemnitz, Chemnitz
| | - M Scholz
- Department of Medicine, Klinikum Stuttgart, Stuttgart
| | - S Mueller
- Practice for Hematology and Medical Oncology, Ansbach
| | - M M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald
| | - D P Modest
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - T Kirchner
- Department of Pathology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - A Jung
- Department of Pathology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - V Heinemann
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
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Affiliation(s)
- M. Michl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86135 Augsburg, Germany
| | - Th. Bauer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86135 Augsburg, Germany
| | - P. Lunkenheimer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86135 Augsburg, Germany
| | - A. Loidl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86135 Augsburg, Germany
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Bartoš J, Švajdlenková H, Šauša O, Lukešová M, Ehlers D, Michl M, Lunkenheimer P, Loidl A. Molecular probe dynamics and free volume in organic glass-formers and their relationships to structural relaxation: 1-propanol. J Phys Condens Matter 2016; 28:015101. [PMID: 26613507 DOI: 10.1088/0953-8984/28/1/015101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A joint study of the rotational dynamics and free volume in amorphous 1-propanol (1-PrOH) as a prototypical monohydroxy alcohol by electron spin resonance (ESR) or positron annihilation lifetime spectroscopy (PALS), respectively, is reported. The dynamic parameters of the molecular spin probe 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) and the annihilation ones of the atomic ortho-positronium (o-Ps) probe as a function of temperature are compared. A number of coincidences between various effects in the ESR and PALS responses at the corresponding characteristic ESR and PALS temperatures were found suggesting a common origin of the underlying dynamic processes that were identified using viscosity (VISC) in terms of the two-order parameter (TOP) model and broadband dielectric spectroscopy (BDS) data.
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Affiliation(s)
- J Bartoš
- Department of Structure and physical properties, Polymer Institute of SAS, Dúbravská cesta 9, SK-845 41 Bratislava, Slovakia
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Geirhos K, Lunkenheimer P, Michl M, Reuter D, Loidl A. Communication: Conductivity enhancement in plastic-crystalline solid-state electrolytes. J Chem Phys 2015; 143:081101. [DOI: 10.1063/1.4929554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- K. Geirhos
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - P. Lunkenheimer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - M. Michl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - D. Reuter
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - A. Loidl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
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Michl M, Bauer T, Lunkenheimer P, Loidl A. Cooperativity and heterogeneity in plastic crystals studied by nonlinear dielectric spectroscopy. Phys Rev Lett 2015; 114:067601. [PMID: 25723245 DOI: 10.1103/physrevlett.114.067601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Indexed: 06/04/2023]
Abstract
The glassy dynamics of plastic-crystalline cyclo-octanol and ortho-carborane, where only the molecular reorientational degrees of freedom freeze without long-range order, is investigated by nonlinear dielectric spectroscopy. Marked differences to canonical glass formers show up: While molecular cooperativity governs the glassy freezing, it leads to a much weaker slowing down of molecular dynamics than in supercooled liquids. Moreover, the observed nonlinear effects cannot be explained with the same heterogeneity scenario recently applied to canonical glass formers. This supports ideas that molecular relaxation in plastic crystals may be intrinsically nonexponential. Finally, no nonlinear effects were detected for the secondary processes in cyclo-octanol.
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Affiliation(s)
- M Michl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - Th Bauer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - P Lunkenheimer
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
| | - A Loidl
- Experimental Physics V, Center for Electronic Correlations and Magnetism, University of Augsburg, 86159 Augsburg, Germany
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Michl M, Holtzem B, Koch J, Moosmann N, Holch J, Hiddemann W, Heinemann V. [Metastatic colorectal cancer--analysis of treatment modalities and survival now and then]. Dtsch Med Wochenschr 2014; 139:2068-72. [PMID: 25268205 DOI: 10.1055/s-0034-1387283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM In metastatic colorectal cancer (mCRC) available systemic treatment options substantially increased in the last decades. Nowadays, overall survival in mCRC patients ranges from 25 to 35 months as recent studies report. We compared treatment modalities and survival in mCRC patients who were treated at our center in two different periods. PATIENTS AND METHODS Within two sequential monocentric analyses patients with mCRC treated at our Comprehensive Cancer Center (CCC) between 07/1994 and 10/2007 (cohort 1) and from 11/2007 to 05/2010 (cohort 2) were evaluated for applied treatment, for best response to treatment and for survival (OS). For statistical analysis the Kaplan-Meier estimator was used. RESULTS Both patient cohorts showed comparable characteristics regarding median age (63 vs. 64 yrs), localization of primary tumor (colon 60% vs. rectum 40%) and number and site of distant metastasis (1 site [75%] vs. ≥ 2 site [25%]; liver-only metastasis [55%]). About half of all patients in each cohort received at least three consecutive chemotherapy regimens. In cohort 1, treatment mainly consisted of chemotherapy alone (>80%), whereas in cohort 2 chemotherapy was combined with a monoclonal antibody in nearly 70%. Rate of surgical resection of metastasis increased over time (8% vs. 17%). Median OS was 27.3 months (cohort 1) vs. 39.4 months (cohort 2). CONCLUSION The increasing availability of effective substances including monoclonal antibodies and individual approaches including secondary surgery of distant metastasis might explain that survival in pts with mCRC has substantially improved over the last decades.
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Affiliation(s)
- M Michl
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - B Holtzem
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - J Koch
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - N Moosmann
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - J Holch
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - W Hiddemann
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
| | - V Heinemann
- Medizinische Klinik und Poliklinik III, CCC - Comprehensive Cancer Center, Klinikum der Ludwig-Maximilians-Universität München, Standort Großhadern
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Michl M, Koch J, Laubender RP, Modest DP, Giessen C, Schulz C, Heinemann V. Tumor markers CEA and CA 19-9 correlate with radiological imaging in metastatic colorectal cancer patients receiving first-line chemotherapy. Tumour Biol 2014; 35:10121-7. [PMID: 25023402 DOI: 10.1007/s13277-014-2280-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/24/2014] [Indexed: 12/16/2022] Open
Abstract
In patients with metastatic colorectal cancer (mCRC), radiological imaging represents the current standard to evaluate the efficacy of chemotherapy. However, with growing knowledge about tumor biology, other diagnostic tools become of interest which can supplement radiology. The aim of the present study was to examine the correlation of tumor and serum markers with radiological imaging in patients with mCRC receiving first-line therapy. Patients were included if tumor (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9)) and serum marker (lactatdehydrogenase (LDH), γ-glutamyltransferase (γGT), alkaline phosphatase (AP), C-reactive protein (CRP), leucocyte count (WBC), hemoglobin (Hb)) levels were available at baseline and at least two times during treatment. The decline and increase of tumor and serum markers over time were approximated for each patient by estimating slopes depending on the radiological assessment. A linear mixed effects multiple regression model for each subject was used to evaluate the intra-class correlation of these slopes modeling tumor and serum marker changes with radiological imaging. Data of 124 patients (41 female, 83 male; median age 62.9 years, range 27-85) who received first-line chemotherapy for mCRC from 11/2007 to 04/2010 were analyzed retrospectively. CEA level slopes (n = 49; slopes = 102) differed between radiologically determined progressive disease (PD) and partial response (PR) (p = 0.005) and between PD and stable disease (SD) (p = 0.042). CA 19-9 level slopes (n = 57; slopes = 127) also showed a significant difference between PD and PR (p = 0.002) and PD and SD (p = 0.058). Furthermore, CRP slopes (n = 62; slopes = 134) differed significantly between PD and PR (p = 0.009). For LDH, ALP, γGT, Hb, and WBC, no correlations were observed. The results indicate the correlation of the tumor markers CEA, CA 19-9, and the serum marker CRP with radiological imaging in patients with mCRC receiving first-line chemotherapy. Further data analyses would be helpful to develop a predictive model for tumor response based on an early tumor marker increase or decrease.
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Affiliation(s)
- M Michl
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Marchioninistr 15, D-81377, Munich, Germany,
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Huss R, Von Einem J, Hermann F, Niess H, Michl M, Scherhammer V, Bruns C, Heinemann V, Guenther C. 615: Cell-based biopharmaceuticals in a Phase I/II trial (TREAT-ME 1) for targeted drug- and gene delivery as an innovative treatment modality in advanced cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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von Einem JC, Heinemann V, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, Decker T, Klein S, Held S, Jung A, Kirchner T, Haas M, Holch J, Michl M, Aubele P, Boeck S, Schulz C, Giessen C, Stintzing S, Modest DP. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial. J Cancer Res Clin Oncol 2014; 140:1607-14. [PMID: 24816724 PMCID: PMC4131148 DOI: 10.1007/s00432-014-1678-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Purpose AIO KRK-0104 investigated first-line therapy of metastatic colorectal cancer (mCRC) with cetuximab, capecitabine and irinotecan versus cetuximab, capecitabine and oxaliplatin. This analysis investigated the impact of primary tumor location on outcome of patients. Patients and methods Left-sided primary tumors were defined as tumors from rectum to left flexure, while tumors in the remaining colon were regarded right sided. Overall survival (OS), progression-free survival (PFS) and response rate were correlated with primary tumor location. A Cox regression model was used to evaluate interaction between primary tumor location and KRAS mutation. Results Of 146 patients of the AIO KRK-0104 trial, 100 patients presented left-sided (of those 68 KRAS codon 12/13 wild-type) and 46 patients right-sided primary tumors (of those 27 KRAS codon 12/13 wild-type). Left-sided tumors were associated with significantly longer OS (p = 0.016, HR = 0.63) and PFS (p = 0.02, HR = 0.67) as compared to right-sided tumors. These effects were present in the KRAS codon 12/13 wild-type population (HR OS: 0.42; HR PFS: 0.54), while no impact of primary tumor location was evident in patients with KRAS codon 12/13 mutant tumors (HR OS: 1.3; HR PFS: 1.01). A significant interaction of KRAS status and primary tumor location concerning OS and PFS was observed. Conclusion Our findings suggest that primary tumor location and KRAS codon 12/13 mutational status interact on the outcome of patients with mCRC receiving cetuximab-based first-line therapy. Left-sided primary tumor location might be a predictor of cetuximab efficacy.
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Affiliation(s)
- J C von Einem
- Department of Medicine III, University Hospital Grosshadern, University of Munich, Munich, Germany,
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Michl M, Haug AR, Jakobs TF, Paprottka P, Hoffmann RT, Bartenstein P, Boeck S, Haas M, Laubender RP, Heinemann V. Radioembolization with Yttrium-90 microspheres (SIRT) in pancreatic cancer patients with liver metastases: efficacy, safety and prognostic factors. Oncology 2013; 86:24-32. [PMID: 24401529 DOI: 10.1159/000355821] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/13/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinical efficacy of (90)Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. METHODS Data from 19 pancreatic cancer patients (9 females/10 males) who had received (90)Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. RESULTS The median age at (90)Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after (90)Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at (90)Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. CONCLUSION (90)Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.
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Affiliation(s)
- M Michl
- Department of Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center, Munich, Germany
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Lehle K, von Suesskind-Schwendi M, Diez C, Michl M, Geissler EK, Wottge HU, Schmid C, Hirt SW. Relevance of maintenance triple-drug immunosuppression to bridle the amplification of rat cytomegalovirus infection after experimental lung transplantation. Transpl Infect Dis 2012; 14:649-56. [PMID: 22676701 DOI: 10.1111/j.1399-3062.2012.00751.x] [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: 11/22/2011] [Revised: 12/28/2011] [Accepted: 01/21/2012] [Indexed: 11/30/2022]
Abstract
Immunosuppressive therapy required to treat rejection after lung transplantation (LTx) contributes significantly to the pathogenesis of cytomegalovirus (CMV) infection and disease. In a weak allogeneic left LTx model in the rat (Fisher 344 [F344] to Wistar Kyoto [WKY] rats) we analyzed the influence of acute CMV infection on postoperative day (POD) 3, with application of standard triple-drug immunosuppression (TD-IS) (cyclosporin A, azathioprine, prednisolone) on late outcome after LTx. Native right lungs and syngeneic grafts (WKY to WKY) served as controls. Rats were sacrificed on POD 15, 30, 60, and 100. TD-IS completely prevented acute and chronic rejection in non-infected rats. Allografts of CMV-infected rats treated with TD-IS showed only mild perivascular infiltrations in 6/10 rats (POD 15 and 30), which persisted up to POD 100 in 4/10 rats. In the long-term course, mild isolated interstitial and alveolar changes were found in 40% of these animals. In conclusion, rat CMV infection partially neutralized the immunosuppressive effect of TD-IS. However, an amplification of CMV infection under TD-IS can be controlled and does not result in fatal outcome.
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Affiliation(s)
- K Lehle
- Department of Cardiothoracic Surgery, University Hospital Regensburg, University of Regensburg, Regensburg, Germany.
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Ganslmeier P, Schneider HJ, Keyser A, Michl M, Foltan M, Hirt S, Hilker M, Schmid C. Hemodynamic effects of pump flow reduction in patients with axial flow pumps during exercise training. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Herrmann M, Michl M, Kohlhäufl M. Pulmonale Toxizität eines weit verbreiteten Antibiotikums. Pneumologie 2011. [DOI: 10.1055/s-0031-1272106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Heinemann V, Di Gioia D, Vehling-Kaiser U, Harich HD, Heinrich B, Welt A, Ziske C, Deutsch G, Pihusch R, Kölbl H, Hegewisch-Becker S, Michl M, Stemmler HJ. A prospective multicenter phase II study of oral and i.v. vinorelbine plus trastuzumab as first-line therapy in HER2-overexpressing metastatic breast cancer. Ann Oncol 2010; 22:603-608. [PMID: 20724574 DOI: 10.1093/annonc/mdq409] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of oral and i.v. vinorelbine plus trastuzumab as first-line regimen in a patient-convenient application for human epidermal growth factor receptor 2 (HER2)-overexpressing patients with metastatic breast cancer. PATIENTS AND METHODS Forty-two women were enrolled in a multicenter study. The patients received i.v. vinorelbine at a dose of 25 mg/m(2) on day 1 followed by oral vinorelbine at a dose of 60 mg/m(2) on days 8 and 15 in a 3-week cycle. Standard dose trastuzumab was given at 3-week intervals. RESULTS Complete response was observed in 7 patients (18.9%) and partial response in 19 patients (51.4%), for an overall response rate of 70.3% [95% confidence interval (CI) 53.0-84.1]. The disease control rate reached 91.9% (95% CI 78.1-98.3). The median time to progression was 9.3 months, while median overall survival reached 35.6 months. Hematological and non-hematological toxic effects were acceptable with grade 3-4 leukopenia of 14% and neutropenia of 38%; cardiac toxicity did not reach the level of clinical relevance. CONCLUSION The combination of i.v. and oral vinorelbine plus trastuzumab demonstrates high activity and good tolerability in first-line treatment of HER2-overexpressing metastatic breast cancer. In addition, it offers convenience for the patients with only one i.v. treatment every 3 weeks.
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Affiliation(s)
- V Heinemann
- Medical Department III, University of Munich, Munich.
| | - D Di Gioia
- Medical Department III, University of Munich, Munich
| | | | | | | | - A Welt
- Department of Medicine (Cancer Research), West German Cancer Center, University Hospital Essen, Essen
| | - C Ziske
- Oncological Practice, Troisdorf
| | - G Deutsch
- Department of Gynecology, Diakonissenkrankenhaus Karlsruhe, Karlsruhe
| | | | - H Kölbl
- Department of Gynecology, University of Mainz, Mainz
| | | | - M Michl
- Medical Department III, University of Munich, Munich
| | - H J Stemmler
- Medical Department III, University of Munich, Munich
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Michl M, Hoffmann RT, Laubender R, Haug A, Bartenstein P, Stemmler H, Helmberger T, Stintzing S, Heinemann V, Jakobs TF. Selective internal radiation therapy (SIRT) for treatment of patients with breast cancer with metastatic liver disease. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Michl M, Husemann K, Hellmich B, Kohlhäufl M. Lungenfibrose als Erstmanifestation einer limitierten systemischen Sklerose. Pneumologie 2010. [DOI: 10.1055/s-0030-1251308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Husemann K, Michl M, Ott G, Friedel G, Kohlhäufl M. Nekrotisierende sarkoide Granulomatose als seltene DD pulmonaler Rundherde. Pneumologie 2010. [DOI: 10.1055/s-0030-1251216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dobbertin I, Friedel G, Jaki R, Michl M, Kimmich M, Hofmann A, Eulenbruch HP, Weber J, Spengler W, Ott G, Kohlhäufl M. Bronchiale Aspergillosen. Pneumologie 2010; 64:171-83. [DOI: 10.1055/s-0029-1215306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dvořák M, Fidler V, Lohse PW, Michl M, Oum K, Wagener P, Schroeder J. Ultrafast intramolecular electronic energy transfer in rigidly linked aminopyrenyl–aminobenzanthronyl dyads—a femtosecond study. Phys Chem Chem Phys 2009; 11:317-23. [DOI: 10.1039/b813232a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Duschl J, Michl M, Kunz W. A Porphyrin Dye with Monoexponential Fluorescence Intensity and Anisotropy Decay Behavior in Spherical Micelles. Angew Chem Int Ed Engl 2004; 43:634-6. [PMID: 14743425 DOI: 10.1002/anie.200351773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Josef Duschl
- Institut fur Physikalische und Theoretische Chemie, Universität Regensburg, 93040 Regensburg, Germany
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Duschl J, Michl M, Kunz W. Ein Porphyrinfarbstoff mit monoexponentiellem Intensitäts- und Anisotropieabklingverhalten in sphärischen Micellen. Angew Chem Int Ed Engl 2004. [DOI: 10.1002/ange.200351773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Yu H, Schleuning WD, Michl M, Liberatore G, Tan SS, Medcalf RL. Control elements between -9.5 and -3.0 kb in the human tissue-type plasminogen activator gene promoter direct spatial and inducible expression to the murine brain. Eur J Neurosci 2001; 14:799-808. [PMID: 11576184 DOI: 10.1046/j.0953-816x.2001.01700.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tissue-type plasminogen activator (t-PA) participates in the control of synaptic plasticity and memory formation in the central nervous system (CNS). Transgenic mice harbouring either 9.5, 3.0 or 1.4 kb of the human t-PA promoter fused to the LacZ reporter gene were used to assess t-PA promoter-directed expression in vivo. The 9.5 kb t-PA promoter directed expression to the brain, most notably to the dentate gyrus, superior colliculus, hippocampus, thalamus and piriform cortex. Staining was also observed in the retrosplenial and somatosensory cortex. The 3.0 kb t-PA promoter directed generalized and poorly defined expression to the cortex and hippocampus, while the 1.4 kb t-PA promoter directed expression selectively to the medial habenula. Intravenous administration of lipopolysaccharide into mice harbouring the 9.5 kb t-PA promoter resulted in an increase in reporter gene activity in the lateral orbital cortex and thalamus. Results of in vitro transfection experiments of NT2 cells with a series of t-PA promoter deletion constructs confirmed the presence of regulatory elements throughout the 9.5 kb promoter region. Finally, we describe a cis-acting element related to the NFAT recognition site that provides a protein-binding site and which may play a role in the selective expression of the 1.4 t-PA promoter in the medial habenula. These results indicate that elements between -3.0 and -9.5 kb of the t-PA promoter confer constitutive and inducible expression to specific regions of the CNS.
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Affiliation(s)
- H Yu
- Monash University Department of Medicine, Box Hill Hospital, Arnold Street, Box Hill 3128, Victoria, Australia
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Grüne S, Michl M, Schinharl D, Reng M, Frick E, Holstege A, Schölmerich J. Rapid effects of lipopolysaccharides on indocyanine green clearance in rat liver. Eur J Gastroenterol Hepatol 2000; 12:679-85. [PMID: 10912489 DOI: 10.1097/00042737-200012060-00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Lipopolysaccharides (LPSs) are thought to be one of the triggers of organ reactions to sepsis, which causes hepatocellular dysfunction. This dysfunction can be demonstrated by a reduction of organic anion transport. The aim of our study was to assess whether the transport of indocyanine green (ICG) is affected by LPS, and whether Kupffer cells are involved. METHODS Single-pass liver perfusion with ICG at a concentration of 57.8 mg/kg/min was performed for 130 min. pH, oxygen tension and perfusion pressure were continuously measured in influent and effluent. Taurocholate was infused at 48.3 mg/kg/min to achieve a stable bile flow. LPS was added at concentrations of 0.45, 0.9 and 1.44 mg/kg/min for 30 min. ICG was determined photometrically in perfusate and bile. To depress the function of Kupffer cells male Wistar rats were treated with GdCl3 24 h in advance. Primary cultured hepatocytes were used for studying the direct effect of LPS on the uptake rate of ICG. RESULTS Forty-five minutes after administration of LPS a significant dose-dependent decrease of ICG uptake was seen in animals treated with LPS. Livers of animals pretreated with GdCl3 did not show this decrease. LPS had no direct effect on the uptake of ICG into primary cultured hepatocytes, whereas treatment of these cells with 8-bromo-cGMP resulted in a significant increase of ICG uptake. CONCLUSION LPS has a rapid dose-dependent effect on the detoxification properties of the liver for ICG. The rapid effect of LPS on ICG uptake in hepatocytes is mediated by Kupffer cells.
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Affiliation(s)
- S Grüne
- Department of Internal Medicine I, University of Regensburg, Germany.
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Vlcková B, Smejkal P, Michl M, Procházka M, Mojzes P, Lednický F, Pfleger J. Surface-enhanced resonance Raman spectroscopy of porphyrin and metalloporphyrin species in systems with Ag nanoparticles and their assemblies. J Inorg Biochem 2000; 79:295-300. [PMID: 10830880 DOI: 10.1016/s0162-0134(99)00172-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The advantages of systems with Ag nanoparticles and their assemblies for surface-enhanced resonance Raman scattering (SERRS) spectral investigation, detection and determination of porphyrin species are demonstrated. SERRS spectral detection limits of the testing porphyrin species (including porphyrin aggregates) in these systems are shown to be, on average, 10(2)-10(3) lower than detection limits by resonance Raman scattering (RRS). Systems with Ag nanoparticles modified by anionic organosulfur spacers enable us to obtain SERRS spectra of unperturbed cationic porphyrin species. In the case of thiopheneacetate-modified Ag particles prepared by laser ablation, no negative effect of the spacer on the spectral detection limit of the porphyrin was observed. Systems with isolated Ag nanoparticles allow for obtaining SERRS spectra of porphyrin species upon excitation into the Soret electronic absorption band which leads to at least a 10-fold decrease in the detection limit.
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Affiliation(s)
- B Vlcková
- Department of Physical and Macromolecular Chemistry, Charles University, Prague, Czech Republic.
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Zhang X, Somorjai GA, Rous PJ, Tobin D, Gonis A, MacLaren JM, Heinz K, Michl M, Lindner H, Müller K, Ehsasi M, Block JH. Efficient determiniation of multilayer relaxation in the Pt(210) stepped and densely kinked surface. Phys Rev Lett 1991; 67:1298-1301. [PMID: 10044110 DOI: 10.1103/physrevlett.67.1298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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